A recent survey of healthcare leaders cited “change fatigue” as one of the primary drivers of burnout among healthcare workers, particularly physicians who work with a traditional autonomy that carries some risk of becoming isolating and depressing. The survey respondents were 123 leaders at hospitals, clinics, and health systems across the United States and Canada, according to a report on the project.1
The survey was complemented by interviews with some 45 healthcare executives, academics, and thought leaders. These discussions focused on establishing a culture of resilience, well-being, and joy for all members of the healthcare team.
Some of the report’s concluding recommendations include the following:
• Build an intentional, human-centered culture. Culture sets the stage for authentic human connection, a core element of resilience, well-being, and joy.
• Approach burnout and well-being comprehensively. Many organizations are trialing well-being projects, but one-off initiatives will not solve the core issues.
• Cultivate a team mindset. Healthcare today is a team-based endeavor, relying on nurses, staff, physicians, families, volunteers, and patients to provide high-quality, safe, compassionate care.
• Integrate burnout and well-being strategies with all other organizational priorities.
Overall, 57% of research participants said change fatigue is the leading cause of care team burnout. Of course, some change may be needed to correct that situation, creating a classic catch-22.
Hospital Employee Health interviewed one of the principals involved with the report, Corey Martin, MD, leader of Physician Resilience Training and Burnout Prevention in the Allina Health System in Minneapolis.
HEH: Can you elaborate on this concept of “change fatigue” as one of the main drivers of healthcare burnout?
Martin: One of the biggest causes of change fatigue is that typically in healthcare, we have a new program or something rolled out all of the time. Anytime this happens we have different ways to measure it, different boxes to click, different things to do — a different process. Change is happening so quickly in healthcare, but maybe we can measure things a little bit easier with the electronic health records and computers.
We are trying to measure a lot of things, but I think a lot of what we measure probably doesn’t matter. There’s a lot of things we measure that matter, but a lot of it doesn’t matter. We are just measuring it because we can measure it. A lot of times that gets in the way of providing face-to-face, good healthcare and allowing people to have joy, meaning, and purpose in the work that they do. Because anything that shifts them from the face-to-face patient interaction really has been shown to undermine joy and purpose.
HEH: How do you manage that change and prevent that fatigue from setting in? Is there a way to prioritize what is important in terms of change?
Martin: I think that is the biggest question that’s facing healthcare right now, and I don’t think anyone really has a great answer for it. Change comes from a lot of different places — from bigger organizations, government regulations, insurance companies, and pharmaceutical companies. It is going to take a whole organization to look at it and try to do something about it, and I would say that for the most part, organizations are in the infancy of looking into this. Most programs start with a lot of personal resilience, taking better care of yourself, and that kind of approach.
HEH: The report also emphasizes the concept of an “intentional” culture.
Martin: What underlies all of this work is, how do we work on the culture within the organization? If you show up at work and you love what you are doing, and you have joy, meaning, and purpose, you are going to be able to take care of patients. You are going to have better patient outcomes and experiences. One of the things that is talked about in the report is, how do you be intentional about the fact that everything we do has something to do with a person’s burnout and resilience? How do we take that into account in every decision we make for change management?
Some of the organizations are doing that and trying to get their hands around this. Then, there is the whole idea of the personal resilience work that many organizations are doing, including us. How do you show up and be your best person at work? How do you be intentional in incorporating a mindful practice into what you do every day, incorporating gratitude into the things you see every day, being present in the situation that you are in, instead of thinking about the 42 other things that you have to do? It really is both an organizational intent and a personal intent that go into this.
HEH: You note that taking into account the effect of change on healthcare workers has not always been part of the equation.
Martin: For years, what we have done is take into account what change will do to finances and the bottom line. That is built into what we do, but we haven’t been very good as healthcare systems in taking into account what this is going to mean for the people who are doing this every day. How do we make sure that they still find joy in what they do every day?
HEH: The report makes the point that the healthcare system cannot afford to ignore this problem, particularly in terms of the cost of burnout physicians that translates to high staff turnover.
Martin: There are a lot of different things that play into it, and physician turnover is the big one. [There is a recently published] calculator2 that you can use as an organization by putting in your known physician burnout rate. Many of us do surveys to find that out. You put in your physician turnover rate and they have built-in metrics for what it typically costs for physician burnout and turnover. You can find out what the bottom-line effect is on your organization.
It costs about $500,000 to recruit and replace a physician. And that includes all costs of moving expenses, signing bonus, and that kind of stuff. I believe that is about $88,000, and then the rest of it is getting a physician into a community and [establishing their practice]. Because the physicians that left were really busy and they were covering that cost. New physicians typically take one to two years before they are billing enough for their organizations to cover their costs.
They have also looked at nursing, and nursing is about $50,000 per nurse that we replace due to turnover. So those are important things to build the business case.
The other thing is that about 400 physicians per year commit suicide. That is a lot of patients who don’t have their doctor the next day. In terms of taking care of your patients and your employees, that is pretty huge. If you are losing 400 physicians in a year, that’s a 747 going down.
HEH: You note that physician culture is more autonomous and less interconnected than nurses, which may lead to increased isolation.
Martin: We have created a physicians’ burnout hotline. It is actually a physician-to-physician conversation. I am the person at the other end of that hotline and when I get calls from physicians — by the time they pick up the phone and call, they are really burned out. It’s up to me to have a conversation with them about our resources and why they should use the employee assistance program, and a whole host of [programs] within the organization that we can get them into. Because of our training, physicians tend to be lone-wolf type people, and so when they do reach out they are pretty far along. We need to have somebody who is willing take us under their wing a little bit and kind of show us the way.
1. Abrahams R, Boehm L, Purdy A, et al. Experience Innovation Network. In Pursuit of Resilience, Well-being and Joy in Healthcare. Vocera, 2017 Research Report.
2. Shanafelt T, Goh J, Sinsky, C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017;177(12):1826–1832. doi:10.1001/jamainternmed.2017.4340.