Hospitalist Crystal Kondowe, MD, quickly established herself as a rising star in her practice at Hospital Sisters Health System St. Elizabeth’s Hospital in O’Fallon, IL. Despite the professional satisfaction she experienced most days, she couldn’t anticipate the challenges of being a care provider in the midst of the coronavirus pandemic. “I was mostly working nights during that time, which was exceptionally isolating,” she says. For the first time, she felt the undertow of burnout pull at her.
Kondowe is far from alone, and today she’s on a mission to help other providers whose wellness and job satisfaction are less than optimal. With clinician burnout rampant and job dissatisfaction at historic highs, workplace resilience has become a survival imperative for health systems.
In partnership with Healthcare Dive, Vituity hosted a webinar with clinical leaders discussing actionable ways that providers can improve their personal and professional wellness and resilience. Below, Dr. Kondowe and other Vituity clinical leaders share resiliency insights and experiences from the front lines.
Years of research strongly suggest that burnout impacts patients’ experiences. “It’s no surprise that burned-out providers deliver less pleasant, personable care,” says Gregg Miller, MD, Chief Medical Officer and a practicing emergency physician.
“But the problem goes deeper. Burnout also tracks with lower clinical quality scores. So patients who are cared for by burned-out physicians, advanced providers, and nurses may actually experience worse outcomes.”
Miller also looks at the issue from a team perspective. “One provider with burnout will tend to bring down others,” he says. “For example, when someone’s cracking jokes at the expense of a patient, everyone’s morale sinks. And that impacts the care of all the patients on the unit—even the ones who never see the burned-out clinician.” Miller notes that the opposite is also true and that supportive, empathic colleagues can actually raise team morale.
While most clinicians and healthcare leaders understand the dangers of burnout on an intellectual level, it’s an easy problem to overlook. Unlike other metrics, low clinician morale doesn’t announce itself through metrics or dashboards.
“Hospitals can now gather real-time data on lengths of stay, bed utilization, and cost per discharge, which allows us to respond with dynamic solutions,” says Kondowe. “But most hospitals don’t gather timely data on provider wellness. As a result, they don’t get the type of feedback that creates urgency for change.”
Hospital leaders may also hesitate to tackle burnout because it doesn’t lend itself to neat and tidy solutions. “It’s a lot easier to change a process than to change hearts and minds,” Kondowe says. “So it might feel like you can only solve burnout at the expense of other goals. But the truth is, improving provider morale will often move the dial on other goals.”
Essentially, provider burnout encompasses three dimensions:
Exhaustion is characterized by low reserves of physical and emotional energy. “Interestingly, it manifests differently along the gender spectrum,” says Vanessa Calderón, MD, MPH, Medical Director of St. Mary’s Medical Center in San Francisco, CA, and director of Vituity’s resilience program. “Individuals on the masculine end might appear totally withdrawn, joyless, and disengaged from loved ones. And if you tend more feminine, you might notice constant physical exhaustion.”
Providers experiencing depersonalization can feel distant or indifferent toward others, including patients, colleagues, and family members. Outward signs include cynicism, sarcasm, humor at the expense of others, and frequent venting. “It can also show up as poor bedside manner,” Calderón says.
And finally, there’s a perceived lack of accomplishment. “That’s when you start doubting the meaning of your work,” Calderón says. “You think, ‘Does this even matter? Am I actually making a difference? Everything would be fine if I wasn’t here.’”
Experiencing one (or all three) burnout signs doesn’t mean anything has gone wrong. “Most providers will ebb and flow through burnout across their careers,” Calderón says. “That’s perfectly normal. But it’s important to tune in to ourselves and our colleagues and notice when someone is struggling to cope.”
Conventional wisdom suggests that the pandemic drove an increase in burnout. However, the truth may be more nuanced. “The truth is, Medscape has been tracking burnout rates for several years, and they were just as high before the pandemic,” Miller says.
Why might this be? For one, not all providers experienced the pandemic in the same way. EDs in many parts of the country, for example, actually saw lower volumes for much of 2020. And interestingly, the national emergency may have fueled a sense of pride and accomplishment that actually helped to combat burnout. “More than any other year, we’ve been reminded of the noble cause, the reason why we went into medicine,” Miller says.
Miller notes that while burnout rates remained steady, providers are trending downward on other measures of job satisfaction, such as happiness at work. More are also announcing intentions to retire or leave the profession early. However, he remains optimistic. “On one hand, people are feeling more stress and anxiety,” he says. “But it’s been inspiring to see that counterbalanced by a sense of mission.”
Many hospitals tackle burnout by focusing on clinicians’ personal resilience. While this approach can sometimes help, it can also leave providers feeling misunderstood.
“Clinicians with burnout need resiliency training the same way patients with appendicitis need painkillers,” says Miller. “Painkillers are important, but they don’t cure appendicitis. For that, we also need surgery or antibiotics.”
“The same goes for wellness. Too often when providers feel overwhelmed, organizations prescribe yoga and motivational speakers and gym memberships without addressing the deeper issues. We need to focus more on issues like practice efficiency and overall organizational culture.”
Kondowe’s experience with burnout turned a corner when she attended Vituity’s COVID-19 Resiliency Workshop. “The speakers helped me see that I wasn’t alone in this,” she says. “It encouraged me to open up to my medical director to share some of the challenges I was facing. That was a huge comfort to me.”
“I’m so grateful for Vituity’s dedication toward supporting providers. You can tell our leadership truly cares. The experience inspired me to take these strategies and pay them forward so that I can help others.” One of the ways Kondowe helps foster resilience is by serving as her site’s Wellness Champion.
Whether or not your organization has a formal resilience program, certain habits of mind can help clinicians deal with stress and overwhelm.
“Now that you have a moment to catch your breath, notice what’s no longer serving you,” Calderón says. “Maybe you want to set new professional goals. Or maybe it’s time to prioritize health or family. Chances are you learned a lot about yourself during this past year, so take some time to really explore and integrate that.”
The panel of Vituity clinical leaders included: