Overcoming Burnout and Building a Health System Where Workers Thrive

Overcoming Burnout and Building a Health System Where Workers Thrive



In healthcare, burnout doesn’t discriminate – it exists across departments and job titles. Even before the pandemic, healthcare workers faced challenging working conditions that lead to burnout, including working long hours, risk for hazardous exposures, high administrative burdens and other stressors. Healthcare leaders and workers alike need deeper, multifaceted and lasting employer support to reduce burnout and strengthen professional well-being. In this webinar, in partnership with U.S. News and World Report, hear from an expert panel about some of the organizational-level solutions, practices and policies for creating incremental and sustained impact for individual hospitals. The goal is a system where healthcare workers can thrive and be as well supported as those to whom they deliver care.

Learn more at: https://www.cdc.gov/niosh/impactwellbeing

This video can also be viewed at

>> Hi everyone. I'm Liz Whitehead,
Managing Editor at U.S. News & World Report. Today's webinar is focused
on overcoming burnout and building a health
system where workers thrive. This webinar was
developed with support from the National Institute for
Occupational Safety and Health. I'd like to welcome now
Senator Tim Kaine of Virginia, who has been a legislative
leader on these issues in Congress and who will offer
a few introductory remarks. Senator Kaine? >> Liz, thank you. And to all who are participating in this very important
CDC webinar. This topic couldn't
be more important. Liz moderated a similar
panel that I was on about three years
ago, and frankly, the issues aren't
getting better. They're getting more
and more challenging. And that's why CDC's devotion to
this topic is so very important. It's been nearly four years
since the start of COVID-19, and it's clear that
the long-term effects of the pandemic will be with
us for some years to come. I remember saying a
couple of years ago that the day public
health officials declare that public health
emergency is over, there will still
be two significant ongoing consequences. One is the mental health
toll that death and loss at such a massive scale has
visited upon the entire global population, but particularly
upon the frontline healthcare providers who had to
do so very, very much. And the second ongoing
consequence is folks all over the world in this country
dealing with long COVID. I'm dealing with a
mild form of long COVID that I wish I didn't have,
but at least it connects me with those who have much
more serious problems and makes me want to
work on their behalf. But the issue of
healthcare, mental health, wellbeing of our
healthcare workforce is so critically important. We need a healthcare
workforce to last. We have too many hospitals
and other healthcare providers that are experiencing
record levels of vacancy. So the first thing we
should do is make sure those who are making up the healthcare
today have the resources and the support they need. Thanks and calling somebody
a hero only goes so far if you don't provide resources to help them build a
long-term, sustainable career. I am encouraged by some of
the steps that we've worked on together to support
our healthcare healers, including the passage
of my bipartisan bill that Dr. Lorna Breen Healthcare
Provider Protection act, bipartisan, bicameral,
very much focused on a much-needed investment in
the mental health and wellbeing of our frontline healers
and other frontline workers. Lorna Breen, many of you know
her story, a Charlottesville, Virginia, native, who was
working in an emergency room in New York City at the
front end of the pandemic when she was seeing death
at an unprecedented scale, and it was still a poorly
understood public health disaster that was unfolding. She got COVID. She came back to work probably
too soon because she felt such a sense of responsibility
for her colleagues and her patients and her mission
as an emergency room physician. That led her into a significant
mental health challenge, and she eventually
died by suicide at the end of April 2020. But her sister, Jennifer,
and brother-in-law, Corey, basically have devoted
their last years to — in Lorna's honor,
trying to build into our healing
professions a deeper awareness of mental health
challenges, burnout, stress, but more importantly,
what are the strategies that can be undertaken
to keep people healthy and to reduce any
stigma or barrier that healthcare professionals
would feel in seeking help that they need. I'm pleased that President
Biden signed this bill into law last year, and
we've seen real progress from both private and public
sectors and today's launch of Impact Wellness Campaign
is the first federal campaign to help hospital leaders
improve the wellbeing of healthcare workers. I want to recognize so many
organizations in the field who have raised awareness,
who've developed solutions, who shared best practices, and
the first panel of doctors, Dyrbye, Farley, Howard, and
Mutha, who represent some of the organizations that have
really been on the front lines in trying to help us
address this issue. So I want to thank
everybody who's participating in today's conversation. I look forward to deriving
from you the latest thinking about implementing the Breen
Act, but also, the next steps that we can take to make sure that we have the healthcare
workforce that America needs for a long-term future. Thanks so much for being part of
this today, and with that, Liz, I hand it back to you. >> Thank you very much
Senator Kaine for providing such important context
for today's discussion. I'll now turn to my colleague,
U.S. News' Managing Editor, Michael Morella, to
introduce our panel and lead the discussion. Michael? >> Thanks Liz, and thank
you also, Senator Kaine. I'm very pleased to
introduce our panel. You can find their full bios
along with links to past and future webinars
at usnews.com/events, and just one more quick note. We are recording
today's session, and it will be available to
watch on demand on our site. We encourage you to look for
a follow-up email from us and share it with your networks. With us today, I'm pleased to welcome our Dr. Lotte Dyrbye
Senior Associate Dean of Faculty and Chief WellBeing
Officer at the University of Colorado School of Medicine. Dr. Heather Farley,
Chief Wellness Officer at Christiana Care and a
Professor of Emergency Medicine, Sydney Kimmel Medical College
at Thomas Jefferson University. Dr. John Howard, Director
of the National Institute for Occupational Safety and
Health, and the Administrator of the World Trade Center Health
Program in the U.S. Department of Health and Human Services,
and Dr. Sunita Mutha, Director of the Health Force
Center and Professor of Medicine in the Division of
General Internal Medicine at the University of
California, San Francisco. Thank you all so much for
making the time to be with us, and let's jump right into it. Could each of you just
briefly share a little bit more about your roles,
your institutions, and how you're working
to address burnout and improve healthcare,
worker wellbeing. Dr. Howard, maybe we
could start with you. >> Thank you. Thank you, Mike. The National Institute
for Occupational Safety and Health is a part of the
Centers for Disease Control and Prevention that concerns
itself with the safety and health of American workers. And I think we're all familiar
with the tremendous stressors, as Senator Kaine mentioned,
on the healthcare workforce that happened during
the pandemic. And we have a great interest in
trying to assist those workers in their work environment by an
emphasis on what the employer, what the CEO of the
health system, what the frontline supervisor
can do to alleviate some of those conditions that are
associated with the operation and the organization
of work itself, and we've devoted quite a
bit of effort in this area over the years, but I think the
pandemic has only exacerbated all of those risk factors. And so, we're really
thrilled to be able to launch impact wellbeing
and thrilled to join the rest of the panelists to explain
the new campaign to you. Definitely look forward
to hearing more and exploring more
about that campaign. Dr. Dyrbye, would you tell us a
little bit more about yourself? >> Yeah, thanks a lot, Michael. So as a Chief Wellbeing Officer
and Senior Associate Dean of faculty at University of
Colorado School of Medicine, I really oversee our
multi-pronged strategy for how to really create
a work environment which top diverse
talent can thrive. So we're really focusing
on building out initiatives to promote meaning
and purpose in work. as well as growth and
development opportunities for all of our faculty and to
build community, connection, and support, which
I know we'll talk about is really an
important piece of it. And our fourth sort of
operational aspect is really around aligning culture,
values, and actions. So all of this gets implemented
really through a lens of shared responsibility. There's pieces that
every healthcare worker, every clinician, you
know, can do every day. And then there's pieces that
supervisors and leaders, you know, need to do to
really cultivate an optimal work environment. And as an academic medical
center, we work very closely with our clinical
affiliates to, you know, try to improve the
work environment and the clinical practice. But here at University of
Colorado School of Medicine, we're also thinking a lot
about the academic practice, about our learners, and
all the other constituents that we serve in our community. >> Thank you. Dr. Farley? >> Thanks, Michael. So I'm an emergency
physician by training and the Chief Wellness
Officer at Christiana Care, and my role is pretty
similar to Lotte's. But Christiania Care, for those
of you who might not be familiar with it, is a nonprofit tertiary
care academic health system, and we're headquartered
in Wellington, Delaware, while we do have a four
state ambulatory footprint. We have over 14,000
employees, and we call all of our employees,
whether they're caregiver or whether they're
patient facing or not, we call them all caregivers. So if you hear me use that word, I'm talking about
all of our employees. The other thing that I
think is important to know about Christiania Care is
we have a longstanding, strong commitment to the
wellbeing of our caregivers. And I think we've been
pioneering in this field, and one of the keys to that has
been that we build the wellbeing of our caregivers into
our strategic aspirations. And one of our aspirations is to enable every caregiver
to thrive. And that drives how we
approach our work in this area. So in line with this commitment,
it's actually in 2016, that we opened and
established our Center for Work-Life Wellbeing,
and our center's mission is to foster work-life
meaning, connection, and joy. So in my role as Chief Wellness
Officer, I oversee our center and the overall wellbeing
strategy for our organization so that we can ensure that
we're creating that environment where all 14,000 of our
caregivers can thrive. And I know we'll talk more about
how we're doing that as we get into the conversation. >> Dr. Mutha. >> Great. Great to be here with
this wonderful group of people. I lead an organization
called Health Force Center at the University of
California, San Francisco, and we are very much focused
on the workforce quite broadly. We are focused on regional,
statewide, and national efforts to understand workforce
capacity and wellbeing. And both of these are
inextricably linked and affected by burnout. So I know we'll touch on this. And in particular, shortages in
the workforce increase burnout, and burnout amplifies shortages. So there is a cycle to break. The work that I'll highlight
for just very briefly, and we'll talk more about
it later, is in 2021, we interviewed and scanned
the landscape looking at where were the investments that would actually help promote
wellbeing of health workers? Clearly, there's been
a lot of work going on, a lot of activity,
a lot happening at institutional levels and
nationally, and an issue that really drew our
attention was one that was very little
understood experience of middle-skill workers. Now, these are the individuals
whose jobs generally require education that's beyond high
school, but it may be less than a bachelor's degree. They may have certifications
that are vocational, significant on-the-job training,
and previous work experience. So think medical assistants,
nursing assistants, food service technicians,
all kinds of other groups. And what we really, I think,
what were struck by is that they are very — they're
much less well studied, but clearly are experiencing
burnout, as well. And I think we'll have
that conversation. That's what I'm excited
about the NIOSH piece is that it addresses the
workforce holistically because I think we often tend
to focus, understandably, on physicians and nurses
as an important priority. >> Thank you all,
and I think you all and the Senator have
really helped set the scene. You know, a lot of our
audience is deeply familiar with the challenges
that healthcare workers, that caregivers face, and
the working conditions that lead to burnout. I want to just make sure
we have a little bit of time before we move into
some of these solutions that you all have already
started to talk about. Where do things stand today
from your perspective? You know, what does it
look like in the context of this current moment
in the pandemic and the enormous stresses
and strains of recent years? I know that CDC data
released last week pointed out that some 46% of health
workers reported often feeling burned out in 2022, and
that's up from 32% in 2018. So could you all just
help us, you know, further set the scene before
we explore some of the things that are being done
to address it? Again, maybe Dr. Howard,
we could start with you. >> Yeah, I wanted
to sort of carry on with your nice recitation
of our recent MMWR article, which kicked off our campaign. And you referred to,
you know, one statistic, but I want to draw your
attention in that article to the percentage of
healthcare workers who reported feeling burnout
very often during their working week. It went from 11.6% to
19.0% from 2018 to 2022. So it really kind of
spans this exacerbation that we saw during the pandemic. And what's also interesting
there in that same article, there was a decrease in the
odds of feeling burnout compared to between those who did
feel burnout and those who did not experience. And the characteristics of those who did not experience
burnout was, one, if they trusted their
management. So that issue of trust
is extremely important. Two, they had supervisor help. In other words the supervisor
was engaged with the worker in accomplishing the task, and
three, they had enough time to complete their work,
and I think we'll get into the administrative burdens that healthcare workers
now face, which are really
just a tremendous, and the last factor is they felt that their workplace
supported productivity which was an interesting
question to ask them and what that means is their
own productivity, their own quality care of
their patient, for instance, they did not feel
they had enough time to be productive health care
providers, care providers as Heather talks about. And they thought that
that frustration felt very significant to them and led
to their odds of burnout because the reason healthcare
workers go into healthcare is to interact with their patient. And when they don't have
time, when they're frustrated by the administrative
burdens, et cetera, that leads to burnout. So those statistics
that differentiate between those healthcare
workers feeling burnout, and those who did not, I think, are really the foundational
problem statement that we're dealing with. >> I think there, Dr. Howard
brings up a number of really, you know, excellent points. Maybe I'll just take
this opportunity to kind of define burnout, right? Because our, you know, people
who are watching the webinar may or may not sort of know
what we're talking about. And so, the World Health
Organization has defined burnout as really being a
work-related phenomenon. So it happens from
chronic levels of unmitigated work stress. And I think Dr. Howard pointed
to many of those potential, you know, drivers that we'll
talk more about in terms of what contributes to
burnout and, you know, really the remarkably and scary
high prevalence to burnout in nurses, doctors,
and all other members of the healthcare team. You know, from 2011 until
before the pandemic, we were seeing kind of a
nice decrease in burnout in our big national studies of
US physicians across, you know, all specialties, academic
practice, private practices. But with the pandemic, you
know, this dramatic increase that Dr. Howard mentioned
with upwards of 60% of physicians having lots of
this burnout, and Michael, I'd like to just comment on
sort of the, so what, right? Like why is this important? Why are we talking
about this today? Why are we sharing
potential strategies? And it really comes down
to, you know, the patients. So when docs and
nurses are burnt out, we don't deliver as good care. You know, we know that docs who
are burnt out are more likely to commit major medical errors. They're more likely
to be involved in medical malpractice
litigation suits. That level of burnout
in nurses and doctors in the ICU is an independent
predictor of patients dying. You know, whether or not you
get an infection when you're in the hospital is
related to whether or not your nurse is burnt out. You know, there's
multiple things, and related to what Dr.
Mutha was saying, you know, when doctors and
nurses and other members of the team are burnt
out, they're more likely to quit medicine, leave their
job, or even just cut back on the number of hours they're
taking care of patients. So not only do we see quality
and safety implications, but we see big access to
care, and this, you know, costs the United States
healthcare system billions of dollars a year in addition
if you want to look at it through an economic lens. So I think we know
it's a big problem, and we know that it has
really important ramifications to patients, to families,
to all of us as individuals. >> I'm really glad
that you're kind of setting the groundwork
there, Lotte. And what I think is really
important that you said in defining what burnout
is, is also what it's not. So it's not about our
caregiver's lack of resilience or grit or anything like that. And again, both what you shared
and what John shared around, what differentiates those
who are experiencing burnout from those who don't,
again, is not that lack of personal well-being,
resilience. It's more about the
workplace factors. And I'm sure that all of
you have heard me say this, but every time I
get the opportunity, I will say it again. That I oftentimes
use this analogy of the canary in the coal mine. So you can't take the canary,
teach it to be more resilient, shove it back in the coal mine,
and expect it to survive, right? You actually need to
change the coal mine. So yes, we need to attend
to the personal, you know, well-being of our
individual caregivers, but from an organizational
standpoint where our responsibility
is in the environment around our caregivers, the
culture surrounding them, and the efficiency of work
that they're asked to do. >> So let's talk a little
bit about driving, you know, making some of those
organizational changes. You know, I think, I'll
start this way, but again, I welcome insights
from all of you and what you're doing
at your institutions. But, you know, is it fair to say that we've moved beyond
individual resilience efforts and towards this need for
systems-level changes? Dr. Muthu, maybe you could
kind of respond to that and share a little bit
about what's happening and what you're finding with
the Healthforce Center at UCSF. And in particular, I'd
welcome some insights on how social drivers
and social determinants of health are something
that are really important to consider here, too. >> Yeah, thank you. You know, I will underscore
the things that have been said, and I can't underscore
them enough, right, because they're part
of the solution piece. The things that I'll highlight
are the things that I think, as we started to do the
work really focusing on middle-skill workers we
also identified the place where there was less
attention for reasons that we might imagine is
also in safety net settings. So we're talking about our
public hospital systems and our federally
qualified health centers where resources are lean
often to begin with. Not that attention isn't there, and not that interest
isn't there, but resources are limited. And around the social
drivers, one of the things that really surprised
us the most as we were particularly
talking to national groups around middle-skill
workers and others is — and the pandemic
was this unique time where we brought together
work and life outside of work, and it was blurred. And there was an issue
around the social context in which health workers live and work really affects
their health and wellbeing. So that included social needs,
food insecurity, racism, larger policy issues around
payment reimbursement. So we were hearing things
about workers who actually — these are employed individuals
with housing insecurity, workers who had food insecurity. We recently did a survey amongst
our own team members here. We found that up to 40% of the staff reported
some food insecurity. Again, employed individuals
working in healthcare settings. We heard a lot about difficulty
with transportation to be able to get to work in the
pandemic that really magnified when transportation
was often affected. And what we were hearing is that
these social drivers lead to and add to the stress and
contribute to absenteeism. So not being able to show
up to work and presenteeism. Showing up but having
them so distracted that it's really difficult
to do your job fully. So I think it's that the work
context absolutely matters, but generationally,
and maybe the time that we're living through, the
outside and the larger context in which we are doing this
work clearly influences what's happening with wellbeing
and with burnout. >> Dr. Dyrbye, could you
talk a little bit about kind of your dual vantage
point of somebody who's in an operational role within
an academic medical center, but also who has deep research,
experience, and knowledge here? You know, what are some of
the things you've got going on in Colorado but
also that you've seen in your research
and from others? >> Yeah, thanks for
that question, Michael. I mean, I think core to
really addressing the issue of healthcare worker
burnout is you need to have leadership commitment. Right? So whatever type
of clinic or organization that you're delivering
care in, there needs to be that commitment from the top that healthcare worker wellbeing
is really a priority, right? That it's part of sort of that
organizational performance metric, so to speak, right? Because you can't
deliver on your mission if your most mission-critical
asset, your healthcare workers, you know, are suffering from
high degrees of burnout. So that's definitely a key theme
that we see in our research and that we also really
translate into our work here at the University of
Colorado School of Medicine. I think the second
piece is really to have someone driving the
bus, frankly, you know, big, complicated organizations. We have leaders for finance,
we have leaders for practice, for research, you know, we have
quality improvement leaders, and similarly, there
needs to be sort of a leader who's setting the
strategy and getting, you know, all the rowboats are going
in the same direction with optimizing, you know,
the work environment. So, whether that's a CWO or
some other executive, I think, is a really critical
piece, and then, the third critical piece is
really authentic engagement from every member of the
healthcare team to participate and practice redesign, right? It's not about me as the
general internist going into ophthalmology or telling
nursing, you know, Neurology, what they need to
do differently. It's more about having that
boots-on-the-ground sort of swell up, grounds
activity, right? Which is also very much. promoted with the total worker
health framework at NIOSH with the CDC, that
you need to, you know, sort of engage healthcare
workers and discussions around what are their stressors? And also, importantly, what
solutions do they see, right, at the local level within their
own little work unit, you know, and then at every level of an organization all
the way up to the top. And I think, as Dr.
Howard mentioned earlier, it's also very much
about leadership. So the sorts of things
that we see pragmatically that make a difference
is leadership development around sort of wellness-centered
behaviors and then practice changes,
whether that's, you know, modifications to the
electronic health record, to in-basket management,
all the way to advanced care team models, like who do we put
on our team, right? When you go and see the
doctor, who do you see first? What are the members
of the team? Do you see a medical assistant? You know, do you
see a physician? Do you see a pharmacist? Do you see a social worker? Do you see a mental
health professional? You know, who's on your team? And then, there's other
sort of evidence based around using scribes,
which is kind of a work around for the electronic
health record at the moment. There's been studies looking
at professional coaching, which can really help healthcare
workers sort of gain some skills about how to manage
change and lean in and be more effective leaders. And then, I think one of
the other things that we — that was brought up earlier is
we need to sort of have changes within our own culture, right? There's sort of mistreatment
and abuse that goes on of healthcare workers,
and that also really needs to be addressed while we work on
sort of operational efficiencies and leadership development
and each do our part, again, through that really shared
lens of responsibility to improve our work
environment every day. >> So I just wanted
to comment, you know, that's just a fabulous
tool kit, and it's almost like overwhelming in terms of
a healthcare leader in a small, rural hospital somewhere
that's trying to get a handle on this sort of thing. So I wanted to put in a plug
for one of the of the tools that we developed at NIOSH
called the Worker Wellbeing Questionnaire, or WellBQ. And I think it's the first
step in understanding, well, what do your healthcare
caregivers, what do they think about all of these issues? And I think you have to be
able to start with that, and you really have
to have an environment in which they feel free
to be able to express it. So it has to be anonymous,
and our survey is, and that's really
the first step. And I think the other thing
that Lotte mentioned to me that is central to it all,
and we keep coming back to it here today, is the idea
of the healthcare leader, whether it be the CEO
or the department head or the first-line supervisor
engaging with the folks that are providing the care. There has to be that
trusting relationship. And one of the tools that
we're recommending is the use of the Health Action Alliances
Leadership Storytelling Guide. And if you look at
that particular tool, one of the things that I took
away from it is the leader, whoever that is, being able to share their own
mental health issues. Just as they would
share, I broke my leg because I fell off my
bicycle over the weekend, they would be able to share
with their workers, you know, issues related to
their own stress levels or their anxiety levels or
their fear of being burned out, et cetera, to be able to
actually have that connection and storytelling is
the way we all relate to whatever we're watching on
Netflix or any other channels. So the idea of a leader
telling that story, I think, is extremely important, their
own story with their workers. So again, it's the engagement. It's the engagement, stupid. There's nothing else better than
that, and I think then you go, once you have that, then all
of the things that Lotte said, all of those issues
then can be attacked from a trusting relationship
with the healthcare worker. >> Dr. Farley, could
you weigh in? Will you tell us about some
of the innovations happening in Christiana Care
and then Center for Work Life Wellbeing there? >> Sure, and I'm actually
going take a cue from John, and because I absolutely
second his opinion that leaders sharing their
own experiences is incredibly powerful at destigmatizing
some of the suffering that happens in healthcare. So I'm an emergency
physician by training. I shared that, and we know
that emergency medicine is one of the areas where we oftentimes
see the highest levels of burnout with high workload
and often low resources and a definitely high
exposure to trauma. So many years ago I had my
own experience with this, and I've shared this
with others before, but I think it's important to do
it in a public forum, as well. So many years ago, I was
taking care of, actually, one of our employees,
one of our caregivers, in the emergency department,
and I discharged her from the emergency
department, and she died on the way home from the ED. And obviously, horrible set of
circumstances for her family that as the physician
that took care of her, that was absolutely
devastating for me, as well, and definitely sent me
into a bit of a personal and professional tailspin. And at the time when this
happened, it was a, you know, the culture at that time was one
of shame and blame and silence. And it wasn't — it wasn't okay
to say that you were struggling with something because
maybe that meant that you weren't cut
out for this work. So I didn't talk to
anybody about it. And it took me long time to
get through that and to kind of claw my way back
from the ledge. And once I finally did,
I started to share my, what I had experienced
with some of my colleagues. And I realized that, oh,
my gosh, it's not just me. That there are so many of
us that have these cases and have these experiences, but
we're just not talking about it. And that was a moment
for me that I realized that had a lot of work to do. And we fundamentally
needed to change the culture within my own organization
at the time and in healthcare more broadly. So that was, you know,
really what got me to begin to do this work in well-being and to become our Chief Wellness
Officer and to open our Center for Work Life, Wellbeing. And so obviously, and I've
talked about in our center that sure, we focus on
personal wellbeing, but much, much more so on the
culture of well -being and efficiency of work. And so, what do we mean by
that culture of wellbeing? So that means, you know,
a health system that has that culture of wellbeing
is an environment that actively attends
to concepts like safety, physical safety,
psychological safety, one that fosters camaraderie and
teamwork, equity and inclusion. It's a place where our
employees have a voice and where they feel connected to
a sense of meaning and purpose. And I think, you know,
pursuant to the story that I shared very importantly,
a place where it's okay to not be okay and where stigma around help seeking
is minimized. And so, two of the
programs that we have that I'll just share very
briefly about that are — we're created to
create that environment where it's okay to not be okay. One is our peer support program. So we know that after these
difficult events, counseling and therapy can be very
helpful, but oftentimes, what the caregivers want in the
immediate aftermath is they want to talk to someone who
gets it, who's been there. And so we've trained over
70 peer supporters to serve as that confidential,
friendly ear from someone who's been there to help our caregivers
process the difficult emotions that are often a part
of those adverse events. And we've seen with also a key
component of that program is that it's proactively offered as
opposed to waiting for someone to raise their hand and
say, hey, I'm struggling; I need help, because we know
that that's a huge barrier. And then the second program that I'll highlight
is psychological first aid training. So over the last fiscal
year, we've trained over 50% of our people leaders in
psychological first aid. So we're not asking our leaders
to be counselors or therapists, but what we are doing is we know
that their teams or that people on their teams are struggling. So we're giving them
the skills to recognize when someone's struggling,
to respond effectively, and then to get them connected
with the appropriate resources. And I think those two programs,
both our peer support program and our psychological first aid
training, have gone a long way to creating that culture
of wellbeing and a culture where it's okay to not be okay. >> So I wanted to thank
Heather for sharing that story because it's very powerful. And also, for bringing up a really important
both national policy issue and institutional issue. And that's the stigma issue of a healthcare worker
seeking mental health support. And one of the big reasons,
and I certainly can identify with this also, is that if
you do make your needs known, it can stigmatize you. It can threaten your career. It may even end your job. And then people will say,
well, how is that possible? Well, when you get licensed as a
physician or nurse or other type of professional healthcare
provider, you're often asked on those forms, have you ever
sought mental health care? When you go to get credentialed
in a healthcare institution, a hospital, for instance,
you often see that question, have you ever? And that really, and
everybody knows it; medical students know it, which is why they don't seek
care often, is that you can look at that as a disincentive
to seek mental health care. So there are institutional
arrangements. That is one of the issues that the Dr. Lorna Breen Heroes
Foundation emphasizes is that's got to change or we're
going to make no progress in assuring a health
care worker. Yes, it's okay not to be, okay
and it's okay to reach out. So that stigma is a
difficult, difficult thing, and we hope that our campaign
and impact wellbeing will bring that forward, that
that has to change, and hospital leaders will look at their credentialing
applications. State licensing boards will
look at their applications and be able to remove
those questions because they are destructive for the healthcare
worker mental health. >> Thinking about all of this, do you think the message is
clearer than ever to leaders and providers at hospitals,
and so on, you know, that this is really important? You know, in a lot
of our reporting and webinars we've posted
workforce challenges and staffing shortages are
often the number-one concern that folks bring up. But thinking about
all the nuance that you all are describing, do you think this
message is getting out? I'm sure it's central to
Dr. Howard, the campaign. But could you kind of reflect on
that and maybe where, you know, research and action
and resourcing related to addressing burnout
and helping workers and caregivers thrive is today? You know, maybe Dr. Howard,
we could start with you. >> Yeah, I'll start because
Lotte actually answered that, you know, in two ways. You know, one is the
comparative advantage that a healthcare
institution could have if they become a leader
in worker wellbeing because workers will
flock to work there. They will leave an institution
that does not pay attention to trust in labor
management relationships, that don't take stigma
seriously, that don't support psychological
health, as Heather mentioned. So they — it's a
comparative advantage. And the second issue that
Lotte mentioned is the issue of patient safety. You know, that has been the
major issue in healthcare, right, is the safety
of the patient. And what Lotte said,
there are studies showing that if you don't have a
psychologically healthy workplace providing that
care, the patients get sicker. They get infections, all
of those kinds of things that you mentioned, Lotte. And when you were saying that, I
thought, well, there's a reason to engage in worker wellbeing
by itself, because even if you don't care
much about the worker or have the patient
safety ahead of workers, at least that will be
an advantage to you. That will be an incentive. So I turn it back to Lotte
because she, obviously, raised those issues
and probably has lots of experience in that area. >> Yeah, thanks for that. I mean, I think in
the 20 or so years that I've been doing research in
the field of clinician burnout, you know, we've seen
the story change. You know, so 20 years
ago it was like, there's not such a problem. What are you talking about? This isn't real, right? There was a lot of pushback that
sort of around the what, right? People didn't believe
that there was a problem. Then sort of fast forward, you
know, a good 10 years or so and you start to tell this
sort of so what story, right? Like was pointed out that this
impacts quality, patient safety, patient experience, cost of
care, you know, access to care. And then there's the moral
story, right, that we sort of kicked off with that when
physicians are burnt out or have other forms of
distress, they're, you know, more likely to have
substance use disorders, they're more likely to develop
thoughts of suicide, et cetera. Like there's also this
very personal implications that happen. And so, we've moved from sort
of the, you know, what is it? Like, okay, now we all
buy it, that we know that it's a big problem, we
understand the consequences, and I think many leaders across the United States are
sort of at that, now what? You know, piece of the puzzle,
and I think as we alluded to, there's some low-hanging
fruit and then there's things that are really complicated
because the drivers of workplace stress
are complicated, right? And they come from multiple
factors, your relationships with people in your very
small work environment to how patients, families,
and visitors are behaving, to how your leader
is treating you and whether or not
there's trust. And then there's the external
things outside the direct control of healthcare
organizations, such as credentialing
rules or, you know, medical licensure rules,
CMS documentation rules, quality reporting, right? There's a ton of things that
are also coming from sort of the larger U.S. healthcare
system that is causing, you know, really contributing
to high levels of work stress for all of our caretaking
workforce. >> I would agree with Lotte that I think there is much
greater awareness now, that the what's, and they get
the so what, and there's lots of questions around
the now what? And I have seen, you know, in
my travels around the country and talking to health
executives, there's much — you know, you ask them
what are they most worried about Workforce,
workforce, workforce. So there's definitely
motivation there. But I think what's really
interesting now is the growing financial crisis that health
systems are finding themselves in, even if they began to invest in the wellbeing
of their employees. Now they're facing a
bigger tension there. And there's, I think,
on the part of employees and caregivers, there's a
perceived and real tension between the cost containment
strategies and the investment in the wellbeing of the
workforce, and that this is, unfortunately, leading to some
resentment and even vilification of sort of the business of
medicine and creates this us versus them mentality that ultimately doesn't
do anyone any good. So I'd really love to
see us figure out how to open a different conversation
here, one that captures that interdependence of the different components
of the quadruple aim. We have to have our
health systems in a place of financial sustainability,
of course, and we must provide
safe, quality care. And we've got to — but we have
to do that in a way that figures out how to elevate and not
erode the human experience, both for our patients and
the health care workforce. And so, some of that might be
around some of the efficiency of work opportunities. So we can get ourselves to be more efficient while
also improving how it feels to deliver that care and
how to receive that care. >> Dr. Mutha, could
you pick up on that? You know, I definitely
also would love to get your perspective,
and really, anyone's on what hospitals
that might be limited in their resources can do to
really help their work forces and address, you know, the
needs of their communities. Are there low-cost, high-impact
approaches to make this kind of deep sustained
cultural change, please? >> Yeah, I — all of this, all of this conversation
completely resonates. And I think that
regardless of what kind of health systems we're talking
about, maybe especially though, about poorly or well
less-well-resourced systems like public hospitals and federally qualified
health centers, there is a relentless focus
that I've seen that is on the workers, because without
people you cannot deliver care, most care. And I think that what has been
the focus has been we have to take care of who we have,
in order to retain them, to not magnify the shortages,
because recruitment is so difficult in the setting
of much larger shortages. And the shortages
are widespread. I mean, pick a category
of worker, clinical lab technicians,
there are shortages. And that has huge
cascading impacts on whether or not you can run the test, and
if it can be delivered in time for test results, and what the
ordering clinicians can do. So I think there, that
attention is there. I think that the other
piece that I'll bring in, I want to bring in two things,
and I will answer your question about low-cost ideas,
because I think it's borrowing from other places that have done
this heavy lift in having tools that NIOSH and others
have put in place, so that we're consistently
using similar tools and can then share
what we're learning, as well as what the
interventions are. The piece I want to bring in is
this issue, and I think it came up in one of these
questions around equity, and I think equity has
to be embedded in all of these conversations. Most of our frontline workforce,
the middle-skill workers that I was talking
about earlier, that expand out our care teams,
are racially, ethnically, socially diverse; they're
predominantly female also. So they have added burdens of
responsibility outside of work that do impact their
ability to be at work, whether it's childcare
or elder care. And these individuals are
often not included in some of the interventions
that we're talking about. And oftentimes, this larger
extended team may be taking on additional work to try to
mitigate burnout for clinicians, so inbox management
or things like that. And experience does show, and I think where the
interventions come in, is there some really
interesting work, and it has to still be tested
about wellbeing task force and whether or not they
can help people feel like they have agency
as individuals, not waiting for leaders alone
to set the right context, but having agency for the
things that they can control in their work environment. And I think we have more
to understand about whether or not these relatively
low-intensity task force that our healthcare worker led
can actually help be an asset in addition to the
larger system-wide and policy level changes that have been highlighted
that need to occur. >> I think just piggybacking
off of that, there was a recent publication
by Tait Shanafelt and others at Stanford looking
at exactly, you know, sort of wellbeing
task forces, right? So about, you know, their process is very much
having wellbeing leaders who are trained in all of the
departments and work units and equipping them to be able
to really identify, you know, what are the pebbles in
the shoes and the boulders on the back for that
particular work unit? And then, sorting out what
are the solutions that are in the sphere of
influence of that work unit or that department, feeding
forward the sort of the issues that need to be dealt with kind
of higher up in an organization, and they've shown
in this publication in Mayo Clinic proceedings
just a few months ago, that that process does
make a difference, right? It's not necessarily a super
expensive kind of intervention. It's very much boots on
the ground, you know, grassroots efforts to
improve the work environment. And just kind of before I
pass the baton back, you know, in thinking about the cost,
right, we were talking about how can organizations
afford to do this? It's also a little bit about
how can they not afford to do it, right? So in our research, we've
shown that, you know, burnout is costing organizations at least $7,600 per physician
per year if you just look at burnout resulting in
turnover or reduction in time taking care of patients. If you take that to the level of the U.S. It's costing the
U.S. healthcare system $4.6 billion a year, right? So there's a lot of money
that we're just losing by doing nothing, and when
you have primary care doctors like myself leave the practice
because we're burnt out, that results in an
excess of $260 million of healthcare expenditures. You know, that's
attributable to that. When PCPs, kind of when
primary care physicians, leave their practice
because they're burnt out. So we can't afford not to act. There's a business case for it and there's certainly
a moral case for it. >> We're getting a lot of
great audience questions, and I want to take one now. Dr. Howard, this is for you,
an audience member's response to your comment earlier. So healthcare managers can be
helpful to decrease the burden or stress for healthcare
staff, but how can a manager, a nurse manager, whoever it
might be, do this effectively when they may have 50 or more
staff members reporting directly to them. Is there anything, you know, in
the tools you've shared so far and the impact wellbeing
campaign that you can kind
of reflect on there? >> Yeah, I think the questioner
is getting to the issue of the tremendous burden that
frontline supervisors have in taking care of not only
the direct responsibilities of patient care, but then, you
know, checking in with the folks who are providing that care. How are you doing? Anything you want
to share with me? I know I'm feeling quite
rushed today, blah, blah, blah. That kind of storytelling
where you identify, you know, with the folks that
you are supervising, I think is a great start
because that builds at least what we're talking
about here, engagement, engagement, engagement, so
that it all isn't just business as usual. There's a human element to it. So you're treating that worker as another human being
working together. So I think that would be
sort of a cultural shift that supervisorial folks have to
undertake right at the outset. And sometimes, when
that happens, then the other human being will
respond, and you'll be able to make some progress
in building trust and creating a supported
workplace. >> Another one — >> In our region,
we've really shown that it's not complicated
leadership behaviors. It's not leadership
behaviors that you need to go and get special training for
or somehow carve out, you know, 10 hours of your workday, right? It's pretty simple leadership
behaviors like inspiring people, empowering them, listening
to them, treating them with respect, keeping them
informed, encouraging them to develop their talents, right? Like offering growth
opportunities or saying, wow, you're doing that really well. Would you like to
do more of that? You know, It's not
complicated, right? It's very relational,
and I think, you know, getting to what John
said, these are, it's not rocket science, right? These are sort of
human, human skills, and when leaders
display sort of more of these wellness-centered
behaviors, all healthcare workers
do better. >> Dr. Farley, I want to — >> I think it's really
important, because we know that one of the biggest
reasons for healthcare workers to leave is they're leaving
their supervisor, you know, not just the organization,
but also their supervisor. We know that either
that direct environment, that direct relationship,
is so important. But I think something that we
have to talk about here also is that experience for the
manager, for the supervisor. We are just piling more and
more expectations on them and, you know, often expecting them
to solve all of these, you know, challenges that we have in
the quadruple aim, and so, we've got to think about it. Being clear with our supervisors
around what our priorities are as a health system and that
we are encouraging you, and in fact, expecting
you, to take the time to do these relational
components of leadership, and that that is a priority
over these other pieces. We cannot just keep asking
them to do more with less. So I think I think we have to have real difficult
challenging conversations and internally in
organizations to make sure that our leaders feel that
they have the time, energy, and space to do these
really important components of the work. >> Dr. Farley, I want to turn
to you for another question on policy and advocacy and
explore that a little bit in the, you know, the
10 minutes we have left. But first, I just do want
to acknowledge as someone in our audience writes,
“Thank you so much for sharing your story. It really makes such
a difference in allowing our health care
workers to know it's not — it's okay to not be okay.” So thank you on their behalf. We heard from Senator Kaine
early in the hour, and you know, I think there's some
awareness about the, you know, things happening at the national
level, but let's talk more about that and let's
talk more locally at the state level, as well. Dr. Farley could you kind
of talk a little bit about, you know, your involvement
federally, but also, what's going on in
Delaware and some of the work you've been involved and seen you make
real action there? >> Sure, and so I'll start
with that the state-level because I know we're getting
kind of tight on time. So I think and Taking a cue
from the Lorna Breen Act and all of the great work
happening there That's work that is happening at, you
know, a national level and we all have a responsibility
at a state level to do — to remove any of
those barriers that — to help seeking for
our health workers. So, you know here
in Delaware we — there's kind of a growing
consensus and understanding that the state's professional
licensure requirements, those that require health
professionals to answer some of those intrusive or
unnecessary questions about their behavioral health
conditions in the past, that can have a negative
impact on their health and their willingness to
seek care and treatment. So in Delaware, we worked
collaboratively with a number of key state health
organizations and bipartisan legislative
sponsorship, and happy to report that last year we
passed Senate Bill 300, and this removed mandatory
reporting requirements for physician mental health
or substance use concerns, except in the case
of true impairment. And then, we're taking
that forward. This winter, we'll
build on that momentum and introduce a legislative act that will direct healthcare
professional licensure boards to revise or remove
any of that intrusive or stigmatizing language around
mental health care and treatment from any licensing applications,
and that would be not just for physicians, but for
all health professionals in the state. So there's state-level efforts. And then as I think John
mentioned, there are things that we each need to do
in our own organizations to take a good hard look at their credentialing
applications. And I think the Lorna
Breen Foundation and All In has a credentialing
challenge out there that helps walk you through. And they're happy to work
with you to look at all of the credentialing
applications in your organization and
make sure it's consistent with best practices there. >> Any others want
to comment on kind of the policy or advocacy front? >> I think I'd just kind
of change it a little bit to policies within
healthcare organizations. So one question that often
comes up is, why is there so much more burnout in
healthcare workers of color or healthcare workers who come from historically
excluded groups? And a contributing factor,
there's likely many more that haven't yet been
delineated in the research, but is harassment and
mistreatment, belittlement, that happens in the workplace from a variety of
different sources. It happens more often in the
emergency room, Dr. Farley, and it happens more awfully
to women and to ethnic and racial minority colleagues. And so, health systems,
right, emergency rooms and everywhere else, has
an obligation, I think, to have policies and procedures
in place for how we deal with these workplace issues,
whether they're coming from, you know, other healthcare
workers or they're coming from patients, families, and
visitors, and also making sure that we train our healthcare
workers so that we, you know, know what to say and how
to say it in the moment to protect ourselves, to
protect our colleagues, and to tow the line with, you
know, what are the behaviors that we all should
have, you know, when we're seeking healthcare,
when we're working in healthcare as another important sort of
policy within an organization in addition to this really
important policy work that needs to happen outside
of organizations. >> Dr. Mutha, someone in
our audience asks or says, you know,” I love
what you mentioned about the social
determinants of health. Are you able to point to
any, you know, adjustments or maybe what's been the
kind of biggest adjustment that have helped caregivers in
terms of an intervention related to a social determinant of
health or anything like that?” >> Well, you know,
I think these are — I think the solutions tend
to be very local or regional because of what the needs are,
and there's a real balancing act of identifying social
determinants, helping to mitigate them but
not adding additional stigma for people who are experiencing
food insecurity or issues with transportation
and otherwise. The kinds of things that I've
seen are actually people taking work that has been externally
facing largely, so food, pharmacies, and things
like that, but starting to turn it internally to
face their own populations, their own employees, and
realizing that, perhaps, we can add these
as add-on supports. They are part of a much
broader network of supports that we've been talking about, of policy changes,
trainings for people. Both those are, I think,
some examples of things that are really proactive and
also forward thinking and saying if we're doing — if we're
addressing and trying to mitigate social drivers
of health externally for our patients to be more
holistic in how we deliver care, what of those can we
reasonably also provide to our own employees? And then, how do we do that in a
thoughtful way that doesn't add to the stigma particularly? >> We're running low on — oh. >> Yes. The one other
large piece I'll add, because all of this
work is happening in this broader context. I think a big policy solution
has been trying to work focus on work for shortages. So there are various states who
are — and at the federal level, there are policies and
efforts underway to try to increase the workforce because that is clearly
magnifying this set of issues. >> We are running low on time. I want to squeeze in one
more question, but also, make sure I have some time for a
final comment from each of you. Dr. Howard, it was
mentioned a little bit earlier about physician/health
worker harassment for those who might face mistreatment. I wonder if that's something you
could talk a little bit about, and again, whether there
are tools or resources that NIOSH has to help
institutions and individuals in departments that might
be dealing with this? >> Well, we need another hour
to cover that adequately. I think we all realize, and
certainly, in our MMWR article, you know, we pointed a
doubling of the number of healthcare workers
reporting harassment. And whether it's just a —
I'm not saying just a threat, but a threat as opposed to an
actual physical act, bullying, verbal abuse, other types of
abuse, other types of actions that don't rise to the level
of a battery, let's say. But all of those
things are additive. And again, unless the employer
is involved in saying no, that's unacceptable
in my workplace, and you can report it,
and we will take action to ameliorate that situation. Unless workers have
that trust again, and the employer is engaged
in creating that trust, then harassment actions
just become very, very, very dangerous to that work and to the workforce
that's in that institution. >> We definitely do
need another hour, but I want to at least
take another few moments, few minutes, just to
hear from each of you about something else that,
you know, what have we missed? We've missed a lot, or what
might you want to share or highlight or kind
of reaffirm from some of what we've already discussed? Maybe Dr. Farley, we
could start with you? >> Sure. So I guess the thought
that I'd like to leave you with is a plea for us
to set the bar higher. So we've talked a lot
about decreasing burnout, but I think we, actually, need to help our healthcare
workforce rediscover their joy. And oftentimes, we get joy? Are you kidding me? I'm barely surviving right
now, but this is so important. There's a reason we
went into this work, and it's incredibly meaningful
and incredibly fulfilling. And so, we need to help
people rediscover that. And I'm just going to
leave you with a quote from there is an article
in the IHI publication, I think of early 2023,
and it was entitled, “Don't Talk to Me
About Joy and Work.” And it says, “Far from being
out of touch, leaders who work to reconnect the healthcare
workforce to a sense of purpose and restore the meaning
behind what we do and how we do it are facing some of healthcare's biggest
challenges head on. So I challenge us to
set that bar higher and bring the joy
back into medicine. >> Dr. Dyrbye? >> Thanks, that was a
really great comment. You know, the absence of burnout
shouldn't be what we're striving for, right? It's really a thriving
workforce. I would think I'd conclude
really with pointing people to some great resources that
are out there to learn more. So one is the U.S. Surgeon
General's Advisory Report on Building a Thriving, you
know, healthy workforce, which is freely available,
has lots of great information about what individual
healthcare workers can do, healthcare organization,
the government payers, electronic health record
vendors, et cetera. At the National Academy
of Medicine, there's been really a
collaborative looking at clinician burnout, trying to pull together various
resources and information. So not only is there
the National Academy of Medicine Consensus
Study Report on how to advance a clinician
wellbeing and address burnout, there's also a whole
host of other resources on the National Academy
of Medicine websites that really can be very
pragmatic and useful to organizations, to
individual healthcare workers across the United States. So, in addition to
the CDC NIOSH, to the Worker Health Program
information, I encourage people to look both at the Surgeon
General's Report and then at the National Academy of Medicine website
for more information. >> Thank you. Dr. Howard? >> Engagement, engagement,
engagement. That's the answer. >> Very well said. Dr. Mutha? >> I'll say two quick things. I've been making, I think,
the case for thinking about low-resource settings. I will also say those settings
are incredibly creative, and there's been some
really interesting work around trauma-informed training
for staff as a way to try to balance out some of the
issues we talked about. So, thinking of resources
that can be used to their best possible ability. The last thing I'll end with
is I am hopeful and I — maybe because we need to
be hopeful, but I'll leave with a quote also
by John Gardner who started Common Cause. “We're faced with a series
of great opportunities that are brilliantly disguised
as insoluble problems, and I think we just
need to really continue to be relentlessly
focused, think creatively, and think inclusively
about our workforce. >> Thank you so much. It's a great, great sentiment to
end on, and I really appreciate that feeling of hope and
action and real solutions that you all have shared. And that are out there. So thank you so much, Dr. Sunita
Mutha, Dr. Heather Farley, Dr. John Howard, and Dr.
Lotte Dyrbye for your time, and thank you to those in our
audience for joining us today and for your great questions. Looking forward to
seeing you again soon. >> Thank you very much. >> Thank you.

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