Minimizing Medical Burnout: Dr Christine Gall On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout
An Interview With Jake Frankel
Optimize Workflows. Identifying opportunities to improve and streamline workflows to keep people from having to do those mundane repetitive tests that take them away from the real gift that they provide patients, which is their knowledge, expertise, and care.
The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example)
What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout?
To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Christine Gall, Dr.PH, MS, BSN.
Dr. Gall is a highly accomplished healthcare visionary with more than three decades of experience in the industry, bringing a wealth of knowledge on Patient Safety and Engagement, Quality, and Public Health. She has extensive clinical expertise in med-surg, pediatric clinical and critical care, oncology, and blood and marrow transplant. As the Chief Nursing Officer at Collette Health, she is the driving force behind clinical innovation initiatives working closely with clients to seamlessly integrate virtual patient safety solutions with the clinical workflows of caregivers on the floor.
Thank you so much for joining us in this interview series! I know that you are a very busy person. Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I grew up in a suburb just North of Milwaukee. The population was only 9,000, and it was a very small and historically rural farming community. However, it turned into a destination for folks who wanted to take day trips. I have four brothers and most of my family are self-employed and own businesses. So I grew up thinking about things from the perspective of finding opportunities, and what impact could I have. Academically, I did fine and I was really into sports. I played three sports: volleyball, basketball, and fastpitch softball, and two of my teams went to the state tournament. That team sport concept really taught me some great life lessons like how to win, how to look at things from a team perspective (winning and losing together), how you cover for somebody when they’re stumbling, and how you celebrate somebody’s success or development. I think that was a life skill as a leader that I really took to heart. I realized very early on that the good leaders on the court or on the fields were those who were always giving themselves to help and elevate everybody around them. Because as everybody elevates so does the leader and so does the outcome.
What or who inspired you to pursue your career? We’d love to hear the story.
I decided to go to the University of Wisconsin-Milwaukee for higher education. I always knew I was going to do something in healthcare. I settled in on nursing because my father has a couple of chronic diseases and over the years he was hospitalized a fair amount. During that time I saw how the physicians were episodic. I had originally thought I was going to go to medical school, but as I saw what the nurses did for my dad and their impact, it really spoke to me. So I went to UWM and graduated from the School of Nursing. During that time I had the opportunity to have a clinical at Children’s Hospital of Wisconsin, and I was sold. I only applied at Children’s because I had decided that if I could not be a pediatric nurse clinically, I was going to find another career. That’s what I really wanted to do. It was tough timing because there was actually a surplus of nurses at the time, which made getting positions a bit of a challenge. So I was so thankful that I ended up on a cardiac surgical floor caring for kids who were born with genetic heart defects. That was just a fantastic time in my career.
About six months after I started in nursing we moved to a brand new campus and my unit became an intermediate ICU where we took care of critically ill patients. During that time there were very few kids that actually were discharged from the hospital. I took care of a little girl who I will never forget especially this one day. It was the first beautiful spring day. It was sunny and warm so I decided to take her outside for the first time. She’d never been outside before. I called for respiratory therapy because we had a policy that you had to have a respiratory therapist come and be with you to transport. But they were busy. I decided I was taking her outside by myself. I took her in her wheelchair with her ventilators mounted on the back and we went outside in front of the hospital. I had brought a little towel and took her out of her chair so she could sit. It was the first time she was feeling the grass. It was just amazing watching her. I also noticed she kept blinking and I thought the sun was too bright, but I realized after watching her a little while it wasn’t that at all. She had never felt the breeze before. She had no idea what that wind was up against her face. Then I heard tires screech on the road about 20 feet away and one of the ICU doctors jumped out of her car and I thought, “I’m so in trouble” but she played with us on the grass. It was such a memorable day for me. Unfortunately, she is an angel in heaven at two and a half years old and I’ll never forget.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
We’re in this unique environment of healthcare that I’ve never experienced in my 35+ years. We have challenges with our workforce, financial challenges that have not recovered since the pandemic with supply chain and operational expenses, and challenges that customers are getting more savvy with how and where they want to access healthcare. All of this, I think, is both the greatest challenge I’ve ever seen, but also the greatest opportunity.
I am fortunate to work with Collette Health. They are one of the most talented groups of people who are mission-driven and totally focused on improving the safety of the patients that we serve and supporting the leaders and staff at improving that care while achieving the best possible outcomes. We’re looking at opportunities to help our nurse customers and leaders identify those patients who could benefit from the added intensity of monitoring and the ability for somebody to observe them for what their needs are and where there might be safety risks. We’re also delving into pediatrics and making an impact in that sector of the industry.
We’re also looking at another challenge that is going on right now, which is the substantial rise in violence against employees and nurse providers. We’re researching how we can leverage our technology to improve security for staff as they’re caring for patients at the bedside. By using trained security staff for observation who are skilled in identifying patients at risk for escalation tactics and securing the area if the nurse or care team member enters the room and is at risk. The ultimate goal is to help a patient stabilize within a very stressful healthcare environment. Those are a couple of the areas that we’re currently working on here at Collette Health.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
I would say the first is that I consider myself a forever learner. I’m never satisfied not knowing something. I always have to figure it out. I think that curiosity and that need to understand something in depth really drove me to continue on with schooling to receive my master’s and doctorate degrees. It also prepared me in a way that I otherwise might not have been able to develop my skills and expertise.
Secondly, I love to create meaning. I approach issues as a blank canvas so to speak and I look at not just areas that are similar to what the issue I might be trying to address is, but looking at my full life experience and maybe even taking something from my personal life, my spiritual life, or a previous role that had nothing to do with what I’m doing now and dive into what I learned, what I could apply and look at things differently. Throughout my career, I think I have self-selected and sometimes been ‘voluntold’ to take on new roles that hadn’t been tried before and that’s been incredibly exciting to me. To be able to create something from nothing and build it to ultimate success. I’ve had many mentors who have allowed that for me, and I’ve loved that.
Lastly, I would say that my ultimate goal in any leadership position is to help everybody around me rise to their personal best and that allows me to do the same. I think it’s a style that has served me well and has been quite well received by the people I’ve worked with.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?
I think the term burnout goes well beyond just being dissatisfied or marginally or deeply unhappy with your work. It is a physiologic condition. That means that you aren’t able to energize and become excited. Hopefully, all of us decide to enter into a profession because we’re excited. In healthcare that means asking, what can you do to make your impact on individuals and populations?
The minute that you lack the ability to restore and refresh and you’re continually struggling to regain your energy, your positivity, your joy for what you do, that becomes more of a physiologic condition than just a mood. I think that that’s an important distinction of burnout.
How would you define or describe the opposite of burnout? From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout? In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
I would say that resilience is the opposite of burnout. That’s a Press Ganey framework so I cannot take responsibility for owning that approach. They have a resilience burnout framework that as a leader you’re responsible for clearing things that increase the burden for your teams. Avoidable burdens that are repetitive and that prevent people from practicing at the top of their knowledge, expertise, and licensure. That’s really a great role of leaders, that if you’re able to clear that and then on the other side ensure that you have strategies in place that take people who are generally satisfied in their careers and encourage development growth for them to achieve their personal goals, the team can ultimately elevate.
However, that’s the balance, it’s like a seesaw. You have to first clear the things that cause the strife and the ongoing concern. When I think about healthcare, it’s the emergence of the electronic health record, which has so many valuable facets to it but also has created incredible challenges to employee workflow for nurses, physicians, and other practitioners. Unfortunately, sometimes solutions include a human factor that wouldn’t have otherwise been necessary. That’s an example of taking somebody from being able to continue to think about the proactive care and management of a patient’s condition to now having to remember to click here, point here, move the cursor to go to another application because you forgot to do that. It all really destabilizes the whole thought process. These are the things that, in my mind, that are really creating burnout.
The acuity of patients is another factor of burnout, as well as their length of stays is shortening. For all the things that you have to do in admitting, managing, caring for patients, and discharging them while the time frame you have to do that work is getting increasingly compressed. All of those factors play a role in clinician burnout.
Another thing I think is important is nurse tenure. When I grew up in nursing, the average tenure of my nurse colleagues was 18 to 20 years and that has reduced steadily. Many nurses decided to exit their careers prematurely, and it takes a while on that novice to expert trajectory to really get your sea legs under you to be able to develop the magic of nursing, the intuition. What I like to say is when you are a seasoned nurse you can walk in and within seconds have done a head-to-toe assessment and that is automatic, you might not even recognize it’s happening, and within a few seconds of entering that room whether somebody needs your attention directly or not and that’s just not something that a fresh nurse typically develops until they’ve had lots of experience seeing different types of patients in different scenarios.
Have you seen burnout impact your own organization? Can you give a first hand description of how burnout can impact the operations of an organization?
I think we all have burnout when you care for and you’re working with patients. Any time that something doesn’t go as well as it can it leads to some challenges or people feeling bad. If I know something like that happens, I like to try and scan the scene and listen for that and make sure that I check in with people and that we really talk about it. That can look like an honest debrief, a learning moment, or discussing what we might have done to contribute differently to an outcome, or look to see if it was system-related that didn’t go the way we wanted and then really dissecting it.
Our organization, and I’m very proud to say, is very transparent and focused on the ultimate goal of providing the very best possible services and outcomes to our customers. Those crucial conversations that we need to have to help lift each other up by first recognizing where we might have had opportunities to do things differently in an environment are very important. So that’s what I aim to do. This group at Collette Health is very dedicated.
Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.
I think it’s really important for individuals to learn their own bodies, the mind-body-spirit, but I think it’s important for leaders to recognize that the work that we do, by definition, is going to lead people to have intermittent stressful periods. Negative outcomes arise that we couldn’t have impacted differently, the worst that you see on the news that you’re trying to deal with, and as a result, I think it’s so very important that we need to look at those opportunities. I’ve spent the last three years of my career looking at the landscape of what’s out there technologically and where we can extend the reach of our very limited resources.
We don’t have enough Behavioral Health Services. We know that; so how do we extend the services that we do have? Services like what we do at Collette Health is just a piece of the entire continuum of care to help our staff. I remember so many times that I would wake up in the middle of the night thinking, did I do this for this patient that I had left my shift from. When I worked with children, I worried about if I was leaving them calm and not crying, fed, taken care of, in a safe space. If I would have had an opportunity to have another person be my eyes when I wasn’t in the room the impact would have been significant on my mental health. It would’ve been less stress to be able to think “I don’t have to get back to this patient” knowing somebody else was there and they would let me know if there was something I needed to do is just priceless. There are many examples where people are trying to solve that problem of access to Behavioral Health Services, resources, products, and solutions that enable the practice of healthcare to be executed in a way that allows for the staff to be resilient and the patients to be satisfied with their care and achieve their best possible outcomes. I believe how we implement, integrate, and align those technical resources and solutions that improve access to Behavioral Health Services are an important consideration for leaders today.
Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?
1. Optimize Workflows. Identifying opportunities to improve and streamline workflows to keep people from having to do those mundane repetitive tests that take them away from the real gift that they provide patients, which is their knowledge, expertise, and care.
2. Get Input on New Solutions. Ensuring that the people who are going to be utilizing any new product solution or service are deeply involved in the planning and implementation. The voice of the people who are actually in the trenches and doing the work really needs to be listened to.
3. Consider Patient acuity. We need to be mindful that as we focus on and develop innovation that shortens the length of stay, the burden of all the care that needs to occur in a shortened window often leads to increased acuity and increased intensity of service. As a result, I think it’s very important that we look at assignments; how they’re made, and what that burden means so that there is an ongoing focus on whether or not a particular assignment enables the nurse and the care team to successfully deploy the entire care management solution for that patient, their plan of care, and leaves the patient feeling that they’ve been cared for in a the best way possible.
4. Find Opportunities for Flexibility. We also need to look for opportunities to give flexibility where possible in things like scheduling and work-life balance. For example, enabling people to flex perhaps between one work setting that might be incredibly intensive, like staffing in the ICU, and balancing that perhaps with the opportunity to do other things that aren’t quite as physically or mentally stressful, but still leverage that person’s expertise. Perhaps a nurse may work one shift a week virtually to support the novice nurses, helping them with their assessments and virtually helping them determine the best strategy to manage their assignment that day. Utilizing that virtual second set of eyes to ensure that the plan of care is being executed, the patient assessment is being done robustly, and that the patient gets the best care they possibly can. The more creative we can be with that kind of balance, which enables people moments to refill their tanks and regain their resilience, is really important.
5. Give Recognition. I think recognition is so important. We have to celebrate what’s important to our patients. We have to share the voice of our patients and all the great things that happened rather than solely focusing on the things that didn’t go well. Celebrate people who have risen to the challenge, who developed a new level of expertise, and who are leading either informally as a colleague or formally by taking on an advanced role. We can’t celebrate enough when it comes to the incredibly important work that happens in a hospital and in other care areas for healthcare.
What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?
Concerned loved ones can play a crucial role in helping someone navigate through burnout by offering understanding, empathy, and practical assistance. Encouraging open communication and providing a non-judgmental space for them to express their feelings is essential. Additionally, friends, colleagues, and life partners can support the individual in prioritizing self-care by encouraging activities that promote relaxation and well-being.
Offering practical support with daily tasks and responsibilities can also help alleviate some of the burdens contributing to burnout in healthcare. It’s important to check in regularly, provide resources for professional support if needed, and encourage healthy boundaries between work and personal life. With the support of their loved ones, individuals experiencing burnout can feel empowered to take steps toward recovery and reclaim a sense of balance and fulfillment in their lives.
What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?
One frequent error is ignoring the signs that you truly have burnout. It’s important to prioritize self-care and many fail to recognize the importance of rest and rejuvenation. People often push themselves too hard, believing that they must continually push through their exhaustion, which only exacerbates burnout.
Another mistake is relying solely on short-term solutions or quick fixes without addressing the underlying causes of burnout. While temporary relief may occur, it’s essential to implement sustainable practices and make meaningful changes to prevent burnout from recurring.
Additionally, individuals sometimes hesitate to seek help or support from others, mistakenly believing that they must cope with burnout alone. However, reaching out for assistance and leaning on the support of friends, family, and professionals can be immensely beneficial in overcoming burnout.
To avoid these mistakes, individuals should prioritize self-care, including adequate rest, relaxation, and activities that bring joy. They should also take proactive steps to address the root causes of burnout, whether it involves reassessing workload or seeking professional guidance.
It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
I was preparing for my first presentation to the hospital Board of Directors in my career at the ripe old age of 31. I had been given the privilege of leading the development of a new program aimed at providing day services for technology-dependent children (like children dependent on ventilators). It was the first program of its type in Wisconsin. I spent hours on slides, my talk track, and the gestures I would make to accentuate certain points. Let’s just say it could have been a cure for insomnia.
Thankfully, my CFO asked me to give him a dry run. Within 30 seconds of my “performance,” he said “Hold on! This isn’t the way you talk about your program Chris! Lose the notes, and talk from your heart.”
I started from the top and shared the story of the evolution of the Pediatric Extended Care program, and stories about how it had impacted the lives of the children in the program, and their families. When I finished, the CFO had a big smile on his face and said, “Now THAT’S how you tell this important story!”
The presentation to the board was painless and I got fantastic feedback. I learned the valuable lesson that it’s the STORY that keeps people engaged. I try to remember that every time I present.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
I thought of a quote that I made into my own version of stationary and it’s by Anne Frank. “How wonderful it is that nobody need wait a single moment before starting to improve the world.”
Just think about somebody writing that as they’re huddled in this tiny little apartment with 13 other people and they can say something so inspirational to improve the world. I used to have it sitting on my desk and it became so faded I couldn’t read the print anymore.
Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
The movement would be to bring medical care, compassion, empathy, and access to needed resources to people where they are and when they need it to avoid things that could have been prevented had they had that access and support in a timely manner.
I think that’s probably the greatest version of an idyllic position that I would like to influence and it’s actually the reason that I decided to go to three different schools in my education. First nursing, then my master’s was in business administration because I wanted to be able to speak that language. Then lastly, I wanted to make a bigger footprint and leave this world a better place if I could, so really understanding and studying population health and public health leadership became my passion. I was fortunate when I was deciding on my dissertation topic I was managing a database for Pediatric Critical Care patients. It was a voluntary database that we used to improve quality for Pediatric Intensive Care patients around the country and ultimately across the world. The state of Ohio wanted to improve their pediatric mass casualty disaster plan. So in 2014, I defended my dissertation on mass casualty pandemics and that led me to a consulting opportunity in 2020 that I couldn’t have anticipated. But I share that because I think that starting conversations that are difficult to deal with and facing challenging questions that those of us who’ve walked a few miles in our professional careers have different insights and the more we share and we think about things in unique and different ways the potential solutions and outcomes can be impactful.
How can our readers further follow your work online?
Christine Gall, DrPH, MS, BSN LinkedIn
ColletteHealth.com
Collette Health LinkedIn
This was truly meaningful! Thank you so much for your time and for sharing your expertise!
