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Practicing Medicine Quality Improvement The Effects of Burnout

The Effects of Burnout

Quality & safety

Understanding burnout’s impact

Burnout among health care professionals goes beyond personal well-being—it directly impacts the quality and safety of patient care.

When physicians face exhaustion, frustration or moral injury, their ability to deliver compassionate, high-quality care can be diminished. This can lead to increased errors, reduced patient satisfaction and compromised team dynamics. By addressing burnout and fostering a supportive environment, we can enhance both physician well-being and patient outcomes, creating a safer, more resilient health care system.

Organizational and systemic approaches

  • Report practice barriers: Encourage health care professionals to report barriers to ethical practice, such as insurance company policies, government regulations or resource limitations that lead to moral injury. Reporting these barriers can be the first step in creating change.
  • Develop advocacy channels: Establish clear channels for health care professionals to report practice barriers and ethical conflicts. Ensure that these reports are acted upon by advocacy teams who can address these issues at a policy or organizational level.
  • Engage in policy advocacy: Health care organizations should work with professional associations and advocacy groups to push for policy changes that reduce the bureaucratic and administrative burdens on health care workers, which are common sources of moral injury.
  • Provide ethical support services: Implement ethical support services within health care organizations, such as ethics consultations, where professionals can seek guidance on difficult decisions.
  • Promote a culture of ethical practice: Create a workplace culture that prioritizes ethical practice and values the moral integrity of health care professionals. This includes ensuring that staff have the resources they need to provide care that aligns with their ethical beliefs.

Individual strategies for health care professionals

  • Recognize and acknowledge feelings: One of the first steps in addressing both burnout and moral injury is recognizing and acknowledging the feelings of exhaustion, frustration, guilt or anger. Naming these feelings can help in seeking appropriate support.
  • Seek peer support: Engaging in peer support groups where health care professionals can share their experiences in a confidential setting can help validate feelings and provide emotional support.
  • Set boundaries: Clearly define and maintain personal and professional boundaries to prevent overextension. This might include limiting overtime, ensuring adequate time off and saying “no” when necessary to avoid taking on too much.
  • Practice self-care: Regular self-care practices such as exercise, meditation, adequate sleep and engaging in hobbies can help manage stress and reduce the risk of burnout. The AOA has compiled a wellness kit to support the wellbeing physicians. Learn more.
  • Debrief after difficult cases: Regular debriefing sessions after challenging cases can help process emotions and reduce the impact of moral injury. This can be done individually or in a group setting with colleagues.
  • Ethical reflection: Regularly engage in ethical reflection, either through journaling or discussions with trusted colleagues, to reaffirm your values and reconcile any actions taken that may conflict with your ethical beliefs.

Specific strategies for addressing systemic issues

  • Simplify documentation requirements: Streamline documentation processes to reduce the administrative burden on health care professionals, allowing them to focus more on patient care and less on paperwork.
  • Advocate for flexible policies: Advocate for policies that allow health care professionals to have more flexibility in patient care decisions, reducing the ethical dilemmas caused by rigid insurance or government regulations.
  • Provide training on navigating bureaucracy: Offer training on how to effectively navigate interactions with insurance companies and government agencies, including tips on advocating for patient needs within these systems.
  • Monitor and act on reports: Regularly monitor reports of practice barriers and ethical conflicts and ensure that these are addressed at the organizational level. This could involve working with advocacy teams to push for systemic changes based on the struggles reported by health care professionals.
  • Encourage open communication: Foster an environment where health care professionals feel safe and supported in discussing the challenges they face with bureaucracy and systemic barriers, without fear of retaliation.

Organizational support and leadership

  • Leadership commitment: Ensure that leadership is committed to addressing burnout and moral injury by providing the necessary resources, support and time for health care professionals to engage in self-care and ethical reflection.
  • Regular mental health check-ins: Implement regular mental health check-ins with staff, where they can confidentially discuss their mental well-being, and any concerns related to burnout or moral injury.
  • Flexible work schedules: Offer flexible work schedules and reduce mandatory overtime to allow health care professionals to maintain a healthy work-life balance.

Long-term strategies

  • Invest in staff well-being programs: Long-term investment in staff well-being programs, including mental health resources, resilience training and wellness initiatives, can help reduce the impact of burnout and moral injury.
  • Collaborate with insurance and regulatory bodies: Work collaboratively with insurance companies and government regulators to develop policies that prioritize patient care and reduce the ethical burden on health care professionals.
  • Advocate for systemic change: Engage in advocacy for broader systemic changes that reduce the administrative and ethical burdens on health care professionals, such as reforming insurance practices or reducing unnecessary regulations.

Resources and contacts

Reporting practice barriers and safety events

  • Submit safety events or practice barriers impacting quality improvement via the AOA PSO Reporting Portal.
  • Contact [email protected].

Advocacy support

Learn more

Physician services

  • Access billing, coding and documentation support via the Physician Services Team.
  • Contact [email protected].

Physician voices

Explore these firsthand accounts for insight, support and strategies for overcoming burnout, featured in The DO:

Read more

Additional information

  • Dean, W., Talbot, S., & Dean, A. (2019). Reframing Clinician Distress: Moral Injury Not Burnout. Fed Pract., 36(9), 400-402.
    • This article differentiates between burnout and moral injury, offering insights into how moral injury is a result of ethical conflicts rather than just stress.
  • Epstein, E. G., & Hamric, A. B. (2009). Moral distress, moral residue, and the crescendo effect. The Journal of Clinical Ethics, 20(4), 330-342.
    • Discusses the concept of moral distress, a precursor to moral injury, and provides strategies for managing these ethical challenges in health care.
  • Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129-146.
    • Offers organizational strategies for reducing burnout, including leadership commitment and systemic changes.
  • National Academy of Medicine. (2019). Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies Press.
    • Provides a comprehensive overview of the causes of burnout and suggests systemic solutions to promote clinician well-being.
  • Litz, B. T., & Kerig, P. K. (2019). Introduction to the special issue on moral injury: Conceptual challenges, methodological issues, and clinical applications. Journal of Traumatic Stress, 32(3), 341-349.
    • Explores the concept of moral injury, its distinction from PTSD, and implications for clinical practice.

Conclusion

Addressing burnout and moral injury requires a multifaceted approach that includes both individual strategies and systemic changes. Reporting practice barriers, engaging in advocacy and fostering a supportive workplace culture are crucial steps in mitigating these challenges. By prioritizing the well-being and ethical integrity of health care professionals, organizations can improve patient care and create a healthier, more sustainable work environment.

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