Imagine the following conversation between a hospital CFO and a hospital CEO:
“What happens if we invest in developing
our people and then they leave us?”
“What happens if we don’t, and they stay?”
The focus on developing people, maintaining engaged employees, and creating a healthy work environment is easy to lose amidst the demand for rapid change across healthcare systems. What would the world be like if this CEO’s sentiment prevailed among all hospitals?
First, we need to understand if burnout is a problem, its pervasiveness, and its impact on patient care.
What are the costs?
Burnout-related turnover has created staggering costs (both human and financial) across the U.S. healthcare system, ultimately undermining patient care. Consider the following human costs:
A Mayo Clinic study in 2012 found that 45.4% of physicians experience at least one symptom of burnout.
- Female physicians have twice the suicide rate of females in the general population.
- Overall job satisfaction for physicians hovers around just 50%.
- 1 in 5 nurses plan to leave their current job within the next year according to one study.
- Hospitals with higher patient-to-nurse ratios have higher levels of job dissatisfaction and higher patient mortality rates.
Further, a study published in the Health Care Management Review found the following financial costs:
- Turnover costs account for 3.4-5.8% of a hospital’s annual operating budget, or $17-29 million on a $500 million annual operating budget.
- Nurse training comprises about 60% of the training budget, or approximately $4 million of a total $7 million training budget, signifying turnover may be contributing to a large portion of this cost.
Poor work-life balance is common
Doctors and nurses often forego the down-time needed to rejuvenate or to deal with the traumatic experiences they encounter, regularly sacrificing their own health and well-being. The threat of malpractice lawsuits creates an environment where perfection is simply expected and successes are rarely rewarded. New EHR systems, changes in workflow, and large patient panels detract from the personal patient interactions that bring them satisfaction in their work. In addition, many physicians have medical school loans leaving them $200,000 – $300,000 in debt. These high-magnitude stressors factor heavily into physician burnout, which can be characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a low sense of personal accomplishment. Burnout can lead to a broken home-life, depression, even suicidal ideation, and is the leading cause of employee turnover for both physicians and nurses. This turnover is evidenced by early retirement and unexplained departures, which have a deleterious effect on teamwork and morale.
As Harvard Business School professor and innovation expert Clayton Christensen might say, “If you want to get a sense of the true values and priorities of the hospitals, take a look at their financials.” The priorities of companies are embedded in their financials. High-performing companies like Google understand that investments are needed to create a truly great place to work. In doing so, turnover decreases, while employee engagement and the quality of their employees’ work increases. Research by the Cleveland Clinic found that for corporations in general, average healthcare costs fall by about $3.37 and absenteeism costs fall by about $2.73 for every dollar spent on wellness programs. These are real returns, so why are initiatives such as these so slow to be adopted in the healthcare industry?
The current “churn and burn” model is unsustainable and prevents the people who are caring for our loved ones from leading a healthy life and performing at the top of their game. It’s not enough for hospital employers to simply pay for an Employee Assistance Program (EAP) to “check the box”; EAPs only help after crises hit rather than by preventing burnout or improving engagement.
Provider organizations must develop proactive and holistic solutions, which might include removing the dis-satisfiers that are within the control of the organization to change, such as:
- Surveying for the exact causes of stress and burnout in the provider pool and address those profit killers with a significant budget and committee that has executive support to act on provider suggestions. Empower the providers to improve care delivery.
- Addressing a poorly designed EHR processes and training. Bring all providers up to “power user” status by design.
- Improving processes to address coverage of duties when an employee is suddenly unavailable to work due to illness.
- Replacing negative cultural norms such as the acceptance of disrespectful communication or rewarding those who work non-stop while punishing those who take breaks in the work-day to re-energize.
- Reducing the administrative burden of highly-skilled workers.
- Ensuring the hiring process places a larger emphasis on hiring for cultural fit.
- Implementing a comprehensive on-boarding process to successfully integrate providers into the hospital system, so they grow deep roots and flourish professionally; this aims to decrease turnover.
- Re-engaging employees to connect again with why they started a career in medicine in the first place.
- Offering services that can realistically be accessed based on the clinicians’ work-schedules.
In addition to removing dis-satisfiers, providers should consider offering personal wellness services such as:
- Marriage/relationship counseling
- Dealing with trauma
- Stress management
- Personal finance
- Time management
- Food and fitness
The hospitals that embark on this journey of creating an engaged workforce to eliminate burnout will be able to attract top talent and will rediscover their true competitive advantage: their people.