Organizations must lead by example in improving well-being and reducing physician burnout
Source / Disclosures
Shanafelt T. Organizational efforts to cultivate the well-being of healthcare professionals: before and after the COVID-19 pandemic. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 26-29, 2021 (virtual meeting).
Disclosures: Shanafelt reports that he is the co-inventor of the Well-Being Index and Participatory Management Leadership Index instruments. Mayo Clinic owns the copyright in these instruments and has licensed them for use outside of Mayo Clinic. Shanafelt receives a portion of the royalty payments made to the Mayo Clinic.
Healthcare organizations must take action to reduce burnout and improve the well-being of physicians, according to a guest speaker at the American Association of Clinical Endocrinology virtual meeting.
“We can do better in the clinical environment that we create for physicians to provide the best possible care for patients, and we need to do better.” Tait Shanafelt, MDJeanie & Stewart Ritchie professor of medicine and director of wellness at Stanford University School of Medicine told Healio. “We have many structural issues in the practice environment that create professional distress for clinicians, which impacts the quality of care they provide – reduced access, increasing errors, decreased satisfaction. patients. These challenges are motivated by the characteristics of the care delivery system. “
No more burnout among doctors
According to a study published in JAMA Iinternal Medicine, physicians work a median of 50 hours per week compared to a median of 40 hours for the general population (P <.001>Almost 40% of physicians work more than 60 hours per week compared to 6% of the general population. Physicians also have a higher prevalence of burnout compared to the general population (38% vs. 28%, P <.001 and a higher prevalence of work-life dissatisfaction vs.>P <.001>
A lack of personal resilience is not the reason for higher burnout among doctors, Shanafelt said. Incoming medical students have less burnout, lower rates of depression, and a better quality of life than students entering other fields, and practicing physicians have higher resilience scores than the general population.
“After [attending medical school] for 2 years that profile completely reverses – higher burnout, higher depression scores, lower quality of life in all areas, ”Shanafelt said during the presentation. “Burnout crescendos during residency, and once we get into practice, there’s what we call the mid-career peak. We’ve adjusted the hours, adjusted for age, adjusted for all the other variables, and there’s that window of time, 10 to 20 years in a career, that burnout increases. “
Burnout is not only a concern for physicians, but also for the organizations they work for. Shanafelt said several studies have shown an association between physician burnout and decreased quality of care, decreased productivity, increased medical errors and greater job turnover.
Although physician burnout has been a concern for years in the healthcare community, Shanafelt said, the COVID-19 pandemic has brought the problem to light. He noted that providers have had to deal with societal challenges that all people have faced, such as lockdowns, social justice issues and political tensions. In addition, doctors have faced professional constraints, such as caring for COVID-19 patients and the heavy emotional toll that this entails, as well as the ethical dilemma of caring for patients while trying to protect themselves. themselves and their families.
“We had to swing the pendulum just to meet very tangible needs – nutrition on site, rooms where people can rest, sometimes providing hotels near the hospital, psychological first aid,” Shanafelt told Healio. “We really had to go back to meeting the very basic needs of healthcare workers who felt so strained.”
How to deal with physician burnout
To tackle physician burnout, 80% of change must come from organizations, with the remaining 20% coming from physicians, Shanafelt said.
Individually, physicians should prioritize personal care, take breaks, and get enough sleep. In the long term, physicians should optimize their sense of work, identify their core values, improve work-life integration, and emphasize self-assessment. Shanafelt said doctors can assess how their well-being compares to that of their colleagues at the national level using tThe Mayo Clinic Wellbeing Index, a tool where physicians can receive feedback based on their answers to nine questions about their individual wellbeing. The index also includes links to resources, tools and exercises designed to promote change in a person’s well-being.
For organizations, Shanafelt discussed the Stanford WellMD model of professional achievement, where organizations combine effective practice and a culture of wellness with the personal resilience of physicians to create greater professional growth. Creating a culture of wellness involves leadership, aligning the organization’s values with those of its employees, giving employees a voice, creating a sense of community and building a culture of compassion. In practice, organizations should focus on optimizing the usability of electronic health records, planning, documentation, team care, and staffing.
An organizational focus on improving physician well-being has reduced physician burnout and burnout at the Mayo Clinic, Shanafelt said. In 2013, 40% of Mayo Clinic doctors who responded to a survey had symptoms of burnout. After an organizational change to focus on the well-being of physicians, the percentage of physicians reporting emotional exhaustion fell to 32% in 2015 and 30% in 2016, and the percentage of physicians reporting overall exhaustion fell to 33 % in 2015.
“We can drive change at the organizational level,” Shanafelt said during the presentation. “It requires prioritization and a number of efforts that I have highlighted. It’s a journey and it starts where we are today. “