3 Practices to protect your people from toxic stress and burnout

Burnout is on the rise in healthcare. Increased stress and complexity, and the demands to achieve higher productivity are taking a toll. Each year nearly 400 physicians commit suicide, more than double the rate of the general population

. Healthcare workers are also susceptible to anxiety, depression and addiction. What can be done?

One of the most effective ways to address rising pressure on healthcare workers is to foster a life-giving culture of supportive relationships that benefits all, including patients and their family members. The best practices of leading healthcare organizations and recent scientific research provide evidence that an organizational culture which fosters connection among people positively affects human productivity, wellness, wellbeing and overall performance.

Sloan Kettering's Connection Culture

My wife, Katie, was diagnosed with advanced ovarian cancer in 2004, a year after being treated for breast cancer. While she was in the midst of six rounds of chemotherapy at our local hospital that spring, we chose to go to Memorial Sloan Kettering Cancer Center in New York City for a second opinion on her treatment plan.

I expected Sloan Kettering would be a bleak environment that reeked of death and dying. It was anything but.

I'll never forget our first visit. As we came within eyesight of the building's entrance a doorman named Nick Medley locked his eyes on Katie and greeted her like a returning friend. This surprised me, given that people on the sidewalks of New York City rarely make eye contact. Nick was intentionally reaching out to connect with Katie and others whom he recognized were cancer patients.

The security and administrative people we encountered were friendly and helpful, and our oncologist was informative, upbeat and optimistic. I already knew that Sloan Kettering was among the best at treating ovarian cancer. By the end of our visit, I also knew they cared.

Katie went on to do further surgery and chemotherapy at Sloan Kettering. The feeling of connection we experienced made me more optimistic about Katie's prognosis. Earlier this year we celebrated her 12th year of being in remission for ovarian cancer.

Research supports that the medical care she received helped her survive. In addition, research has established that the psychosocial support that came from feeling connected with our family, friends and the healthcare workers we interacted with also helped Katie survive. Observing Sloan Kettering's Connection Culture first-hand and discussing it with a wide range of employees, I know that it is helping healthcare workers too.

Creating a Connection Culture

In the context of an organization's culture, "connection" is a bond based on shared identity, empathy and understanding that moves individuals toward group-centered membership. Organizations with greater connection experience five benefits that add up to a powerful source of competitive advantage:

1. superior cognitive and physical performance of employees,
2. higher employee engagement,
3. tighter employee alignment with organizational goals,
4. better communication that helps improve decision-making, and
5. greater employee participation in efforts to innovate.

Certain collective beliefs and behaviors promote this bond of connection among people. There are three distinct elements in a Connection Culture that can be summarized as the 3V Leadership Model, with the 3V's being Vision, Value and Voice. Each V provides a practice that protects people from stress and burnout.

1. Communicate an Inspiring Vision

Vision exists when people in an organization are motivated by the mission, united by the values, and proud of the reputation. The M.D. Anderson Cancer Center has a strong vision summarized in the phrase "making cancer history" that appears as part of its logo. M.D. Anderson has a reputation for being one of the leading cancer research centers in the world. Its vision provides an enormous source of pride to its employees and it helps connect them.

Vision also includes an organization's values--its core beliefs about the ways it goes about doing its work and, by inference, the ways it deems as unacceptable. For example, many healthcare organizations embrace the values of excellence, integrity, respect, and caring and compassion for patients and their families. Leaders are responsible for making these values clear. They do this by articulating them in word and deed. Because Vision leaks as people get caught up in the day-to-day tasks and lose sight of it, leaders must regularly communicate the Vision.

Most healthcare organizations are strong when it comes to Vision because workers see they are making a difference in the lives of people. Unfortunately, because of the stress on people in healthcare organizations, most are not very strong at embracing the next two elements of a Connection Culture.

2. Value People

Value is the heart of a Connection Culture. Value exists when everyone in the organization understands the needs of people, appreciates their positive, unique contributions, and helps them achieve their potential. People in a Connection Culture value others as human beings and treat them as such rather than being indifferent to them or treating them as means to an end.

Dr. Herbert Pardes is a great example of a leader who promoted Value in a healthcare culture. When he was president and CEO of the not-for-profit New York–Presbyterian Hospital, Dr. Pardes devoted time to make bedside visits to patients, something that other senior leaders might dismiss as inefficient. He understood that walking the talk influenced his colleagues.

Dr. Pardes valued employees. He put practices in place to assure that people who worked at New York–Presbyterian were caring individuals and that they would be engaged at work. He advocated that everyone should have personal and professional mentors, and he strived to help the people he led balance their personal lives and professional growth. To extend the feeling of connection outward beyond the staff, he encouraged members to memorize the names of patients as well as their family members.

By combining Value in the culture along with sound management practices, Dr. Pardes and his leadership team turned around the hospital system. New York–Presbyterian's revenue rose from $1.7 billion in 1999 to $3.7 billion in 2011. Although most hospitals were scrambling to attract and retain nurses, New York–Presbyterian's vacancy rate for nurses was less than one-third the national average. The New York Times observed that while "most urban hospitals have struggled, New York–Presbyterian has thrived."

3. Give People a Voice

The third element of a Connection Culture is Voice. This element exists when everyone in the organization seeks the ideas of others, shares their ideas honestly, and safeguards relational connections. In a culture with Voice, decision-makers recognize that they don't have a monopoly on good ideas so they are intentional about keeping people in the loop on matters that are important to them, and seeking their ideas and opinions to get different perspectives.

The Cleveland Clinic boosted Voice in its culture by holding Cleveland Clinic Experience workshops in which 40,000 physicians, nurses, environmental service workers, administrative and other staff sat together and had conversations on the patient experience they aspired to deliver.

The Science of Connection

Research shows that chronic stress damages telomeres, the caps at the end of chromosomes, by shortening them. This damage weakens the immune system and promotes rapid aging. Conversations in which people experience mutual empathy and emotional support release telomerase, an enzyme that heals damaged telomeres. A culture that fosters connection can play a role in healing the corrosive effects of stress, literally.

When the human body is in stress response it over-allocates blood, glucose and oxygen to the body's fight or flight systems, at the expense of parts of the brain that affect memory, the digestive system, the immune system and the reproductive system. Connection has been found to help keep the human body in a state of balance or homeostasis. Connection also helps prevent the "amygdala hijack," in which brain activity shifts from the cortex (where we make rational decisions) to the midbrain (where there is a greater probability we will make rash decisions).

Other research studies support the positive effects connection has on organizational performance. Compared to organizations with connection/employee engagement scores in the bottom quartile, organizations with top quartile scores have been shown to experience 2.5-4.5X greater revenue growth, 21% greater productivity, 22% greater profitability, 10% higher customer service metrics, 41% lower quality defects, and 37% lower absenteeism.

Over the last decade, research studies by Gallup consistently show that two-thirds or more of employees in the U.S. are not engaged. They show up for the paycheck but don't give their best efforts. While this may sound bleak to some, I see it as a major opportunity. Create a Connection Culture in your healthcare organization and watch what happens. You will likely see people in your organization experience greater productivity, prosperity, and joy, and your patients experience superior health outcomes.

To get started, download the free 28-page 100 Ways to Connect e-book. The attitudes, uses of language and behavior in 100 Ways to Connect will help equip you to create a high-performance, life-giving culture in your healthcare organizations.

Michael Lee Stallard, writes, speaks, and teaches seminars and workshops at E Pluribus Partners on leadership and organizational culture (mstallard@epluribuspartners.com). He is the author of Connection Culture: The Competitive Advantage of Shared Identity, Empathy and Understanding at Work and the primary author of Fired Up or Burned Out: How to Reignite Your Team's Passion, Creativity and Productivity.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.​

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