How to change the conversation on burnout: 4 questions with Ascension Medical Group CMO Dr. Baligh Yehia

Burnout is pervasive among clinicians. It affects 2 in 5 physicians and 3 in 5 nurses, Ascension Medical Group CMO Baligh Yehia, MD, noted in a recent LinkedIn post. Burnout directly affects the quality of care patients receive and costs the U.S. more than $4 billion annually

The problem with burnout is it's difficult to recognize and difficult to treat. It certainly takes more than a few yoga classes, Dr. Yehia told Becker's in an interview. However, there are a few simple ways hospitals can begin to address the issue at its source.

"The most important step is to start the conversation. It's something that doesn't require a lot of resources, but I think it's the first step onto a path to building a robust engagement and wellness program," Dr. Yehia says.

Under Dr. Yehia's leadership, Ascension Medical Group has established a national council of clinicians to lead the charge on engagement and well-being, and the group is working to stand up similar committees at the local level. The group has also developed a self-directed survey for physicians to gauge their own level of burnout and a playbook of best practices to promote well-being and resilience.

Here, Dr. Yehia discusses how Ascension started the conversation on burnout and the initiatives it is using to move that conversation forward.

Editor's note: Responses have been edited lightly for length and clarity.

Question: Are there any common misconceptions about burnout among hospital leaders and clinicians?

Dr. Baligh Yehia: Medicine is a field where many folks expect you to be "tough." One of the common misconceptions is thinking burnout might not affect you or your colleagues. You might not be aware of it, but burnout impacts physicians young and old, male and female, regardless of specialty. It doesn't discriminate. Physicians are afraid to speak about it and share what they might be feeling. As we start to tackle this as a profession, it needs to be OK to raise your hand and say, "I'm having some issues here."

The other misconception, from an organization or societal standpoint, is that burnout is the fault of the individual. Burnout is not for folks who don't know how to have work-life balance or that are not as efficient as other providers. It really is a system issue as much as it is an individual issue. It shouldn't fall on the doctor, advanced practice provider or nurse solely.

Q: What are some signs of burnout?

BY: That's one of the reasons why we want to spread this work, to help individuals assess themselves and their colleagues. Burnout is an actual syndrome with a constellation of different manifestations. When we think about some of the signs you might be able to see, it's folks who may have depression, substance abuse, broken relationships. You can see folks become more inefficient at work or more prone to medical errors. They are also more prone to quitting the profession or leaving organizations. The signs of it are exhaustion, cynicism, fatigue and inefficiency.   

It's one of those things, though, where you can't just look at someone and say, "You are burned out." That's why at Ascension we have developed ways to measure burnout. Our version is both anonymous and voluntary. Folks take a nine-question survey that helps them understand their sleep patterns, how much time they're at work versus at home, and how their professional career is impacting other parts of their life. Many doctors who have taken the survey reach back out to me and say, "I didn't realize I was a little higher than I thought I was, or that there were so many other people who are just like me."

Q: Ascension Medical Group developed a "playbook" with nearly 40 best practices for clinician resilience and well-being. Can you tell me more about how Ascension created this resource?

BY: We had so many folks raise their hand to be part of this work. We would have calls at 7 a.m., with about 30-50 doctors sharing best practices that they have used or have seen used. We also looked at literature to see what other best practices existed at other organizations. That's how we got to our suite of best practices.

We organized them around three different themes:

  • The first is creating a culture of wellness, so how can we create a workplace environment that really supports well-being and engagement? Some of the best practices in that area relate to having an organization focus, like a clinician well-being committee, or creating a mentoring or coaching program that allows folks to handle burnout or some of the stress you see in day-to-day life.
  • The second was about practice efficiency. As you talk to doctors, some of their biggest frustrations are with the EHR, and not having enough time to spend with patients because of the administrative burden of practicing medicine. We have best practices to elevate the entire care team, so everyone is working at top of their license; to turn the EHR into a partner, so they can automate certain activities. We talked about how to do pre-visit planning or how to have a better rooming strategy or daily huddles to make sure everyone on the team is in the same place, or how to better manage your inbox so you don't get unnecessary messages.
  • The last section is on personal resilience. I think of this as how you make sure you have enough gas in the tank. You are always going to have good days and bad days, but you want to have reserve in your tank for those bad days. This is how to practice mindfulness, stress management. We are a mission-driven organization, so a lot of this has to do with community-building and how you give back to your communities, which restores individuals as well.

Q: As a physician and hospital leader yourself, what strategies work really well to manage stress for clinicians?

BY: As organizations start to focus on this, one of the most important things is to start talking about it and put it out there that this is an issue. We established clinician engagement and well-being as a priority, and we put people, processes and technology behind it. One of the first things is recognizing it and talking about it. You would be surprised at how that elicits a lot of positive feedback. Then the issue is you must take it to the next step. It actually could backfire if you talk about it and don't do anything or offer things that are the "bare minimum" and very superficial, like doing a community-building event or offering yoga classes. You miss the root cause of the burnout, which is really how you create a better culture and a more efficient practice environment.

That's what's really important for organizations: Start to speak about it and make it a priority, but also really invest in some of the tactical activities that relate to improving the efficiency of practices and the EHR, and specific things to improve the culture. Stress management courses and yoga are helpful, but not sufficient to really move the needle in this area.

Q: Is there anything else you think is important to mention?

BY: The one other thing that comes up a lot in this area is we first focus on doctors, nurse practitioners, physician assistants, residents and fellows, but really this work is for many people working in the healthcare space. While there is more literature and evidence-based best practices surrounding the physician community, this impacts nurses and other care team members. Over time, there needs to be more resources for other care team members, not just our clinical leaders and physicians. That's something we are looking at very closely because they are in similar stressful situations that require resources and strategy to support them as best as we can.  


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