These are extraordinary times in our country and around the world. We are collectively outraged at the senseless loss of lives - black lives on our streets, and COVID-19 patients lives in our hospitals and nursing homes, with 300 of those lives being healthcare workers themselves. (Note: This is on top of 300-400 physician suicides annually.)
While burnout has been recognized as a crisis for clinicians for many years, things have changed. We are now experiencing a combination of factors that have healthcare, and society as a whole, stressed like we haven't seen for decades.
In my keynote presentations on clinician burnout I list the external factors that have incrementally impacted the clinical workplace over the last 10-20 years:
The EHR
Meaningless abuse - oops sorry, Meaningful use
Coding requirements worsened by ICD-10
Prior Authorizations
The ACA, MACRA, MIPS
CMS star ratings with a focus on patient satisfaction
Changing patient demographics
The corporatization of hospitals and medical groups
Google and Yelp
The opioid crisis
and many more... (I'm sure you could add many yourself)
Clinicians absorbed each of these one at a time, like another straw added to the proverbial camel's back, staying in the game as long as we could still experience what drew us to medicine in the first place - our opportunity to connect with patients and colleagues, and truly make a difference in people's lives.
But we can't absorb any more. At this point clinicians have become overloaded and starting to break as new "straws" are added to the burden.
Then along came the overwhelming Corona virus pandemic. It's no straw. It's an anvil tossed on top of the heap. It's crushing the fragile healthcare "system" and the clinicians and administrators struggling to cope with it.
This may seem a bit overly pessimistic, considering that across the country, the worst-hit hospitals are improving. We're learning more about the pathology and treatments. Inpatient care and elective procedures are slowly ramping back up. We've converted outpatient practices to a rate of virtual visits we did not think possible a few months ago.
Like we always do, clinicians have responded to a crisis and made it thru by putting in the heroic effort needed to just make it happen. We are good at heroics! But heroic activity is unsustainable.
We survived the crisis. We now need time to rest and recover. AND, we need to prepare for the ongoing impacts of this that are still weighing down on us and limiting our ability to recover:
The emotional trauma and moral distress that clinicians have experienced, which remains smoldering and will manifest as PTSD in the weeks, months, and years to come
The clinical uncertainty of a disease we are just starting to understand and for which we still lack the usual tools of our trade - vaccines, medications, and other treatment modalities
The breakdown of supply chains to provide PPE and ventilators during the highly likely second wave that is coming
The financial uncertainty of health systems as their already thin margins go negative from decreased revenues and increased expenses
The financial fear of health care workers as these systems react by reducing pay and benefits and temporarily or permanently eliminating jobs
Our healthcare system is at risk of failing massively.
The parallels between these unprecedented stresses to healthcare and society are clear. The factors that have increasingly stressed us as a society have also been increasing like we haven't seen for decades:
Growing political polarization
Worsening income disparity and financial inequity
An accelerating 24-hour news cycle
Social media that thrives on conflict
A lack of trust in, and accountability by, those in power
All exacerbated by the overwhelming impact of the pandemic
Our society has reached that breaking point, with too many straws on this camel's back. The results are clear and potentially ominous. Our society is at risk of failing massively.
In both of these crises, clinician burnout and societal disruption, leadership is the key to not only surviving, but coming through the crisis better and stronger.
Herein lies the challenge. We do see examples of great leadership in healthcare and in governmental and other institutions. But we see too many examples of leadership that is not up to the task at hand - some of it simply inadequate, some of it quite toxic.
It's long past time for all healthcare leaders to become fully engaged in preventing clinician burnout. Done right, not only do clinicians' lives improve, so does every aspect of the organization, including the financial stability that ensures organizational resilience.
Over the next few weeks I'll be posting about great leadership. There have been plenty great books written about the high-level approaches to leading change. I'll get into the nitty-gritty.
I'll focus on what I know - health care and how to lead in a way that relentlessly reduces the drivers of burnout, decreases toxicity in the clinical workplace, empowers clinicians to realize the true potential of professional fulfillment, and leads to organizational resilience.
(I'll leave specifics of fixing society to others. The principles are the same but the interventions are different.)
I hope you'll join me on this deep dive into burnout-proof leadership.
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