Burnout has been defined as a sense of exhaustion, loss of connection, and depletion of energy and motivation occurring in response to chronic stress (Leiter et al., 2015).
Many people have their own personal definition and understanding of what it means to feel “burnt out”. The experience of burnout has been described as a disconnect between “what people are and what they have to do” and is thought to place a strain on someone’s sense of self—their values, their dignity, and their sense of meaning and purpose in their lives and work (Maslach & Leiter, 1997).
Recognizing the signs of burnout.
To understand what people experience when they feel burnt out, researchers have identified three key components of burnout: exhaustion, detachment, and loss of self-efficacy or confidence (Maslach & Jackson, 1981).
- Exhaustion can involve a loss of physical, cognitive, and emotional energy. Simply put, clinicians struggling with burnout are likely to feel less equipped to manage the physical and emotional demands of their work and life.
- Detachment can involve thoughts and feelings of cynicism and a sense of disconnection from oneself and others. This may manifest as a detached or impersonal view of patients, and clinicians experiencing burnout may struggle to relate to friends, family, patients, and colleagues or have difficulty connecting to the emotional and social aspects of their work and life.
- Loss of self-efficacy/confidence can involve losing a sense of purpose or personal accomplishment. This might manifest as a sense of losing the ability to enjoy and feel pride in one’s work and life. Clinicians experiencing burnout may feel less accomplished or adequate and may think to themselves, “What’s the point?”
Even before the COVID-19 pandemic pushed doctors and health care staff to the brink of their limits, burnout among clinicians reflected a crucial area of need that health care systems, researchers, and clinicians have been working to address for decades. In fact, the term “burnout” was first coined to describe the experiences and struggles of health care professionals (Freudenberger, 1975; Maslach, 1976).
According to a 2021 report, current rates of clinician burnout are estimated to be at a staggering 42% (Chandawarkar & Chaparro, 2021), with significant consequences for the delivery of health care and the well-being of those who deliver it.
So what causes clinicians to burn out?
There are a range of risk factors for burnout in clinicians, including clinician level risk factors and risk factors associated with the broader health care system and the environments in which clinicians work.
Many clinicians view personal sacrifice, striving for perfection, independence, and a commitment to altruism as important aspects of not only their work, but who they are. In some environments, these qualities and behaviors may be thought of as desirable—the mark of a model employee or clinician—but are actually the hallmark of unsustainable standards that may lead to worsening performance and low morale.
In hospitals and other workplaces, these values may conflict with limitations to environmental resources (e.g., not having enough staff, supplies, or support) and time constraints (e.g., limited time to interact with patients or recover from stress). Under these pressures, many clinicians detach and suppress their feelings to simply get through each workday.
Culturally diverse clinicians experience greater pressures and bias in the workplace which can lead to faster burnout. They experience a “minority tax”, which includes feeling a disproportionate need to treat patients of the same background (only 4% of clinicians are Black), experiencing racism or discrimation in the health care system, and a constant need to validate their place in the health care system. These psychological stressors add to the list of burn out factors placed on all other clinicians.
If left unaddressed in clinicians, burnout has consequences:
- Lower patient satisfaction and care quality
- Higher medical error rates and malpractice risk
- Higher physician and staff turnover
- Physician alcohol and drug abuse and addiction
- Physician suicide
Some things you can do to prevent clinician burnout:
- Reduce the burden of lived experience. Routing all patients with a lived experience to a clinician with the same lived experience can place a toll on the clinician. Figuring out ways to identify culturally competent clinicians outside of lived experience could be a key to reducing burnout. Violet has a proprietary framework for measuring cultural competence, that takes into account education, work experience, and cultural humility on top of lived experience to further expand the inclusivity in your care delivery team.
- Leadership. Research shows consistently that when it comes to clinician burnout, leadership matters. In fact, one study found that higher scores on a measure of empowerment among leadership was linked with less burnout among clinicians (Omar et al., 2015). To manage and improve workplaces that cause clinician burnout, change has to come from the top down to reduce the stress that clinicians face in their workplace.
- Autonomy. Autonomy refers to a sense of self-direction and agency in work, and many clinicians experience a sense of reduced professional autonomy due demands on their time. Supporting clinicians’ autonomy, unsurprisingly, is best served by a clinician-centered approach that values their perspective and feedback and trusts clinicians with agency. The opposite? Micromanaging.
- Mastery. Provide clinicians with goals to master their well-being. Mastery is an important sense of professional efficacy that clinicians are trained to harness, but it’s a surefire pathway to burnout. Reroute mastery to involve personal wellness goals for the team and celebrating workplace achievements when clinicians are responsible for positive health outcomes and care delivery.
Supporting mastery might involve helping to reorient goals that are both meaningful and reasonable. Many outcomes in health care are under clinicians’ power and control to some extent, but many are not! To support mastery, help clinicians to engage in activities for which they feel a sense of control and ownership over the potential for positive impacts of their work. It can be helpful to manage expectations around what is (and is not) a clinicians responsibility, or to create a reasonable teamwide goal that helps prevent the feelings of helplessness and powerlessness associated with burnout.
- Sense of purpose. Purpose lives at the intersection of mastery and autonomy—a belief in a clinicians’ personal mission, or “why” for the work they do. The better one’s work aligns with their values and their reasons for doing it, the better off they will be in terms of purpose.
Wherever possible, communication can support clinicians in reorienting to the meaning of their work to them. Though for some people, this purpose may involve being evaluated favorably at the individual and institution level, there’s a reason why evaluation means something: it feels good to be evaluated favorably for something that matters. When clinicians have a sense of control and self-direction in their work, they may feel accomplished and capable, upheld to reasonable and thoughtful standards, and have a way to be frequently reminded of the importance (to them!) and the impact of what they do. These are just some of the practical ways you can actively work against burnout for your care delivery team.
- Reduction of non-clinical tasks. Recent attention has shifted toward organizational and educational interventions, including reduction of time clinicians spend on non-clinical tasks and efforts to promote the rights and dignity of clinicians through policy change and education.
- Commit to supporting the well-being of your team. For example, creating a budget for staff appreciation and emotional support resources is invaluable. The power of supporting personal resilience and individual wellness must be thought of alongside the necessity of improving the overall workplace.
It is important to ensure whenever possible that the intervention for burnout is not itself a stressor—center clinicians by asking them how they would like support. Send out a survey to see how they would like their workplace to change rather than imposing new protocols that may not help. Trust them to help guide the process.
At the end of the day, wellness should be prioritized for everyone in health care.
Though individual level interventions can be effective, make no mistake: burnout is not a problem of clinicians not being “resilient enough”. A workplace that strives to address burnout will challenge the notion of personal sacrifice and suppression of emotional and physical distress as requirements for a career in health care.
Support for clinician wellbeing and efforts to prevent and address burnout are a critical component of the health care system. Addressing clinician burnout has the potential to not only improve workplace satisfaction, retention, and wellness for clinicians but also has the ability to improve the quality of care, communication, and relationships between clinicians and their patients. The entire health care system improves when wellness is prioritized for everyone involved.
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