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Burnout in Healthcare: A Call To Arms For Clinician Well-Being


Written By: Toomas Truumees, Wesley Palmer, and Meghan Galligan, M.D.





The Case for Clinician Well-Being


Clinician well-being has emerged as a national priority [1]. The literature characterizing burnout in physicians and physicians in training has revealed its negative impact on the quality, safety, and experience of care for patients [2,3,4,5,6]. Burnout also appears to impact physicians more than individuals in other professions. The rate of suicide for physicians exceeds the rate of other professionals and is double that of the general population [7,8].


Beyond these serious health ramifications, the literature from Shanafelt and others [9] provide insight into the fiscal impact of physician burnout on health care organizations. Especially the fiscal impact associated with reduced physician productivity and resignations [9,10].


Based on all the above findings the business case for physician well-being has become ubiquitous among the health care industry [11]. So, health care organizations have begun to invest in physician well-being and support the development of various clinician well-being interventions.




Summarizing Shifts in Frameworks, Physician Well-Being Interventions, and Policy Due to Burnout


In 2007 the Triple Aim of Healthcare was introduced by the Institute for Healthcare Improvement [12]. This helped many health care organizations shift to outcomes-based medicine.


The Triple Aim focuses on enhancing patient experience, improving population health, and reducing costs. Since its introduction, the Triple Aim Framework has become widely accepted as a compass to optimize health system performance.


However, burnout for physicians and the entire health care workforce has continued to increase. In addition to other deleterious effects of burnout, it has also been associated with lower patient satisfaction, reduced health outcomes, and the potential to cause an increase in costs (12,13). According to the Institute of Medicine’s compass for health system performance that targets improved quality, cost, and experience of care for patients – all together, these above findings reveal burnout’s threat to the Triple Aim (12,13).


In response, thought leaders developed conceptual models for physician well-being to identify areas for intervention [14]. While solely focusing on physician interventions was a good start, more would be needed to address the full effect of burnout through the healthcare industry.


The National Academy of Medicine (NAM) and other policy makers broadened the work beyond physicians. They recognized that the challenges faced by physicians were also encountered by nurses and other clinicians [1,15].


The culmination of these efforts resulted in a revision of the Triple Aim. The Triple Aim would include care team well-being as a fourth performance metric, recognizing it is a prerequisite for health system outcomes in quality, costs, and experience [13].


This inevitably would result in the Quadruple Aim [13] which represented a significant achievement for well-being policy. It signaled a paradigm shift in clinician well-being. The Quadruple Aim translated well-being from an individual construct — with a primary impact on providers — to a systems-level construct with significant ramifications for health system performance.


As a result of this shift, it became no longer sufficient for organizations to rely on provider-level interventions. Rather to date, health systems must now confront well-being at all levels of the organization.




Burnout and the Future Impact of Covid-19


Nobody knows the future for certain. Meaning there are those who opinions vary as to how Covid-19 will affect burnout. There are those who have speculated that the pandemic may have positive effects by renewing physicians’ sense of autonomy and altruism and thus will mitigate burnout [16]. However, the data suggesting that the pandemic is and will continue to have negative effects is becoming prevalent.


A recent publication by the NAM Collaborative on Clinician Well-being and Resilience argued that the health care industry is in danger of a parallel pandemic related to clinician well-being because of Covid-19 [17]. It is easy to understand this threat — particularly given the tragic reports of clinicians dying by suicide in pandemic-stricken cities like New York [17].


Social media and other outlets have also experienced a steady stream of health care professionals’ citing deep fears for their own health, as well as the health of family members. Indeed, front line workers facing Covid-19 have been likened to the heroic volunteers who responded to the World Trade Center attacks, as both groups have risked their physical and mental health to serve others in need [17].


If prior disaster scenarios such as the 2003 SARS outbreak or the 2011 Fukushima Daiichi nuclear disaster offer any benchmark indication. Covid-19 will likely result in high levels of emotional distress for health care workers. This would be due to social isolation, loss of peers to the disease, and social stigma — among other factors [17].


While the impact of the Covid-19 pandemic on clinician well-being remains uncertain. If no additional interventions are made, it is likely that clinician and entire care team burnout will increase following the pandemic — to the detriment of health system performance.




A Call to Arms for Health Care Organizations


Health care organizations face many challenges in the era of Covid-19. These range from mitigating operational and financial uncertainty, to rapidly testing and scaling effective changes for care delivery [18]. In this environment of continuous change, health systems have a unique mandate for cultural agility. They must quickly identify and address both helpful and harmful factors affecting the organization, with a goal of cultivating system resilience [12, 19, 20, 22].


Organizations should leverage this unique period to establish clinician well-being as a key performance indicator — both during the pandemic and beyond. As the NAM outlines, clinician well-being should be considered in the crisis response of any health system. This includes having the chief wellness officer or designated well-being leader in the ‘command center’; and sustaining and supplementing existing well-being programs [17]. Organizations must also identify strategies for fulfilling the Quadruple Aim beyond the pandemic.


Routine assessments of burnout will be critical to these efforts, along with shared accountability for well-being among organizational leaders [10]. Without these measures in place, clinician and care team well-being may indeed become a parallel crisis of unprecedented proportions.






Biography


Toomas H. Truumees is the Founder and CEO of Adaptive Strategic Partners (ASP)*. He founded Adaptive Strategic to combine his expertise with decision making under uncertainty with novel sensing technologies to enable healthcare leaders see sooner and act faster to fight the burnout crisis.


Toomas is a trusted advisor to boards and senior management teams to craft decisions designed to thrive in complex and uncertain environments. He found his passion for helping others at a young age in the competitive world of athletics. The great Arthur Ashe once said, “You’ve got to get to the stage in life where going for it is more important than winning or losing” and it is a philosophy that he strives to live by and share in his personal and professional relationships.


Toomas is a recognized expert in the areas of strategic planning, judgements under uncertainty and competitive positioning. He accelerates the performance of his clients by finding the elusive balance between near-term decisions to long-term strategic direction. He has partnered with hundreds of clients over his 20 plus year consulting career including AT&T, Bristol-Myers Squibb, Children’s Hospital of Philadelphia, Children’s Hospital Association, Children’s Miracle Network, Coca-Cola, Federal Reserve Bank, Ferring, General Electric, Genentech, GlaxoSmithKline, Harvard, Knight Foundation, Johnson & Johnson, Mayo Clinic, Medtronic, Memorial Sloan Kettering, NASA, Pfizer, Sanofi, Shell Oil Company, University of Miami, University of Pennsylvania and Zoetis.


Toomas is a frequent speaker on the future of healthcare and strategic leadership. He has authored numerous articles which include: Breaking the Nurse Burnout Cycle with a Proactive Approach to Well Being, The Future of Cancer Care in 2020, How to Enhance Leadership by Sharpening Your Competitive Edge, Form Strategy to Execution in Pediatrics, and Why you need to Play War-games.




Meghan M. Galligan, MSHP, M.D., is a core faculty member of the Center for Pediatric Clinical Effectiveness (CPCE) at the Children’s Hospital of Philadelphia (CHOP). She is an Assistant Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania and an attending hospitalist in the Division of General Pediatrics at CHOP.


Dr. Galligan’s scholarly focus is in the organizational science of healthcare delivery, leveraging research and improvement methods to understand how hospital systems and culture impact patient care. Dr. Galligan’s current work is focused on preventing adverse patient safety outcomes through early recognition of clinical deterioration. As part of this work, she has helped to design and evaluate clinical event debriefing practices at CHOP. She is also working with researchers from the Wharton School to understand how the organizational dynamics of healthcare teams influence patient care and outcomes.


Dr. Galligan completed her fellowship in Pediatric Hospital Medicine and her residency training in General Pediatrics at CHOP. She completed the Master of Science and Health Policy Research program at the University of Pennsylvania. She completed training in improvement science and patient safety as a fellow in the Center for Healthcare Improvement and Patient Safety (CHIPS). Dr. Galligan received her medical degree from the Stanford University School of Medicine, and her undergraduate degree in Neurobiology from Harvard College.




Wesley W. Palmer is the COO & Co-Founder of Adaptive Strategic Partners*. He is an ambitious healthcare strategic consulting professional with over 10 years’ experience in innovative solution design. Driven by his passion for identifying enhanced solutions to business challenges, Wesley believes that exploring fresh perspectives and techniques can help healthcare businesses evolve and grow—particularly in the creation and adoption of new technologies.


Wesley’s success as an innovator within healthcare businesses relies on his ability to engage corporate enterprise partners in effective, collaborative partnerships. He has fostered a reputation as a trusted advisor based on his problem-solving skills and his ability to distill diverse data sources into actionable insights for businesses.


Wesley serves on the board of PrecisionGx, an innovative Artificial Intelligence (AI) company focused on aiding healthcare payers fight claims fraud, waste, and abuse. He also serves on the Young Members Board of The Pennsylvania Academy of Fine Art, America's first school and museum of fine art.






*ADAPTIVE STRATEGIC PARTNERS (ASP) is working with a select group of Hospital Systems to uncover signals of employee burnout. Our Burnout Anticipation Technology (BAT) is an enterprise SaaS solution designed to help surface and measure early indicators of burnout in real-time and at scale. BAT applies novel technologies in combination with advanced decision making under uncertainty methods to enable healthcare leaders see sooner and act faster to fight the burnout crisis.





References


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