Michael Dowling: Burnout wins when we get vague

Precise diagnoses and actionable treatment plans are essential when it comes to one's health. In healthcare, we often find ourselves at odds with both for one condition: burnout.

Currently, it is rare to participate in any healthcare discussion without the issue of burnout being raised and discussed. There is, however, some confusion about its precise meaning and prevalence. I am well aware of the seriousness of chronic burnout, but in my view, the normal stresses and discomforts of work and life are labeled as burnout. This is a mistake and deflects from targeting that which is more serious.

Burnout is a relatively modern concept for its ubiquity. The term was coined in 1974 by American psychologist Herbert Freudenberger, PhD, for the stress and exhaustion felt by those in service professions that makes it difficult to cope. In 2017, CEOs of U.S. health systems categorized burnout among physicians as a public health crisis and outlined an 11-step response. In 2019, the World Health Organization finally included burnout in its International Classification of Diseases, describing it as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed."

I share this context to recall the attention paid to burnout pre-pandemic. I fully acknowledge burnout as a distinct syndrome, as the WHO defined, with consequences to physical, emotional, mental and overall health. If burnout is the culmination of chronic workplace stress that is poorly managed, there's responsibility on employers to address contributing factors, provide support and improve the work environment. 

At the same time, I have seen use of the term "burnout" explode since the pandemic. What was once a distinct type of work-related stress is now the word pinned to a range of emotions and stress levels, from the temporary and minor to the long-lasting and serious. It seems as though the term has come to carry its own meaning to each of us, which is challenging. Health conditions are rarely interchangeable. 

The variation in experiences of burnout can leave managers unsure of how to respond when employees raise it. One thing to keep in mind is that burnout is both a condition to be managed and relieved with structural interventions. Our relationship to stress is lifelong. Workplaces, managers or coworkers cannot necessarily absolve people from stress or eliminate it. What we can do, and what I would argue is more valuable, is help people better cope while enacting system changes or improvements to support them. 

When regular experiences of discomfort are declared as burnout, the conversation often ends there. I worry about this for several reasons. For one, it contributes to a sense of passivity — that burnout is something happening to people without opportunity for change or improvement. Secondly, by painting burnout with a broad brush, we avoid dealing with the highest and most impairing levels of the condition. If that's the case, our industry will continue to miss important opportunities to address the tactical and measurable things that contribute to the well-studied and distinct feeling of exhaustion.

A 2021 cross-sectional survey published in JAMA measured burnout among physicians and nurses in 60 U.S. hospitals by using reliable frameworks to assess symptoms, such as the Maslach Burnout Inventory. Concerningly, it found high burnout rates among an average of 32 percent of hospital physicians and 47 percent of nurses. Unlike others, this study also surveyed the clinicians about the interventions they see as most promising to alleviate burnout rates. 

The top interventions that most physicians ranked as "very important" to improving their wellbeing are, in order, reducing the time they spend on documentation, improving the usability of EHR systems, reducing the emphasis on clinician productivity targets, and reducing the rate at which they work unscheduled hours. 

The top interventions that most nurses ranked as "very important" to improving their wellbeing are, again in order, improving the time they can spend with patients, supporting clinicians' ability to take uninterrupted breaks, improving team communication and enabling clinicians to spend more time on direct patient care. 

All eight of these interventions are important, but notice how the two professions value interventions differently. Such granularity is needed in healthcare. Specificity and solutions are cornerstones of healthcare, and we can't afford to loosen our grip on both when it comes to burnout. To better do this, some simple steps come to mind: 

1. Help employees understand what burnout is. This step may sound reductive, but don't underestimate the power of clear, shared definitions. Google searches for the phrase "burnout symptoms" tripled before reaching an all-time high in May 2023. Instead of leaving employees to figure this out for themselves, take the lead. Help them understand how burnout differs from stress. Revisit the definition often and regularly. They deserve such clarity from their workplace leaders. Otherwise, it will be difficult to move the needle on burnout if apples-oranges communication persists.

2. Equip managers to ask questions about burnout. Burnout is real but it is not a fixed state. If an employee says they are burned out, the conversation should not end there. Equip managers — through training, guidance and resources — to extend the conversation to identify contributing factors. Some challenges raised may be easily addressed in a relatively short time. Others may require more time or resources. Managers play an important role in finding the information that can drive action and positive results, both of which are incredibly important to culture.

3. Extend a menu of action items and solutions. Stress is inherent to most jobs in America, particularly in healthcare. Assuming people are inherently resourceful and resilient, leaders should focus on a range of structural improvements in the near-, mid- and long-term that can better seal their organizations against burnout. Consider the eight top-ranked interventions identified by nurses and physicians. Different roles may need different forms of support. When leaders organize a toolkit of interventions to counter burnout — based on feedback and information — it reflects credibility, realism and inclusivity.

4. Set realistic expectations. There will be no single savior that ends the burnout battle. Efforts to address it must be made by managers, leaders, teams, departments, organizations and the industry at large. Burnout can also be cyclical throughout the course of a career. This is a long game we're playing. But if we are precise about burnout, focused on a range of solutions, and accept self-determination and the possibility of change, we are better positioned for longevity in this effort.

5. Push for regulatory change. Use the issue as an opportunity to lobby government and oversight agencies to limit and discard those regulations that limit doctors and nurses time with patients and do little to promote quality and service.

Michael Dowling is president and CEO of Northwell Health, the largest healthcare provider and private employer in New York State.

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