Meeting NewsPerspective

Organizations must make meaningful system changes to battle physician burnout

NEW ORLEANS — Burnout and occupational stress are pervasive among health care providers. While there are actions physicians can take to reverse this trend, almost two-thirds of the responsibility for change lies with health care organizations, said a pioneer on the topic here at the American College of Cardiology Scientific Session.

“If I were to stand here and propose to you we have a system issue in the U.S. health care delivery system in your hospital, in your clinic, that was eroding quality of care, increasing errors, decreasing patient satisfaction and decreasing access to care and that it was so pervasive of a system problem that in some form or another it might impact up to 50% of patients seeking care in our institutions... You’d imagine what the national response as well as the leadership response in our organizations would be. Our legislatures would be having hearings. Our board would be meeting. Our CEOs and deans would be in front of those boards, Tait Shanafelt, MD, chief wellness officer at Stanford Medical, said during the 50th Annual Louis F. Bishop Keynote.

“And what I would suggest to you is that we have precisely that type of a system issue in our health care delivery systems. We have known about it and we have not responded to it in a way that we have responded to other system problems.”

Organizations and systems need to seek out the equivalent of construction worker’s hardhat and earwear for the physicians, Shanafelt said.

Occupational syndrome/burnout is characterized by depersonalization, emotional exhaustion and low personal accomplishment leading to decreased effectiveness at work, he said.

Burnout and occupational stress are pervasive among health care providers. While there are actions physicians can take to reverse this trend, almost two-thirds of the responsibility for change lies with health care organizations, said a pioneer on the topic here at the American College of Cardiology Scientific Session.
Source: Adobe Stock

The personal toll on a physician includes increased risk for divorce, alcohol and substance use, depression and suicide, Shanafelt said. The professional consequences include decreased quality of care and medical errors; decreased patient satisfaction; decreased productivity and professional effort; and turnover.

Shanafelt noted obvious reasons for burnout including productivity demands and regulatory issues but chose to focus on a topic not often discussed: the isolation experienced by physicians.

“The fabric of our profession has been frayed,” he said. “This has always been demanding, emotional work and one of the things that always saw us through were the people to your left and right. And as we interact with each other less due to these many forces and we become more isolated it increases [burnout].”

Further, “physicians meeting with colleagues to discuss what’s good and what’s challenging about the work and supporting each other” is essential to turn the tide in burnout and improve meaning in work, he said.

Additionally, Shanafelt recommended that physicians review one’s values professionally and personally “and have an honest look at where your two sets of priorities are incompatible.”

He also recommended optimizing meaning in work and being able to verbalize what is one’s most personally meaningful aspect of work as few physicians can do so.

Shanafelt said organizations must do more; he described the Stanford WellMD Model of Professional Fulfillment, which includes the three components of culture of wellness, efficiency of practice and personal resilience.

And with culture of wellness and efficiency of practice, “at Stanford, these are Stanford’s responsibility and we own more of this than does the individual.”

“The culture of wellness speaks to the behaviors and attitudes by which we lead ... and the values of the organization,” he said.

Behavior of leaders and immediate supervisors have a large impact burnout and satisfaction of an individual physician and because of that he suggests creating systems for individuals to have a voice and fix “the local pebbles in their shoe and the broken windows they walk past every day.”

Creating a process and a task force not only will fix problems, but also demonstrate to physicians that “leadership is listening” and “change is possible.”

“This turns physicians from construction workers back into architects in creating their practice,” Shanafelt said.

The session was chaired by Cardiology Today Editorial Board Member Dipti Itchhaporia, MD, and James L. Januzzi Jr., MD, and was part of the ACC Clinician Wellness Intensive. – by Joan-Marie Stiglich, ELS

Reference:

Shanafelt T. 50th Annual Louis F. Bishop Keynote. Reducing burnout and promoting engagement: Individual and organizational approaches to physician well-being. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.

Disclosure: Shanafelt reports he is the coinventor of the Well-being Index and receives royalties from Mayo Clinic.

NEW ORLEANS — Burnout and occupational stress are pervasive among health care providers. While there are actions physicians can take to reverse this trend, almost two-thirds of the responsibility for change lies with health care organizations, said a pioneer on the topic here at the American College of Cardiology Scientific Session.

“If I were to stand here and propose to you we have a system issue in the U.S. health care delivery system in your hospital, in your clinic, that was eroding quality of care, increasing errors, decreasing patient satisfaction and decreasing access to care and that it was so pervasive of a system problem that in some form or another it might impact up to 50% of patients seeking care in our institutions... You’d imagine what the national response as well as the leadership response in our organizations would be. Our legislatures would be having hearings. Our board would be meeting. Our CEOs and deans would be in front of those boards, Tait Shanafelt, MD, chief wellness officer at Stanford Medical, said during the 50th Annual Louis F. Bishop Keynote.

“And what I would suggest to you is that we have precisely that type of a system issue in our health care delivery systems. We have known about it and we have not responded to it in a way that we have responded to other system problems.”

Organizations and systems need to seek out the equivalent of construction worker’s hardhat and earwear for the physicians, Shanafelt said.

Occupational syndrome/burnout is characterized by depersonalization, emotional exhaustion and low personal accomplishment leading to decreased effectiveness at work, he said.

Burnout and occupational stress are pervasive among health care providers. While there are actions physicians can take to reverse this trend, almost two-thirds of the responsibility for change lies with health care organizations, said a pioneer on the topic here at the American College of Cardiology Scientific Session.
Source: Adobe Stock

The personal toll on a physician includes increased risk for divorce, alcohol and substance use, depression and suicide, Shanafelt said. The professional consequences include decreased quality of care and medical errors; decreased patient satisfaction; decreased productivity and professional effort; and turnover.

Shanafelt noted obvious reasons for burnout including productivity demands and regulatory issues but chose to focus on a topic not often discussed: the isolation experienced by physicians.

“The fabric of our profession has been frayed,” he said. “This has always been demanding, emotional work and one of the things that always saw us through were the people to your left and right. And as we interact with each other less due to these many forces and we become more isolated it increases [burnout].”

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Further, “physicians meeting with colleagues to discuss what’s good and what’s challenging about the work and supporting each other” is essential to turn the tide in burnout and improve meaning in work, he said.

Additionally, Shanafelt recommended that physicians review one’s values professionally and personally “and have an honest look at where your two sets of priorities are incompatible.”

He also recommended optimizing meaning in work and being able to verbalize what is one’s most personally meaningful aspect of work as few physicians can do so.

Shanafelt said organizations must do more; he described the Stanford WellMD Model of Professional Fulfillment, which includes the three components of culture of wellness, efficiency of practice and personal resilience.

And with culture of wellness and efficiency of practice, “at Stanford, these are Stanford’s responsibility and we own more of this than does the individual.”

“The culture of wellness speaks to the behaviors and attitudes by which we lead ... and the values of the organization,” he said.

Behavior of leaders and immediate supervisors have a large impact burnout and satisfaction of an individual physician and because of that he suggests creating systems for individuals to have a voice and fix “the local pebbles in their shoe and the broken windows they walk past every day.”

Creating a process and a task force not only will fix problems, but also demonstrate to physicians that “leadership is listening” and “change is possible.”

“This turns physicians from construction workers back into architects in creating their practice,” Shanafelt said.

The session was chaired by Cardiology Today Editorial Board Member Dipti Itchhaporia, MD, and James L. Januzzi Jr., MD, and was part of the ACC Clinician Wellness Intensive. – by Joan-Marie Stiglich, ELS

Reference:

Shanafelt T. 50th Annual Louis F. Bishop Keynote. Reducing burnout and promoting engagement: Individual and organizational approaches to physician well-being. Presented at: American College of Cardiology Scientific Session; March 16-18, 2019; New Orleans.

Disclosure: Shanafelt reports he is the coinventor of the Well-being Index and receives royalties from Mayo Clinic.

    Perspective

    Dr. Shanafelt, a well-known expert on physician burnout, delivered an outstanding Louis F. Bishop keynote address at ACC. His emphasis on enhancing local organizational structure to facilitate collegial interaction within the health care team and enhance the spirit of providing meaningful and mutually satisfying service to our patients is well-placed. A more global approach might also address much-needed changes in the electronic health record, often cited as the single most oppressive aspect of medical practice today, and the physician compensation system, which still directly or indirectly relies on fee-for-service financial calculations to determine physician compensation, resulting in perversion of an exhaustive and exhausting electronic health record needed to document chargeable services rather than facilitate good patient care. These are indeed very large "pebbles in our shoes." Individual physicians also bear some personal responsibility for their mental health, work-life balance, resilience and spirituality, as workplace wellness programs, while welcome, have limits.

    • L. Samuel Wann, MD
    • Cardiology Today Practice Management Section Editor
      Ascension Healthcare Milwaukee

    Disclosures: Wann reports no relevant financial disclosures.

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