Environmental interventions should take a systemic view and address the key factors associated with burnout, which include administrative demands and unwieldy workflow, excessive and often redundant documentation that largely addresses liability rather than clinical communication, reduced direct contact with patients, and deep seated expectations of herculean productivity .
Systemic interventions that are tokenistic or focused on symptoms alone have limited utility and waste limited resources. For example, numerous institutions have implemented resilience-building tools, physician engagement surveys, physician recognition by way of annual doctors’ day barbeques or golf outings, and the addition of crisis and suicide help lines, but these are far from a systemic cure . Rather, these organizational interventions focus on symptoms rather than on core issues, and as such offer limited solutions.
Licensing bodies constitute a significant stakeholder in the issue of burnout as they obligate prime performance and wellness in order to best serve patients. While physicians do aspire to primum non nocere, the fulfillment of this principle by the standards of today’s regulatory authorities may in fact constitute a source of friction in the conversation about burnout . Prescribing that thou shalt not burnout to physicians predictably interferes with help seeking as self-identification may jeopardize licensure [11, 23, 25, 43]. Accordingly, the recommendations and resources subsequently suggested account for these competing contributors and facets of physician burnout. While an individual medical trainee or practicing physician reading these recommendations may not be able to implement these systemic-level approaches, there is a crucial role for advocacy to implement change at the organizational and systems level.
Local ecosystem (organizational level) changes [4, 5, 9, 11, 15, 26]
Align staff wellness with organizational mission
Institute physician wellness and work satisfaction as quality indicators and identify internal benchmarks
Identify and implement standardized metrics that will enable an assessment of the impact of organizational efforts to reduce and eliminate burnout
Provide safe spaces for physicians and health delivery partners to identify need and utilize internal resources for support
Assess the problem
Implement routine staff engagement surveys with responsive interventions to address findings. Incorporate standardized tools like the ProQol Measure, WBI, or MBI into these appraisals
Identify and utilize standardized metrics that allow ongoing measurement of the impact of efforts to reduce and eliminate burnout
Identify, implement, revise, and refine based on findings of serial measurements
Build community and foster belonging
Move beyond annual staff appreciation days and invest in recurring social events
Provide common break areas in addition to role-specific break spaces
Utilize interprofessional team building exercises and give recognition to teamwork
Provide interdisciplinary break rooms to foster communication and team liaison outside clinical tasks
Acknowledge the contributions of all staff including learners
Implement more tangible and more frequent medical trainee recognition
Implement wellness stewardship as a cornerstone
Appoint wellness officers across the institution, establish a central wellness committee, and integrate the wellness officers’ feedback into organizational development and quality improvement efforts
Provide more robust psychological stewardship programs (See Chap. 10, “Recognizing Compassion Fatigue, Vicarious Trauma, and Burnout”) that invite staff use without fear of penalty in staff members endorsing burnout and psychological distress
Promote professional development
Build capacity through leadership development, internal continuing medical education programs, internal mentorship opportunities, and professional support programs
Develop or partner with clinical fellowship programs for career renewal
Minimize administrative interference with physician autonomy so that physicians can increase direct patient contact time and the time available to attend educational rounds
Recruit with the intention of retention
Develop more robust physician onboarding processes and resources, particularly for newly licensed physicians.
Position interdisciplinary occupational wellness as an organizational target.
Evaluate and monitor the administrative burden on trainees and staff physicians. Identify methods to download unnecessary or excessive administrative tasks from physicians and clinical staff to non-clinical staff. Some institutions have intervened by way of professional scribes and enhanced clerical staff capacity.
Evaluate the organization’s EMR infrastructure for user-friendliness, with the goal of minimizing the volume of documentation, and upgrading or eradicating cumbersome aspects of the EMR.
Provide a work climate of growth and safety across emotional, physical, psychological, and spiritual domains.
Regional ecosystem [5, 15, 43]
Continued increase in regional medical association advocacy for physician safety in identifying and seeking help for burnout.
Maintain a repository of data on organizational health to enable identification of regional organizational champions and detection of effective practices.
Continued quality improvement of the wellness curriculum in medical education and training programs; this should incorporate periodic assessment of learners for indicators of psychological distress and burnout.
Develop more robust physician health programs and build on identified best practices.
Provide direction and encouragement to healthcare institutions seeking to address physician burnout; identify and acknowledge organizational champions.
National ecosystem [4, 5, 9, 11, 15, 23, 43, 44]
Change the conversation at the societal level: increase the recognition of toxic effects of herculean expectations of physicians by health consumers and by physicians themselves
Maintain a repository of data measuring physician health, well-being, and burnout over time to allow action-oriented appraisal of national trends
Continued work on national standards for trainee duty hours so that the same high volume of work is not merely shifted into more compressed duty hours
National standards for suicide prevention and mental health promotion across the trajectory of medical education and training
Denormalization of perfectionism and overachievement ➔ shift the mentality of viewing overwork and burnout as badges of honor and rites of passage
Continued appraisal, recognition, and reform of the hidden curriculum
Increased industry oversight to promote increased collaboration, product usability and durability from EMR vendors as a number of EMR products are unnecessarily complex
Enhance the dialogue with licensing bodies with regards to physician self-identification without undue penalization. Make it safe to seek assistance without penalty
Reevaluate and redesign the physician complaints investigation process by licensing authorities to reduce the duration and undue strain inherent in the process