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  • Writer's pictureBruce Cummings

JAMA Open Network Piece On Clinician Burnout Misses The Bigger Target

Updated: May 13

As most students of the subject of burnout know, burnout is an occupational phenomenon -- an individual response to persistent, noxious conditions in the workplace.  Most hospitals are replete with such conditions.  Here are just 5: 


  • EHR's which reduce clinicians to being data-entry clerks 

  • Inefficient workflows that inhibit if not prevent clinicians from being able to work at the top of their license and/or which require workarounds in order to get the right care to the right patient on a timely basis 

  • Inflexible staffing and scheduling practices 

  • Lack of meaningful input by clinicians into operational decision-making

  • Outdated policies, practices, and/or procedural requirements


So I was therefore excited to see the title of the following piece in the April 24 issue of JAMA Open Network: "Learning How to Protect the Health System by Protecting the Caregivers".  Finally, I thought:  on the critical issue of clinician burnout, here will be a strong piece -- written by 3 physicians no less -- that will clearly articulate the imperative for healthcare leaders to change persistent, systemic issues in the workplace that give rise to clinician burnout.  Indeed, the article starts out on a strong note: 


"Burnout among US health care workers is an increasingly recognized problem.1 General Social Survey data suggest that almost one-half of US health care workers experienced symptoms of burnout often or very often in 2022, up from less than one-third in 2018.1 The Chief Medical Officer of the Centers for Disease Control and Prevention has said that “burnout among [health care] workers has reached crisis levels.”2

            

In recent years, this burnout crisis has accelerated alongside the COVID-19 pandemic and broader workforce trends...

            

Overall, US health care workers are now more burned out than they were before the COVID-19 pandemic."


But then the authors veer into a discussion about peer support programs, implying that the availability and quality of such efforts will stanch the rising tide of clinician burnout.  (Hint: they won't.) 


"[S]trengthening peer-peer interactions in the workplace offers a potential target for reducing burnout in health care...  [O]rganizational leadership may want to consider devoting resources for peer-based support initiatives to build workplace relationships and mitigate burnout. As we think about ways to help a generation of healthcare workers heal from the pandemic and its aftermath, focusing on peer-peer dynamics and workplace culture as the targets of intervention may be especially effective in reinforcing strong institutions, engaged health care workers, and robust community and collegiality in health care."


Peer Support Programs and Clinician Burnout


To be clear:  peer support programs are, indeed, a valuable component of an overall plan to reduce the incidence and severity of clinician burnout.  They have been shown to be especially valuable in dealing with so-called "Second Victim" situations -- a not uncommon phenomenon in hospitals.  Sachs and Wheaton in a recent piece for the National Library of Medicine define "Second Victim Symptoms" as --   


 "...the result of a traumatic patient care event in the healthcare setting. These events can include near misses, patient adverse events, deaths, or provider mistakes but really encompass any event that leads to significant mental stress on the part of the provider (otherwise known as the "second victim"). Each second victim will have unique perspectives, needs, and emotions related to the event, and symptoms can occur in various timelines after the event."


My concern about the JAMA Open Network piece, then, is not the merits of peer support programs per se.  Indeed, as noted above, they ought to be an essential part of an overall burnout reduction plan.  Rather, it's the implication that starting (or maintaining) peer support programs will somehow materially reduce Maslach's 6 drivers of organization-wide clinician burnout:  work overload, lack of control or agency, insufficient reward/recognition, loss of community, perceived unfairness, and conflicting values (between those of the individual and their employer).  I fail to see the connection.  At best, the JAMA Open Network piece is a starting point for discussion and action.  At worst, it deflects attention from the larger, multi-faceted, organization-wide, and sustained approach to burnout reduction that is required of healthcare leaders.


Organizational Wellbeing Solutions for Hospitals, Health Systems, and Medical Group Practices:  Leadership-Driven Changes


The locus for curing clinician burnout and staffing shortages runs through the c-suite.  Here are examples of leadership-driven changes to the workplace my colleague Paul DeChant, MD, MBA and I often recommend:

  • regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays

  • 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

  • expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)

  • 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

  • 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")

  • 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.





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