Module 2 – Avoiding Burnout, Enhancing Resilience

Module 2 – The Importance of Organisational Strategies to Minimise Physician Burnout

by Dr Suzy Jordache

Evidence suggests that system-level factors are the predominant drivers of physician burnout. Are there opportunities for clinicians to influence burnout risks at this unit level?

At Premium Medical Protection, we are keen to explore issues that affect you and your medicolegal risk and we believe that this is a key area of concern for many.

Aims

1. To explore the link between organisational strategies and physician burnout.
2. To offer ideas and practical solutions to improve practice efficiency and culture of wellness.

Learning outcomes

To understand the importance of working at a unit level to improve practice efficiency, promote a culture of wellness and generate ideas and practical solutions to put in place at the unit level to actively reduce burnout in clinicians.

Physician wellbeing

The first webinar in this series explored how wellbeing is proposed as a three-legged stool with practice efficiency, a culture of wellness and personal resilience, all playing a part in stability and physician wellbeing. Doctors working in inefficient systems with a poor culture of wellness can suffer burnout.

Relying on the resilience of individual doctors to somehow ‘just cope’ can be a recipe for disaster. A one-legged stool does not work well – no matter how strong that one leg is!

System-level factors that drive burnout

There is now a clear understanding that the predominant drivers of physician burnout are at the system-level rather than at the individual physician-level.

Experts in this field have worked for years to understand system-level factors that drive physician burnout. Much has been written about the growing demands and complexity of the job, a faster pace of work and tighter financial constraints. Doctors report less control over decision making, more moral conflicts at work, long hours working in emotionally demanding situations and ever-increasing regulation and litigation. Frustration around rotas, IT systems, remuneration, lack of changing or rest facilities and food, all erode much of the pleasure at work and burnout risk rises.

Studies confirm this:
“Practice efficiency and a culture of wellness in the workplace have been proposed as key elements of physician wellbeing.” Bohman B, et al (2017).

“The predominant drivers of burnout are systems-level factors rather than individual physician-level factors.” Panagioti M, et al (2016).

“Six Areas of Work” model

The psychosocial safety climate in a workplace is key and the “Six Areas of Work” model can guide interventions to maximise resilience. This model is also discussed in a paper by Montgomery A, et al, “Burnout in Healthcare: The Case for Organisational Change” (2019).

The six areas are as follows:

1. Workload
   An excessive workload means there is little opportunity to rest, recover and restore balance. However, sufficient and varied work is also key. Clinicians do not function well when underemployed or performing repetitive tasks that hold little meaning. Organisations should consider allocating work to ensure that staff spend at least 20% of their time undertaking personally meaningful tasks.
2. Control
   Experiencing a lack of control or autonomy is a consistent predictor of burnout. Conversely, the perception of having the capacity to influence decisions and exercise professional autonomy is more likely to lead to resilient and engaged physicians. Units that encourage clinicians to be closely involved in work-related decisions, particularly where change occurs, tend to thrive.
3. Reward
   Insufficient recognition and reward, whether financial, institutional, or social, increases people’s vulnerability. Appropriate and consistent appreciation and reward are associated with deep personal intrinsic satisfaction. A show of gratitude, eg, a thank you card from patients and colleagues, helps pull health professionals out of the “accelerating burnout spiral”. Organisations that use reporting systems to recognise and celebrate excellence have seen huge benefits to staff morale.
4. Community
   The concept of belonging or being part of a community is an important area to consider. Relationships that are characterised by a lack of support and trust or unresolved conflict have the potential to increase the risk of burnout. Units may consider team building opportunities within and outside of work.
5. Fairness
   Fairness is the extent to which decisions at work are perceived as being equitable. Feelings of cynicism, anger and hostility are common if individuals do not feel they are being treated appropriately. Care needs to be seen to be taken, for example, when allocating patients, budgets, study leave and drawing up the Christmas rota.
6. Values
   Values are the ideals and motivations that originally attracted people to their jobs. Units with clear mission statements tend to have high levels of engagement.

Practical initiatives

Examples of practical ways to enhance practice efficiency and psychosocial safety at the unit level include:

• “Getting Rid of Stupid Stuff”: “GROSS” projects is championed by the American Medical Association, an amusing title. However, evidence suggests that it is exactly this kind of initiative that can transform practice efficiency dramatically.
• “Joy in Work programme”: championed by the Institute for Healthcare Improvement (IHI), is a simple yet effective structured programme using careful conversations to ask staff, “What matters to you?” This teases out a range of issues from all six areas of work that can lead to small and large shifts in efficiency and wellness culture.
• “Schwartz Rounds”: launched by the Schwartz Centre for Compassionate Healthcare in 2002, is a group reflective practice forum that provides an opportunity for staff from all disciplines to reflect on the emotional aspects of their work. This initiative can dramatically increase a sense of community and can realign values safely.
• “GREAT-ix reporting”: created by NHS Wales, is an initiative that can improve recognition and reward in the workplace. The system is designed to enhance patient safety and learning through excellence. Staff can submit a “GREAT-ix” report and their colleague then receives a formal thank you letter.

Summary

PMP hopes that this second module in the Avoiding Burnout, Enhancing Resilience webinar series has provided you with new insights, food for thought, and some great ideas to work on organisational strategies that help prevent burnout. The final module discusses how to enhance personal resilience.