The Problem of Burnout in Healthcare
Burnout, disengagement, and turnover are epidemic in healthcare. What we've been doing isn't helping. It is no longer enough to tell people to “just buck up” and become more resilient. It is essential that we take a new look at the cause and strive for a cure. 49% of physicians describe themselves as “often or always experiencing feelings of burnout.” 54% rate their morale as “somewhat or very negative.” 1 34% of hospital nurses struggle with burnout 2 and, according to KMPG, there is a 14% turnover of nurses each year. Many nurses quit in the first year. Healthcare is sick.
What We're Doing isn't Working
Not surprisingly, there has been quite a bit of talk about burnout over the past few years. Traditionally, the focus has been helping people to become “more resilient”. However, focusing on resilience alone can make things worse. Eventually, if pushed hard enough, anyone can fail. Focusing on resilience alone is about as futile as giving people on the Titanic swimming lessons. If we ignore the causes of burnout and disengagement, it can lead to a downward spiral of inadequacy as people hang their heads and say, “I should be able to handle this” or, even worse, "I just don't have what it takes."Dan Pink’s revolutionary work on workplace drive and motivation3 is more relevant in the world of healthcare today than ever before. He explains that drive is directly related to three needs: autonomy, mastery, and purpose. Unfortunately, all three are being threatened in healthcare workers today.
Autonomy, or the ability to determine one's course, occurs primarily at the interface between a provider and their place of work. There has been a significant shift in the practice of medicine. Physicians rarely practice independently any longer. Most are now employees of larger healthcare systems. Such systems must focus on the standardization of medicine to benefit from increased efficiencies, cost savings and a focus on measurable outcomes. Consequently, physicians abdicate their control when they sign on the dotted line.
Once touted as the cure to improve productivity, the electronic medical record (EMR) has become the ball and chain of medicine. A recent study published in the Annals of Internal Medicine shows that for every hour that a provider spends with a patient, they end up spending two hours with the EMR.4 Stop for a moment and ponder the impact: 2/3 of the practice of medicine now is consumed by interfacing with the EMR! The impact on the loss of autonomy is palpable.
Time Constraints Impact Mastery
Mastery occurs at the interface between the patient and the provider. Evidenced based medicine is changing rapidly, and the body of knowledge is exploding. One of the rewards of practicing medicine has been the sense of discovery and the joy of life-long learning. However, with the relentless pressure to see more patients per hour, the opportunity to provide the level of care required for "mastery" is diminishing. According to the 2016 Physicians Foundation Survey of American Physicians, only 14% of physicians say that they have the time they need to provide the highest level of care. (Remember, 2/3 of their time is consumed by the EMR.) Time constraints are stifling mastery.
Consistently ranked as one of the top five TED talks of all time, Simon Sinek's presentation, Start With Why5, stresses that the most successful organizations are the ones that focus primarily not on the WHAT they do but the WHY they do. But, it is easy to lose sight of Senik's advice in a healthcare world that is struggling with ever decreasing margins and ever increasing regulations. The "WHY" in medicine is no longer simply "because I want to help people." It is often "because they said I had to (fill in the blank)." Purpose has become diluted and polluted.
Better Solutions Come From Asking Better Questions
This short blog article is not the place to outline a detailed plan to address each of these complex issues. It is, however, a great place to begin a discussion. My goal in writing this today is to expand our focus to a more divergent perspective. To develop solutions, we are going to have to consider the core issues. Is resiliency training still important? Absolutely!
We need to ask better questions if we hope to find better solutions. Rather than just asking how we can make healthcare workers more indestructible, here are some of the questions I believe we should ponder together:
- How can providers be freed up to do the work that only they can do?
- Is there a way that patients can record their own history in the EMR? Can that history then be displayed in a manner that improves decision making and communication between providers?
- Can we use AI (artificial intelligence) in the EMR to produce a ranked probability of diagnosis based on the history that patients provide?
- How can we make the EMR so efficient that providers can finish their documentation at the time of the visit and not take work home?
- How can healthcare workers better support each other across departments/disciplines?
- How can we improve the way that patients interface with the healthcare system to be sure that they are receiving the right care at the right time in the right location.
Please join the conversation by posting your comments below.
- The Physicians Foundation 2016 Physician Survey ↩︎
- McHugh, MD, et al, Health Aff (Millwood), 2011:30(2):202-210. ↩︎
- Dan Pink's Drive Presentation Summary (https://youtu.be/u6XAPnuFjJc) ↩︎
- Ann Intern Med. 2016;165:753-760 ↩︎
- Simon Senik's TED Talk (https://youtu.be/sioZd3AxmnE) ↩︎