The current narrative on healthcare burnout is just plain wrong

MedCity News

We see the headlines every day: healthcare workers are burned out, dissatisfied and leaving the workforce. Surveys show this is currently the number one issue on the minds of hospital CEOs. Staffing shortages negatively affect patient safety and the bottom line. In response, health systems and hospitals are scrambling to provide better compensation, offering days off, establishing wellness programs and encouraging workers to meditate, keep gratitude journals, exercise, eat well, sleep better and seek professional mental health support to cope with stress. Let’s pause right here. We must awaken. While these actions are noble and may provide modest relief, we are ignoring the forest fire raging all around us.

The current narrative, commentary and even research on burnout is almost entirely focused on “resilience” and “well-being.” The solutions being put in place inherently define the problem as residing within the individual person. In other words, the approach has largely been to fortify every healthcare worker with greater tolerance for stress. This is as appropriate as telling every worker in a nuclear power plant with a radiation leak to put on another layer of hooded coveralls and get back to work. Is the real problem that we are not resilient enough, or is it that we are drenched in a toxic environment every time we walk into the building? No matter how many well-earned bonuses, vacations, massages, or wellness apps are offered to employees, if they step into a damaging environment every day, nothing will meaningfully change. Their emotional, physical, mental and spiritual harm isn’t going to go away by building more resilience. We must definitively and mercilessly confront the oppressive systems and circumstances in which they work.

A major factor contributing to physician and nurse burnout is a feeling of loss of autonomy. People feel helpless, unable to make decisions, change their environment or make a difference. Healthcare workers don’t feel heard, valued or authorized to act. Nor have they been provided the professional development to acquire foundational skills to navigate change, culture, conflict, teamwork or working in a crisis. Instead, they have been relegated to being task-masters with very narrow scope, shouldering productivity demands and bureaucratic burdens, competing for limited resources, and expected to be self-sacrificing, tireless, and perform flawlessly. My son works on the security team in a community hospital and tells me of daily episodes of verbal and physical assault not only involving patients and visitors against health workers, but also amongst health workers themselves. Sadly, this is commonplace within the US healthcare system. Even more tragic is the rate of suicide among physicians is the highest of any profession and double that of the general population.

The root cause of healthcare workers’ suffering can best be described by the term structural violence, coined in the 1960’s as a means of describing social structures or institutions that keep individuals from meeting basic needs or being severely marginalized. The exact same dynamic exists in healthcare – the environment (structure) in which people work results in harm (violence). It’s no different than a nuclear reactor leak creating harm against the people working within the power plant. While we are eating more omega-3’s and talking to our therapist – or doubling up on our radiation suits – our spotlight needs to shine brightly on the dysfunction of our workplace. And it must be remedied from the inside out. We will be old and gone long before any external agency will come along to fix it for us.

In the decades I spent as a physician executive, I have seen the disconnect between those in the executive suite (myself included) and those on the front lines. I see executives with a deep desire to empower the front line, but they struggle to follow through with concrete action. What stronger, more powerful expression of valuing the healthcare workforce than to declare that everyone here is a leader in their own right, and then to start treating them that way? Healthcare’s most precious resource is its people. Yet, leadership training is usually exclusive to those with fancy titles and rank, leaving the vast majority behind. Our organizations should simultaneously equip top executives with skills to engage, include and empower the front line, while also training the entire workforce in how to build culture, how to manage change, how to resolve conflicts and how to build workplace respect and trust. By developing leadership capabilities in everyone, organizations spread problem-solving capacity across the enterprise, build worker’s trust in the institution by virtue of inclusion, and harness the creativity of the entire workforce. It will take all of this to repair our broken systems.

The workforce crisis is not a hopeless situation, but it takes bold action and big-picture thinking to alleviate these real pressures and unsustainable issues. Preparing caregivers with leadership capabilities is a tangible action that builds a trusting culture, demonstrates respect, promotes inclusion, and is our best bet to begin mitigating the violence our environment is causing us.

Rusty Holman, M.D., is a lifelong student of the nature of people – how beliefs, behaviors and human needs all work together in organizations and impact people’s personal experiences. His leadership has been integral to three health system mergers and ownership changes involving academic, non-profit, venture capital, private equity and publicly traded entities. He is a past-president of the Society of Hospital Medicine, a founder of the SHM Leadership Academies, a Nashville Health Care Council Fellow, a Becker’s Healthcare “Health System CMO to Know,” and was voted a Top 50 Physician Executive for Modern Healthcare. As CMO of LifePoint Health, Rusty created a national quality program across 70 hospitals in 22 states that received the John M. Eisenberg Patient Safety and Quality Award. He is currently founder and CEO of 1821Health, dedicated to the advancement of leadership skills in all healthcare workers through the science of adult learning.