Fixing Toxic Work Environments

Impacts of the COVID-19 Pandemic on Burnout

Remember the "good old days"? Burnout initially did more psychological than physical damage. The manifestations of emotional exhaustion, cynicism, and sense of inefficacy came on gradually. They were usually not immediately obvious. It was a poorly recognized existential threat, leading to 400 physician suicides a year and increasing the risk of medical errors that harm patients.

And because of the gradual and ambiguous nature of burnout, most people didn't understand or recognize the drivers - work overload, lack of control, insufficient reward, breakdown of community, absence of fairness, and conflicting values - that were, and still are, present in the workplace.

“Burnout is a sign of a major dysfunction within an organization and says more about the workplace than it does about the employees.” – Christina Maslach and Michael Leiter

At least that's how I viewed it burnout and professional fulfillment before COVID-19.

The Pandemic Has Changed Everything

There is nothing subtle about our current reality and it's impact on clinicians.

• The unspoken existential threats to physician well-being have been replaced with obvious lethal threats to physicians and their loved ones.

• The patient relationship is now urgently focused on simply keeping people alive without knowing for sure the ideal treatment protocol or having the means to provide the best possible care.

• The prior role of comforter of the afflicted is challenged at the time patients need it the most - when they are gasping for breath without their loved ones at their sides.

• Witnessing the intensity of death and despair is having immediate impacts on physicians that will continue long after the crisis is over.

• Clinicians are distancing themselves from their families for fear of infecting their loved ones, exacerbating the acute psychological challenges.

The Drivers of Burnout Are Now on Steroids

Now there is Work Overload the likes that few have seen before. It's never-ending with extremely ill patients arriving at an increasing pace.

Lack of Control is seen in emergency departments holding ventilator patients in the hallways, urgent care centers having multiple ambulance transports daily, clinics canceled and office visits transformed to telemedicine visits, temporary hospitals and morgues set up wherever possible.

While there is increased camaraderie among doctors and nurses engaged in the intense teamwork of patient care, social distancing / physical separation adds an element of Breakdown of Community at a time we need to be connected with each other the most.

Clinicians experience an Absence of Fairness when they are denied adequate PPE, begging for it and improvising PPE, when they are scolded, punished, or fired for speaking up about the threat to their personal safety, and when salaries and/or benefits are cut as they put themselves increasingly in harms way.

And they see Conflicting Values between themselves and administration in arguments over resources, compensation, work levels, and other rapidly changing issues that lead to conflict.

Physicians feel that administrators don't "have their back" when executives are not communicating regularly, are not seen in clinical areas, and don't appear to understand the stresses on physicians.

What Can Administrators Do Right Now?

Just as this crisis is spurring innovation in ways we did not think possible:

• the rapid transition to telemedicine visits,

• auto manufacturers making ventilators,

• rapid development of tests for virus infection and immunity,

• ORs and PACUs functioning as ICUs, and

• everyone making and wearing masks,

this is an opportunity to transform broken relationships between executives and clinicians.

Leaders have a choice: Become your physicians' allies or deepen the distrust and confrontation that's been increasing as an undercurrent for years.

This process should start with executives listening to their clinicians, clearly understanding their concerns, and collaborating with them to address their needs.

Clinicians don't have a lot of extra time right now, but they definitely need to be heard. Meetings aren't going to be much help at this point.

There are two things executives can do quickly to get a better understanding of clinicians' needs:

• Go to the areas most impacted, talk with and/or shadow clinicians, attend morning huddles to take the pulse of the units, hold informal office hours in the staff lounge.

• Deploy a newly designed Pandemic Experience Survey that asks clinicians specifically about what impacts them most right now - their individual safety, their ability to properly care for patients, and the impact on their loved ones - providing a better understanding of the acute toxicity clinicians are dealing with. The results may dismay you, but you will learn what you need to know.

These steps can both be effective if they are followed up quickly by actions to address the concerns and a communication process that ensures as many people as possible are aware of actions taken.

An Opportunity to Eliminate Dysfunction and Toxicity

As horrible as the current crisis is, it presents an opportunity to transform so many things that are wrong in healthcare today, including the relationship between clinicians and administrators.

The executives, i.e. the leaders, must take the lead in fixing these relationships. Now is the time.

I'm here to help if you would like. I have 25+ years experience as both a practicing physician and a healthcare leader.

I'm offering, for free, time to talk. If you are an executive or a clinician, you can go to the book-online page of my website to find 30 or 60 minutes that works for your schedule, and book an appointment.

I wish you well in the challenging days ahead.