A Promising New Approach to Reducing Burnout and Workforce Depletion

— Change a "vicious cycle" to a "virtuous cycle," an expert suggests

by David Nash, MD, MBA, FACP, Contributing Writer, �鶹��ý October 2, 2023

A photo of a male physician sleeping at his desk.

David Nash is the Founding Dean Emeritus and Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson College of Population Health. He is a board-certified internist. Follow

Last week, I spent three days soaking up every bit of information I could at the 23rd Annual Population Health Colloquium in Philadelphia. With such a broad range of topics and new ideas – enough to populate an entire series of columns -- it was hard deciding where to begin!

A talk that resonated with me was one that proposed a new paradigm for addressing clinician burnout and workforce depletion. The presenter was Jessica Dudley, MD, Chief Clinical Officer for Press Ganey, a company best known for its lengthy track record in surveying patient experience that has also become a leader in assessing healthcare employee experience, nursing excellence, and patient/workforce safety.

A disturbing trend even before the arrival of COVID, clinician burnout and subsequent workforce depletion reached the crisis point for many of the nation's healthcare systems during the pandemic. This pervasive, multifaceted issue has caused performance to suffer in most organizations.

Since the onset of pandemic, Press Ganey's survey data has revealed:

A sustained downward trend in the likelihood of patients to recommend a healthcare facility in which they've received care. Declines were steepest for emergency and inpatient care; there was less of a drop for outpatient care.
An increasing decline (as of 2022) in the reported likelihood of caregivers to remain in their current jobs if a comparable position were offered to them elsewhere. Over the past year, the steepest declines were among registered nurses, licensed technical professionals, advanced practice providers and physicians. Of nurses who said they would accept a position elsewhere, 30% did so within a year.

These and similar statistics paint a pretty grim picture. How can we escape this "vicious cycle"? Dudley says the answer is to swap it with a "virtuous cycle". She makes a compelling case that when things are challenging for patients, they are also challenging for providers -- and vice versa -- and offers three basic premises as a foundation in moving forward: 1) All things are connected; 2) Everyone matters; and 3) Make use of the data. These premises create a shift in perspective:

From "burnout" to cultivating positive engagement and building resilience: Loss of resilience (i.e., the ability to recover or adjust easily to misfortune or change) is the precursor to burnout. Resilience requires both activation (e.g., belief that work is meaningful and makes a difference) and decompression (e.g., ability to disconnect from work – physically and mentally – and enjoy free time). Surveys show that, although activation has remained remarkably stable, decompression scores have declined dramatically.
From "awareness of the issues" to actively using the data to resolve them.
From "hiring replacements" to optimizing the existing workforce and working smarter.
From "individual orientation" to integrated teams.

How does this shift in perspective play out in real world settings?

Employee turnover data show that the average organizational cost of losing a nurse is $50,000 – for loss of a physician, the cost is $100,000. Some high-performing organizations use data to create nurse well-being initiatives as well as to invest in additional training and coaching. One innovative organization used data to identify weak leaders and, rather than losing them, supported improvement efforts.

Employees want to feel that their organization's culture is safe and that they are included. Even within the same organization, different racial and ethnic groups have different perceptions about how diverse and inclusive the organization is. Survey data reveal that top-paying job holders are the least diverse group in most organizations; the most diverse group is generally the lowest-paying job holders. High performing organizations use this type of data to assure that they understand and address perceptions at every level.

From 2018-2023, a growing number of organizations are scoring higher on employee engagement. Senior leadership of organizations in the top decile inspire confidence in their workforces and support the community across all levels. They receive high marks for listening and showing respect. They use data to make improvements and meet the basic needs (e.g., safety) of employees as well as patients.

How do we fix things and retain staff? Dudley shared a few examples:

Change the paradigm from expecting employees to always put patients first to taking adequate care of themselves first; e.g., giving them time to decompress as well as recognition. Institute peer support initiatives (e.g., resilience checklists). Any employee can make a meaningful difference.

Explore team-based models; e.g., encourage the return of retirees to provide virtual care and maintain connections with patients post discharge from the hospital.

Know what employees are thinking; e.g., using relatively simple crowdsourcing software to ask 3,000 employees, "What does respect mean to you?"

My take home here: Let's get to work!