How Can Employers Design an Effective Burnout Strategy for Physicians Amid the COVID-19 Pandemic?

Physician burnout is a constant trend that initially showed signs of decline in the past decade, but has resurfaced amid the coronavirus disease 2019 (COVID-19) pandemic. In a study of frontline health care workers responding to the pandemic at its peak in Wuhan, China, more than a third reported cases of insomnia, with those affected also more likely to feel depressed and anxious and have stress-based trauma.

Notably, findings of a recent Gallup survey of 2175 US health care workers indicated that less than half (49%) of health care workers strongly agree that their employer cares about their well-being. This could have major implications for patient outcomes, as health care workers who strongly agree that their employer cares about their well-being were found to be 2.3 times more likely to feel “well prepared” to do their job than those who do not feel supported.

To address these issues, an article co-written by Vibhas Ratanjee, senior practice expert at Gallup, and Karen Drenkard, associate dean of Clinical Practice and Community Engagement at The George Washington University School of Nursing, discussed the importance of employers in promoting well-being for health care workers. In an interview with The American Journal of Managed Care^® (AJMC^®), Ratanjee spoke on this vital role for employers, as well as key attributes of an effective burnout strategy amid the COVID-19 pandemic and beyond.

Transcript

AJMC^®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences News Network, The American Journal of Managed Care^® is pleased to welcome Vibhas Ratanjee, a senior practice expert at Gallup. Can you introduce yourself and tell us a little bit about your work?

Ratanjee: Thanks, Matthew, and thanks for having me on. So, I work with Gallup and I’ve been working with Gallup for about 20 years based out of our Irvine, California, office. Over the last, I’d say, about 25 years of my career, I’ve worked exclusively and extensively with hospitals, health care clients on a range of different subjects. I work on employee engagement surveys—I do a bit of leadership development and executive coaching, and other culture-based work that is focused really on ensuring that the hospitals are able to focus on key outcomes, health care outcomes overall. So, that’s me.

AJMC^®: Can you discuss the threat of burnout among physicians, and how this risk is being intensified amid COVID-19?

Ratanjee: Absolutely, and Gallup has been actually measuring and studying burnout for a fairly long time. I really think it’s a larger issue than just COVID-19. In fact, the 2019 study that we did, we saw that 28% actually reported very often always facing burnout. As you know, burnout is now classified as a disease by the World Health Organization, but we do think that the impact of COVID-19 is really cratering well-being. In fact, Gallup is even measuring the overall life evaluation—so, the percent of Americans who are thriving. We’ve seen that it is at a 12-year low, because that’s as low as the 2008 economic crisis. So, it’s really an issue, in fact, in most of our health care workers, as you all know.

So, we did a survey, a pretty large survey about 2000 health care workers in the peak of the crisis—I’d say in March. When we did the survey, only 1 in 3 felt safe that they will continue to do the job successfully if the outbreak continues, which is really concerning. Only 1 in 2 felt well prepared to do their jobs. So, hospitals must obviously do a lot to focus on physical well-being and safety. I think those are important issues, but hospitals I feel in the midst of the COVID-19 crisis should also focus on overall well-being, because there are other aspects of well-being, like I think financial well-being, a career well-being, community well-being, social well-being, even spiritual well-being.

So, the focus for hospitals amidst COVID-19 should not only be to look at the safety elements, but really larger elements of well-being. I’ll give you 2 more data points which are interesting. One, which is very concerning, only 1 in 2 employees of hospitals feel that their employers care about their well-being right now—that’s a concerning area. What we found interesting was those who said yes, strongly agree that my employer actually cares for my well-being, they were 2.3 times more likely to feel well prepared to do their jobs. So, it’s very important that the focus is on burnout, for sure, but also on resilience and on overall well-being. That's going to be all the more important.

AJMC^®: To build off that, what influence can employers have in assisting health care workers who are on the front lines of the pandemic?

Ratanjee: I think a lot, and I think a lot of health care organizations and providers need to act fast, because the other element we’re seeing is that 78% of health care workers feel that this will have a negative impact on how they feel about their organization. So, this is going to lead to higher levels of turnover, besides just burnout. I’m going to frame this answer in terms of what Gallup has found to be important in terms of leadership as this really is a leadership crisis. So, we did some research to try to understand what followers want from leaders and then, for a lot of research, we found that there were 4 things: trust, stability, compassion, and hope. These are 4 things that followers really need.

I’m going to frame this in the context of what's happening with health care workers, trust for sure. It really is about organizations being crystal clear around expectation, around communication, and on letting health care workers know what’s going on, and what the situation is, for example, in terms of materials and equipment like ventilators and PPE [personal protective equipment], for instance; but here's the data point here, only 1 in 5 felt that they were not communicated with. So, that’s another area. The other one was stability. Only 37 felt that they’ll be able to keep working well, working safely if the outbreak continues. So, there’s a need, again, for assurance for clear direction and a strategy plan. Now on compassion, it's kind of interesting. There’s a lot that can be done on physical well-being like I said, relaxation, meditation, and a lot of providers are providing that, but 1 thing that is very important is financial worry. We think that’s very, very important.

According to the CARES Act, there’s a lot that has been provided, but in our survey, 1 in 3 believe hospitals won’t provide paid sick leave. So, obviously, you can do a lot and invest in well-being, but if you’re not alleviating financial worry, it’s going to be a big issue. In fact, a lot of health care workers, it might be that their spouse has lost their job, for instance. There’s a lot of financial worry that impacts their life. The last one is hope. I talked about trust, stability, compassion, and then hope is to provide this focus on hope. We found a few things that were interesting. One, 58% felt worry the prior day, 63% faced stress the prior day, and what is interesting is 26% actually felt loneliness in health care workers.

As you can imagine, a lot of them are self-isolating. They’re staying away from their families, they’re sleeping in their cars, in their garages. So, that’s important, the level of psychosocial support that health care workers will need is going to be very important. In fact, in Wuhan, the epicenter when this happened, 72% of health care workers there, a different study, reported psychological distress. So, I feel that hospitals need to provide hope. They need to provide hope, trust, stability and compassion, and that includes psychosocial therapy importantly. There’s a hospital in New York, who started doing these hope huddles, instead of doing just normal huddles. So, they were talking about things that were working well, they were talking about how many patients went off ventilators yesterday. So, creating and instilling that sense of hope, I think is a primary responsibility as health care leaders.

AJMC^®: As you alluded to prior, a recent Gallup poll indicated that only approximately half of health care workers strongly feel their employer cares about their well-being. What implications may this have for patient outcomes?

Ratanjee: I think a massive impact on patients—all the data points I’ve shared with you are really going to lead to active employee disengagement. In a lot of Gallup’s research, we know that if you have an actively disengaged employee, an actively disengaged health care worker, there’s likelihood for active disengagement as far as patients are concerned; but it’s not just that, our research also indicates a direct correlation between burnout and engagement—how engaged you are at work and engagement with a range of outcomes, not only patient satisfaction, but patient safety, safety incidents, readmission, mortality rates. So, if organizations do this well, health care providers do this well, they can impact employee engagement. That’s very important.

I think this impact will really be felt in the long term as a second wave or the third wave likely comes in. Even the second wave of elective surgeries when they come in, they’re really going to overwhelm the system—this is when you need engaged employees, engaged physicians, engaged nurses driving the right kind of physician outcomes. I think this is larger than just COVID-19, and the impact will certainly be felt for years to come.

AJMC^®: You touched on this briefly, but can you discuss what steps an employer can take to design an effective burnout strategy?

Ratanjee: I’m glad you’re saying strategy because sometimes burnout tends to be like an episodic event, and suddenly you find out through a research survey that your employees are burnt out when you start putting together a strategy. I really think that a strategy for burnout has to be a long-term strategy. In fact, it has to be at 3 levels. I think there’s an organizational strategy that's required. At an overall level, what is it that an organization must do? And this means that you need to look at systems and processes, you need to look at where you can actually save time, save energy for physicians, as well as, for errands for example. So that’s one, systems and processes.

The other, and it’s the most crucial part, is the manager, the nursing manager, for instance. We know at Gallup, that 70% of the variance on engagement is the manager. So, really focusing on managers as a way of ensuring that burnout is lower, alleviating burnout, I think that's important. Then I think there’s individual level strategies that are required because every individual season faces stress and burnout in a very different way. So, managers are able to individualize their response to burnout, that’s going to be important. I think at an individual level, a lot of the stress and burnout is also a factor of people’s circumstances, their family circumstances, for instance, and social circumstances.

So, starting to look at well-being, instead of burnout, I’d say burnout is sometimes a negative word. I think we should look at the positive aspect which is how do we create higher well-being? That’s important. So, like I said, the manager—very important. How they’re coaching, how they’re investing their time, their energy, their awareness and attention, doing purposeful rounding—I think is very important. Not just focus on rounding, not just rounding where you're asking a few questions that you’ve been asked to give, but rounding, just like the whole part as I talked about is such an important way of ensuring that you have your pulse on how employees are feeling and when they're burnt out. Being very proactive, with the right kind of strategies to really reduce burnout.

AJMC^®: What other preventive mechanisms can employers provide for physicians?

Ratanjee: I think a lot. I think the basic one is sleep, but you know, just getting enough sleep. We know that there’s a huge challenge with physicians, I do feel physicians are wired a certain way—it's a great degree of responsibility they have, but ensuring that they are able to care for themselves is important—to self-care. I think it could be meditation or mindfulness, but 1 thing I can say is picking a particular well-being activity, whatever that might be, and sticking to it. Consistency is important, because sometimes there’s so much that one can do, but there’s a lot going on so it’s important to be consistent.

I'd say disconnecting, whether when you’re away with your family, or I think disconnecting from the news. There’s a lot of research that’s actually showing that over exposure to news and the negative elements actually creates a lot of disengagement overall. I’d say that our own research shows, Gallup’s research, that the level of awareness people have of the news right now is as high as 9/11. So, this is obviously of epic proportions, if you may. So, choose a well-being activity and stick to it.

Another thing we found is multitasking. I think there's an importance for monotasking, rather than doing too many things, focus on 1 activity and do that. Of course, think of work itself as a series of sprints rather than a marathon. So there's a lot of things that can be done, especially by physicians to take care of their own well-being, which is critically important; but sticking to a consistent way would be our biggest focus area.

AJMC^®: Are there any further studies or polls under development by Gallup to address physician burnout, or related effects of COVID-19?

Ratanjee: Yeah, absolutely. We’re really investing a lot in research at this time, whatever we can do to help hospitals and really the world in terms of the best insights we can get from all the polling we're doing. So, we will continue to track well-being for one. We have a massive uphold in the US, maybe asking specific questions of health care workers also. So, we’ll continue to do that. We’re also doing a lot of research in the future of telehealth, which I think is going to be important. Telehealth, I think, is going to be a very important weapon in our fight against the disease. Our recent research actually showed that there’s a big jump in not only usage of telehealth, but likelihood that people will use telehealth, especially for younger patients. I think that's going to be an important one.

We’re also going to be publishing some research around physician leadership development, specifically around key experiences, the experiences that they require to grow in their capacity as leaders. I can’t think of any other experiential learning activities in COVID-19. I think there’s a lot that people will take away from this from a learning point of view. So, we're looking at how that impacts physician leadership in general, I think that'll look very, very different in the future than it has in the past.

AJMC^®: Lastly, are there any other topics that you want to address that have not yet been talked about?

Ratanjee: No, I think, as I mentioned, I think the focus needs to be in on a consistent strategy. When you keep talking about burnout, we’ve been researching burnout for years, and somehow, we report the same level of burnout and the same level of stress—that’s not really going down. So, hospitals really need a consistent strategy. One of the things I must say is that this requires more of a focused intervention by all payers and providers. When you think about health care providers, payers, med-device producers, or pharmaceuticals—if you really want to transform health care you need to look at the ecosystem and the ecosystem needs to work together extremely well.

I think that that’s going to be key as we start revolutionizing health care. People are talking about the revolution that’s coming in health care for a really long time. Whether it’s artificial intelligence, whether it is analytics, and so on and so forth. The role that people play, I think is going to continue to be very, very important and that’s the focus for us is that human element, that emotional engagement element. The focus on the individual as a human being is going to be continuing going forward.

AJMC^®: To learn more, visit our website at ajmc.com. I’m Matthew Gavidia. Thanks for joining us.