The prevalence of burnout among physicians is estimated to be more than 50 percent and has grown in recent years. This alarming trend is largely due to changing patient demographics, increasing cost constraints, new federal and state regulations, and other external factors that have reshaped the daily work experience of physicians. Too often today, physicians spend more time on data entry than in direct patient care.
Professional burnout, as it has been defined by researchers, is a response to stress in the workplace. It consists of three components: emotional exhaustion, depersonalization or cynicism, and a low sense of personal accomplishment in one’s work. It is caused by a “mismatch” between the worker and the workplace in one or more of six domains: workload, control, reward, community, fairness, and values.
Burnout among physicians has significant negative consequences, including effects on patient safety, quality of care, the patient experience, and personal costs to the individual physician: depression, substance use, suicide. It also affects health care organizations and our health care system as a whole, as physicians choose to cut back on clinical hours, retire early, or leave clinical practice for other careers.
Effectively addressing burnout requires an understanding of its true causes—just as an accurate diagnosis of respiratory distress is essential to effective treatment. Despite the fact that the cause is quite often systemic, frequently individual physicians and the health care organizations in which they work respond as if it were a problem solely within the individual. Too often, physicians and leaders “neglect the organizational factors that are the primary drivers of physician burnout.”
As a physician who left clinical medicine because of burnout and as a writer, I’m drawn to stories of physicians whose professional and personal lives have improved after reasoned interventions. So my ears jumped to attention earlier this month when a colleague at a summit on physician burnout described the positive results his practice had achieved in reducing burnout. Read Pierce, MD, is interim director of the Hospital Medicine Group (HMG) and is the associate director of the Institute for Healthcare Quality, Safety and Efficiency at the University of Colorado.
Leaders in HMG, a hospital-based internist group that includes 85 physicians, physician assistants, and nurse practitioners, conducted a detailed survey three years ago as the first step in an effort to better understand the existing culture at work. The survey gathered information from frontline clinicians on engagement, satisfaction, burnout, mentorship, safety culture, and other topics. Results indicated that 45 percent of clinicians were experiencing some degree of burnout. Initially, leaders were unsure how to respond to the results, but they made a firm commitment to action, in part based on frustration with prior institutional surveys in which similar challenges were identified but little definitive change followed.
Pierce told me that the group sifted through the data and brainstormed on possible interventions. Over time, they chose 13 (an interesting number!) to take on. Here are three of them…
Why would a well-respected, venerable health care organization adopt a soft and squishy approach—tracking disrespect and other forms of emotional harm—to monitor its performance?
In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has not yet achieved perfection in this area, but the bold goal has catalyzed substantial advancement in patient safety at the organization.
Sands and colleagues described this courageous approach and their patient safety efforts at a presentation at the Institute for Healthcare Improvement Annual Forum in December. BIDMC patient safety experts have developed a process by which serious events, such as medical errors, are sifted from the “noise” of the thousands of reports received each year, such as “near miss” events. High-level statistics regarding these events are included on the organization’s performance dashboard, portions of which are shared publicly. Since launching the initiative, BIDMC has seen a 70 percent drop in serious harm events, despite improved reporting mechanisms that likely increased the number of harms reported.
According to Sands, the bulk of the improvement was due to several initiatives to decrease specific harms (for example, decreasing cardiac arrest in med/surg units). Quality and safety leaders realized that the harms that remained would require a broader approach.