Overcoming Physician Burnout: A Culture of Conversation for Provider Wellbeing and Institutional Prosperity

• In Event: Learning From Leadership Failures and Successes

Short Description

More than 50% of medical residents and doctors in the United States report burnout, adversely affecting the quality of patient care, health care costs, and personal practitioner mental health and wellness. Depression, alcohol, substance use, and suicide are linked to burnout. Healthcare leaders seek sustainable solutions that benefit the organization and the individuals within the organization. Solutions are predicated upon reengineering healthcare systems to calibrate and monitor the patient and provider experience. The purpose of this theoretical analysis is to evaluate the most current preventative and positive approaches that address physician burnout. Four recent trends will be presented.

Detailed Abstract

PROBLEM, NEED, SIGNIFICANCE
In the U.S., over 50% of medical students, residents, and physicians experience burnout (Pearson, 2017; Richter, 2017; Stone, 2017). Burnout adversely affects patient safety and care, health care costs, and practitioner wellness (PRNewswire, November 28, 2017). Stress and other unmanageable circumstances experienced by physicians result in suboptimal patient care and medical errors (Wallace et al., 2009). Lower patient satisfaction leads to financial burden (Shanafelt & Noseworthy, 2017). Further, burnout contributes to 300 to 400 physician suicides annually (PRNewswire, November 28, 2017; Richter, 2017; Stone, 2017).

Physician burnout is a mental health issue that increases with workload and work-home conflicts (Győrffy, Dweik, & Girasek, 2016). Burnout in the healthcare is attributed to a “Triple Aim” focus on cost, quality, and population health (Berwick, Nolan, Whittington, 2008; Bodenheimer, & Sinsky, 2014). Ignored by leadership, physician burnout contributes to depression, alcohol, drug use, or suicide (Fralick & Flegel, 2014; Rosenfeld, 2017). Physician and surgeon suicide rates are higher than that of the general public, and women physicians successfully complete suicide 250-400% more than women in other professions (Kuwada, 2016). The mental health of physicians and medical students are in need of intervention from the American Medical Association (AMA) and healthcare organizations to alleviate the causes and symptoms of burnout (Rosenfeld, 2017).

FRAMEWORKS, QUESTION, DESIGN
There are multiple approaches applicable to the solution of physician burnout. We sought to apply a strengths-based approach. The solutions that emerged include moving to a “Quadruple Aim” model (Bodenheimer & Sinsky, 2014; Drummond, 2017)—improving patient health and health care experience, while optimizing costs, and improving work-life of health care providers (Bodenheimer & Sinsky, 2014), and the construct of “grit” to persevere (Duckworth, Peterson, Matthews, & Kelly, 2007). Within this framework, the research question was posed: What are the most current, strengths-based and positive approaches applied in the healthcare industry that address physician burnout? A mini literature was conducted to review solutions from the past three years (2014-2017). Searches engines included EBSCOHost, PubMed, and GoogleScholar.

RESULTS, FINDINGS, OUTCOMES
Culture of Conversation:
Gunderman asserts, “cultures of compliance can spread burnout like a contagion” (Pearson, 2017, para. 3), defines compliance as mindless obedience, and characterizes burnout as exhaustion, depersonalization, and lack of efficacy created by reliance upon 19th- and 20th-century efficiency experts (Pearson, 2017). Transforming cultures of compliance into cultures of conversation is a multi-step process—recruiting leaders who define their role as facilitators in a two-way conversation (Pearson, 2017).

Future Health Leaders Program (FHLP):
UNSW School of Public Health partnered with Shanghai’s Renji Hospital to develop a research program about burnout in medical students training and living at the hospital (Dunlevy, 2017). As Shanghai’s oldest hospital, in 2016 Renji had approximately 5000 staff, 4.3 million outpatient emergency admissions, and 100,000 surgeries. The success of FHLP catalyzed additional collaborations in international health management training, and nursing leadership training.

Chief Wellness Officer (CWO):
Stanford Medical is the first academic medical center in the U.S. to create a CWO position to counter physician burnout. Recruited from the Mayo Clinic, Shanafelt is “an international thought leader and researcher in the field of physician wellness and its implications on quality of care” (Richter, 2017, para. 3), and will direct Stanford’s WellMD program.

One approach is to strengthen individual physician resilience; the Mayo Clinic achieved results by targeting systems, the practice environment, organizational culture, and leadership, resulting in a decline of physician burnout 7% over two years, during which time national physician burnout increased 11%. In subsequent assessments, Mayo physician burnout decreased to 67% of the national physician burnout rate (Richter, 2017).

American Conference on Physician Health:
The first American Conference on Physician Health, sponsored by the Stanford University School of Medicine, the AMA, and Mayo Clinic, was held in the U.S. in 2017. Researchers and health care practitioners, representing 44 states and seven countries, explored the theme of “Creating an Organizational Foundation to Achieve Joy in Medicine” (Erickson, 2017). The findings included that administrative requirements, such as data entry into electronic health records (EHR), electronic medication prescription, meant to decrease burden, lead to physician discontent. Additional factors included a “toxic culture” in many health care organizations, which demand physician perfection and physician refusal to recognize their situation (Erickson, 2017).

Three primary strategies may reduce burnout: personal resilience, organizational culture, and more efficient processes (Erickson, 2017). Re-engineering EHR practices can generate dramatic improvements—3-5 hours a day of physicians’ day. Other strategies include card readers instead passwords, printers in patients’ rooms, efficient workflow (Erickson, 2017).

“Grit”:
Recent studies corroborated the relationship between grit and engagement, job satisfaction, burnout, and attrition among healthcare providers. Studying the relationship between grit and attrition among U.S. residents, Salles et al. (2016) found the perseverance associated with grit promoted resident well-being. Researching correlations between grit and burnout among United Kingdom doctors, Halliday et al. (2016) concluded that high levels of grit may be associated with less burnout, recommending resilience training interventions to increase grit.

UCLA’s Healthy Campus Initiative and Pediatrics Department partnered with the Semel Institute of Neuroscience and Human Behavior to develop the UCLA Pediatric Residency Resilience Training Program (Jupin, 2016; Lagnado, 2016; Vickers & Vickers, 2017). The pilot included 96 residents, representing four institutions, who participated in six workshops. The experiential workshop included presentations and role-playing activities designed to strengthen coping mechanisms. Safeguarding residents’ wellness reduced medical errors, improved job satisfaction, and prevented burnout and frustration (Jupin, 2016; Lagnado, 2016; Vickers & Vickers, 2017). Grit has emerged as a more reliable and accurate predictor of retention than intelligence, physical aptitude, personality traits, and job tenure (Eskreis-Winkler et al., 2014).

CONCLUSION
Healthcare leaders seek out sustainable solutions that counter physician burnout and increase well-being. Building capability is viewed as an aspirational goal for healthcare organizations. Well-designed organizational interventions can reverse trends for physician distress and burnout. Recent solutions within a strengths-based approach were summarized. Remediation is predicated upon reengineering systems of care to calibrate and monitor the provider/physician experience. It is possible to prevent health practitioner burnout, enhance the patient experience, while maximizing organizational outcomes.

Participants

• Lunthita M. Duthely, University of Phoenix, School of Advanced Studies

• Elizabeth Johnston, University of Phoenix

• Terri Jones Meineke