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The burning issue in healthcare

I know what you’re thinking. I cannot read another article on burnout.

But, before you move on, let me highlight some key lessons I have learned discussing the issue of physician burnout with the world’s leading experts.

Let me start by emphasising what this article is not about.

1. Physician suicides – As tragic as this growing problem is, it is unlikely to be the lever that is required to effect the changes we wish to see in healthcare.

2. Mindfulness as a treatment of burnout – As much as I am a proponent of contemplative practices, we need to understand that offering mindfulness classes is likely to make the issue of physician burnout worse rather than better.

Physician burnout is a quality and safety issue

Yes, the welfare of those working in healthcare is of paramount concern and a figure of more than 400 physician suicides a year in the USA alone is unacceptable. But largely this only ever results in a round of concerned statements from governing groups and organisational leaders. These announcements then fade into the background until the next tragedy strikes. Cue another series of concerned statements.

For organisational leaders to sit up and listen, the language must be of the key performance indicators of quality and safety. Physician burnout is tightly linked to several key measures of quality and safety in healthcare. To not address physician burnout is to not address fundamental quality and safety issues in healthcare.

Patients who are managed by burned out physicians are significantly more likely to suffer adverse events; to be less compliant with prescribed therapies; to be less satisfied with their care and even run a higher risk of dying during an inpatient admission. The literature is quite clear here; for every increase in a physician’s rating of burnout, medical errors increase proportionately with it.

Addressing physician burnout is not about having physicians like what they do; it is about delivering safe and effective healthcare. To not address physician burnout is to make healthcare progressively more unsafe and of lesser quality. Unfortunately, to achieve the desired effect of fewer physician suicides we will need to highlight its impact on patients; perverse logic I know, but ironically what is required.

Stop with the mindfulness classes

Acquiring a personal meditation practice is one of the most important skills I have ever developed and, in general, I am a major proponent of contemplative practices. However, to offer this as a solution to those who are burning out in healthcare, routinely enrages rather than enriches physicians.

The reason for this is that doing so shifts the onus of responsibility of tackling burnout, from the organisation to the individual.

The evidence is very clear here. Burnout is primarily caused by the environment in which people work, rather than the personality characteristics of the individual within it.

To address burnout, organisational leadership groups need to change the ecosystem, not the people. To think that a mindfulness class will make a difference is akin to arming someone with a better fire extinguisher as they run into a burning building. What we need is fewer burning buildings, not better fire extinguishers.

Change your mind or your environment

When it comes to changing your environment it may mean leaving a post or even the country, as evidenced by the number of unfilled GP and consultancy posts. Though that may seem drastic, if the ecosystem in which you foresee yourself in is unlikely to change in the near future then try not to be surprised when the inevitable occurs.

Choosing to stay means that one needs to develop a progressive attitude towards the immense task of changing the environment of healthcare; no doubt daunting, but possible in small stepwise increments.

The key to addressing physician burnout is in recognising it as a quality and safety issue, focusing less on the mindfulness classes and more on the ecosystem factors that drive the issue.

Burnout is a quality and safety issue. The question is: Are healthcare systems interested in quality and safety?

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