The COVID-19 pandemic highlighted the physical and emotional strain on healthcare workers like never before. Burnout in healthcare isn’t anything new, and recent data shows it’s only getting worse (Shanafelt, et al., 2022). Even the U.S. Surgeon General has taken notice, setting strategic objectives specifically targeting healthcare workers. Clinical burnout is also intimately tied to financial challenges.
Recent financial challenges have impacted the larger healthcare system; the American Hospital Association reported that over half of US hospitals ended 2022 at a financial loss. They also explained that labor costs account for around 50% of a hospital’s budget and that labor expenses per patient rose almost 25% from 2019 to 2022. As costs to employ staff increase, we’re also faced with the stark reality that higher levels of burnout are associated with lower quality of care and patient safety (Panagioti et al, 2018).
Organizations often offer rewards like sign-on bonuses, retention bonuses, and pay increases to mitigate burnout, but these options may not be possible due to cost increases. So, then, what should hospitals and healthcare organizations do to combat burnout for healthcare workers in 2023 and beyond? While acceptable pay, bonuses, and great benefits are absolutely essential to managing healthcare burnout, there are other strategies to support healthcare workers.
Battling Burnout? We can help.
# Strategies To Mitigate Burnout in Healthcare
As a healthcare consulting firm with deep experience supporting employees and patients, Propeller understands the critical significance of mitigating healthcare worker burnout and establishing enduring frameworks that alleviate workers in the long term.
Learn more: Healthcare Consulting to Build Healthier Tomorrows
In 2021, we focused on individual strategies to build resilience as a way to reduce burnout. A year later, we looked at systems-level strategies, focusing on leveraging human experience design and people-oriented interventions to help nurse and doctor burnout further.
Read the blog: Reduce Healthcare Burnout with People-first Staffing Strategies
Today, we want to further the discussion and dig into a model to help us understand how burnout develops and look at a relationally oriented coaching strategy that supervisors, managers, and leaders can use with their staff. Before looking at causes, let’s align on what we mean by burnout.
# What Is Healthcare Burnout?
The World Health Organization defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- feelings of energy depletion or exhaustion,
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job,
- reduced professional efficacy.”
Burnout is not technically classified as a mental health disorder like Generalized Anxiety Disorder or Major Depressive Disorder. Nevertheless, burnout can and does coexist with these for many people and can significantly impact all aspects of life on its own.
While Propeller doesn't provide mental health or medical treatment, we want to stress the importance of professional mental health support in a healthcare organization's strategy to address worker burnout.
We’ve known provider burnout is a problem for years, related to increased costs and lowered quality of care, and now we’ve clarified what we mean when we say the word. So, how does burnout develop?
# Burnout Causes for Healthcare Workers: Job Demands & Resources
Several theories have been developed to explain how clinician burnout shows up, but one of the most popular is the Job Demands-Resources (JD-R) model, first suggested by Demerouti and colleagues in 2001. According to this model, two primary factors play a role in how work impacts burnout: Job Demands and Job Resources (Bakker & Demerouti, 2017).
# Job Demands
Job demands, according to Bakker & Demerouti, are the elements of a job needing persistent physical or mental effort, often resulting in exhaustion. For healthcare workers in particular, high workloads, patient demands, irregular work hours, and complex decision-making and responsibilities can add pressure to the demands of their workday.
# Resources
On the other hand, they explain that job resources are the physical, psychological, organizational, or social aspects that can help alleviate these job demands and their physiological and psychological impacts. Resources at work can be organizational or environmental in nature but also personal. When demands exceed resources, physical, mental, and emotional fatigue sets in. If this imbalance is maintained over time, it becomes chronic, eventually leading to burnout.
# Managing Provider Burnout in the Healthcare Industry
The allure of this model lies in its simplicity — to address burnout, you may think, “Let’s just reduce demands and increase resources.” Unfortunately, the real-world application of these principles is much more complicated. Healthcare organizations face a host of challenges, such as resource constraints, constant changes in healthcare regulations/requirements, and a continual state of uncertainty about the future, among many others. Also, when talking about burnout, we’re talking about people.
Healthcare workers are a diverse group who come with histories, personalities, preferences, and so much more. While vital system improvements are needed, and individual strategies can help, we turn to a relational strategy, focusing on adapting to the individual’s culture, experiences, and preferences.
To address burnout strategically, healthcare organizations need a flexible, staff-focused approach that allows everyone to understand their unique job demands and resources while providing coaching to facilitate necessary adjustments.
# Coaching to Build the Capacity for Resilience
Our approach involves educating leaders, managers, and supervisors in a coaching conversation framework. This method focuses on mitigating clinician burnout risk by strengthening resilience and creating an ongoing, continuously improving, personalized practice that improves resources and awareness of potentially adjustable demands.
# The Importance of Resilience in the Workplace
Crane & Searle (2016) explained that resilience is commonly described as an observable outcome in people who experience a stressful event but only show a slight decline in their well-being and functioning before bouncing back to normal levels. We desperately want to have resilient healthcare workers who can face challenges head-on, rest, recover, and get right back to the next situation with high levels of performance.
Recent research has consistently found that routine conversations with a manager—especially those addressing stress and support—are key to fostering this resilience (Kho, Karin, Gucciardi & Crane, 2022). While this is great news, we've noticed that managers sometimes lack the confidence or skills to facilitate effective conversations in areas like stress, burnout, or emotional exhaustion, so we created a framework to help anyone develop these.
Related: Increasing Employee Retention by Building Trust - Mistakes & Remedies PDF
# Nurturing Resilience in Healthcare: The 3-Part Framework
Our three-part approach is discussion-based and occurs as a recurring meeting series, delivered the same way each time. Consistency in these conversations ensures that the process becomes a familiar and integrated part of the workplace routine, reducing resistance and increasing comfort with the discussions. The repetitive nature of the series allows for continual reassessment and refinement of strategies, fostering an environment of growth and adaptation. This model of consistency and recurrence is designed to build trust, promote open dialogue about physician burnout, and, ultimately, support a more resilient workforce by building habits of resilience.
There are three parts, and the more they’re practiced, the better both staff and managers will be at the process.
- Identification
- Evaluation
- Adaptation
# 1) Identification:
Every conversation begins here. The objective is to ask the employee to reflect on a recent stressful event until, over time, they identify the typical ways that they personally respond to stressors. The types of questions to ask are:
- Tell me what you were thinking in that situation.
- How did you act to cope?
- How did you feel physically and emotionally?
The more familiar someone becomes with their typical stress response, the more they build their ability to recognize that in the moment of a stressful event, which primes them to apply the coping strategies that are discussed in steps two and three of the coaching conversation.
# 2) Evaluation:
The objective here is to continue reflecting on the same stressful event and evaluate how helpful their coping strategies were in relation to either their values or their goals. The key questions to ask are:
- In this situation, how might you have ideally behaved?
- What different strategies did you use to reduce your levels of stress or cope?
- What aspects of each strategy were helpful and unhelpful?
# 3) Adaptation:
Finally, every conversation ends here, where the manager and the employee discuss what other strategies to cope with future stressors exist that the employee can explore. The manager may ask:
- How would you change your strategy in the future to cope better in a similar situation?
- What resources are available that could help you identify new approaches or build knowledge or skills?
# The Benefit of Coaching for Resilience
The coaching process helps employees navigate these demands, maximize the use of available resources, and develop new strategies to bolster their resilience further. Over time, repeated conversations like this achieve three important things that mitigate the risk of burnout:
- Build the capacity for resilience: These conversations allow the manager and the employee to test and adapt new coping strategies that build the employee’s ability to bounce back from future stressors (i.e., the capacity for resilience).
- Create a resource to combat stress: Regular coaching conversations lead the employee to perceive that they are being supported by their manager, which drives them to return to the manager to use as a resource for stress.
- Build a peer-to-peer support system: That same perception drives the employee to proactively offer themselves as a resource to their peers undergoing stress, which can foster a culture of psychological safety and resilience (Kho, Karin, Gucciardi & Crane, 2022).
# Take The Next Step to Alleviate Healthcare Burnout
There is a real risk that more healthcare workers will leave the profession due to burnout, which could increase costs and ultimately lower quality of care. While the burnout problem is multifaceted and complex, understanding the Job Demands-Resources (JD-R) model gives leaders a framework to think within.
Furthermore, clinician burnout does not arise from a single source, so we should not attempt to manage it through a single intervention. It will take a combination of national shifts in healthcare operations, as well as the three areas we’ve discussed:
- Individual efforts
- Adjustments to how people interact with their work
- Relationally driven coaching support
Healthcare worker burnout is bad for individuals, patients, and the healthcare system at large. If you or your organization would like to explore how Propeller can help, either through our coaching framework or any of our other areas of expertise, please reach out to see how we can support you.
