Leaders in healthcare recognize that clinician burnout is not a new problem—and that it grew in severity during the crucible of the COVID-19 pandemic. But Burnout in healthcare is too complex for a single leader or resource to solve. Driving burnout are work overload, loss of control, insufficient reward, erosion of community, absence of fairness, and misalignment of values.¹  Addressing these drivers in highly complex sociotechnical systems requires comprehensive organizational commitment, multiple strategies and tools, and support for high-functioning teams. Solving these issues also requires respectful, humble leaders who have the tenacity to change systems and can deliver the solutions that healthcare workers need to thrive.

These types of people-first leaders (some use the term “servant leaders”) put the needs of others first by sharing knowledge and power and by helping individuals perform to their highest capacity. People-first leaders whose actions have a positive impact on clinician burnout and well-being share common traits. Leaders recognize burnout as a problem unique to the workplace(s) in their charge that profoundly affects the multidimensional well-being of the people they lead and the patients they serve. They understand a hard truth about burnout, as described by experts Christina Maslach and Michael Leiter: “Burnout is shown to be a sign of a major dysfunction within an organization, and [it] says more about the workplace than it does about the employees.”²  With this realization, people-first leaders react by saying, “This is unsustainable. We have to do something!”

Commit

People-first leaders elevate their organizational commitment by making workforce well-being a measurable strategic imperative—prominently displayed on the organization’s performance dashboard—with dedicated resources, the same as other major strategic organizational priorities. Depending on the size of the organization, actions may include creating a chief wellness officer or champion position that has authority and resources.

Measure Impact

People-first leaders assess their workplace with validated instruments that measure burnout, well-being, and the organizational costs of burnout in physicians, nurses, and other clinicians. Evidence-based tools support accountability and help establish a baseline for tracking and reporting measurements over time as commitments are put into action.

Build Leadership Skills

Skilled leaders committed to healthcare worker well-being are needed at all levels. People-first leaders acknowledge this and take steps to strengthen and develop their own and others’ leadership skills and behaviors and invest in building high-functioning teams—expert teams instead of teams of experts. One of these behaviors is to shadow clinicians at work, using “ humble inquiry” to ask frontline staff questions to which the leader does not already know the answer.³  Questions that will reveal opportunities to support include: “How has the pandemic affected your life? What do value and appreciation look and feel like at work? What gets in the way of doing a job you would feel proud of? What can be done to move forward and help you do a job you are proud of?”⁴

Answers to these questions from frontline staff point to the solutions that leaders with operational authority can deliver or enable staff to design and implement. People-first leaders deemphasize “doing more with less” in favor of change that is done with, not to people. Teamwork and inclusion are critical. Involving frontline workers in the improvement process empowers them to do the work well.

A positive rounding frame used by people-first leaders in “Positive Leadership WalkRounds” is “associated with better healthcare worker well-being and safety culture.”⁵  Instead of asking, “What isn’t working?,” leaders ask “What are three things that are going well and one thing that could be better?”⁵ They openly acknowledge the individuals and teams doing the good work and take respectful, supportive action to effect change. Effective people-first leaders also model pro-wellness behaviors for self-care⁶  and cultivate these actions for their teams.

Take a Hard Look

Next, people-first leaders examine their policies and practices with an eye toward eliminating the drivers of burnout that come from leadership mandates. These include nonevidence-based policies, metrics over mission, dysfunctional EHR systems, unaddressed patient safety concerns, trivial administrative tasks, regulatory myths, staffing shortages, and lack of childcare or mental health support. Leaders gain knowledge by rounding during busy late shifts and observing firsthand the change opportunities that stare them in the face.⁷

Fix Inefficiencies

While shadowing, rounding, and (most importantly) listening deeply, people-first leaders scan for opportunities to enhance workplace efficiency and facilitate improvements for streamlining functions. Implementing time-saving team-based documentation and care, Lean methods, EHR optimization, and staff training eliminates waste in workflows and allows clinicians to spend more time with patients.

Cultivate a Culture of Well-being

Finally, people-first leaders work to cultivate and sustain a culture of respect, community, connection, and support. This starts with creating conditions that allow healthcare workers to feel safe and joyful at work and return home with enough time and energy reserve to enjoy their personal lives. It continues by building support and time for a culture that includes at-work buddy systems, meal sharing, and peer-to-peer and mental health programs. People-first leaders destigmatize and normalize asking for help.

The evidence-based actions discussed here have been field tested by healthcare leaders in the real world, organized into a framework of six essential elements based on expert guidance, and assembled into a compendium of resources for healthcare worker well-being by the National Academy of Medicine.⁸  With the promulgation of these resources and others—like the 2022 Healthcare Workforce Rescue Package from ALL IN: WellBeing First for Healthcare—a movement is underway.⁹

While leaders may not be able to fix every problem, people-first leaders achieve quick wins on easier challenges and take collaborative action to build the capacity to address the bigger challenges. Taking people-first action is imperative. The well-being of our nation’s healthcare depends on it.

References

1. Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999;21(4):472-89.
2. Maslach C, Leiter MP. The truth about burnout: how organizations cause personal stress and what to do about it. Jossey-Bass;1997. https://psycnet.apa.org/record/1997-36453-000
3. Schein EH. Humble Inquiry: The Gentle Art of Asking Instead of Telling. Berrett-Koehler; 2013.
4. Palamara K, Sinsky C. Four key questions leaders can ask to support clinicians during the COVID-19 pandemic recovery phase. Mayo Clinic Proceedings. January 1, 2022.  https://doi.org/10.1016/j.mayocp.2021.10.015
5. Sexton JB, Adair KC, Profit J, et al. Safety culture and workforce well-being associations with Positive Leadership WalkRounds. Jt Comm J Qual Patient Saf. July 2021.  https://www.jointcommissionjournal.com/action/showPdf?pii=S1553-7250%2821%2900094-5
6. Shanafelt TD, Makowski MS, Wang H, et al. Association of burnout, professional fulfillment, and self-care practices of physician leaders with their independently rated leadership effectiveness. JAMA Netw Open. 2020;3(6):e207961.  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767214
7. Gamble M. Hospitals’ ivory tower problem. Becker’s Hosp Rev. February 2, 2022. https://www.beckershospitalreview.com/hospital-management-administration/hospitals-ivory-tower-problem.html
8. National Academy of Medicine. Resource compendium for healthcare worker well-being. https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/
9. ALL IN: WellBeing First for Healthcare. 2022 healthcare workforce rescue package. https://www.allinforhealthcare.org/articles/76-2022-healthcare-workforce-rescue-package

Resources

American Association for Physician Leadership, Servant Leadership in the Medical Practice

American Medical Association

• Building Bridges Between Practicing Physicians and Administrators
• Burnout and Well-Being Toolkits
• Creating the Organizational Foundation for Joy in Medicine
• Cultivating Leadership
• Debunking Regulatory Myths
• Establishing a Chief Wellness Officer Position
• Organizational Cost of Physician Burnout

Cassel CK. The Doctor’s Advocate. Clinician Burnout: From a Crisis to a Movement

Institute for Healthcare Improvement

• Health Care Leaders: Heroism Is Out, Humility Is In
• “What Matters to You” Conversation Guide for Improving Joy in Work

Journal of Patient Safety, Evaluating the Costs of Nurse Burnout–Attributed Turnover

National Institute for Occupational Safety and Health, NIOSH Worker Well-Being Questionnaire

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.