Article

Physician, nurse, clinician and healthcare leadership burnout has reached its critical level in the U.S., creating real and significant consequences on both the impacted caregivers and the essential mission of our healthcare institutions. Eliminating burnout and the subsequent exodus of talent from American healthcare organizations is essential for our clinicians and health care workforce. It also is crucial for our patients and families. 

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Numerous well-designed studies have demonstrated that patient safety and patient and caregiver experience are compromised significantly by burnout. Yet invariably leaders are unsure where or how to begin to address what often appears to be a large and amorphous challenge. As such, clinicians and leaders need a clear, integrated roadmap on how to not only reduce burnout but, more importantly, optimize caregiver well-being. 

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At the Institute for Healthcare Excellence, we believe it is time to move from discussing burnout to more positive outcomes such as creating emotional thriving in all our teams. Based on our research with the National Taskforce for Humanity in Healthcare (NTH), we identified important trends that still persist nearly three years into our healthcare crisis.

The National Taskforce for Humanity in Healthcare focused on understanding this dilemma by working with a broad group of U.S. physicians, nurses, clinicians, patients and healthcare administrators over a 5-year period. NTH initiated a series of national collaborations and a pilot program that is described in the September 2021 issue of The Joint Commission Journal on Quality and Patient Safety. Below are four key takeaways from this important work: 

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1. In order to achieve real performance improvement, we need to change what we measure. The understandable focus on burnout — emotional exhaustion, depersonalization and personal accomplishment — has been invaluable in shining a spotlight on the problem; but professional and emotional thriving is our real goal, not just eliminating burnout, which is really just measuring a deficit state. To support that goal, NTH worked with national experts to develop and employ novel, validated measures for thriving and recovery. These measures provide direct insight into caregivers’ current state across the spectrum from burnout to thriving. 

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2. We need targeted interventions matched to the team’s specific needs. Interventions to reduce burnout and create thriving must link directly to the specific circumstances and current emotional state of the team. Using the NTH’s novel measures for recovery and thriving, our pilot program describes how to create customized solutions tied directly to caregivers’ emotional state to drive lasting change. 

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3. Customized interventions must be part of a broader, holistic approach that elevates human-centered leadership skills to facilitate an ideal environment for the entire caregiver team to nurture that environment. While customizing interventions is essential for success, those interventions must fit within a broader approach that goes beyond individuals’ emotional states. Along with individual interventions, a simultaneous focus on systemic processes with a focus on removing hassles and instilling joy into daily workflow is essential. The last step is ensuring that all these processes and skills are hardwired into daily work. Although this comprehensive approach requires time commitment from the staff, we have observed that the “work” invariably creates positive energy for participants and can be comfortably accomplished even for the busiest clinicians and leaders.

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4. Positive emotions must be the focus. As clinicians and health care leaders, we are taught to focus on identifying and fixing what is wrong. But neuroscience and psychology teach us that humans tend to place outsized attention on negative experiences and emotions. To offset this reality, it is critical to help team members notice and cultivate what is going well. We can’t rely on team members finding diffuse, non-structured “feel-good moments” because we have a deep sense of professional purpose. Rather, interventions to reduce burnout must regularly and systematically connect the team with positive emotions – even in small doses – every day. 

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Achieving Significant  Improvement in Well-Being 

Following implementation of this four-step approach, we witnessed statistically significant improvement in emotional exhaustion (48.1% decreased to 34.5%, p=0.037) at approximately one year, which was equal or superior to any reported interventions in the literature. 

We also observed a statistically significant improvement in the likelihood to recommend. There was a trend toward improvement in emotional thriving and recovery, but we expect it will take somewhat longer for those improvements to reach statistical significance than our six-month intervention followed by remeasurement at one year allowed. 

Leadership support of this work is critical. The expected ROI on these methodologies is conservatively estimated to be  5:1, as measured by improved safety, efficiency, clinical outcomes, experience culture (value-based care) and decreased turnover. 

Today, the Institute for Healthcare Excellence is helping healthcare organizations across the country rediscover well-being, joy and performance. We welcome you on that journey together. 

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^{About the authors:}

• _{William J. Maples, M.D. is the Founder and former CEO of the Institute for Healthcare Excellence in Ponte Vedra Beach, Florida.}
• _{Read G. Pierce, MD, was Vice President of Culture Transformation at the Institute for Healthcare Excellence and is Chief of the Division of Hospital Medicine, Department of Internal Medicine, at Dell Medical School, University of Texas at Austin.}
• _{Ronald Paulus, MD, MBA, is President and CEO of RAPMD Strategic Advisers in Santa Monica, California.}