Improving Team Well-Being: Addressing Provider Burnout with Culture and a Systems Approach
A growing challenge for our providers and team members
Burnout continues to be a leading challenge in healthcare. While the concept of burnout preceded the pandemic, Covid-19 has only made things more difficult. Our care delivery teams are being pushed beyond their limits with heavy burdens of work, large patient volumes, and the physical and emotional exhaustion of the pandemic. Providing exceptional patient care, a goal most providers strive to achieve, has become much more difficult. As many in healthcare already know, patient experience can suffer due to burnout and it can even jeopardize quality and safety.
The causes and effects on our teams
To address burnout and take steps to reduce and develop defenses against it within your teams, it’s important to understand and address its root causes that arise from a combination of environmental, organizational, work system, and individual factors. As highlighted in the National Academy of Medicine (NAM) report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, some of the biggest factors include:
- Long hours and overburden of work
- Time-consuming bureaucratic tasks
- Lack of respect in the workplace
- Lack of autonomy with work
Added Covid-Related Stressors
It goes without saying that the Covid-19 pandemic has added even more stress to our already overburdened and stressed teams due to the added pressures and workload combined with ongoing changes and ambiguity. According to a study in JAMA Network Open, more than one in five healthcare workers (21%) have considered leaving their jobs due to the additional stress related to Covid-19. Some of the additional stressors have included:
- Growing backlogs of elective and non-Covid-19 care
- Expectation to work outside areas of expertise to support surge
- Emotional toll from both work and personal life
These added stressors make it even more urgent that leaders and organizations prioritize addressing burnout now. They also represent symptoms of issues that teams will continue to face beyond this crisis.
These causes all lead to diminished engagement and to increasing levels of burnout, manifesting in three key dimensions according to the NAM report:
These dimensions lead to negative outcomes for our patients, clinicians, organizations and society as a whole. Fortunately, developing our understanding of how these factors contribute to burnout allows us to develop sustainable approaches to reducing it amongst our teams.
A Systems Model of Clinician Burnout and Professional Well-Being
Adapted from National Academies of Sciences, Engineering, and Medicine 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.
Where to begin?
Addressing burnout can seem like a daunting task. Taking a systems approach to reduce burnout can seem difficult and resource intensive. Fortunately, there are simple ways leaders and teams can begin taking smaller steps that align with a systems approach to address the issue and begin making improvements in team well-being and resilience.
Taking steps to address two foundational pillars for eliminating burnout can serve as a way forward.
Our Virginia Mason Production System® (VMPS) house represents the foundational methodology of a culture of continuous improvement. This model is based on proven improvement principles and best practices of systems leadership and change management. At its core this methodology is about engagement – the issue at the heart of burnout.
Using this methodology as a reference point, we’d like to help share some key areas to focus on for reducing burnout by starting with our two core pillars – respect for people and continuous improvement.
It’s important to address each of these pillars – no matter how advanced a team is in one of these pillars, a healthy culture without increasing levels of burnout cannot be sustained without the other. These pillars surround a central focus of improvement from the patient’s perspective.
1. Respect for People:
Engaging your teams and ensuring a respectful environment
Respect for People is foundational to creating and maintaining a culture of collegiality and respect where your team feels safe to raise concerns without fears of retribution, can fully contribute, and where they feel heard and encouraged. Team members should never end their workday feeling exhausted, overwhelmed, or discouraged about their work.
Their work should also feel engaging and rewarding with alignment to their personal and professional development goals.
Some ways you can approach making improvements with this pillar include:
- Promoting personal and professional development by having leaders support individual goal setting processes that align and cascade with team, department, and organization goals.
- Ensuring a safe and respectful environment where your team member feels safe to share ideas regardless of their position through focused huddles, an idea-sharing process, and leader involvement.
- Facilitating small-group discussions with leaders and team members focused on the topics of well-being, resilience and emphasizing a culture of respect and foundational behaviors of respect.
- Participating in training on diversity, equity, and inclusion (DEI), respect behaviors, empathy, and communication – with leader-supported reflection and discussion.
Taking a first step: Facilitating targeted discussions around respect, well-being and burnout can be difficult or uncomfortable even for experienced leaders. One way we help make this easier is by using standard resources and templates like this Speaking Up to Disrespect activity guide. Use this activity guide to help engage your team in a targeted activity around respect behaviors.
2. Continuous Improvement:
Empowering your teams to improve their workflows
Prioritizing improvement is about improving the patient experience, but it is also about improving your team’s experience and reducing the burden of your work. Overburden and exhaustion, key causes of burnout, can often be the result of wastes that can be reduced through improvement work – inefficient processes, missing and ambiguous communications flows, lack of standardization, missing equipment, improper resourcing, etc.
It’s important to find a balance and avoid the pitfall of focusing too much on process improvement which can increase stress and be counterproductive. When the right emphasis on improvement is achieved teams will unlock the ability to drive their ideas forward, obtain buy-in, and increase ownership and teamwork.
Driving continuous improvement forward with your team can include:
- Training team members on how to lead improvement work with observation, flow mapping, and data collection.
- Leaders sponsoring improvement work in priority areas that align and cascade with individual, team, department, and organization goals.
- Developing clear communication flows to reduce ambiguity, frustration and room for error.
- Standardizing and improving setup for equipment to reduce stress associated with improper setup.
- Developing clear, easy-to-understand daily huddle dashboards so team members always have a sense of who’s in the clinic, who’s working with whom, daily patient demand, and coverage needed.
Taking a first step: Does your team have a way to gather ideas? Use this toolkit to jumpstart developing a standard way for your team to connect regularly on new idea collection and prioritizing how to move the best ideas forward.
“[Training with Virginia Mason Institute] has provided a common language to communicate in. This is extremely important in this crazy time and it allows a non-threatening way for others to identify they need help without necessarily having to ask for it. The daily huddles highlight where the busy areas are for the day and where there may be resources to help. This has led to increased engagement and better collaboration.”Sara Hebel, MHA Vice President, Ambulatory Operations Pierce Region Franciscan Medical Group Administration
Executives and Senior Leaders
Learn more about your role in making sure your team members don’t face increasing burnout and have the support needed to improve their workflows and increase engagement.
Process Improvement and Operational Leaders
You can get started using our free tools mentioned in this article, but if you’re ready for additional training and coaching we encourage you to learn more about our introductory Improving Flow workshop, our Advanced Process Improvement Training intensive program or our Respect for People Training.