Burnout & the Great Resignation - Can Healthcare Survive?

According to Stefan De Hert in his masterful paper, “Burnout in Healthcare Workers: Prevalence, Impact and Preventative Strategies”, here is part of his Introduction:

“Burnout is a work-related stress syndrome resulting from chronic exposure to job stress.”

“Healthcare workers, and especially perioperative clinicians seem to be at particular risk for burnout.6 ,7 This may have significant negative personal (substance abuse, broken relationships and even suicide),8 ,9 but also important professional consequences such as lower patient satisfaction,10?12 impaired quality of care,13 ,14 even up to medical errors,15–18 potentially ending up in malpractice suits with substantial costs for caregivers and hospitals.”

I particularly wish to point out the parts I highlighted by italicizing: ?

“chronic exposure to job stress”

?“lower patient satisfaction,10?12 impaired quality of care,13 ,14 even up to medical errors”

De Hert is describing classic systems stress and the dysfunction it causes in care delivery systems. Burnout is a systems problem with the primary root cause being stress in the systems in which caregivers must deliver care. This systems stress is passed on to those who work in the systems as long-term emotional stress. Welcome to burnout, PTSD, moral injury, even suicide.

Moving from the Story to the Root Cause

We’re inundated with stories about how the healthcare system is failing us all—patients, nurses, physicians, and communities. Following each story is usually a list of solutions to the problems, most of which have been tried and failed or cannot be implemented because the vested interests at the top who make all the money won’t allow change.

Probably the biggest problem facing the system itself today is nurse and physician burnout, which may be an existential threat. Burnout threatens to explode into a positive feedback loop whereby burnout creates more burnout and staffing shortages multiply. Already we are seeing reduction of services in healthcare due to staff shortages.

Also on the immediate horizon is healthcare’s version of the great resignation. Many nurses and physicians are simply quitting so as extricate themselves from a system that has taken the joy and satisfaction out of helping others and replaced it with long term stress and dissatisfaction.

Why Can’t We Fix Healthcare

Many of the ills of healthcare stem from the erroneous belief that the system is designed to be about the care of sick and injured people, which it isn’t. The macro healthcare system, the system to which healthcare has evolved, has nothing to do with health or care. It is big business.

For big business healthcare, the system is only about making as much money as possible, much as for any large for-profit business such as Apple, Google, General Motors, and, of course, big pharma and big insurance. Even as most big businesses abuse their workers, healthcare has been particularly myopic to the well-being of its nurses, physicians and care team support staff.

Healthcare is big business and big business is about making money. This is required by the macro system, capitalism/free markets, and any administrator/leader who cuts into profits to do something expressly for the wellbeing of workers or patients is punished by the system. The name of the “free markets” game is: maximize profits—period! Anything that must be done beyond making money is usually turned over to the PR department to justify doing as little as possible.

Healthcare sees nurses and physicians as expenses. They are only valued if they bring profits to the organization, the more the better. If there was some way to outsource or eliminate the services provided by nurses and physicians, you can bet healthcare would fire or layoff as many as possible as quickly as possible. In addition, physicians are sometimes competitors and healthcare, like other big businesses, loves to crush its competition.

The Triple Threat

Healthcare is somewhat unique in that it is comprised of a triple threat to all but self. Big hospitals compete with big insurance and big pharma, all trying to exploit the others to maximize profits, almost always at both worker’s and patient’s expense.

This triple threat monster is fed by big chemical companies, most of which are owned by big pharma, and big agra, creating synergies in making and keeping people around the world sick. It appears that healthcare’s supply chain of the chronically sick, for which there is no cure in healthcare, is indeed robust.

Just like every other big business, we should stop looking at healthcare as anything other than what it is, the world’s biggest money-making machine for the vested few at the top. We can then begin to make sense of the senselessness of healthcare and look for the types of solutions we might look for in dealing with any large, predatory, for-profit business.

We know healthcare resists any change that cuts the flow of profits. Still, the transformation clock is ticking for the existing system. Healthcare, as we know it, has unintentionally sowed the seeds of its own "reorder", a flight into chaos before transforming into a completely new system.

Stress – The Enemy Within

The Law of Dissipative Structures, which won Ilya Prigogine a Nobel Prize, describes how all systems, both natural and man-made, grow, evolve, and change. All systems resist change in a changing environment. This resistance stresses the system and creates dysfunction within it. The care delivery systems in healthcare are highly stressed and remarkably dysfunctional.

Worse for physicians, nurses and care team members, as noted earlier, stress in systems is passed on to those who work in those systems as long-term emotional stress. It is this emotional stress that is the primary root cause of both burnout and the great resignation.

The Solution: Follow the Stress

The best way to identify the systems that are burning out our caregivers is to follow the stress, starting with the emotional stress in our care teams. This is done through the use of 3D, which is short for: Discovery, Distillation, and Defining. These tools collect emotional data (stress energy) from the care team and then trace it back to the systems that created it. Normally, 20% of the systems are creating 80% of the stress.

Then the team fixes/de-stresses the systems and suddenly everything starts working better. Everyone wins, including patients, physicians, nurses, other members of the care teams and even the organization, which now has happier, more productive employees. Add to this improvements in quality of care and safety that accrue naturally with the improvement of systems and what’s not to like?

3D – A Great Start

UAB Medicine recently wrote an article on the bottom/up, evidence-based, 3D Change Model it is using to resolve burnout and other care delivery issues https://lnkd.in/d5ZaGUeD. Notice the renewed energy of nurses and physicians, who can now use that energy in taking good care of patients and each other.

UAB will be submitting peer reviewed papers on 3D to major journals for publication in the next 60-90 days. ?It appears, if 3D can make some inroads into mainstream healthcare, we can begin to resolve the burnout and great resignation problems at their source, highly stressed care delivery systems.