By Melinda Young
Teamwork may be an antidote to burnout in healthcare.
Before the COVID-19 pandemic, burnout affected 43% of physicians and nurses. Doctors reported more isolation, according to a recent study.1 Worse, the pandemic pushed burnout to crisis levels, affecting more than half of all nurses and physicians, according to a recent report by U.S. Surgeon General Vivek Murthy, MD.2
“Confronting the long-standing drivers of burnout among our health workers must be a top national priority,” Murthy said in an advisory on the topic. “If we fail to act, we will place our nation’s health at risk.”
The pre-pandemic research began as a response to an initiative called Joy in Medicine Task Force, says Elizabeth Lee Daugherty Biddison, MD, MPH, study co-author, chief wellness officer at Johns Hopkins Medicine, and director for professionalism and credentialing in the department of medicine at Johns Hopkins School of Medicine.
“The task force was an interprofessional group that came together to look at facilitators of and barriers to meaningful, fulfilling clinical practice,” Biddison explains. “The task force met for six to eight months. At the end of that time, a survey was conducted across the healthcare enterprise — that’s where this data comes from.”
Biddison and colleagues focused on the physicians and nurses who responded to the survey. “There were questions that asked specifically about the efficiency of care teams,” she says.
Survey statements included:
- “The degree to which my care team works efficiently together;”
- “I feel isolated at work;”
- “The clinical environment in which I work allows me to deliver outstanding clinical care.”
Researchers also asked respondents to report any symptoms of burnout. This included a range of five levels, from the person agreeing they are not experiencing symptoms to the person saying they feel completely burned out and may need to seek help.
If a person expressed feeling isolated at work, the odds of reporting burnout symptoms were significantly higher. “There were significantly decreased odds of burnout experience if care teams worked efficiently together and the clinical environment allowed them to deliver outstanding clinical care,” Biddison says. “What this highlights for us — and it’s documented elsewhere in the literature — is that a sense of community and belonging are protective in terms of experiencing burnout. As we look for a way to create a better workforce, fostering a community is a way to keep people working well together, keeping them in the workforce, and keeping them thriving.”
Team Dissatisfaction Can Lead to Burnout
An important component of team-based work settings is the interprofessional team. One example could be case management teams that include nurses, physicians, advanced practice providers, pharmacists, health educators, and other professionals.
Some physicians reported dissatisfaction with their facility’s teams. This largely was because of high turnover on the team, which made it difficult to establish rapport among team members.
“The relationships weren’t there, and there was a desire for camaraderie between physicians and staff and wanting that interprofessional connectiveness,” Biddison explains. “This is something we’ll continue to wrestle with post-pandemic because the job market is so competitive, and people are moving from one job to the next for higher pay. It’s a real challenge.”
The Surgeon General’s advisory addressed the growing shortage of physicians and nurses, noting more than 200,000 job openings for registered nurses each year. The advisory also reported physician demand is growing faster than supply and will lead to a shortage of up to 139,000 physicians by 2033.2,3
Nurses Express Frustration
The healthcare workforce will continue to work under the stress of staffing shortages, so health systems need to find stress-reducing tactics under less-than-ideal circumstances. For instance, organizations can improve fostering consistent care teams, minimizing variability, and supporting good communication across teams, Biddison suggests. Anything that supports camaraderie is helpful, including outside work social engagements that can allow people to connect personally.
Some physicians and nurses who answered the survey offered their own insights into what works and does not work in care teams. One nurse said, “There isn’t a consistent standard of care for our department due to varying clinical roles.”
A physician expressed frustration with follow-up care, noting, “Coordination of care: the following up, the ensuring medications prescribed actually get insurance coverage and [are] paid for, ensuring consults are actually scheduled and seen, is awful.”
A nurse recommended the hospital expand ancillary support, such as case managers and social workers. “We need pharmacists or medication history technicians obtaining medication histories,” the nurse reported.
All those problems were discussed a few years before the pandemic greatly exacerbated burnout among hospital staff. But some of the wellness and stress-relieving tactics developed during the pandemic could continue as health systems face staffing shortfalls and other issues.
Keeping a team together was difficult during pandemic surges since staff were redeployed to new areas. “You’re bringing together a team in a whole new space with a new set of parameters,” Biddison says. “In our institution, we had one unit that was converted to a COVID ICU. There was a real concerted effort to foster community for them.”
This effort included spiritual care, mental health support, and stress or psychological first aid. “The support one person wants or responds to may not be the best for the next person,” Biddison says. “Their needs are different, so you should have a diverse array of resources available.”
This could include wellness rooms or spaces, leadership forums, aggressive communication, and some practical help that acknowledged how hospital staff could not manage household activities when they were working around the clock to care for patients during the pandemic.
“We brought basic groceries into the hospital for people who didn’t have time to get to the grocery store,” Biddison explains. “We made efforts around meals, providing meals for people who were coming off the night shift so they could take it home for themselves or share the meal with a family member. We did that first thing in the morning for the night shift, and again later in the day.”
Within units, leaders made efforts to build group cohesion and find creative ways to connect during a space of disconnection. These included conversations with psychologists on stressors for that division, with Zoom check-ins or WhatsApp groups.
“For a large institution, trying to figure out what one size fits all can be problematic,” Biddison says. “We do what we can to support grassroots efforts to fit local needs. This is much more effective.”
REFERENCES
- Lu MA, O’Toole J, Shneyderman M, et al. “Where you feel like a family instead of co-workers:” A mixed methods study on care teams and burnout. J Gen Intern Med 2022 Aug 29;1-10.
- U.S. Department of Health and Human Services. New Surgeon General Advisory sounds alarm on health worker burnout and resignation. May 23, 2022.
- U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Registered nurses, job outlook. Page last updated Sept. 8, 2022.
Teamwork may be an antidote to burnout in healthcare. Before the COVID-19 pandemic, burnout affected 43% of physicians and nurses. Doctors reported more isolation, according to a recent study. Worse, the pandemic pushed burnout to crisis levels, affecting more than half of all nurses and physicians.
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