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As the pandemic drags on and on, worker burnout continues to be a crisis at health care systems. But there are proven strategies that health systems can use to mitigate the physical and emotional depletion that their employees are suffering. This article offers five. They are derived from the authors’ interviews with health care leaders, their own collective experiences in quality improvement, critical care medicine, and physician leadership, and research on burnout that they and others have conducted.
Even before the pandemic, burnout among health care workers was well documented. The pandemic turned it into a crisis. A key component of burnout is depletion, which is characterized by feeling physically and emotionally drained, just barely hanging on — like the ICU nurse who sits in her car outside the hospital and texts a friend, “I don’t think I can make it through another shift.”
But leaders of health care providers can do a lot to combat this problem. By implementing a variety of approaches, they can restore their workers’ physical and emotional reserves, sense of self, and trust in the organization that employs them. We have identified five effective strategies that some organizations have adopted. They are derived from our interviews with leaders of health care systems, our collective experiences in quality improvement, critical care medicine, and physician leadership, and research on burnout that we and others have conducted.
1. Make the most of extended teams.
Well-executed, team-based care honors clinicians’ level of training and reduces the time and effort clinicians spend on the administrative tasks that they so often find physically and emotionally depleting. Here are approaches that some organizations have taken:
- Bellin Health in Green Bay, Wisconsin, organizes both core teams (e.g., registered nurse, receptionist) and extended teams (e.g., social worker, diabetes educator) to support physicians. Before the doctor enters the exam room, team members complete forms, schedule appointments, identify care gaps, prepare anticipated orders, and start the documentation template. The extended team participates as needed.
- University of California San Francisco Medical Center has prioritized solving the problem of in-basket management (phone calls, online communications). The organization’s “triage playbooks” for different medical specialties enable nonphysician team members to field the most common requests and queries.
- Henry Ford Health System, in Michigan, alleviates physicians’ time-intensive burden of justifying and obtaining insurers’ approval for treatment by assigning the task to prior authorization specialists, who act as intermediaries between clinical staff and insurance companies, thereby minimizing treatment delays.
- Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program asks employees to nominate unnecessary or poorly designed electronic-health-record tasks for elimination. One implemented suggestion was ending the requirement that nurses and nurse aides document in the health care system’s EHR that they had conducted hourly rounds. Getting rid of it saved about 1,700 nursing hours per month at the system’s four hospitals.
2. Be a reliable advocate.
Health care workers’ emotional well-being depends on robust support from their employer, including an institutional commitment to protecting their physical safety and economic security. During the first wave of the pandemic in 2020, for example, Torrance Memorial Medical Center committed to a no-layoffs policy, which persists today. Some staff from shut-down procedural areas served as screeners for visitors and made face shields and hand sanitizers. Nearly 700 other staff were sent home but received 50% of their pay — and assurance that their jobs would return. Torrance also has strict policies forbidding abusive behavior toward staff. It requires offending patients to sign a contract not to do so again in the future, and it is enforced.
Although temporary furloughs were necessary at Henry Ford Health System, it established a Covid-19 employee relief fund that accepted monetary donations for fellow coworkers in need. Senior leaders donated 10% to 25% of their salary to the fund. Some 92% of furloughed employees were eventually brought back.
Being a reliable advocate could also mean giving clinicians the time and space to replenish themselves during lulls in the pandemic just as the U.S. military gives its personnel periods of reprieve from active duty. In health care, reprieves could include leaves of absence, temporary role changes, and reduced hours. Current health care workforce shortages are likely to worsen without such respites.
3. Lead with kindness.
Mayo Clinic has invested heavily in selecting and developing leaders who seek to combat depletion with kindness. Leaders are assessed annually with a survey, of all 73,000 staff, on five kindness-fostering behaviors:
- Include: Treat everyone with respect and nurture a culture where all are welcome and feel psychologically safe.
- Inform: Transparently share what you know with the team.
- Inquire: Consistently solicit input from the people you lead.
- Develop: Nurture and support the professional development and aspirations of staff.
- Recognize: Express appreciation and gratitude to employees in an authentic way.
The survey questions and results are shared with leaders at all levels to inform their daily practice. Published research from Mayo Clinic shows that leading with these five acts of kindness was associated with greater employee satisfaction and fulfillment and lower levels of burnout among staff at all levels.
4. Offer access to emotional support resources.
It’s essential for leaders to recognize and invest in mitigating the relentless stress of health care work, today more than ever. Providence — a health care system based in Renton, Washington, that has 52 hospitals and more than 1,000 clinics in seven states — has taken various steps to mitigate emotional depletion. They include:
- Providing curated content, such as articles and podcasts, for staff on topics such as “compassion fatigue” and parenting during a pandemic. Offerings were used more than 30,000 times by the end of 2021.
- Instituting its “No One Cares Alone” program, whereby teams of behavioral clinicians. social workers, and chaplains consult with members of high-stress units (e.g., ICU, emergency, respiratory therapy, and pharmacy) and offer practical suggestions. One is a technique developed by the Duke Center for Healthcare Safety and Quality: Individual staff members are asked to reflect on three things that went well during their shift and specify their role in making those things happen.
- Giving unit leaders direct support that, among other things, helps them understand the importance of creating psychologically safe environments to promote mental health and well-being among team members. Common recommendations include limiting staff time on site in one shift and pairing workers for peer support in a “buddy” system. Managers are trained to recognize risk factors and monitor employees for signs of distress.
- Sending out annually to all staff an anonymous mental health checkup survey developed by the American Foundation for Suicide Prevention. The survey addresses anxiety, depression, burnout, PTSD, and suicidality. Therapists review de-identified surveys on a secure platform that allows them to communicate with the employee confidentially. Providence leaders openly discuss the importance of seeking mental health care to de-stigmatize and normalize it.
5. Allow time for what matters.
Rushing clinical interactions with patients has both human and financial costs. When clinicians are hurried, they may miss pertinent information, potentially rendering the treatment plan they recommend less effective. Compressed encounters may mean clinicians don’t have the necessary time to correct disinformation or misinformation that may be influencing patients. Given the questioning of the Covid-19 vaccines that continue to occur, giving clinicians time to cultivate patients’ trust is especially important in the campaign to improve vaccination rates.
Health care systems that focus too narrowly on getting the most productivity possible out of each clinician risk depriving patients and their care teams of what matters most: a trusting, collaborative therapeutic relationship. Placing primary value on productivity is shortsighted, disempowers patients, and ultimately depletes clinicians by diminishing their joy in work. Simple acts of connection and kindness can change the tenor of care for both parties, but administrators must value these acts and bake compassion into the design of the work, as these health care systems have done:
- Kaiser Permanente locates its infusion pharmacies in the chemotherapy treatment space and encourages pharmacists to visit patients during infusions. The pharmacists meet their patients (and often family members), see for themselves how patients are tolerating the toxicities of chemotherapy, answer questions, and build relationships. The clinical pharmacists get to witness the candid experience of the patient and use their expertise to offer suggestions that may ease the treatment’s often harsh side effects. In turn, the pharmacists’ work is enriched and enlivened by seeing in real time how much their interventions matter.
- Clinicians at Australia’s Peter MacCallum Radiation Center make the time commitment to learn — and then act on — patients’ anxieties and fears. Truly individualizing service is a cornerstone of excellent health care, requiring clinicians to directly invite patients or family members to express concerns, listen closely to their responses, and keenly observe their body language. The mother of a child with cancer recounts: “My son had a general anesthesia for radiation therapy, but he felt a lot of anxiety about it, and the team allowed him to sit on me during anesthesia. They also noticed that when he woke up, he got upset about lacking a shirt. Now the team puts his shirt back on before he wakes. To me, these small acts were the ultimate kindnesses, reducing his anxiety and distress and, therefore, my own.”
With the kind of multipronged approach that we’ve described, health care systems can mitigate their workers’ physical and emotional depletion, reduce burnout and turnover, and improve patient care. At a time when so much of society is unwilling to take basic steps to reduce risks to public health, these workers consistently prioritize patients’ needs above their own. Especially given the considerable personal sacrifices that their workers are making, health care systems have an obligation to take care of them.
The authors thank Steven Bird, Ruth Chang, Cynthia Lasecki, Jonathan Leighton, Jennifer Perkins, Arpan Waghray, and Jeremiah Hargrave for the valuable information they shared in interviews.