Burnout: What If The System Is Broken — Not The Worker?

December 20th, 2019

By Gary Evans, Medical Writer

Facing an epidemic of burnout, healthcare workers are turning to all manners of self-care to stop the bleeding and stay at the patient bedside. But what if the system is broken — not the worker?

This provocative question was raised recently in Orlando at the Institute for Healthcare Improvement’s 2019 National Forum on Quality Improvement in HealthCare.

Speakers underscored the flow of work through labyrinths and impenetrable silos, amid a toxic culture of overriding silence due to the lack of psychological safety. Such forces are largely responsible for the conditions of anger, blaming, and misunderstandings among workers that lead to burnout.

Yet the answer to this problem is too often that workers must become more personally resilient, said Jessica Fried, MD, of the diagnostic radiology program at the Hospital of the University of Pennsylvania in Philadelphia.

“Interventions to date have focused on activities that can address wellness, balance, and well-being,” she said.

While yoga, meditation, and mindfulness are valid approaches, the problem is it places an enormous burden on the individual to see after their own well-being, she said.

“If you are burned out under this model — it is your fault,” Fried said. “You didn’t take enough time for mindfulness — you were not resilient enough. Victim blaming is something we never want to do."

It is also really obvious that even resilient people get burned out and depressed, she added.

“We must move beyond mindfulness and yoga,” Fried said. “The burnout epidemic facing healthcare professionals requires major culture change.”

This is often expressed in the adage, “Culture eats strategy for breakfast, lunch, and dinner,” she observed. “We also know that culture change is incredibly difficult.”

Burnout eventually degrades employee performance, manifesting with such signs as irritability and cynicism. In other professions, this behavior may be ignored or tolerated, but the stakes are too high in healthcare.

“Burnout in healthcare professionals matters because it can impact patient care,” Fried said. “If we don’t do something about the burnout epidemic in healthcare professionals, this could be a public health crisis.”

For more on this story see the February 2020 issue of Hospital Employee Health.