Transcription:

Bill Klaproth (Host): When a physician is burned out, that can impact many things including patient’s safety and quality of care. So what is being done to guard against this? Let’s find out with Linda Williams, Director of Provider Relations at Southern New Hampshire Health. Linda, thank you for your time. Let’s start here, what is provider burn out?

Linda Williams (Guest): Well I think that’s a challenging question to ask because everyone really experiences it a little differently. You know, there’s this big continuum from wellness and thriving to burnout and it’s all kind of interrelated, so I think the importance is being self aware and recognizing where we are along the continuum, but when people talk about it specifically in the literature, they’re talking about the three main components, exhaustion, and not just I’m tired and I need to take a nap but true emotional exhaustion and then cynicism. I’m not sure what I’m doing is making any difference and that couples with feeling ineffective or like there’s no meaning behind what you’re doing, and of course there’s meaning all the time in healthcare in everything you do, but when you couple those three things together, it really becomes a time when you’re so disengaged where you can’t do it anymore. It’s different than feeling disengaged when you just don’t want to do it, you just don’t want to go to work, but really you can’t do it, and that’s kind of the bottom pit of burnout.

Host: So you can’t do it anymore, not that you don’t want to do it, you’re just physically and mentally you’re so exhausted you can’t. Is that what you’re talking about? You’re done.

Linda: Yeah and it is a continuum so hopefully we don’t get there, but everybody knows the, at least everyone in healthcare knows the statistics that we lose about a medical school class worth of physicians, so about 300 physicians a year to suicide and that’s not all related to burnout, but certainly some of that number is.

Host: Oh my, wow that is sobering statistics. So you said this is a continuum. Everyone experiences burnout differently. So when a physician is in that burnout continuum, how does this affect patients and patient care?

Linda: Well if you can imagine being on the other side of this right? If you’re the patient and you’re walking into a physician or non-physician provider, a nurse practioner, or PA, even the nursing staff, you sense if they’re not there with you. This really is a relationship between providers and healthcare professionals and when they’re not there, they’re not paying as much attention to you, it increases medication errors, it increases patient dissatisfaction, it increases in fact mortality in hospital medicine and also in outpatient medicine because we can’t pay attention as well because we’re just not there. So things that the patients don’t even think intuitively related to whether their provider is burned out or not, can be changed simply by how the provider’s doing and this is not in a day to day situation, right? It’s not moment to moment, I’m burned out or I’m not burned out. We’re talking like you get there and it takes you a while to get back.

Host: Okay, so that’s a really good distinction. So this is a debilitating disease if you will, crushing. This isn’t a I don’t feel like it today, this is a day in, day out thing. So how does this also impact other staff members around the physician?

Linda: Oh absolutely, it affects relationships with other staff members, not only bringing them down and increasing their exhaustion, but just how providers interact. If you’re at that stage of burnout where you are not valuing the other people on your team, the whole team’s involved and the whole team is down, and so they’re more likely to make errors. They’re trying to catch your errors but they’re at risk too.

Host: I could see how that would impact them and how that would affect the whole office and bring the performance down. So let me ask you this Linda, what do physicians generally do to avoid this?

Linda: The most important thing to do is recognize it and talk about it, and certainly we have some tools in our toolbox that will help, right? Any resilience that you have, going for a walk, getting regular exercise, sleeping, eating right, all those things contribute to resilience, but we’re learning more and more that organizational changes are necessary, and not necessarily in your own organization, but systemically, nationally because it’s that one on one time with patients that really makes a difference to us, that’s why we went into medicine. So it’s not something inherently wrong with the physician that leads to burnout, it’s that things have changed and this pace of change we haven’t really kept up with it as healthcare providers.

Host: Yeah you want your physician paying attention to you.

Linda: It’s the relationship aspects and not the operational aspects that most of us in healthcare are – that’s where we thrive, that’s what we want to do, but really we spend out 27% of our day meeting one on one with patients and the majority of it is administrative duties.

Host: Right, so it’s good that we know of this provider burnout and good that you’re bringing this topic to the forefront, so what is being done at Southern New Hampshire Health to fight against provider burnout?

Linda: Well we’ve taken a page from the Stanford model. Stanford is really leading the charge in this and at the center is professional fulfillment because if healthcare providers feel fulfilled, they are way more likely to have good patient care and have patients who are satisfied and have the whole team be satisfied, so we’re looking at the cultural wellness that we’re creating in our organization. We take care of people, right? But taking care of people is not only our patients, it’s taking care of ourselves and each other as well.

Host: Right, doctors are people too and self-care is very important. So this sounds like a multi layered approach that you’re taking. What are some of the other steps?

Linda: We’re looking at the efficiency of practice, which sounds like kind of a buzz phrase, but there are so many non-truly patient related things that we do every day, using the electronic medical record, doing prior authorizations, working with insurance, doing more clerical duties, operational duties rather than relational things. We are actually looking at those two and how we can lesson those for our providers as well because that’s a key component across the board and that’s nationally where a lot of the focus is on this issue.

Host: Well it’s good to know that nationally this is being recognized and that steps are being taken to help prevent provider burnout. Let me ask you this Linda, for a consumer who may notice burnout, or that something is wrong with their physician, they can sense it, hmmmm something’s not right with this person, what is your advice for the patient that may notice this in their provider?

Linda: I think saying something to the provider is a good piece of advice. I’ve certainly been there. I’ve been in the midst of burnout and people have said to me afterwards yeah I could tell you were just not right. It is incredible when our patients care about us. We are used to, it is our job to care about our patients, but when a patient reaches out and cares about us, it’s not going to bring you from the bottom pits of burnout, out of it, but it might make you stop and think.

Host: And stopping to think might be just what that person needs to address what’s really happening and take a step back to assess, oh my gosh I’ve got to do something. So really good point, if you sense your doctor is not into it that day, it’s okay to say, hey doc are you okay? Is everything okay with you? Is everything all right? So it’s okay to say that?

Linda: Oh absolutely. Oh yeah.

Host: Okay, great advice. Well this has really been fascinating Linda. Thank you for talking with us about provider burnout and what you’re doing at Southern New Hampshire Health. To learn more, please visit snhhealth.org, snhhealth.org. And if you found this podcast helpful, please share it on your social channels and be sure to check the entire podcast library for topics of interest to you. This is Simply Healthy, a podcast by Southern New Hampshire Health. I’m Bill Klaproth, thanks for listening.