Why It Matters
A prominent psychologist has found that individuals have differing capacities for resilience, but also that resilience can grow over time. Here’s what that means for health care.
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Don’t Blame Staff for Burnout — It’s a Systems Issue

By Stephanie Garry Garfunkel | Tuesday, October 18, 2016

Tom Lee Press Ganey

Dr. Thomas Lee’s daughter is a first-year resident, following in her father’s footsteps at Brigham and Women’s Hospital in Boston.

For now, she’s loving it. But will she feel that way when she’s her father’s age? Lee, now the Chief Medical Officer at Press Ganey, isn’t counting on it.

Clinicians are feeling burned out: a loss of autonomy, a sense of failure in communication and coordination, and hopelessness about the direction of care, Lee said. Even senior leaders can feel overwhelmed by the complexity and bureaucracy. Lee spoke to about 100 health care leaders at a recent meeting of the Leadership Alliance, a dynamic collaboration of health care executives working to deliver on the full promise of the IHI Triple Aim. He shared a framework for thinking about burnout, and recommended two books to help leaders improve employee morale, or joy in work.

“We need more than zero burnout,” Lee said. “We need intrinsically motivated people at every level of the organization.”

Here are a few of the concepts Lee discussed to help develop an understanding of the causes of burnout and what leaders and individuals can do about it.

  • Health care isn’t alone in trying to adapt to a complex era. General Stanley McCrystal describes how he abandoned a conventional organizational structure to fight Al Qaeda in Iraq in his book, Team of Teams. Instead, he first built exceptional teams, then linked them together in a “team of teams.” Every day from 8 am to 10 am, the team leads would “dock” together on the same call, coordinate, and then operate with autonomy until the call the next day, when they “re-docked.” “I think that model has adaptability for health care,” Lee said. “When a patient has both Parkinson’s and prostate cancer, it shouldn’t feel like it’s completely uncoordinated. The patient shouldn’t feel like they’re leaving one country and entering another.”
  • There’s evidence that individuals have different capacity for resilience. Angela Duckworth, a psychologist who wrote the book Grit, has developed a scale that can predict which people will stick with a difficult task — for example, graduating from West Point Military Academy. The good news, though, is that she’s also found that it’s something you can get better at. People can develop grit by developing a growth mindset, the belief that intelligence and skill can grow over time. In the book, Duckworth encourages readers to focus on sustaining interest in a goal, practice regularly, connect to the purpose of the work, and be hopeful about the prospect that their work can make a difference.
  • It’s important not to place responsibility for burnout at the feet of individuals. Decades ago, IHI President Emeritus and Senior Fellow Don Berwick began moving health care away from blaming “bad apples” for defects, instead promoting the idea that systems failures lead to poor quality. Now, Lee argues that burnout is also a systems issue, caused by the complexity of health care, and not a failure of health care workers to have grit.

These days, Lee added, many clinicians can feel that they are no longer professionals, but commodities that health systems are using to generate RVUs – the relative value units that Medicare uses to reimburse providers.

“The idea of them getting better personally is not a priority,” he said.

To counter that feeling, Lee said, it’s especially important for leaders of teams to help staff grow as professionals and as members of teams. How? By cultivating grit, developing strong teams, and providing the organizational structure for employees to thrive.

What leadership books have you read that have helped increase joy in work? Please share your favorites in the comment box below.

Joy in Work is a featured track at this year's IHI National Forum on Quality Improvement in Health Care.

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