Extinguishing the flame: the truth about therapist burnout.

Editor’s Note: This article is a guest contribution from Patient Success Systems co-founder, John Woolf (MS, PT, ATC, COMT).

You can’t have a global pandemic without talking about burnout. However, the topic of burnout has been creeping into the healthcare industry well before the pandemic hit. The pandemic has only increased our awareness of the issue and its impact on employee morale and performance.

As we begin to take off our masks and attempt to resume some semblance of “normal”, many are still struggling to find a new groove in the workplace. At the same time, businesses are attempting to ramp up productivity to serve those who have put off needed care over the past year.

To fully grasp how pervasive burnout is and how organizations can tackle the problem, let’s work backwards from the problem and identify the causes.

The goal: strong organizational performance

Success for the rehab professional requires the capacity to form a therapeutic relationship with their patient. In a perfect world, we would have a fresh and enthusiastic approach to each patient on our schedule. But at minimum, if providers want to be successful, they must be fully present with their patient and able to connect with empathy. Patients are wired to feel the degree to which you connect with them, so they will know when you are stressed, distant, or emotionally detached.

Success for the clinic leader is a healthy workforce, which can greatly impact your business’ performance. The Triple Aim is widely accepted as the model for optimizing performance for many health systems, but those aims don’t include clinic staff or clinicians. As illustrated in Bodenheimer (MD) and Sinsky’s (MD) research, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider, some of the most common problems that organizations face are caused by not improving the work-life balance of clinicians and staff¹. The authors’ recommendation is the Quadruple Aim:

1. Enhance the patient experience
2. Improve population health
3. Reduce medical costs
4. Improve the work-life balance of healthcare providers

The authors recognized that our success with a patient is beyond the procedures we perform. It is a relational process that depends upon the people who show up for the engagement—both the patient and the provider.

But what if we don’t show up because we’re too burnt out? Let’s look at how burnout manifests and the downstream impacts of failing to maintain a healthy team.

The recipe for burnout

Burnout isn’t caused by a single factor, but rather a combination of factors. The conservation of resources (COR) theory is an easy way to understand how burnout develops.

COR is a behavioral hypothesis describing how individuals react to stress. Generally, people have evolved to acquire and protect four valuable resources: important personal characteristics, valued objects, energies or pursuits, and favorable conditions. When a person feels as though any of these valuable resources are under threat, they will experience stress that can have serious consequences.

On top of that, time is a universally-valued but limited resource. For healthcare providers, the dissonance happens when they want to spend more time with patients but also have administrative tasks to complete. Workflow inefficiencies can eat away at their valuable time, draining energy, impacting their pursuits, and creating unfavorable conditions that impact both their professional and personal lives. This is where burnout comes into play.

The four conditions of burnout

Based on the burnout assessment tool², burnout is defined as a condition that includes four components:

1. Exhaustion: Sensations like being tired, lethargic, and unmotivated. Like getting home and feeling you have nothing left to give, or struggling to go to work in the morning.
2. Mental distancing: Burned out individuals begin to consider ways in which they need to separate themselves from the profession or the organization. They’re looking for reasons to leave the situation, and tragically, they become biased and fail to see the good things. They put on the “grass is greener on the other side of the fence” glasses.
3. Emotional regulation: Defined as the capacity to modulate emotions through situational awareness and appraise situations in a manner that down-regulates stress hormones, those that are burned out may find it hard to accomplish emotional regulation. Small situations that would not normally be considered a big deal become stressful. For example, a patient being late or a mix-up on the schedule that creates an unusually heated reaction from the provider or staff.
4. Cognitive regulation: Defined as the ability to control or influence our own thoughts, beliefs, and affect toward attaining a goal. But if the goal is to connect with the next patient, a burned-out provider might not have the grit to properly regulate their thoughts, and will instead just go through the motions.

Based on the COR model, we know that burnout is like a match dropped in a forest. If the forest is well tended and there has been adequate rain, it’s not a big deal. But if the conditions are dry and the wind is up, it becomes a big problem and very difficult to fight. This is why when one becomes “burned out” it is difficult to gather the adequate resources to correct the slide.

The key is burnout prevention³. When identified early, steps can be taken to replenish the resources, decrease the stress and get back to high performance.

How leaders can prevent burnout

Burnout is an issue, and leaders should get people talking about it. I have worked with too many leaders who don’t want to talk about difficult topics, thinking that by doing so they’ll exacerbate the issue. Wrong.

Burnout, like many other mental health conditions, exists and will smolder until it is addressed. It’s evident in decreased engagement, decreased performance, and when staff look like they’re just going through the motions.

Here are some practical steps to prevent burnout:

• Talk about it. Catch burnout early by teaching your team exactly what to look for.  Conduct a mini-course on the topic so your team can have a cognitive framework to work with, showing them how burnout presents itself and how they can help themselves. People often don’t know what they are feeling, and unfortunately have developed coping strategies that ignore vital symptoms.
• Check your fears. If you think talking about it and teaching it will make it worse, it won’t. In fact, if done well, you may identify some key opportunities to improve efficiency, performance, and decrease attrition.
• Culture check. I work with clients to develop a relationship-centered culture where people feel safe in talking about dissonant topics. Trust me, you want to know how your team is doing and if no one will talk, you may not have a culture of psychological safety. Leaders should create a culture where people are willing to be vulnerable, feel safe sharing their perspective, and can tell you about what they perceive as working or not working. I have a client who meets with each PT for 30 minutes every two weeks to talk about anything that is important. His relationship and coaching skills allow him to connect at multiple levels, everything from performance to work-life balance. He gathers this “qualitative research” from his team and uses it to explore ways to improve his clinic.
• Accept and prepare for change. I have a client who will soon be going through a software implementation. He is aware of the stress this will create for his team and is taking action to talk about the stress that change creates. He knows that by talking about change ahead of time, and listening to people’s fears and concerns, he can build up his team’s emotional resources and minimize the chance that people will feel overwhelmed or burnout. Whenever any change comes your way, consider opening up a dialogue with your staff and be prepared to listen.

Burnout is a significant threat to any professional’s health and to an organization’s success.  However, with active employee engagement around the topic and a culture that includes psychological safety, healthcare leaders can help prevent burnout and improve the overall health of the organization.

References:

¹ Bodenheimer, Thomas (MD), Sinky, Christine (MD). (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine, 12(6), 573-576.

² Schaufeli, W. B., Desart, S., & De Witte, H. (2020). Burnout Assessment Tool (BAT)—Development, Validity, and Reliability. International Journal of Environmental Research and Public Health, 17(24), 9495.

³ Otto, M. C., Van Ruysseveldt, J., Hoefsmit, N., & Van Dam, K. (2021). Examining the mediating role of resources in the temporal relationship between proactive burnout prevention and burnout. BMC Public Health, 21(1), 1-15.

About the author: John Woolf, PT, MS, ATC is a PhD candidate in performance psychology. As CEO of Patient Success Systems he consults with leaders and teaches Relationship-Centered Care™ to healthcare organizations. You can email the author at jwoolf@patientsuccesssystems.com.