In my recent post on the stigma associated with burnout, I shared messages that clinicians learned in training and on the job about self-care, being human, and being vulnerable. Their responses illuminate the toxic culture that exists in our health care system. Turning this culture around should be a top concern for every one of us. As one participant wrote, “The general public should care. Patients have a stake in this. Who will be around to take care of them?”

In this post I’ll focus on some suggested solutions (from me and from participants in the session) to create a more positive environment for care providers, non-clinical staff, and for patients and families.

Create a safe place to connect with peers.
Psychologists tell us that the way to disarm shame is to share the secret with others who can accept it.

• “Share what I learned in this session with my burnout workgroup”
• “Discuss burnout with my team/group”
• “Hold biweekly meetings to let my team know it is okay to discuss burnout”
• Develop a safe space to share feelings of burnout, like a women’s physician group or similar
• Develop peer-to-peer support programs
• Learn about existing examples, such as the Center for Professionalism and Peer Support at Brigham and Women’s Hospital and The Healer’s Art

Foster team and peer relationships

• “Take the principles of self-care and burnout back to my clinic”
• Let team members know they are appreciated; spread gratitude
• Divulge mistakes and struggles with coworkers
• Seek out colleagues who appear to be struggling
• Start a mentoring program

Prioritize and model self-care

• “Allow myself to relax; schedule time to relax”
• “Say no to unrealistic expectations/corporate wants”
• “Be a role model at clinic with self-care and making family a priority”
• “Delegate! Accept help!”
• Model self-preservation and self-care for coworkers
• Practice meditation before clinic or over lunch
• Make time for journaling and reflection
• Make time for exercise, maybe with peers
• Consider working with a personal coach
• Call out unreasonable expectations

Foster culture change

•  “Talk to supervising physician about what she does to cope and prevent burnout; start a conversation about the topic.” (from a premed student)
• Normalize and break the secrecy/silence
• Acknowledge burnout and emotional exhaustion
• Create a culture of openness about these topics
• Support a Just Culture, where errors are met with accountability and system redesign, not individual blame
• Acknowledge and address the negative hidden curriculum in health professional training

Support system/process/organizational change

• Implement system change at clinic: previsit labs, change to team documentation
• Allow time for clinician to use the top of skills only; utilize team to do the busy work
• More involvement of staff and medical assistants in documentation (which would help with physician, staff, and patient satisfaction)
• Assess ways to change workflow to decrease burnout
• Advocate for supportive policies (for example, removal of questions on state medical board applications that ask about past mental health conditions)

Demand accountability from organizational leaders
Effective leaders will:

• Adopt a servant leadership style of leading
• Share their own difficulties to normalize struggling
• Provide support for clinicians dealing with bad outcomes or burnout
• Reduce documentation burden
• Provide support for tasks related to maintaining board certification (time off, money, etc.)
• Provide burnout remediation strategies
• Encourage balance

We all have a stake in turning around the toxic culture in health care, because at some point virtually every one of us is a patient. We can’t make this shift overnight. But we need to start.

Photo credit: Diane Shannon