Reducing surgeon and physician burnout is the responsibility of surgery center leadership, healthcare organizations, professional societies, and everyone who has a hand in the practice environment.
“We all take responsibility for changing the practice environment in a way that makes it sustainable,” says Bryan Bohman, MD, interim director of the Well MD Center at Stanford University.
Stanford has developed and studied strategies to tackle the problem of physician burnout and has developed the following three wellness domains that affect burnout:
- Efficiency of practice. Built-in efficiency at surgery centers can help surgeons provide outstanding care without it resulting in long hours and burnout, Bohman says.
- Culture of wellness. “Does the organization support — as a high priority — the concept that we need to look out for the professional satisfaction for the physician and others?” Bohman asks. “Do they provide resources promoting wellness, and do they pay attention to wellness when they promote leaders? Do they look at a wellness indicator as an important indicator for how well the organization is performing?”
- Personal resilience. It’s also the responsibility of individual surgeons to take care of themselves. They can practice mindfulness and find their own meaning in medicine. “These are things that improve people’s wellness, even in stressful circumstances,” Bohman says. “Look at what’s going on in wellness in recent years. There is increasing attention to the topic of resilience.”
For surgeons, the domain of efficiency of practice is particularly important, he notes.
“It’s things like turnover,” Bohman says. “When we talk to surgeons at Stanford, in orthopedic grand rounds, all they want to talk about is the turnover times.”
Delays can be caused by a surgery center not providing the right instruments in the operating room or when the workflow is inefficient, resulting in scrub techs searching for an item multiple times in a routine case, he explains.
“These are things that make life difficult in an operating room environment,” Bohman says.
Surgeons who are waiting for the next case are wasting their time, and they can become upset about it when the turnover starts to be an hour, instead of 15 to 20 minutes, he adds. “It keeps them in the operating room, being nonproductive, and then they get home late to their family that day.”
Additional wellness strategies include the following:
- Learn mindfulness techniques. “It’s also what we call ‘self-compassion,’” Bohman says. “We’re finding that is an important element of mindfulness.”
Physicians sometimes blame themselves for anything that goes wrong in a system, but mindfulness training can help prevent negativity. Meditation apps, like Mindspace, also can help.
“Then we also do things like have ‘Medicine in Literature’ courses, or we fund people to go to lunch together and talk about what’s on their minds,” Bohman says.
Any activity that creates a sense of community or encourages mindfulness can help.
“We developed a survey that looks at burnout and professional fulfillment at Stanford, and we found that these are things that correlate with fulfillment: if you are mindful, have compassion, connect with the meaning of medicine,” he explains. “These are the things that really matter.”
Mindfulness also can be achieved in brief moments of time. “Find tiny clues during the day that cue you into taking a minute to take a deep breath and think about what you’re doing,” Bohman suggests. “For example, some of our doctors, before they enter an exam room, will take that as their cue to stop, take a deep breath, and try to focus their mind on why they’re seeing this patient, connecting with the meaning of the visit.”
The key is to not also think about the next three tasks.
- Identify positive leaders. “There’s a lot of information coming out about good leadership traits,” Bohman says.
For example, good leaders listen to their employees, care about their career development, and provide opportunities for others to speak up and have autonomy.
“A really good leader has a huge amount of influence on satisfaction,” he says. “In Stanford, we’ve incorporated that into our questionnaire.”
The organization conducted a survey about leadership and will meet with physicians in every department to let them know the results, he adds.
- Incorporate efficiency changes. Surgery center directors and leaders should make sure surgeons are included and engaged in efforts to improve care processes, Bohman says.
“Is turnover being done efficiently? Is the patient being checked in efficiently? Are my phone calls being routed appropriately?” Bohman asks.
“If physicians are encouraged to be part of the solution and to work with process improvement efforts, then that’s where we see people really feel less burned out and feel more professional fulfillment,” he adds.
- Reduce documentation burden. “We’re working with our medical informatics people at Stanford to figure out ways to make the electronic medical record more efficient in terms of documentation,” Bohman says.
Surgery centers can invest some time and effort into making those kinds of improvements. Also, it will help everyone when quality metrics are standardized nationally, he notes.
“We need the same metrics so we don’t have to document blood pressure one way for one organization and another way for another organization,” Bohman says.