Physician burnout, Engagement, Leadership Recently, in presenting a workshop at a pathology national meeting on how to effectively give negative feedback, one of the attendees told us the following story: “I just had my annual review by my supervisors and they asked me how things were going. I responded by asking if they honestly wanted to know. They said they did. I told them I felt burned out. Morale is bad. No one is happy. No one seems to care and it’s becoming really hard to come to work everyday and pretend everything is fine.” “What did they say?” we queried. “Nothing. There was about 30 seconds of awkward silence and then they just continued by telling me what I should be doing to help orient new hires.” “Really? Did they follow up with you afterwards?” “Nope. There was nothing.” This interaction resulted in a number of other individuals conveying similar experiences of feeling neglected, abused, or underappreciated. Poor workplace engagement and physician burnout are unfortunately not uncommon occurrences in pathology laboratories. The recent Medscape Lifestyle Report 2016 indicated that 45% of pathologists reported burnout.1 Burnout, according to the Maslach Burnout Inventory, has three dimensions: (1) emotional exhaustion marked by a lack of enthusiasm for work or feeling drained; (2) depersonalization, characterized by cynicism or a cold approach to others; and (3) low sense of personal accomplishment, which is marked by a sense of ineffectiveness at work and a feeling that one’s work has no meaning.2,3 Workplace burnout manifests as emotional exhaustion, a sense of inferior personal accomplishment, and depersonalization.2 The sequelae of burnout are well established and include negative impact on patient care, negative impact on the physician’s own health and safety, decreased work effort, and problems with professionalism, and it contributes to inefficiency in the workplace.2 Burned out physicians are more likely to leave their jobs or medicine altogether.4-6 This can result in more work for those left behind and workplace chaos as things are readjusted to compensate for this loss. Recruitment and replacement of a lost individual takes time and money, and may be more challenging if word gets out that the workplace environment is less than optimal. Productivity, both clinical and academic, may be impacted in an adverse manner.7,8 This is not only the result of the individual’s decreased drive but is exacerbated by dysfunctional workplace operations. More mistakes are likely to be made and lapses in professionalism more common.7,9 Then, there are the personal costs to the individual, including risks of substance abuse, depression, chronic fatigue, added stress to relationships, and suicide.7,10 By definition, burnout is a work environment-induced phenomenon and is closely tied to physician engagement; to quote Tait Shanafelt and John Noseworthy, “Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work.”11 Lack of individual or physician engagement is symptomatic of burnout. There are two sides to engagement. There are the individual person’s behaviors and interactions within her/his workplace and then there is the workplace environment and its leadership, and their interactions with the individuals in the workplace. Both sides require addressing. In some organizations, a common tactic employed to address this problem is to suggest that the physician is in some way primarily responsible for his or her own burnout, leaving the onus mainly on the individual to develop strategies for coping. Such organizations may ostensibly offer support for their employees to this end (eg, yoga classes, mindfulness sessions, even massage sessions). Although these strategies can be helpful to some extent, it is up to the individual to engage in these activities, and such activities often do not directly address all of the true underlying issues; hence, the problems persist and so does the burnout. Both individual-focused as well as organizational and structural strategies need to be employed together to effectively address the issues.12,13 Organizations need to reflect on their own behaviors and adopt strategies to address environmental factors that may escalate the problem. Strategies to tackle issues that contribute to the development of burnout among physicians also need to be addressed.13 At the same time, factors that contribute to physician wellness, including appreciation, mentoring, opportunities for growth and development, communication, support staff and systems, and fair compensation, need to be fostered.13 What follows are five Es to be considered when tackling poor engagement and employee burnout. Esteem: One of the greatest needs of human beings is to feel appreciated. Expressed gratitude and individual acknowledgment of efforts and accomplishments are important to this end. Too often, there is no recognition of what the individual is doing, unless it is to point out mistakes or failures, focusing on the negative. Taking the time to celebrate the little things that are done well helps the individual foster a sense of self-worth. Catching people doing the right thing and reinforcing the positive behaviors is essential. When appreciated, employees are willing to go the extra mile, if needed. Although group appreciation is worthwhile, the individual recognition is what is critically needed and is often lacking. Empathy: A good leader needs to have an appreciation of what people are really doing and an understanding of the problems and challenges in the workplace. The excellent leader, additionally, is attuned to the individual as a person and knows something more about the individual, their motivations, concerns, and perhaps a bit about what their life is like outside of the workplace. There are workplace problems that can be easily remedied and, in so doing, are easy ways to create a sense of empathy, providing one takes the time to listen. Conversely, there are other issues that may not be fixable and there will be circumstances in which there will be disagreement on how to best handle a situation. Either way, it is critical that people are listened to and understood and that their perspectives are appreciated and valued. This needs to be done not only in a group context but also on an individual basis. It is much easier to make unilateral decisions as a leader. By so doing, a sense of helplessness is engendered. However, sometimes someone else may have a better idea, which a savvy leader recognizes and leverages. Endorsement: This follows from esteem and empathy. If one feels appreciated and listened to, this creates a sense of empowerment. The individual not only feels good about herself or himself, but in belonging to a group, feels part of something bigger. This confidence will bring out the best in people. They will be more vested in what is going on, more willing to participate, more willing perhaps to grow beyond their comfort zones. The more people know about what is going on by being engaged participants, the more informed ideas and perspectives are shared. The collective wisdom of the group will generally exceed the wisdom of the individual. Endorsement of the individual also encourages confidence building and fosters loyalty. Unfortunately, many physicians learn to tolerate burnout, despite its negative consequences.14 They feel helpless to deal with it and have no one to turn to for support. Efficiency: Efficiency of operation or lack thereof is often at the core of engagement. Inefficiency in operation ironically is also the result of poor engagement. An understanding of operations is vital. Communication with everyone in the workplace environment on issues and decisions related to operations is important. Complete transparency and honesty is the goal. The minute one starts withholding information from the group and the group knows this, the credibility of leadership is undermined. Engaging everyone makes everyone stakeholders in what happens instead of creating a feeling that employees are just along for the ride. Studies have demonstrated that declining satisfaction and burnout are associated with reduction in professional work effort.14 People are often willing to put in extra effort if they feel vested in something. Energy: All of these goals require constant effort, a commitment of time, earnestness, patience, and oversight. To connect with individuals personally is a commitment. Especially in situations in which workplace engagement has been suboptimal for a period of time, it is going to require more than an occasional group discussion to turn things around. It needs a campaign, a change in culture. The approach needs to be a top down one; all people in leadership positions need to buy into a single plan of action. It may require a capital expenditure of effort up front, but at some point, if the action plan is successful, the efforts become part of the new norm and benefits will be realized. Delivering health care is a team sport. If all members of the team are engaged and feel valued, they will be energized to participate to the best of their capacity with regards to the goals of reducing clinical variation—the overuse, underuse, or improper use of practices and resources.15 What engaged employees do will be perceived as having meaning. To quote US Navy Commander Michael Abrashoff, “It all came down to employee engagement. It all came down to recognition. It all came down to leadership, which led to every sailor feeling ownership and accountability for the results. You can ask a team to accomplish a mission but you can’t order excellence.” References 1. Medscape Lifestyle Report 2016 . Bias and burnout. http://www.medscape.com/slideshow/lifestyle-2016-ovrview-6007335. Accessed January 25, 2018 . 2. Maslach C , Jackson SE , Leiter MP. Maslach Burnout Inventory Manual . 3rd ed . Palo Alto, CA : Consulting Psychologists Press ; 1996 . 3. Maslach C , Schaufeli WB , Leiter MP . Job burnout . Annu Rev Psychol . 2001 ; 52 : 397 - 422 . Google Scholar CrossRef Search ADS PubMed 4. Williams ES , Konrad TR , Scheckler WE , et al. Understanding physicians’ intentions to withdraw from practice: the role of job satisfaction, job stress, mental and physical health. 2001 . Health Care Manage Rev . 2010 ; 35 : 105 - 115 . Google Scholar CrossRef Search ADS PubMed 5. Shanafelt TD , West CP , Sloan JA , et al. Career fit and burnout among academic faculty . Arch Intern Med . 2009 ; 169 : 990 - 995 . Google Scholar CrossRef Search ADS PubMed 6. Bucklin BA , Valley M , Welch C , et al. Predictors of early faculty attrition at one academic medical center . BMC Med Educ . 2014 ; 14 : 27 . Google Scholar CrossRef Search ADS PubMed 7. Wallace JE , Lemaire JB , Ghali WA . Physician wellness: a missing quality indicator . Lancet . 2009 ; 374 : 1714 - 1721 . Google Scholar CrossRef Search ADS PubMed 8. Salyers MP , Flanagan ME , Firmin R , et al. Clinicians’ perceptions of how burnout affects their work . Psychiatr Serv . 2015 ; 66 : 204 - 207 . Google Scholar CrossRef Search ADS PubMed 9. Shanafelt TD , Bradley KA , Wipf JE , et al. Burnout and self-reported patient care in an internal medicine residency program . Ann Intern Med . 2002 ; 136 : 358 - 367 . Google Scholar CrossRef Search ADS PubMed 10. Shanafelt TD , Sloan JA , Habermann TM . The well-being of physicians . Am J Med . 2003 ; 114 : 513 - 519 . Google Scholar CrossRef Search ADS PubMed 11. Shanafelt TD , Noseworthy JH . Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout . Mayo Clin Proc . 2017 ; 92 : 129 - 146 . Google Scholar CrossRef Search ADS PubMed 12. West CP , Dyrbye LN , Erwin PJ , et al. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis . Lancet . 2016 ; 388 : 2272 - 2281 . Google Scholar CrossRef Search ADS PubMed 13. Schrijver I . Pathology in the medical profession? Taking the pulse of physician wellness and burnout . Arch Pathol Lab Med . 2016 ; 140 : 976 - 982 . Google Scholar CrossRef Search ADS PubMed 14. Shanafelt TD , Mungo M , Schmitgen J , et al. Longitudinal study evaluating the association between physician burnout and changes in professional work effort . Mayo Clin Proc . 2016 ; 91 : 422 - 431 . Google Scholar CrossRef Search ADS PubMed 15. Lakier N , Malone J . Physician engagement can reduce clinical variation . https://www.hhnmag.com/articles/8336-physican-engagement-can-reduce-clinical-cvariation. Accessed January 25, 2018 . © American Society for Clinical Pathology, 2018. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
American Journal of Clinical Pathology – Oxford University Press
Published: Apr 28, 2018
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