Karen Lasater, PhD, RN, associate professor at Penn Nursing and a fellow of the American Academy of Nursing, and I have never met. We come from different professional backgrounds (she in nursing, me in healthcare management). But we are kindred spirits with regard to what causes clinician burnout (organizational and systems failures) and what doesn't (lack of individual resilience), and on what will be effective in ameliorating burnout (addressing dysfunction at the organizational level) and what will not ("throwing pizza parties and doing resiliency trainings").
Professor Lasater was one of several panelists at a December 1 webinar presented by the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Here are some of her cogent observations. Read them carefully:
“We know that burnout is a state of emotional exhaustion. It's brought on by prolonged or repeated stress, and it results in depersonalization, cynicism, and a lack of engagement and work,” Lasater said. Burnout is the result of avoidable occupational stress that's caused by system failures, she said. “It's those system failures that are interfering with the nurses’ ability to do their work effectively. It's really important to note that burnout is not the result of individual failings or lack of resilience. So any interventions that are targeted at the individual level — trying to boost someone's resilience — is not an effective strategy to reducing burnout.”
Lasater said the research is clear on the driving factors of nurse burnout is clear. The number one factor is unmanageable workloads in the context of poor work environments. “It's not the work itself being difficult, but rather the organizational failures that are hindering nurses from doing their work effectively that drive nurses to feel burned out,” she said.
Some of the interventions hospital executives talk about for reducing or preventing burnout don’t appeal as much to nurses when they are surveyed, she said. “There's a real mismatch in what hospitals think they should do and what nurses want them to do. Nurses said appointing clinician wellness champions is not effective; providing resiliency training is not effective. Those are interventions that are really targeting the individual, as opposed to addressing dysfunctions at the organization level that are putting this undue stress on frontline workers who are being hampered and doing their jobs effectively,” she said. “If hospitals and other employers of nurses are really serious about addressing the drivers of burnout, they really need to dispense with these ideas of throwing pizza parties and doing resiliency trainings, and instead be responsive to what nurses say they need, which is manageable and safe workloads.” [preceding excerpt appeared in "Whatever Happened to the Nursing Workforce, Healthcare Innovation, December 4, by David Rath]
Healthcare & Hospital Executives - Focus on Outdated Systems & Problematic Workflows
Healthcare executives would do well to read -- more importantly, to act on -- Professor Lasater's admonition. To paraphrase: if you want to reduce the incidence and severity of clinician burnout at your organization, tackle broken or outdated systems and problematic workflows. Forget -- or at least stop relying on -- personal resilience-related offerings as the antidote.
If you're a hospital executive and appreciate the salience of Professor Lasater's findings, consider these actions:
expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized)
create and require leader standard work (LSW)
develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS)
consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
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