How COVID-19 has exacerbated burnout among care providers

June 29, 2020
by Valerie Dimond, Contributing Reporter
Working in healthcare has never been easy. Yet, many would say it’s never been this hard.

The COVID-19 pandemic has made one of the most difficult jobs even tougher, with burnout, emotional and physical exhaustion, anxiety, and depression on the rise exponentially. Although these problems are nothing new in healthcare, when unexpected catastrophe strikes an already-weakened environment, where active concern and respect for everyone’s well-being is lacking — coupled with a shortage of personal protective equipment, medical supplies and equipment — a bad situation just gets worse.

“They are under exceptional stress, being faced with extreme workloads, difficult decisions, risks of becoming infected and spreading infection to families and communities, and witnessing deaths of patients,” stated the World Health Organization in a policy brief released in May. “There have been reports of suicide attempts and suicide death by healthcare workers.”

Dr. M. Bridget Duffy, chief medical officer of Vocera Communications Inc., who was also the first chief experience officer in the U.S. at the Cleveland Clinic, is one of many who are concerned about how healthcare workers will cope going forward. “We already had a crisis of burnout and cognitive overload before COVID,” she said. “I can only imagine what post-COVID stress disorder syndrome and burnout will look like.”

Dr. M. Bridget Duffy
Duffy is part of a growing body of professionals who are urging healthcare organizations to get serious about making staff well-being a top priority at all times. Dr. William Maples is another. He is founder, president, and CEO of the Institute for Healthcare Excellence, an organization that works with healthcare groups to develop and nurture the relational skills needed to create a culture of trust, respect, compassion, and teamwork — critical actions he says ultimately lead to quality, safety, and efficiency.

“It’s really been a challenge for the industry over the past decade,” said Maples. “Healthcare providers really need to deal with the roller coaster of emotions that happen throughout the day during these 15-20-30-minute blocks where we need to really be able to respond and connect to patients very differently based on what the clinical situation is — and do it in a way that if you are being authentic and truthful, they know that you really care. But that’s a real large roller coaster of emotions, more so than any other profession that I can think about, where you need to have the tools to respond and at the same time create enough space for your own self so that you don’t get overwhelmed by the process.”

Indeed, those on the front lines today are faced with numerous pressures, often brought on by reimbursement and regulatory factors, to ramp up efficiency, do more cases, and routinely engage in nonclinical activities with fewer resources and less time than ever before.

“A second dimension is this need to produce, and the financial stresses to do more and more and that’s really created a little bit of a disconnect and actually takes people away from their connection to purpose,” said Maples. “The ways that you do things now, you really wouldn’t if you didn’t have all of the pressures to see more patients in a shorter period of time and do more with less. That actually weighs significantly, particularly as we’re trying to navigate the roller coaster of emotions.”

Maples continued, “Then you have things that are actually taking you away from the purpose of why you went into medicine. It takes away your autonomy. When you lose your autonomy and you lose your connection with purpose; that is a definition of a pathway to burnout.”

Dr. William Maples
An unhappy clinical staff leads to high turnover, and fortune in lost revenue that could have been avoided. “The data is there. It is a significant financial burden to the health system. We see these things, we talk about it, but actions don’t necessarily follow what the financial numbers actually state,” said Maples. “Everybody gets caught up in that circle. We then tend to forget how to treat each other as human beings, as individuals — human beings that really need some appreciation and recognition. That’s the background of where it’s been and how we’ve entered the coronavirus pandemic.”

Leadership must listen
Clearly, meaningful change is needed and fortunately, several organizations are taking the lead in making a lasting transformation in how they do business. For example, Dr. Roxana Nederi, faculty member and hospitalist at University of Colorado School of Medicine, shared her experience during a virtual fireside chat hosted by the National Taskforce for Humanity in Healthcare on mental health. She said what made her team’s roller coaster less scary was the genuine support they consistently received from the top every step of the way.

“We’re all fish out of water. This is, clinically, something we don’t recognize, clinically not managed this way before,” said Nederi. “The communication from the hospital leadership has been incredibly transparent and robust. Having that leadership engagement, the ear of leadership to quickly make changes and respond in live-time to the feedback we’re giving for our needs on the front line is something that I hope continues well beyond this pandemic.”

Experts say that’s exactly what needs to happen for healthcare organizations to weather any storm — today and tomorrow — and building that solid structure requires a true cultural shift that continuously engages every person on the team, as Nederi’s organization did.

“When you do that you unleash just an incredible amount of innovation and solutions in ways that you can walk through this, and if there are gaps such as missing equipment, or missing medications, you actually develop a plan that will help the team successfully, safely, and as efficiently as possible provide care for the people they are serving,” said Maples. “It can’t be written as policy. Nobody can write a policy that is going to say we are going to listen to our physicians, our nurses, our teams. It is the culture, and it does take some concerted effort, an intentional process that you weave into the organization to really help evolve that culture. To actually do the work takes some time to invest and giving the right skills to all of the team members, not just a few of them. The C-suite has got to be part of it. We tried to skip over that step for the last 20 years … and we’ve not really gotten to the place that we’ve hoped to be.”

Duffy agrees but remains cautiously optimistic. “I think we have a lot of work to do, as a country, to lead through this pandemic and on the other side of it,” she said. “We’ll need to lead differently. The hierarchy will need to go away.”