Billings Clinic, Aspirus share their framework for curbing burnout

Burnout in healthcare employees has been one of the most disruptive forces in hospitals as front-line employees battle the COVID-19 pandemic.

Burnout causes healthcare workers to quit, and nearly one-third of nurses cite it as the reason for leaving their job. It also brings up questions on how clinician burnout affects patient safety.

Hospitals and health systems are looking for ways to reduce burnout in their staff and protect the well-being of their employees.

Scott Ellner, DO, CEO of Billings (Mont.) Clinic told Becker's it's his primary responsibility to care for [his] employees and make sure that their well-being is maintained. 

"We are seeing burnout manifest itself in a number of ways, including decreased employee engagement, lack of desire to move into leadership roles, challenges with staffing and people considering leaving healthcare," he said.

At the Montana health system, he is seeing three main causes for burnout: increased demands from COVID-19, short-staffed hospitals and higher-acuity patients.

Dr. Ellner said: "It is harder to find and keep employees right now, so we see staff covering shifts, working short-staffed or feeling unable to be successful during the day because they feel overwhelmed. Leaders and managers especially experience this because of the pressure to meet organizational goals, balance expectations and then lead and engage their employees. They are often trying to fill staffing needs, train staff and meet increasingly demanding patient expectations."

Wausau, Wis.-based Aspirus is also noting burnout in its employees.

"We have all been feeling the mental and physical effects since the start of the COVID-19 pandemic," said Rebecca Knutson, director of the Office of Learning & Development at Aspirus. "In many ways, this has provided us all with a unique opportunity to come together, be strong and support our organizations and employees in the best ways possible."

The Wisconsin health system is placing a significant emphasis on addressing staffing shortages. Aspirus implemented a vigorous nursing recruitment strategy internally and externally, as well as partnered with the federal government to bring in Disaster Medical Assistance Teams. The Wisconsin health system also filled temporary positions in the hospital to alleviate stress associated with staffing shortages.

Aspirus leaders worked to improve rounding processes, identify key areas that are causing burnout and emphasize to staff what resources are available to them. The health system created tranquility rooms within its facilities to give providers and employees a quiet, peaceful break during their shifts. It also enhanced its employee assistance program by offering drop-in counseling sessions to make sessions more easily accessible.

At Billings Clinic, the health system is taking a balanced, well-rounded approach with many different resources because it believes that no one program can mitigate burnout.

The health system is offering its staff access to town halls, which allow hospital leaders to address hospital issues, trends or concerns with staff over videoconferences. 

The health system has also enhanced its staff and recruiting strategy, developed employee well-being groups, scheduled regular listenings and is improving operational efficiencies so its staff can feel more successful throughout the day. It is also working to rebuild the organizational culture into something that emphasizes kindness, safety and courageousness. 

"The key is keeping in front of people and continually following up to make sure they're getting what they need," Dr. Ellner said. 

At Aspirus, measures to reduce burnout are not going unnoticed.

"According to employee satisfaction survey results, we saw a 12 percent increase in staff reporting that Aspirus is interested in their well-being," Ms. Knutson said. "We saw significant improvement in all five survey statements related to burnout and resiliency."

Billings Clinic is hoping that its efforts for reducing burnout are helping its staff, but is still working on measuring it.

"We will be implementing an engagement and culture safety survey in May and will then use that data to help give us a baseline of information on burnout and engagement," Dr. Ellner said. "We can then implement the interventions and strategies, and pulse check to see if we are moving the needle. Our employee turnover data will also help us to measure improvements."

Dr. Ellner believes that mitigating employee burnout is a partnership and both sides need to work at it.

"It takes the organization to be focused and clear on establishing a culture and infrastructure that allows employees to be their best selves," he said. "We can affect the environment and work factors we know lead to burnout. It is then the employees' role to take ownership for using our resources, speaking up, being engaged, and aligning with the mission, vision, and values."

According to labor and employment lawyer Jill Lashay, employers have certain federal, state and local legal obligations to ensure that employees are not exposed to hazards that will affect their well-being when they come to work each day.

"Although employers cannot be held responsible for all of the pressures employees face outside the doors of the workplace, they can certainly work to secure the well-being of employees while they are engaged in work," Ms. Lashay said.

Employee burnout can cause legal implications for hospitals and health systems.

"When employees are subject to burnout, they are more prone to errors," she said. "Errors can result in medical malpractice claims or claims of general liability. Moreover, employee burnout and dissatisfaction can result in unions organizing in workplaces."

To improve employee well-being and prevent liability implications, Billings Clinic and Aspirus have one piece of advice for other hospitals trying to do the same things.

"You need to meet your employees where they're at. Be creative, seek their input and partner with your community," Ms. Knutson said. "One of our values is compassion, and that means we demonstrate caring in all we do and cherish the honor of improving lives."

Dr. Ellner suggests that hospitals "look closely at the variables that are impacting burnout and break those down so you understand exactly what is impacting people. Then you can start to improve or leverage change in the areas that will have the biggest impact."

He also suggests changing the culture at your hospital so it's encouraging the right behavior.

"This has a significant impact on burnout and engagement," he said. "After the culture is created be very clear about expectations and priorities, measure the right things, and reinforce and lead people in a positive way toward those goals and priorities."

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