Executives Face a Moral and Business Imperative to Address Burnout

Contributors:  Linda Roszak Burton, ACC, BBC, BS and Betsy Chapin Taylor, FAHP
To learn more about Linda and Betsy, click here.

 

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A drumbeat about the acute burnout faced by clinicians continues to plague the healthcare industry — and rightly so. Today, 49% of physicians say they are burned out.1 Further, one in five physicians indicate they are likely to leave their practice within two years.2 Burnout harms individuals and encompasses a variety of injuries including chronic stress, depression, exhaustion, and loss of joy in work as well as increased substance abuse and suicide.1 Clinician burnout clearly presents a wicked problem to address. However, the negative impacts of burnout in healthcare extend far beyond clinician well-being. As Dr. Thomas L. Schwenk said in a recent article in JAMA, physicians have effectively been the "proverbial 'canary in the coal mine.' While the canary may be sick, it is the mine that is toxic. Caring for the sick canary is compassionate, but likely futile until there is more fresh air in the mine."3 Therefore, it is imperative to usher fresh air into the mine by pulling up to understand and address burnout in a more holistic and comprehensive manner.

Clinicians are not the only constituency in the healthcare organization harmed by burnout. There is an increased understanding that healthcare executives are also in pain. A recent WittKieffer study shows burnout amongst healthcare C-Suite executives has swelled in recent years, with 74% now experiencing burnout.4 Similarly, an ACHE study found 70 percent of healthcare CEOs have burnout scores "in the high range."5 Healthcare executives have the highest turnover rates of all major industries, with burnout accounting for 70% of leadership turnover.6

CEOs also indicate feeling overwhelm, isolation, and seemingly inescapable pressure in the face of pervasive financial challenges, including increased labor and supply costs, decreased patient volumes, and workforce challenges that place tremendous burdens on executives and inhibit their ability and capacity to address issues and to advance strategy. While 88.1% of healthcare leaders still indicate they "like" their job, the pressure on leaders is clearly mounting and presents new forms of fragility in the leadership ranks.5 

Burnout also harms the healthcare organization. Clinician burnout is directly linked to increased infection rates, increased medical errors, decreased quality of care, and reduced patient satisfaction.7,8 Burnout cascades across almost all job titles and roles in the healthcare workforce and is a root cause of disengagement, unplanned absenteeism, and departure, causing increased cost, unfilled vacancies, decreased productivity, and lower morale. These issues, in turn, create other organizational vulnerabilities, including decreased financial performance, decreased likelihood to refer and return, lower patient experience scores, and more, all at a time when financial pressure is already acute. Healthcare executives also acknowledge burnout as a direct threat, with 93% saying it is "negatively impacting" the health organization.3 

It is not OK to let these issues linger, since addressing burnout is both a moral and business imperative. While healthcare executives feel their hands are tied by resource constraints, CEOs and C-Suite leaders still hold the key to elevating burnout on the leadership agenda; and it is essential to do so for the well-being and viability of clinicians, leaders, and the entire organization. Addressing burnout on a large-scale and systematic way will require leadership lift, strategic alignment, cultural commitment, and meaningful investment. Therefore, it's time to alert non-profit governing boards of the implications of burnout across all levels of the organization to secure their ownership and support. It's also time to craft a broad strategy to address whole-organization culture rather than indulging in seemingly quick fixes indiscriminately applied to check the box that the organization has done something. 

Burnout for executives, clinicians, and the wider healthcare workforce is often rooted in challenging working conditions — such as excessive workload, inadequate staffing, scheduling challenges, administrative burden, and feelings of isolation.9 Given many of these issues are sensitive to resource allocation, many of these conditions have deteriorated further in recent years as healthcare operating margins have taken a beating. However, investment to address these issues must be seen as an investment in the entire organization that has a direct connection to achieving a more stable financial future.

Beyond addressing systemic infrastructure issues, there is another powerful lever: embracing values and virtues. Peer-reviewed journal articles demonstrate the value of fostering an organizational culture where humanistic beliefs and behaviors — such as gratitude, kindness, compassion, and love of humankind — become part of the organizational operating system. When these values and virtues are ingrained in what those across the organization say, do, and use as a guide in decision-making, it creates a virtuous circle. As leaders, clinicians, and others demonstrate living these values, it boosts patient experience which, in turn, deepens the likelihood of receiving expressions of gratitude from patients and a deepening of human connection. This, in turn, affirms and induces efforts to continue exhibiting pro-social behavior.

While behavior change is never easy, integration of value and virtues is more about communications, modeling, and integration of new habits into daily life than monetary investment, once leaders have a basic understanding of what psychology and neuroscience show has an elevating effect and how to weave it into the organizational culture. 

Healthcare organizations have a powerful and noble mission to heal and safeguard the well-being of their communities. However, for healthcare organizations to have the people and capacity to fulfill their mission's potential, it's critical for leaders to focus first on curing the moral injury and implications of burnout across the organization. Doing so is an expression of financial stewardship, strategic focus, and care for all those who care for not only patients and family members, but also for their health organization colleagues. Ultimately, pursuing a holistic, systemic approach to burnout will be essential to strengthen and sustain organizational success.

Steps to Take Now:

  • Have forthright conversations about the many organizational costs of burnout, including not only clinician well-being but also leadership capacity, financial success, quality, workforce issues, and more.
  • Address system organizational issues related to workload, scheduling, availability of mid-level, advanced-practice clinicians, and similar. Given stress is created and compounded by the workplace environment, it must be addressed.
  • Remove the stigma from burnout by honoring the importance of mental health and normalizing burnout as a reality that deserves open acknowledgement and support of leaders in pursuing self-care without shame or penalty. Also, set and model appropriate boundaries as leaders.
  • Create and implement plans to foster a values- and virtues-driven work environment to redefine the culture of the organization as one that embraces gratitude, kindness, compassion, and love of humankind to create a virtuous circle of pro-social behavior.

Contact Linda at: [email protected]
Contact Betsy at: [email protected]


References

  1. Medscape Physician Burnout & Depression Report 2024: 'We Have Much Work to Do', https://www.medscape.com/slideshow/2024-lifestyle-burnout-6016865, January 26, 2024.
  2. Sinsky CA, Brown RL, Stillman MJ, and Linzer M. COVID-Related Stress and Work Intentions in a Sample of US Health Care Workers. Mayo Clinic Proceedings, Volume 5, Issue 6, P1165-1173, December 2021. https://www.mcpiqojournal.org/article/S2542-4548(21)00126-0/fulltext.
  3. Schwenk TL. Physician Well-being and the Regenerative Power of Caring. JAMA. 2018;319(15):1543-1544. doi:10.1001/jama.2018.1539
  4. WittKieffer, Burnout in Healthcare Executives: A Call to Action, https://insight.wittkieffer.com/acton/attachment/40398/f-14a7b229-a118-4320-acfb-14a9d2e6846b/1/-/-/-/-/2022%20Healthcare%20Executive%20Burnout%20Survey.pdf, 2022
  5. Burnout Among Healthcare Leaders, Healthcare Executive, https://healthcareexecutive.org/archives/september-october-2022/burnout-among-healthcare-leaders, September 2022. 
  6. The silent stress of health system CEOs. https://www.beckershospitalreview.com/hospital-management-administration/the-silent-stress-of-health-system-ceos.html#:~:text=Healthcare%20leaders%20have%20the%20highest,issue%20are%20geared%20toward%20clinicians. 
  7. Berkland BE et.al. A Worksite Wellness Intervention: Improving Happiness, Life Satisfaction and Gratitude in Health Care Workers. Mayo Clinic Proceedings: Innovation, Quality and Outcomes; Volume 1, Issue 3, December 2017, pp 203-210.
  8. Noseworthy J, Madara J, et.al. Physician Burnout is a Public Health Crisis: A Message to Our Fellow Health Care CEOs. Health Affairs. March 28, 2017.
  9. National Academy of Medicine, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, (2019), p. 84. https://nap.nationalacademies.org/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional