When rates of physician burnout increased between 2011 and 2013, the Mayo Clinic made a host of changes to tackle the problem. The result in the following two years was a 7% decrease in the absolute burnout rate in physicians, set against the backdrop of an 11% increase in burnout among physicians nationwide.1
Mayo Clinic’s nine strategies for addressing physician burnout are explained in a paper published in November 2016.1 Physician engagement is an antidote to physician burnout, and where a physician stands between the two is related to workload, efficiency in the practice environment, flexibility/control over work, work-life integration, alignment of personal and organizational values, social support/community in the workplace, and the degree of meaning derived from the work, according to the paper’s authors.
“All of these dimensions are relevant for surgeons, and which is the most problematic will vary by practice setting and organization and individual,” says Tait Shanafelt, a researcher at the Mayo Clinic and one of the paper’s authors.
A physician’s specialty area also can influence physician engagement and burnout.
From a surgeon’s perspective, some strategies that might cultivate a community at work would be offering a surgical lounge and the Colleagues Meeting to Promote and Sustain Satisfaction (COMPASS) group approach, Shanafelt says.
COMPASS groups at Mayo Clinic were devised to provide cost-effective, scalable, efficient, weekly meetings to reduce burnout. Surgeons and other physicians sign up with six or seven colleagues to share a meal at a restaurant every two weeks and to spend 20 minutes of that time discussing a question that explores the physician experience. Mayo Clinic’s randomized comparison of these COMPASS meetings found that there was an improvement in burnout for participants.1
“There are other strategies, as well, and they have to be adapted to fit the local organization,” Shanafelt says.
The Mayo Clinic Program on Physician Well-Being, which was founded in 2007, has identified — through scientific efforts — nine organizational strategies to promote physician well-being. The recently published paper on the nine strategies provides concrete examples, supported by research, on how organizations can prevent and deal with physician burnout. The following is a brief summary of the strategies:
- Strategy 1: Acknowledge and assess the problem. Surgery centers, for instance, must show surgeons that the organization is aware of the potential for burnout and cares about surgeons’ well-being. The Mayo Clinic uses town hall meetings, radio broadcasts, letters, video interviews, and face-to-face meetings as formats with which the CEO reaches staff. The CEO engages in an open dialogue about the challenges physicians face in today’s healthcare environment. The Mayo Clinic has been systematically measuring burnout since 2010, and also regularly measures engagement and satisfaction with work-life integration, benchmarking these measures against national data.1
- Strategy 2: Harness the power of leadership. Some new evidence suggests the leadership behavior of physician supervisors can affect the well-being of physicians. To select the right leaders, organizations should find people who are able to listen, engage, develop, and lead physicians. Good leaders know each physician’s unique talents and how to motivate that person.1
- Strategy 3: Develop and implement targeted interventions. One of the universal drivers of dissatisfaction and burnout is inefficiency in the practice environment, including clerical burden. Mayo Clinic identifies high-opportunity work-units using external benchmarks, including the unit demonstrating burnout rates above the national average and satisfaction rates below the 50th percentile. Then, leaders meet with the high-opportunity work-units to develop strategies for improvement.1
- Strategy 4: Cultivate community at work. Physicians experience unique challenges, and peer support — both formal and informal — can help them navigate these challenges. For instance, peers can help physicians share ideas on improving their careers, celebrate personal and professional milestones, and support one another through challenging experiences. Organizations can help facilitate this sense of community by providing surgeons with a lounge or dining room, a space where they might foster connections with other surgeons.1
- Strategy 5: Use rewards and incentives wisely. Physicians are not salespeople, and it could erode quality of care to link physicians’ financial compensation to productivity. Productivity-based compensation also increases the risk of burnout. Physicians primarily increase productivity or generation of revenue through shortening the time spent per patient, ordering more tests and procedures, or working longer. The latter approach can increase the risk of burnout and may be self-defeating.1
- Strategy 6: Align values and strengthen culture. Organizations must keep in mind factors that influence its culture, keep their values fresh, and regularly take stock of whether their values and actions are aligned. Mayo Clinic’s value proposition is that “the needs of the patient come first.” Its organizational culture supports this value, and it’s built in part on physician leadership, salaried physicians, physician-administrator partnership, a team-based, multidisciplinary approach, term limits for all leaders (including the CEO), and organizational policies that cultivate low turnover and long tenure.1
- Strategy 7: Promote flexibility and work-life integration. Policies related to flexibility and work-life integration affect physician well-being. Physicians often are dissatisfied with their work-life integration, partly because about 45% of doctors work more than 60 hours per week, compared with fewer than 10% of U.S. workers in general. Organizations can offer physicians the option to adjust professional work effort, tailoring their work hours to meet other obligations.1
- Strategy 8: Provide resources to promote resilience and self-care. Resilience training and solutions that focus on helping individual physicians deal with stress and burnout should only be offered in the presence of systemwide approaches to preventing burnout. Otherwise, they are met with skepticism and cynicism. When these self-care resources are offered, they should address diet, exercise/fitness, sleep habits, personal financial health, relationships, hobbies, and preventive medical care.1
- Strategy 9: Facilitate and fund organizational science. Research into physician well-being by Mayo Clinic and other institutions, such as Stanford University School of Medicine, have helped develop new metrics, establish national benchmarks, implement practice analytics, and conduct intervention studies and randomized trials. These programs focus on creating new knowledge on how to reduce burnout and promote physician engagement through organizational science.1
REFERENCE
- Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2016 Nov 18. Epub ahead of print.
When rates of physician burnout increased between 2011 and 2013, the Mayo Clinic made a host of changes to tackle the problem.
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