Three disparate healthcare-related news items appeared in the last week which, taken together, underscore that clinician burnout remains a clear and present danger to both hospitals and health systems and to the patients who depend upon them.
An Uncertain Outlook for Hospital RN Staffing
1. A January 2023 nurse survey of 18,000 RN's across the United States conducted by the interim staffing company, AMN, found that 85% of nurses in hospitals indicated they were planning to quit within the coming year. Did they? Becker's Review checked in with AMN for an update. The latest data, however, show that the giant RN exodus from hospitals did not play out as predicted. Is the threatened crisis over? I don't think so. Hospitals responded to that survey and others indicating a similar imminent wholesale departure from the field by offering both recruitment and retention bonuses to RN's, fast-tracking more flexible scheduling models, creating in-house staffing agencies, introducing remote/virtual roles into which some nurses could transition, and offering more career counselling and advancement opportunities. The latter four responses seem both appropriate and sustainable. But as for the first -- bonuses -- what happens when the prescribed retention period (typically, 3 years) runs out? Meanwhile, in a separate study conducted by AMN published in February 2024, 72% of nurse leaders say they are burned out and 31% say they are considering leaving the field.
As regular readers of these blogs will remember, my colleague, Paul DeChant, MD, MBA and I believe -- and the evidence supports -- that while pay and benefits are important considerations in the recruitment process, non-tangible factors (e.g., teamwork, feeling valued, pride and satisfaction in the type of care one is able to provide, workplace culture, and relationship with one's supervisor) are more important when it comes to retention.
The New Leading Patient Safety Risk: Not Enough Experienced Clinicians
2. ECRI, the non-profit healthcare safety organization, and the Institute for Safe Medication Practices recently released their top 10 patient safety hazards for 2024. The number 1 safety risk? Inexperienced staff. More specifically, "(c)hallenges transitioning newly trained clinicians from education into practice." As experienced physicians and nurses decamp to other less stressful care settings, cut back on their availability, or leave the field altogether, hospitals are forced to rely on newer, less experienced caregivers. In addition to a shortage of trainers and training programs and the loss of veteran clinicians to support and mentor new clinicians, burnout now appears to be a major early risk factor for new clinicians, not just those who have been in the field for an extended period:
"Growing concerns regarding workplace violence combined with complexity of care issues (e.g., behavioral health crisis) is leading to increased staff burnout, even among new healthcare providers. One study showed that 42.5% of new graduate nurses reported they were considering leaving the field of nursing (Ulupinar and Aydogan)—an unsettling sign that the well-documented burnout among healthcare staff is affecting new clinicians and not just senior clinicians. Studies show that the physician burnout rate is over 60% with factors including work overload and sleep impairment contributing to medical resident burnout. (Lubell)".
If ever there were a field where experience is the best teacher, it's healthcare. But here's today's reality, according to ECRI:
"Without sufficient preparation, support, and training, throughout the transition into practice, new clinicians can experience loss of confidence, burnout and reduced mindfulness around culture of safety. The coalescence of these factors may lead to a failure to recognize and rescue patients from preventable harm, and/or contribute directly to patient harm events."
More Physicians Opting for Unions
3. A March 14 Becker's Hospital Review news brief, "Physicians at Mass General Brigham hospital vote to unionize", by staff writer Kelly Gooch, notes that physicians at Salem (Mass.) Hospital voted to form a union with Council 93 of the American Federation of State, County, and Municipal Employees (AFSCME). The vote was posted on March 13 on Facebook. Ms. Gooch, citing data from the American Medical Association, estimated that in 1998 between 14,000 and 20,000 physicians belonged to unions. By 2019, that figure had reached 67,673 -- and appears to be skyrocketing. It's a sobering sign of the times: frustrated by their inability to meaningfully influence policy and practice decisions about how care is to be organized and delivered in hospitals -- or even to have reasonable agency in connection with their own clinical responsibilities -- physicians are increasingly turning to third parties for relief. This is yet another manifestation of a troubled workplace and of the growing schism between front-line clinicians and senior leaders.
Organizational Wellbeing Solutions - Leadership-Driven Changes
There is a set of solutions that address the 3 seemingly disparate phenomena noted above: changing both administrative and clinical practices in the workplace; streamlining workflow to eliminate bottlenecks, excessive data entry by clinicians, and non-value added tasks; and reinventing/inflecting the managerial culture of the organization. Here are examples of leadership-driven changes my colleague Paul DeChant, MD, MBA and I often recommend to address clinician burnout and foster organizational wellbeing:
expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized)
create and require leader standard work (LSW).
develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.