Stop, Drop and Roll if you’re burning

All this talk about burnout has me… well… burned out. Theories abound and prevalence data is flying about.  Are 54% of physicians burned out, or is it 25%? Is it because we’re worked too hard, or because the “new-trophy-for-everyone” generation is finally being hit with reality?

I can tell you from experience, burnout occurs when there are big things about your work you resent, and the rewards become overshadowed by these key persistent resentments. Working 24/7/365 isn’t the problem, its what you’re not doing because you’re working all the time that is. Its not what we’re doing, it’s what we aren’t that leads to burnout.

Duh? Well… it’s not that simple, and once again it comes back to resentment. Most of us resent what we can’t do because we work so hard, but not all resentments are the same; expectations are the second key contributing factor. If you expected to have a lot of purchasing power because of excellent compensation as a physician only to found out that you really don’t because you chose a lower paying specialty, then you may resent what you do. If you expected to be home by 6 pm most nights only to find out that to finish your charting and phone calls you have to stay until 8pm, you may resent what you do. Know your expectations and be aware of your resentments.

Burnout is best prevented, because fixing it can be hard. Both prevention and cure takes efforts on the part of the individual as well as the “system”. The microsystem (your team/clinic or pod), the mesosystem (the group practice, department or service line), and the macrosystem (hospital or network) all need to participate in the process. But without the individual taking ownership, efforts often fail.

The 4 horsemen of burnout from the HappyMD (https://www.thehappymd.com/blog/bid/290379/Physician-Burnout-The-Four-Horsemen-of-the-Physician-Burnout-Apocalypse) are around every corner and their momentum can be difficult to slow. The Workaholic, the Superhero, the Perfectionist, and the Lone Ranger are wicked creatures. All four have haunted me, possessed me and driven me into the ground (nearly literally). The system can’t exorcise them unless the individual desires it so.

But often the individual who carries the burden won’t let go of it unless others are there to take some of it away.  I survived by lowering my expectations (forget about getting home to see the kids before bed, forget about exercising or having friends, forget about doing those things that bring you joy to your work).  What I didn’t know was that constant stress kills.  My advice to anyone who is approaching burnout or is cooking at a broil: be true to yourself, your family and your patients and stop the 4 horsemen in their tracks, because once you’re toast, scraping off the burnt parts is painful, and what’s left isn’t all that appetizing.  If you’re on one of those horses or all of them, stop, drop and rock and roll on your own terms (and take your family and friends with you).

Driving organizational success in children’s healthcare

In 1998 Jeffrey Pfeffer published an article in California Management Review describing what he sees as the seven practices of a successful organization. Comparing these practices to your typical health care organization today portends a crisis (some say the crisis has arrived).   Here is the list (with sarcastic commentary included for comedic effect – because if we didn’t laugh…) :

Employment security – apparently the data suggests that when employees fear for their jobs, they under perform – who knew?

Selective Hiring – the larger the applicant pool the better your workforce…mmmm – pediatric professionals weren’t in abundance as of … yesterday. Choosing employees to your organizational culture and the unique needs of your teams… is currently a luxury.

Self-managed teams and decentralization as basic elements of organizational design – uh – I’m not sure Dr Pfeffer realizes this… but it’s hard to empower practices and units in health care to actually manage their own performance – it takes time, training, dedicated people and robust real time data management – not to mention team meetings and engagement of front-line staff in analysis, action plan formulation, testing ideas, and managing sustained change. It’s easier to just tell them what to do, even if it’s wrong.

High compensation contingent on organizational performance – define performance, define high.   Is it ok to do high compensation no matter what? That would be great, because then we wouldn’t have to change anything.

Extensive training – Doesn’t everyone come into the health care workforce already trained?  Can’t they train themselves?

Reduction of status differences – we might actually be improving on this one in health care, but I’m not sure it’s having the impact we had hoped for.  Instead of collaborating we created more silos. Professionals who do shift work can’t make it to meeting where having reduced status differences allow for free exchange of perspectives and ideas.  Physician burnout has increased, because more and more tends to be dumped on them in this new order of everyone is equal and no one should do menial work, except the person who is ultimately responsible (oh, right, that difference still exists).

Sharing of financial and performance information throughout the organization- we have been tying to get better at this, but it’s …well… complicated.

So, what is the secret sauce for changing our organizational practices?  Sarcasm aside, let me put on my sunshine hat (yes, I actually have one). Accountable care will create the forces needed to shift health care into the realm of organizational success.  Fee for brief units or services of care has created a system of volume rather than value with regulatory and tort systems that drive fear rather than rationale thinking.

Working in teams, driving local continuous improvement, and driving true waste out of our processes, using the data management and sharing necessary to do so, with the staff training and professional development required, which will attract people to health care where professional joy is a given, will get us to the seven practices, and will create a care system that patients and families find value in and the workforce is proud of.