Solutions For Healthcare Worker Burnout
By John August/Director of Healthcare and Partner Programs at the Scheinman Institute
Within the walls of healthcare facilities, in the news media, and most importantly among healthcare workers themselves, the subject of BURNOUT is front and center. While not a new phenomenon, the experience of the COVID-19 pandemic is unprecedented, and BURNOUT has taken on a whole new sense of urgency and concern.
Watch this brief video of a doctor on the frontlines to remind ourselves about what BURNOUT is all about. As shown in the video, healthcare workers and health systems leaders are taking steps to mitigate the impact of burnout as a matter of survival. And even though there is a sense of hope through support systems and problem solving, in my view far too often BURNOUT is associated with a sense of doom and a kind of hopelessness and inevitability.
Like the many failures of American healthcare we live with every day: from high costs which impact family budgets more than any other expense, to lack of consistent and easy access to the care people need (just look at the current crisis of people wanting quick and accurate results from COVID testing), to abhorrent and unjust disparities in care and health outcomes due to racial and ethnic disparities in care, coverage, and access, healthcare worker burnout must be included in the list of dysfunctions in the non-system that American healthcare continues to be.
There continues to be a sense of powerlessness and confusion about how we as a society attain this most central need for all people: how to live healthy lives and how to access high quality affordable healthcare.
There are many great resources for us to turn to that can help us gain perspective. I would like to share one of mine, in the person of Göran Henriks.
Göran Henriks has been Chief Executive of Learning and Innovation at The Qulturum in the County Council of Jönköping, Sweden, since 1997. Qulturum is a center for quality, leadership and management development for the employees in the county and also for healthcare on a regional and national level.
He has nearly forty years’ experience of management in the Swedish Health Care system. He is a member of the Jönköping County Council top management and Strategic Group. The county is ranked among the best in Swedish care with regards to patient satisfaction, access, clinical performance, safety and costs.
Göran is a senior fellow of the Institute for Healthcare Improvement and is the chair of the Strategic Committee of the International Forum on Quality and Safety in Healthcare.
Jönköping County has been among the highest performing counties in Sweden for the past 20 years (Jönköping County Council, Sweden | The King's Fund (kingsfund.org.uk)
Let me share excerpts from a recent interview I had with Göran:
August: Is there a high degree of burnout among Swedish healthcare workers as a result of the pandemic?
Henriks: Of course. We have never experienced anything like this before. There are more patients than ever before and there is less staff than ever before due to so many out sick. People are tired. There is more overtime than ever. It is an existential crisis and it is unprecedented.
August: It seems to me that so much of what is reported in the media and much of the discussion about burnout, while not exaggerated, often sounds hopeless and catastrophic in ways that give the impression of a kind of inevitability of a failed system. What do you think about that?
Henriks: Yes, people feel a sense of hopelessness when they think the system is not behind them. So the real question is what to do about that?
There is a “through-line”, a kind of horizontal, endless line that runs through health systems: THE PATIENT AND THE PATIENT PERSPECTIVE. We must take the time and provide the opportunity to have continuous dialogue about the stressors that the providers of care face, but the key is to create the space to discuss the impact of the stress on the patient.
Most people love their work and they regard it as a privilege to work in healthcare. While we see direct support for healthcare workers to manage stress, the long-term solution is to discuss the stressors as they impact the patient, and to find opportunities to meet the needs of patients no matter what the circumstances.
August: How do you accomplish this?
Henriks: We must learn to see healthcare and healthcare systems as a social science. (Henriks referred me to a recent article in the BMJ Journal, which he co-authored with Helen Bevan, Chief Innovation Officer of the British National Health Service (NHS), which explains what he means).
There is an important philosophical point underpinning these definitions of groups. Often, we see health and care transformation plans that aim to wrap services around the person/patient and/or make services more person/patient centered.
Our perspective is that we view the person/patient not as the center of activity but as a core and equal member of the health and care team. We need both shared purpose and aims for transformation, but purpose needs to come first. Purpose defines the aim and puts it in the context of the bigger picture. In the context of a pre-existing team, building a collective sense of shared purpose and connecting each individual to the mission of the system makes the work of transformation much more meaningful.
“Teams who think and work together with a sense of shared purpose are often the happiest and the most successful.” (Creating Tomorrow Today: seven simple rules for leaders.” by Helen Bevan and Göran Henriks, BMJ Leader, February 16, 2021)
August: How do you think about “Teams” and what does it take to create them?
Henriks: People in healthcare are forced into standardized methods that become rigid. We must gain distance from this and take the time to allow people to confront the existential nature of the crisis that in this case, the pandemic, or for that matter any other crisis or problem must be seen as existential.
The first six months of the pandemic was like a volcano, and the natural reaction of the healthcare worker was to reduce risk for their own health while trying to care for patients with a disease they did not understand. The system did not allow a place for learning, and as a result it was very difficult to learn what to do. The reaction was that the healthcare workers’ inherent purpose was undone.
We know that day-to-day problem solving requires distance to be able to see the problem clearly with data and with the expectation and desire of the patient as central to problem solving.
We have a duty to find this distance, no matter what the crisis, no matter what the barriers to finding true-shared purpose among the patients (people who need and desire care, the workforce (givers of service) and leaders (people who provide the leadership function).
So, our teams are built on shared competencies with the opportunity for all staff to work in simulation settings to practice a wide variety of skills that are designed to mitigate risk to patients, working across patient wards and skill sets. In this way, we lower the risk of staff not having competency necessary in different settings.
All of this work is built on a continuous focus on our shared purpose, which we must take the time to discover: “Shared purpose seeks to make explicit the reason behind something that is being done. Purpose defines WHY we are doing what we are doing, and WHAT we hope to achieve from it.” (BMJ Journal, cited above).
Healthcare worker burnout must be seen in a whole systems frame. In my experience, healthcare settings have a very difficult time establishing the time for “distance”, let alone being able to see their system as a “social science”, that is a continuous set of interactions among the human elements of the system: the patients/community, the workforce, and the leaders. There is a tendency to separate all the stressors into silos: finance, technology, data, patients, and workforce.
Of course, these silos intersect for each care delivery moment, but because health systems tend not to focus on the three components of the social science system (PEOPLE), too often disaggregation and less than optimal outcomes in quality, safety, experience, employee engagement, and employee morale create a hopeless systemic dysfunction.
Burnout should not be seen as a different crisis to address, but rather part of the need for continuous risk mitigation.
Burnout can be seen as an expected reality when crisis arrives. Everyone agrees that it must be confronted and mitigated. But it should not be seen as a “one-off”, or one more thing to do. Rather, burnout must be seen as a dangerous syndrome that occurs in the present, has occurred before, and will occur again in stressful situations. We must be in a continuous mode of prevention and adaptation.
How we think, and taking the time to ensure we have the time for thinking and reflection are central to the attainment of achieving a different direction or path to solving the systemic crises, known and unknown.
I am forever grateful for my friends in Sweden, and to Göran Henriks in particular for the patience and vision to never give into the crisis, but to recognize that crisis is part of experience. The real question is can we step away and create the space for the through-line of the patient.
The answer to burnout for Henriks, Bevan, and for us to consider is to create and sustain teams from the social science that is healthcare: patients, workers, leaders.
As we see in “Seven Questions Showing the Way” for the “micro-team” the path is very specific and designed to empower and support the team at the frontline of the social system that is healthcare.
This is more than possible.
The question is: Can we see healthcare as the social science that it is?