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Physician and nurse burnout.

It’s an issue that has been studied at an increasing rate over the past few years. It’s a ubiquitous topic in any discussion about challenges facing healthcare today. Addressing it is a moral and operational imperative – caregivers need to be cared for, most importantly for their own health and wellbeing and also for the sustainability of provider organizations.

So, how healthcare leaders move from knowledge to action when it comes to burnout?

In our latest podcast, we work towards some answers.

Dan Shapiro, PhD, is a partner at Chartis and the director of the Chartis Center for Burnout Solutions. In that role, Dan and his team assist leaders of multi-hospital systems in their efforts to reduce burnout and the turnover of high-value physicians, nurses, APPs, and other staff. Dan’s background includes a PhD in clinical psychology and  a postdoc at Harvard where we focused on medical crisis intervention.

Shapiro joined Kevin Kearns, a vice president at Jarrard Inc. and expert in organizational development strategy, to talk about some of the issues underlining the rocky healthcare workforce landscape. They also dig into some of the best practices for organizational design and employee support needed to address burnout.

Key Insights

  • Different roles require different solutions: Don’t overlook the unique challenges and needs within different subpopulations of your workforce.
  • Utilize data to develop solutions: Ground your actions in evidence so you can implement a systematic approach tailored to your organization.
  • Start now, before it’s too late: Organizations that aren’t investing in their people when times are tough will see their problems exacerbated in the long run.
  • It doesn’t stop with frontline staff and managers. Engagement efforts must extend to the HR and leadership teams to ensure that everyone can thrive.

Read the Transcript

David Shifrin: I want to start very practically. What are the questions to ask within a leadership team? Whether we’re talking about the HR team or the clinical leadership or executive leadership team, what are the questions that need to be asked to make sure that everyone is assessing and addressing the right problems and addressing them in the right way?

Dan Shapiro: I think you’ve summed up the problem really well, in that there isn’t one or two simple questions to ask healthcare workforce. We have a context where labor costs have gone up. We’ve had massive flight, and simultaneously a massive portion of the population delayed getting healthcare and are coming in. Just like if you don’t service your lawnmower for three years, you start having more difficult problems. So, our emergency rooms are boarding patients now from coast to coast, including Alaska. I just talked to a number of healthcare workers up there. So, in that context, different subpopulations of healthcare workers need and want different things. So, there isn’t a simple, “oh, it’s the boss,” or it’s your relationship with your boss. Oh, you’re not getting good enough communication from leadership. There isn’t a simple one or a few questions that matches everything that everybody needs. If you talk to a cardiac surgeon, the thing that’s most important to them is not the same as if you talk to an internist, which is also not the same as if you’re talking to an ICU nurse, or an emergency room nurse, or an ambulatory nurse, or environmental services, or techs, or therapists, and on. The specific details in their practice world matters, which is why I think we at Chartis have embraced a much more systematic and thorough way of looking at all the doors into the burnout room.

Shifrin: Kevin, what’s your take on how leaders – and I mean leaders very broadly, whether we’re talking about a team lead, on the floor, or executive level – from a communications standpoint and an organizational design standpoint, how do you think about asking those questions in the right way to get that very specific personal information that Dan’s talking about?

Kevin Kearns: I think Dan brings up a great point that everybody has their own unique experience they’re going through, and if you’re an executive trying to support folks in your organization, and you want to take action, how do you know what action to take? How do you know what the experience is? That’s going to require a level of communication and checking-in, and it’s not as simple as just sending out an email and saying, “I’m concerned, I want to help your employee experience.” It’s about, how do you have that conversation in a way that doesn’t disrupt their experience, literally as you’re asking? How do you make it easier for them to give you feedback? Technology is helping a lot with that. At the same time, you need to have an awareness of your people, ongoing, to be able to have the conversation well as you go through different things in the organization. And I would say the most important thing is don’t make it up. Check in, have conversations, and keep them going.

Shapiro: I think what Kevin is raising is really important, this point about not making it up, because healthcare leaders just went through it too, right? They just went through the pandemic, they’re weary, they’re struggling, and I think it’s pretty natural as a leader to check in with yourself and use that compass, like, “what am I feeling? What have I just been through? What would fix that?” and assume that will also apply to your people. “The beginner’s mind” that the mindfulness folks talk about and that Kevin is alluding to I think is a really good point.

Shifrin: Dan, keep going along that thread. How can that mindset be cascaded down through the organization? How can executive leaders encourage and support the team leads, the department leads, to think about those specific questions, to check in with themselves and with their teams? What does that process look like and how can leaders at each level above support the folks immediately below them?

Shapiro: Well, I love the question because it grounds them in what they ought to be doing. First, I think they can model a little bit of self-care for their people. Taking vacations and not emailing everybody on your vacations and not emailing them on their vacations. Being transparent about, “Hey, I’m, leaving early to go exercise. I’m leaving to go spend time with my family. I’m looking after myself, I expect you to look after yourself.” That message matters right now, a lot. We already mentioned “the beginner’s mind,” and the other piece is having a systematic approach to measurement. I’m really biased because I think that matters, but a combination of qualitative and quantitative methods to measure across your workforce what the major stressors are, in a way that’s organized. I think makes a huge difference and is really important right now.

Shifrin: Question for both of you: how do you think about taking that data and turning it into not just action, but action that people can emotionally connect with? I would love to hear how you both think about that process of the qualitative turning into something that anchors the larger story that you’re trying to tell and the larger action that you want people to take.

Kearns: I would say that a lot of times we assume that there’s innate value in goodness, and making some of the decisions we need to make are just obvious, right? Like, of course we’re doing this. It’s the logical thing. It’s the only option we have. And at the same time, if that doesn’t connect with me and my experience, I’m not necessarily going to be able to engage fully. Whereas, if I get how it impacts what we’re all here trying to do, and we have an added benefit of being in healthcare where most people show up – whether you want to call it a calling or just a passion – to make a difference in patients’ lives. So, you have that shared purpose, and if you can connect whatever you’re doing to that, you start to have a shared experience that you both want to achieve. I think that’s the important thing in terms of moving forward. It has to connect to what we all want, so that we can actually put up with the discomfort of figuring it out together.

Shapiro: I love Kevin’s point about connecting to purpose. Beneath that some action plans are dry, but that doesn’t mean that highlighting them isn’t still really important. I was just looking at data showing that 42 percent of ICU nurses at one of the institutions we’ve interacted with have full-blown post-traumatic stress disorder, which is probably three times the rate of Vietnam veterans coming back from Vietnam. Those folks deserve care, mental healthcare, via probably opt-out appointments so that they’re not having to make extra scheduling time, where the clinicians show up, and take them aside, and sit down, and do a nice careful screening and messaging that in the same way I just did. Just comparing to the data I think resonates with people. There are things as dry as hydration. Our nurses don’t have time to drink, eat, or pee. And, reiterating how important it is for middle managers to track, get your folks off the line, to take care of themselves. It might not connect to the highest purpose, but it keeps folks functional. So, I think there’s smart ways to message that.

Shifrin: There are different types of organizations and different types of teams that we’re talking about here. So, in the first place, do you all see any differences, any nuances in how these challenges and/or the solutions play out? If we’re talking about a community hospital versus a larger system versus a physician group or an ambulatory surgical center, what are the things that folks should be considering when it comes to the specifics of their organization?

Shapiro: Another really insightful question. The issue that we run into the most is that most organizations have not been set up to address the wellbeing of their people. They’ve been set up to set that aside to human resources or some other place pre-pandemic, where there’s sort of one person with a flag who’s supposed to carry that up the hill, but everyone else can go off and do their own thing that they’re responsible for. So, you end up without enough alignment and enough juice in the people who have that responsibility. Chief wellness officers, for example, or people who do benefits in human resources, can have too little impact on an entire organization that is struggling with the labor issues that we’re facing right now. We have an overwhelming pressure on the healthcare workforce, and we need aligned leaders with clear roles and the resources to address these issues. We run into that depending on who has brought us into organization.

Kearns: Yeah, Dan, I love the idea that you can have a chief wellness officer, but if that role isn’t incorporated into a holistic view of what you’re doing as an organization, that individual is not going to be successful, right? They’re going to run into their own wellbeing crisis, because they’re there to make a difference, but the processes and the boundaries get in the way. And it’s not as simple as just making a decision and thinking you have it covered. It’s the holistic view of, “how are these things working together?” And then how do we check on that to ensure that we know, and then make adjustments as we go. It’s not like you can check the box and be done. It’s an ongoing holistic view that makes sure that things are lined up and you’re able to understand. Not just “what are the best practices?” but what are effective, successful practices for your organization. And that should be real-time discovery and then tracking and learning as you go.

Shifrin: So, Kevin, you teased the last question when you mentioned these folks who are doing this work are potentially facing their own challenges if things aren’t structured the right way. So, we’ve talked a lot about middle management and clinicians, but there’s this whole organization supporting these folks. Talk a little bit about workforce wellbeing beyond just the frontline and management teams.

Kearns: It’s a great point. We look at human resources, and a lot of times we look at HR as supporting the organization, right? Paying attention to wellbeing, engagement, the experience of the employee. If we have HR caring for everybody else, who’s caring for HR? The landscape has changed quite a bit, and HR, who wants to be a strategic partner in most organizations, finds themselves doing the compliance, tactical things to get things done. And they’re stretched. So, when you hear of nursing shortage, that impacts nursing, of course, and operations. But it’s also impacting HR, talent acquisition. There’s a lot going on, and HR can get lost in the shuffle. So, I’d say it’s important to look at HR, not just the role and service they provide the organization, but also, how are they doing? How are you ensuring that they’re in a sustainable place to keep performance going? And part of that is also, how do you keep them integrated within themselves? Because they have so many people working so hard to meet all these different needs that they sometimes don’t know – you know, right hand, left hand – don’t know what they’re doing. So, being able to have a holistic view of HR and how they work together and partner with operations to be more effective is, I would say, a significant impact for HR going forward.

Shapiro: I’m going to push what Kevin said even a step farther. Before the pandemic, I saw the beginnings of a binary view of human resources. In some places, there was sort of a doubling down, and there were going to be strategic partners, and they’re going to be doing organizational development in addition to all the transactional work. But in others – a sizable portion – they literally left the building, moving towards this sort of self-service model, and pushing a significant part of organizational development, dealing with accountability, performance, and behavioral issues down to nurse managers, for example, and middle managers across healthcare. So, the joke is, “press one for an employee who’s taking too much time off. Press two for an employee who’s bullying their colleagues.” And it’s been a massive loss. The reality is, right now we need HR more than we ever have. The need for really efficient, quick recruiting and talent acquisition, and training people up, looking after our youngest healthcare professionals who are burning out the fastest and leaving the field the quickest, partnering for the business strategy partnerships that middle managers need, the organizational development. We need to be investing across the board more in HR than we ever have, and given labor shortages and how expensive it is, it’s very tempting I think for healthcare leaders to try and trim central services in IT and HR, and this is the exact wrong time to do it. Investing in great recruiting and investing in helping those managers stay and be effective is actually going to pay dividends long term. These are the healthcare organizations that are going to weather this incredible difficulty and emerge at the other side as the employers of choice.

Kearns: Dan, if I can add a little bit to what you said, I’d love it. I would say that if you’re going give people the choice between strategic, purpose driven work and get stuff done, they’re going to want to do this, right? But everybody’s going to lower what needs to be done, like just, “hey, could you just get that rec posted for me?” Yeah, we want to look at that, but we need to do this right now, today, right? It’s Maslow’s hierarchy of needs, just the survival level of it. And as you said, the investment in HR can easily be seen as not the strategic imperative right now. At the same time, you’ll pay for that later and continue to have the challenges because HR doesn’t play the role that it could.

Shifrin: Let’s close out with a 30 second elevator pitch for how we can help. What are some of the tools and assessments and things that we can do to come alongside leaders to help address these problems we’ve talked about today?

Kearns: The 2023 LinkedIn Workforce Survey came out, and the results say that 93 percent of organizations are concerned about retention, and one of the things that they’re seeing as a key piece is what used to be a differentiator: “Hey, we care about growth and development for our folks,” right? We want our workforce to be able to see that they have a future career where they can grow here. That has now become kind of the expectation for new employees entering the workforce, where if I don’t see my career growing within the organization, I’ll grow it somewhere else. And one thing I could say for Jarrard, as we look at growing the ability to manage change, one of the things we need to do is grow the ability for employees to manage change. Be able to see how they can learn and grow, and also see opportunities to kind of optimize their change experience by seeing talent mobility, to be able to shift around in the organization to have a bigger impact. And that takes a learning strategy, and that’s something that, as Dan had mentioned before, you can think that you’re doing enough, but if you’re not intentionally going out of your way to connect performance and work your way back to learning and what you’re doing to support it, you’re going to find yourself just doing a lot of effort and not knowing if you’re having an impact. And there’s good chance, even if you start with impact, you’ll drift away. At Jarrard, we definitely help you take a kind of holistic lens to change management and understand the human side and how to engage with folks to move them forward in their careers, which will help move the organization forward in performance.

Shapiro: I think that leading and identifying the actionable factors that impact burnout, specifically directed to specific healthcare professionals, so that we surface the issues that matter, and we help leaders take practical, actionable steps towards addressing those. And I think we do it better than anybody else.

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