Burnout to Balance

BY MAUREEN LEFFLER

WITH THE ONSET OF THE PANDEMIC, there have been more and more headlines about the burnout crisis in health care. The crisis is real, awareness is important, but the time is now to make meaningful changes.

So, what is burnout? Burnout is defined by the World Health Organization (WHO) as a syndrome resulting from chronic workplace stress. In other words, it is an injury related to occupational exposures. This could be compared to other occupational injuries, such as a construction worker sustaining an onsite injury. With this in mind, it is important to emphasize that it’s not a generational issue. It’s not a lack of resilience. It’s not a mental health problem. And it’s most certainly not a new problem. While the pandemic may have exacerbated the issue and caused more awareness, burnout has been impacting health care workers and patients for decades.

Currently, approximately 60% of nurses and physicians are experiencing burnout. Physicians are at higher risk for burnout than workers in other fields, even those who work the same number of hours and have the same level of training. When experiencing burnout, health workers suffer emotional exhaustion, cynicism, and a decreased sense of self-efficacy. Anxiety, depression, suicidality, substance misuse and abuse, and relationship issues are all associated with burnout.

At its best, medicine can be a very challenging profession, made harder by increasing complexity. For example, we work in a field constantly adapting to advances in medical decision-making, increasing administrative tasks, evolving technology, changes to electronic documentation, and ongoing regulatory demands. It is obvious how this work environment has become unwieldy and even dangerous to workers. Did you know that for every one hour a clinician spends in direct contact with patient, they spend an average of two hours on documentation and administrative tasks? With historically high rates of turnover, staffing shortages, financial pressures, and an increased number of patients with mental health issues, it can be hard to see a light at the end of the tunnel.

Burnout affects more than just the worker; it is associated with diminished quality of care, increased patient safety concerns and suboptimal patient experiences, all affecting patient outcomes in significant ways. Burned out workers are more likely to leave their job and leave the profession. As one can expect, this will exacerbate access to care and impair our ability to achieve health equity. This all matters to those of us who rely on the healthcare system. Burnout affects us all.

We can and must work to unravel one of the most pervasive health care crises, this time, within our own system. In addition to providing support for occupationally induced emotional distress and enhancing access to treatment for mental health needs, we need to prevent harm. This includes radical changes to our health care system that result in decreased administrative and work burden, and improved efficiency through thoughtfully optimized technology. At the hospital and industry level of leadership, we need a transition away from a productivity-based model of care. The culture of medicine will benefit from a shift towards realistic expectations of our health care workers, while creating space for self-care and self-compassion. These changes need to be embraced at every level of the system, from our regulatory and payor groups to our local leaders, our colleagues, patients, and families.

Our health care system hangs in the balance; if you are concerned about how things are today, then it is easy to see that it is time for meaningful change. Now and always, your health care teams will continue to care for you and your families while continuing to push forward well-being initiatives and culture changes for the betterment of our entire population.

Maureen Leffler is assistant vice president and chief well-being officer at Nemours Children’s Health.