Minimizing Medical Burnout: Eric Burch Of Vizient On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout

An Interview With Dan Rodrigues

Quality. Burnout increases the risk of patient safety events and lowers a clinician’s ability to show empathy, which can result in poor patient satisfaction. Research also shows a “contagion effect,” with burned out healthcare workers impacting other team members, which can magnify the negative impact on patient safety and experience.

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 Eric Burch MBA, RN, FACHE Executive Principal, Operations and Workforce, Vizient, Inc.

Eric leads Operations and Workforce services for Vizient. He brings more than 25 years of healthcare experience focusing on innovative healthcare delivery models; clinical quality and operational processes and structures; case management and care coordination; value-based care strategies; and workforce innovation. This team focuses on the efficiency and effectiveness of care delivery, including workforce design and engagement.

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 on a farm in the middle of Missouri and I come from a large family, one of ten children. I spent a lot of my time caring for the farm animals and always trying to nurse any sick wild animals I found back to health. My favorite classes were biology and I loved anatomy and physiology.

What or who inspired you to pursue your career? We’d love to hear the story.

Many of my family members are in the healthcare profession. I come from a long line of nurses; nurse practitioners, RNs, LPNs and nursing assistants. I loved listening to the stories they would share and the passion they had for care giving. I remember watching my mom and aunts care for my grandparents at home as their health declined. To me, it was sad and beautiful at the same time. The compassion and expertise these women provided is what inspired me to go into the profession of nursing.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

High reliability as a concept and as an organizational structure is gaining ground in healthcare. Healthcare organizations face significant challenges with workforce retention, emotional exhaustion, burnout and more. Although COVID-19 did not create these challenges, it did amplify them, calling attention to persistent problems — which if left unchecked can cause harm to patients and care teams.

High-reliability principles, when embedded throughout a healthcare organization, can help address the fundamental drivers of burnout, emotional exhaustion, staff turnover and other workforce challenges.

By focusing on the people delivering care and the environment in which they work, organizations can start to lay the foundation for more consistent, high-quality care experiences that meet the needs of patients, as well as care teams. Such a culture is grounded in respect and trust, gives everyone a voice, and emphasizes both accountability and community.

These are not easy times, and urgent needs often take precedence. However, there are some compelling reasons to put this work front and center:

• Our workforce is frustrated, tired and burned out.
• Our care system has been stressed and injured, and we need to get back to surer footing.
• COVID-19 highlighted the instability of our systems and processes, especially when it comes to culture.
• Patients don’t always have the positive and healing healthcare experiences they need and deserve.
• Our historical performance improvement approaches are not producing or sustaining meaningful results.

It’s also worth noting that organizations whose leaders have leaned into high reliability during the pandemic are seeing levels of engagement and dialogue they haven’t seen in recent memory.

At Vizient, we have correlated clinical outcomes data with culture and engagement data to demonstrate why high reliability should be a top priority. For example, data shows that leaders have a profound impact on culture, and there are specific skills, activities and behaviors that influence it — positively or negatively. In fact, we found a 23% increase in SCORE results when leaders provide visible support and feedback to hospital employees.

The SCORE survey assesses organizations around Safety, Communication, Operational Risk, Resiliency/Burnout and Engagement. By connecting the dots between culture and performance, we are helping organizations gain new insights into how culture impacts clinical, operational, and safety performance, as well as workforce well-being. With these new insights, highly targeted and evidence-based improvement strategies can be deployed to strengthen culture and enable higher quality, more consistent care.

A high-reliability strategy provides an evidence-based and systematic approach to achieving and sustaining performance excellence to meet the needs of patients and care teams. It encourages organizations to look more holistically at how culture serves to drive performance and workforce well-being. By adopting high reliability principles across the organization, from the board room to the bedside, a more mindful, respectful, trusting, engaged and collaborative work environment emerges. And who would not want to work in and be cared for in that kind of organization?

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?

Integrity: Great leaders demonstrate integrity in all their actions. Make sure you are modeling moral clarity to your employees and colleagues. Integrity will help you earn the respect of your employees and motivate them to work ethically. I have found that integrity is essential in building trust, open communication and accountability.

Emotional intelligence: Leaders should check in emotionally with their employees from time to time. Be aware of any emotional strain and provide support for employees facing challenges. Good leaders develop emotional intelligence along with business intelligence. When rounding on my nursing units, this trait was essential to identify challenges, stressors, and my team’s wellbeing.

Empowerment: Empowerment allows employees to be creative. Empower your people and show that you appreciate and respect their work and contributions. Create an environment in which your employees feel excited to try new procedures or practices. I learned early on in my leadership career that I didn’t have to have all the answers or solutions to problems. Empowering my employees led them to owning our practices and increased overall engagement.

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?

A few years ago, the World Health Organization redefined burnout as not a medical condition in and of itself — but rather an “occupational phenomenon” affecting health. The symptoms of burnout result “from chronic workplace stress that has not been successfully managed.” This change of definition moved away from it being described symptomatically “emotional exhaustion, depersonalization and lack of accomplishment” and has led organizations to begin looking at the causative factors.

How would you define or describe the opposite of burnout?

I would use the word engaged to describe the opposite of burnout. Engaged clinicians no longer consider work as a burden and find fulfillment and joy in their workplace.

From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout? (Try to identify 3–5 with short descriptions where necessary and data or anecdotes if possible)

Physicians, nurses and other caregivers who experience stress and burnout often feel as though they are letting down their patients, families and colleagues. Three common causes that we see are:

• The work itself is a big contributing factor to burnout. Sub-optimal organizational design and processes lead to burned out and ineffective clinicians. Administrative tasks, duplication and lack of automation get in the way of clinicians doing what they love, caring for patients. Let’s also not dismiss that we are dealing with life and death issues in our day-to-day work.
• Organizational factors also drive caregiver burnout. These factors include productivity expectations, team structure and support, equity and whether scope of practice matches education and competencies.
• Culture can lead to significant burnout. Organizations that struggle with leadership, inclusivity and effective communication tend to see higher rates of turnover and burnout.

As part of our Clinical Team Insite Program, we surveyed physicians and Advanced Practice Providers (APP) to understand how much of their time was spent on administrative tasks. We found that physicians spent 24% of their full-time employee (FTE) hours and APPs spent 38% of their FTE hours on those tasks. If organizations improved their workflows to reduce the administrative burden and allow these clinicians to work at the top of their license, it would result in the physicians being able to see 528 more patient visits per year and the APPs 836.

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 would answer this question first from the perspective of what you have most seen among the members you work with and then offer a specific example or two that stands out for you to make the perspective real for the reader)

Over the years, I have seen how burnout can affect operations and outcomes for employees and patients. During the time I worked at a hospital, one of our nursing units was really struggling. This unit had the highest turnover, call-ins for days off and patient falls. While the opposite was the case in similar units on other floors of the hospital. Looking at employee engagement scores, it was no surprise to see this unit at the bottom, and the survey identified leadership and communication issues.

In February 2021, The AHA Physician Alliance published the Well Being Playbook 2.0. Their insight on how burnout impacts the operations of an organization are in alignment with what we see across our member organization. Their key takeaways are as follows:

Quality. Burnout increases the risk of patient safety events and lowers a clinician’s ability to show empathy, which can result in poor patient satisfaction. Research also shows a “contagion effect,” with burned out healthcare workers impacting other team members, which can magnify the negative impact on patient safety and experience.

Financial. Burnout causes reduced job productivity and higher rates of turnover. With an average of $500,000 to replace a physician and $88,000 to replace a registered nurse, organizations face substantial replacement costs that could be avoided.

Physical Health Consequences. Burnout has been associated with an increased risk of chronic disease, including hypertension and diabetes.

Psychological Health Consequences. Rates of depression and alcohol abuse are higher among burned out health professionals. For physicians, burnout was linked to 200% increased odds of suicidal ideation.

Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it. (If you have direct experience in a hospital and can offer insight, please include that. If you have examples of the types of resources providers and clinical staff NEED but may not be getting that could be an angle here

Across the country, I am seeing organizations invest in mental health resources beyond the traditional employee assistance program services provided. Many are employing mental health experts and life coaches to work with clinicians one on one. In addition to the mental health resources, healthcare organizations are providing wellness services to include yoga, nutrition classes, meditation and gym facilities.

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.

Yes, I agree that streamlining operations and leveraging digital transformation and automation processes will help ease the workload of providers and clinical staff. In a recent executive briefing, my colleagues at Sg2 discussed leveraging artificial intelligence (AI) and automation as a strategic workforce investment. Their key takeaways were:

• AI and automation solutions for healthcare have seen meaningful development and are now poised for impact across the enterprise.
• AI will not drastically impact head count but will allow the current workforce to operate more efficiently and reduce burnout.
• Thorough vetting of the technology and transparency into AI algorithms will be key to gaining clinician buy-in.

AI applications and automation support numerous care redesign approaches. What once seemed like Star Trek technology has graduated from innovation center pilot to system-wide initiative. Now is the time to deploy AI to automate repetitive work and cut through healthcare’s vast data deluge to truly streamline administrative functions and support clinical decision making.

Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?

Culture strategy

First and foremost, organizations must work within their cultures to become one of the best and most successful places to work. The following principles are key:

• Match strategy to culture.
• Focus on a few critical shifts in behavior.
• Honor the strengths of the existing culture.
• Integrate formal and informal interventions.
• Measure and monitor cultural evolution.

In my experience, culture trumps any strategy. Interventions to improve burnout will only go so far unless the organization is committed to making employee wellbeing a priority. Changing an organization’s culture is not an easy task to undertake and requires an investment in leadership, employees and processes.

Leadership interventions.

This is a critical, if often overlooked, component of a comprehensive burnout prevention program. It includes:

• Creating a chief wellness officer position.
• Engaging stakeholders in efforts to create a culture prioritizing wellness.
• Sponsoring dedicated, interactive physician leadership academies to provide leadership training.
• Developing an advisory council made up of a dozen appointed “physician well-being champions”.

The old adage, “Employees don’t leave a job they leave a manager” is usually right on the money. What I have found over my career is effective leadership is not just how well you manage an area or a group of people — it is how you lead. Successful leaders listen to their employees and have a high level of emotional intelligence. As a leader, I dedicated several hours a day to rounding on my units. It was a time for me to be present and to listen to the staff. These rounds gave my great insight into things that were causing my clinicians stress and allowed them a mechanism to be heard.

Organizational interventions.

• Reducing administrative burden by optimizing technology (screen workflow redesign, standard order sets).
• Enacting policies to support work-life balance (use of scribes, scheduled time for documentation, part-time work options).
• Engaging providers and clinicians so they have a clear voice in clinical issues.
• Redesigning doctors’ and staff lounges to promote collegiality.

Since the pandemic, I am seeing many operational interventions being deployed across organizations. Their goal is to support clinicians, give them a voice in how to change workflows and make the work easier. There has been a real focus on reimaging care delivery through the use of technology, creating a team approach and redesigning processes to allow clinicians to work at the top of their licenses.

Individual interventions

• Offering a confidential 24/7 physician and employee assistance program with peer coaching, counseling and concierge services.
• Fostering a sense of community and empathy with other providers, including physical and social activities.
• Exploring cognitive behavioral therapy approaches.
• Enabling physicians to practice mindfulness, stress reduction, and healthy sleep and exercise habits.
• Training in patient communication techniques.

As I mentioned above, organizational interventions are key to decreasing stress related to work being delivered. At the same time, we must also provide individual interventions to our employees. The symptoms of burnout and coping mechanisms vary by individual. These interventions provide employees individualized resources that are confidential and customizable to their needs.

Address system issues

Focus your organizational efforts to address burnout on system issues that are the primary drivers of this problem verses an individualized approach.

What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?

The first thing is to be there for them. Be tactful about what you are going to say before you approach them. People who are stressed can be irritable and impatient at times. If they are willing to open up, listen to them, don’t judge and make them feel heard and understood. Be patient and don’t push your advice at them. It is good to help them help themselves and feel free to point them to professional help if needed.

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?

I think the first mistake people make is ignoring the symptoms. Burnout develops overtime and many people ignore the physical and psychological symptoms that if manifests. If you have been ignoring burnout, focus on the three A’s, acknowledge, accept and act. The second mistake is waiting for the environment to change. Look at the things you can control within your work environment and come up with an intervention to decrease stress. In several situations, improving your environment could mean a career change. The last mistake that I see is when clinicians try to treat the symptoms of burnout instead of focusing on the causes. These coping methods could be substance abuse, anger, self-isolation, and self-harm to name a few. A better approach is to focus on proactive heathier coping methods such as, exercise, therapy, meditation, diet.

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?

When I started out as a new nurse, one mistake I made was feeling guilty when our ICU unit was short staffed. I would get a call from the manager begging me to come in. I hated the thought of my fellow nurses working short staffed and putting the patients at risk. Because I would always agree to come in, I was always the first person they would call. After several months of this, I started to dread coming to work. I still loved what I did and enjoyed my coworkers, but I was having difficulty sleeping, I was irritable and had no energy. One morning, as I was driving home from work, I fell asleep at a stop light and rolled through an intersection. I woke up in time to narrowly miss oncoming traffic.

After that incident, I realized that I owed it to myself to know when to say “no.” The stress of working so much was really impacting my wellbeing and could have resulted in harm to myself and others on the road and in the ICU.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

“I’ve learned that no matter what happens, or how bad it seems today, life does go on, and it will be better tomorrow.” — Maya Angelou

This quote by Maya Angelou resonates with me because if you are facing burnout, things can really seem hopeless, and you feel that you have no control. It’s important to realize that no matter how bad it seems you have the power to make tomorrow better.

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.

If I could inspire a movement, it would be Clinicians — Care for Yourselves. I don’t believe that this is a brand-new concept, however, many of us fail to do just that. To be the most effective caregiver, we must take time to care for ourselves. Make a list of the activities that make you feel your best and put them on your calendar, don’t feel guilty to say no to that extra shift or guilty to use your time off and surround yourself with family and friends that inspire you and know how to enjoy life.

How can our readers further follow your work online?

My colleagues and I regularly publish through our company newsroom. You can follow us on LinkedIn or Twitter. Or you can subscribe to our newsroom.

This was truly meaningful! Thank you so much for your time and for sharing your expertise!

About The Interviewer: Dan Rodrigues is the Co-Founder and CEO of Tebra, a leader in practice growth technology and cloud-based clinical and financial software for independent practices. With an all-in-one, purpose-built platform to drive practice success and modernize every step of the patient journey, Tebra provides digital tools and support to attract new patients, deliver modern care, get paid quickly, and operate efficiently.