Communication & Burnout

I’ve had a couple of colleagues asked me how I was going to solve #burnout with #communication this past week. From their tone of his voice, they clearly thought I was in over my head and this was some ‘pie-in-the-sky’ scheme that would never work. I thought, wow, this is a great opportunity for me to share. Let’s walk this backwards and I’ll explain.

I came into the field of burnout through #bullying. I’ve been the #victim and I’ve been the #bystander, more times than I can count. I’ve been a locums physician for roughly 10 years, and I’ve seen bullying occur across geographic areas, in all different economic and racial environments. It’s always ugly. When I’ve called it out, someone inevitably says, “That’s not bullying, that’s just the #PoliticsofMedicine.” What? No, it’s not. That's not logical. It’s bullying. When someone is treated like less because of their race, gender, religion, or country of origin, that’s bullying. When that same person is given a greater workload, or lower paying patients, or denied certain bonuses, that’s bullying.

Finally, in the spring of 2021, the #AMA published a series of article that stated #BullyinginMedicine exists, why it exists, and their plan for how to combat it. These articles were based on a study they had been doing since the early 1990s. In other words, they had been studying this for nearly my entire career, and not saying anything about it. While they're out collecting their research data, an entire generation of physicians continued to be the victims of bullying, and the AMA didn't say a word, because it might mess up the results of their study!

Think about that for a minute. Just stop and think about that! I know firsthand that bullying is a driver of burnout. Bullying is causing people to leave the fields of #Medicine and #Nursing. I know firsthand that bullying is a driver of #suicide.

I could stop right here, but I won’t. That’s not what I’m here to discuss today. I’m here to discuss burnout and communication.

When the AMA revealed their findings, they made some recommendations. They recommended these programs, for both bullying, and. For. Burnout. Were these programs based on communication? Why would I ask that? When you’re a child and you get in a fight at school with the class bully, there are two things your teacher and parents generally ask you to do. The first is that they ask you to apologize, whether it’s your fault or not. The second is they ask you to sit down with the bully and talk out your differences. They ask you to communicate.

So, the AMA did that. They gave vague guidelines about changing your policies, changing your culture, something about making sure people felt safe speaking out about bullying, but nothing where the victim and the bully sat down and spoke. No concrete guidelines about #CultureChange-because folks, that’s hard shit. No two organizations are going to do it the same way, etc, etc, etc. Right? What came out of all this was a rash of new trainings on #resilience and #mindfulness. Studies have since shown that #HealthcareWorkers are some of the most #resilient people on the planet. We go into our professions knowing that we will be dealing with death on a regular basis, sometimes the deaths of our own colleagues and family members. As for mindfulness, well, I like mindfulness. I usually do an hour of mindfulness every morning. The problem here is two-fold: first of all, mindfulness will only effect 20% of the things that cause burnout, the other 80% are organizational. Let me say that again. 80% of what causes burnout is organizational. You can’t make it go away with #meditation and #yoga, no matter how much you may want that. Secondly, mindfulness doesn’t work if it’s forced upon you. Even if you are interested in mindfulness, if you are not seeking it out, you aren’t going to get the gains that come with it. That’s just the way it works. There are some people who say that if it is forced upon you, it may do more harm than good. We are starting to see some of that with #WorkplaceMindfulnessPrograms.

Therefore, you must have a culture change. The AMA was correct about that. I bring a system of communication that brings about culture change. That’s how I’m battling both burnout and bullying. Perhaps you’ve heard the phrase, “culture eats strategy for breakfast”-Peter Drucker. When I said that, another friend, he came back with, “you rise to the level of your goals, but fall to the level of your systems,” James Clear. Yes, I get it. There’s a quote and a meme for everything. Your strategy is your system. As I’ve said twice now, I have a system of communication that brings about culture change. If you follow the system, that becomes sustained culture change.

How does it work? We teach people to speak to one another’s values. You’ve heard of listening to answer vs listening to understand? Well, we take that one step further. We teach first to use personality science to find the values of everyone around you, then listen to, and speak to their values. Don’t speak in your own code of values. Speak in the code of values of the other person. Do you know what this does? First, it makes the other person feel valued. Secondly, it causes you to place more value on that person. You actually value them more as a person! This is huge. We spend a lot of time on just this concept. This alone can turn a dysfunctional physician into a leader.

Once you’ve mastered this, we introduce you to some expert skills for boundary setting and negotiating. Right now, in healthcare, administrators appear to have all the negotiating power. They seem to hold all the cards. However, they have no organization without physicians to manage patients and write orders, or nurses and RTs to do bedside care, or lab techs, phlebotomists, x-ray techs, housekeepers, unit clerks, security guards and so many others to make the hospital whole. Administrators are more aware of this than ever. If you have the administrators’ value codes, their value words, and some negotiation skills, you can set boundaries and level the playing field. Know what you want and ask for it, while speaking in a way that values everyone at the table. This is how you get sustainable culture change. This is how you fight burnout. Communication is everything.

Nan Nuessle, MD