Issue link: https://beckershealthcare.uberflip.com/i/821337
75 FINANCE CMO / CARE DELIVERY Hospitals Are Getting Physician Burnout and Engagement All Wrong — Here's Why By Tamara Rosin P hysician burnout poses a threat to cli- nicians' well-being, patient care and the hospital bottom line — and it's on the rise. Healthcare administrators are pay- ing increasing attention to what many have deemed an epidemic of physician burnout, going so far as to enlist consultants to assess and prescribe necessary interventions. Un- fortunately, many of these efforts fail to ac- curately diagnose — and subsequently, help heal — burnout. Failing to properly measure and remedy phy- sician burnout enables the condition to fester and grow. According to Medscape, the overall burnout rate across all physician specialties in 2013 was 40 percent. at figure has risen sharply since then. In 2017, Medscape's annu- al physician lifestyle survey found 51 percent of physicians reported experiencing frequent or constant feelings of burnout. In addition to the direct mental health ef- fects of burnout, such as depression and compassion fatigue, it is also associated with increased medical error rates, heightened malpractice risk and physician turnover, which drive up costs and can be calamitous for patients. Burnout is also associated with physical symptoms in those who experience it, such as headaches, gastrointestinal disor- ders, muscle tension, hypertension and sleep disturbances; as well as negative job respons- es, including job dissatisfaction, reduced commitment to the organization, absentee- ism and increased turnover. Emerging research suggests burnout might be better classified as a chronic condition because only about one-third of afflicted physicians ever fully recover from severe burnout, and it typically takes five to 10 years to do so, according to a 2015 article published in the Journal of Hospital Admin- istration. Thus, the urgent need to identify and address factors that contribute to burn- out cannot be overstated. However, many well-intentioned health sys- tem administrators and physician leaders have failed to accurately measure and con- front the rising epidemic. e reason stems from the way some surveys define and mea- sure burnout. Burnout, defined e prevalence of burnout has made the term ubiquitous — so much so that "burnout" is of- ten used inappropriately and its true meaning is obscured. High stress alone doesn't equate to burnout, for example, nor does physical exhaustion, though both are contributing fac- tors. Social psychologists Christina Maslach, PhD, and Michael Leiter, PhD, professors of psychology at UC Berkeley and Wolfville, Canada-based Acadia University, respec- tively, are considered the pioneers of orga- nizational burnout research. They define people's relationships with their work as a "continuum between the negative experi- ence of burnout and the positive experience of engagement," according to their jointly authored article, "Early Predictors of Job Burnout and Engagement." In effect, burnout and engagement are oppo- sites. ere are three interrelated dimensions of the burnout-engagement continuum, ac- cording to Drs. Maslach and Leiter: exhaus- tion-energy, cynicism-involvement and inef- ficacy-efficacy. e exhaustion factor represents the basic overexertion component of burnout: "It refers to feelings of being overextended and deplet- ed of one's emotional and physical resources," the authors state. Cynicism, also referred to as depersonaliza- tion, is the "interpersonal context dimension of burnout and refers to a negative, callous or excessively detached response to various as- pects of the job." Finally, inefficacy, or the feel- ing of diminished accomplishment, refers to the self-evaluation dimension of burnout and includes feelings of incompetence and lack of productivity in one's work. On the opposite end of the continuum, the positive components of each dimension of burnout together produce engagement, which Drs. Maslach and Leiter define as "an energet- ic state of involvement with personally fulfill- ing activities that enhance one's sense of pro- fessional efficacy." Exhaustion is the most widely researched and reported component of burnout and is likely the one most people think when they hear the term. However, exhaustion alone fails to address various critical aspects of the relationships people have with their jobs, ac- cording to Drs. Maslach and Leiter. ey state: "Exhaustion is not something that is simply experienced — rather, it prompts actions to distance oneself emotionally and cognitively from one's work, presumably as a way to cope with work overload." It's important to note one need not experi- ence all three components of burnout to be at risk for the condition: "It is reasonable to assume that the appearance of high scores on one dimension of burnout, but not the others, could be an early warning sign of impending problems," Drs. Maslach and Leiter write. In particular, exhaustion and cynicism are the two primary measures of burnout because they tend to both be present in those who are burned out and tend to fade away in those who are engaged. According to Drs. Maslach and Leiter, exhaustion and cynicism oen mutually reinforce each other, with a sense of inefficacy arising as a result. Measuring burnout: Why some as- sessments fail e practical significance of understanding the burnout-engagement continuum, accord- ing to Drs. Maslach and Leiter, is that engage- ment is the main objective of any burnout intervention. But before hospital leaders can develop and implement an intervention, they must first accurately assess the problem. is is where many organizations — includ- ing consultancies — get tripped up. With the understanding that burnout and engagement operate on a continuum, some leaders reason they can use engagement surveys to deduce burnout levels. For many years, this was the case at Roanoke, Va.-based Carilion Clinic. e nonprofit health system, which employs 685 physicians across 240 practice sites, has administered a variety of engagement evaluations over the last several years, including proprietary sur- veys from healthcare and workplace consult- ing firms. e results of these surveys indicat- ed Carilion's physicians were highly engaged, but the results of the recently administered Maslach Burnout Inventory — which is rec- ognized as the leading measure of burnout — revealed 59 percent were burned out. A burnout rate of more than half raised serious concerns among the health system's leaders, as well as confusion. "Imagine our surprise when our physician scores on the [Great Place to Work] survey were very high — almost in the category to qualify as a Great Place to Work," Patrice Weiss, MD, CMO at Carilion Clinic, wrote in an email. "e [physician burnout] data were