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How Can Employers Design an Effective Burnout Strategy for Physicians Amid the COVID-19 Pandemic?

Matthew Gavidia
Utilizing a consistent strategy consisting of 4 key attributes—trust, stability, compassion, and hope—can assist employers in designing an effective burnout strategy for physicians amid the coronavirus disease 2019 (COVID-19) pandemic and beyond, said Vibhas Ratanjee, senior practice expert at Gallup.

Physician burnout is a constant trend that initially showed signs of decline in the past decade, but has resurfaced amid the coronavirus disease 2019 (COVID-19) pandemic. In a study of frontline health care workers responding to the pandemic at its peak in Wuhan, China, more than a third reported cases of insomnia, with those affected also more likely to feel depressed and anxious and have stress-based trauma.

Notably, findings of a recent Gallup survey of 2175 US health care workers indicated that less than half (49%) of health care workers strongly agree that their employer cares about their well-being. This could have major implications for patient outcomes, as health care workers who strongly agree that their employer cares about their well-being were found to be 2.3 times more likely to feel “well prepared” to do their job than those who do not feel supported.

To address these issues, an article co-written by Vibhas Ratanjee, senior practice expert at Gallup, and Karen Drenkard, associate dean of Clinical Practice and Community Engagement at The George Washington University School of Nursing, discussed the importance of employers in promoting well-being for health care workers. In an interview with The American Journal of Managed Care® (AJMC®), Ratanjee spoke on this vital role for employers, as well as key attributes of an effective burnout strategy amid the COVID-19 pandemic and beyond.


AJMC®: Hello, I'm Matthew Gavidia. Today on MJH Life Sciences News Network, The American Journal of Managed Care® is pleased to welcome Vibhas Ratanjee, a senior practice expert at Gallup. Can you introduce yourself and tell us a little bit about your work?

Ratanjee: Thanks, Matthew, and thanks for having me on. So, I work with Gallup and I’ve been working with Gallup for about 20 years based out of our Irvine, California, office. Over the last, I’d say, about 25 years of my career, I’ve worked exclusively and extensively with hospitals, health care clients on a range of different subjects. I work on employee engagement surveys—I do a bit of leadership development and executive coaching, and other culture-based work that is focused really on ensuring that the hospitals are able to focus on key outcomes, health care outcomes overall. So, that’s me.

AJMC®: Can you discuss the threat of burnout among physicians, and how this risk is being intensified amid COVID-19?

Ratanjee: Absolutely, and Gallup has been actually measuring and studying burnout for a fairly long time. I really think it’s a larger issue than just COVID-19. In fact, the 2019 study that we did, we saw that 28% actually reported very often always facing burnout. As you know, burnout is now classified as a disease by the World Health Organization, but we do think that the impact of COVID-19 is really cratering well-being. In fact, Gallup is even measuring the overall life evaluation—so, the percent of Americans who are thriving. We’ve seen that it is at a 12-year low, because that’s as low as the 2008 economic crisis. So, it’s really an issue, in fact, in most of our health care workers, as you all know.

So, we did a survey, a pretty large survey about 2000 health care workers in the peak of the crisis—I’d say in March. When we did the survey, only 1 in 3 felt safe that they will continue to do the job successfully if the outbreak continues, which is really concerning. Only 1 in 2 felt well prepared to do their jobs. So, hospitals must obviously do a lot to focus on physical well-being and safety. I think those are important issues, but hospitals I feel in the midst of the COVID-19 crisis should also focus on overall well-being, because there are other aspects of well-being, like I think financial well-being, a career well-being, community well-being, social well-being, even spiritual well-being.

So, the focus for hospitals amidst COVID-19 should not only be to look at the safety elements, but really larger elements of well-being. I’ll give you 2 more data points which are interesting. One, which is very concerning, only 1 in 2 employees of hospitals feel that their employers care about their well-being right now—that’s a concerning area. What we found interesting was those who said yes, strongly agree that my employer actually cares for my well-being, they were 2.3 times more likely to feel well prepared to do their jobs. So, it’s very important that the focus is on burnout, for sure, but also on resilience and on overall well-being. That's going to be all the more important.

AJMC®:  To build off that, what influence can employers have in assisting health care workers who are on the front lines of the pandemic?

Ratanjee: I think a lot, and I think a lot of health care organizations and providers need to act fast, because the other element we’re seeing is that 78% of health care workers feel that this will have a negative impact on how they feel about their organization. So, this is going to lead to higher levels of turnover, besides just burnout. I’m going to frame this answer in terms of what Gallup has found to be important in terms of leadership as this really is a leadership crisis. So, we did some research to try to understand what followers want from leaders and then, for a lot of research, we found that there were 4 things: trust, stability, compassion, and hope. These are 4 things that followers really need.

I’m going to frame this in the context of what's happening with health care workers, trust for sure. It really is about organizations being crystal clear around expectation, around communication, and on letting health care workers know what’s going on, and what the situation is, for example, in terms of materials and equipment like ventilators and PPE [personal protective equipment], for instance; but here's the data point here, only 1 in 5 felt that they were not communicated with. So, that’s another area. The other one was stability. Only 37 felt that they’ll be able to keep working well, working safely if the outbreak continues. So, there’s a need, again, for assurance for clear direction and a strategy plan. Now on compassion, it's kind of interesting. There’s a lot that can be done on physical well-being like I said, relaxation, meditation, and a lot of providers are providing that, but 1 thing that is very important is financial worry. We think that’s very, very important.

According to the CARES Act, there’s a lot that has been provided, but in our survey, 1 in 3 believe hospitals won’t provide paid sick leave. So, obviously, you can do a lot and invest in well-being, but if you’re not alleviating financial worry, it’s going to be a big issue. In fact, a lot of health care workers, it might be that their spouse has lost their job, for instance. There’s a lot of financial worry that impacts their life. The last one is hope. I talked about trust, stability, compassion, and then hope is to provide this focus on hope. We found a few things that were interesting. One, 58% felt worry the prior day, 63% faced stress the prior day, and what is interesting is 26% actually felt loneliness in health care workers.

As you can imagine, a lot of them are self-isolating. They’re staying away from their families, they’re sleeping in their cars, in their garages. So, that’s important, the level of psychosocial support that health care workers will need is going to be very important. In fact, in Wuhan, the epicenter when this happened, 72% of health care workers there, a different study, reported psychological distress. So, I feel that hospitals need to provide hope. They need to provide hope, trust, stability and compassion, and that includes psychosocial therapy importantly. There’s a hospital in New York, who started doing these hope huddles, instead of doing just normal huddles. So, they were talking about things that were working well, they were talking about how many patients went off ventilators yesterday. So, creating and instilling that sense of hope, I think is a primary responsibility as health care leaders.

AJMC®: As you alluded to prior, a recent Gallup poll indicated that only approximately half of health care workers strongly feel their employer cares about their well-being. What implications may this have for patient outcomes?

Ratanjee: I think a massive impact on patients—all the data points I’ve shared with you are really going to lead to active employee disengagement. In a lot of Gallup’s research, we know that if you have an actively disengaged employee, an actively disengaged health care worker, there’s likelihood for active disengagement as far as patients are concerned; but it’s not just that, our research also indicates a direct correlation between burnout and engagement—how engaged you are at work and engagement with a range of outcomes, not only patient satisfaction, but patient safety, safety incidents, readmission, mortality rates. So, if organizations do this well, health care providers do this well, they can impact employee engagement. That’s very important.

I think this impact will really be felt in the long term as a second wave or the third wave likely comes in. Even the second wave of elective surgeries when they come in, they’re really going to overwhelm the system—this is when you need engaged employees, engaged physicians, engaged nurses driving the right kind of physician outcomes. I think this is larger than just COVID-19, and the impact will certainly be felt for years to come.

AJMC®: You touched on this briefly, but can you discuss what steps an employer can take to design an effective burnout strategy?

Ratanjee: I’m glad you’re saying strategy because sometimes burnout tends to be like an episodic event, and suddenly you find out through a research survey that your employees are burnt out when you start putting together a strategy. I really think that a strategy for burnout has to be a long-term strategy. In fact, it has to be at 3 levels. I think there’s an organizational strategy that's required. At an overall level, what is it that an organization must do? And this means that you need to look at systems and processes, you need to look at where you can actually save time, save energy for physicians, as well as, for errands for example. So that’s one, systems and processes.

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