When it comes to physician burnout, Covid-19 is gasoline on a fire. Clearly, burnout preceded the Covid-19 pandemic, but the virus caused worse burnout across more physicians. In 2021, 47% of physicians experienced burnout—almost half of our entire physician workforce.
How Ochsner Health's structured debriefs promote recovery during a crisis
We profiled Ochsner Health's structured debriefing program during our workforce recovery research last year. In this program, trained mental health professionals support physicians with significant burnout. Physicians and APPs in this program participated in hour long sessions with a focus on sharing, reflecting, reframing, and growing in the wake of difficult experiences.
Another year into the pandemic, we caught up with Dr. John Sawyer, Medical Director of Professional Staff Experience and Ashton Sloan, Assistant Vice President of the Office of Professional Well-being at Ochsner Health. We wanted to get an update on how they're continuing to improve workforce well-being at the not-for-profit health system covering Louisiana, Mississippi, and the Gulf South.
Dr. Sawyer and Ashton told us they have since created an internal coaching program called the professional experience program (PXP) to support physicians and APPs facing even more acute burnout. Both the structured debriefing program and PXP face a common challenge: they only reach a subset of providers experiencing burnout. In this situation, most organizations expand the program. But the Ochsner team is looking at other ways to scale their success too.
By working with more than 30 providers in the PXP, the team noticed common profiles or "archetypes" of burnout among physicians and APPs. They found burned out providers usually fell into one of four categories based on their personality, goals, and symptoms of burnout.
The team collected these findings and is equipping leaders in the organization with the learnings from the program. The goal is for physician leaders and executives to use this archetypal framework to scale Ochsner's wellbeing efforts in a way that's both meaningful for providers and sustainable for leaders. The Ochsner team told us this takes three steps:
The cornerstone of this approach is a leader's ability to form relationships with the physicians and APPs they are leading.
Through these conversations, leaders understand the provider and their personality while thinking about characteristics of burnout they may exhibit.
While each individual is unique, Ochsner found commonalities among burned out physicians and APPs. They organized these commonalities to create four categories or archetypes. Leaders keep these archetypes in mind when working with providers in their sphere of influence as a cheat sheet for identifying burnout and improving wellness. A brief snapshot of the four archetypes Ochsner found:
Shows up as: inability to say no, taking on too many tasks, and certain tasks not being completed due to being so stretched.
Executives can: try to uncover why the physician is over-engaged. Common reasons are wanting a promotion, more compensation, a different role, or a misperceived expectation. Grounding this conversation in the physicians long and short-term goals will help them decide which tasks are worth doing and what is worth offloading.
Shows up as: difficulty setting boundaries, performing tasks that are not top of license, not confronting colleagues when they disagree or have made a mistake.
Executives can: create a comfortable, confidential environment for the physician to freely express their needs and ability to self-advocate. Simply say, "what's one way you can set limits with patients, so your time doesn't get away from you?"
Shows up as: long clinical notes, continuously charting, or beliefs that nurses or MAs are unable or not skilled enough to help them.
Executives can: validate physicians standards and then identify ways that the level of perfectionism that the physician is striving for has benefits, but also costs. Ask the physician to prioritize tasks based on how related it is to patient care quality versus personal style.
4. Problem-finder cynic
Shows up as: quick to point out problems or lead with worst case scenario planning, perceive negative intentions, and complain but reject helpful suggestions.
Executives can: lead with empathy even if the physician is being critical. To establish trust over time, focus on consistent positive interactions and demonstrating transparency. When it's time to discuss burnout with the physician own your past mistakes that fostered cynicism, this will encourage the physician to be more open to being positive. Frame the conversation as "cynicism isn't working for you or the team." Come to the conversation with a list of examples of when they approached a situation with a negative attitude. By identifying times when the physician had a choice of either a negative or positive mindset, they can start to notice that they have more control over their attitude than they once thought.
The goal of Ochsner's archetypal framework is not to stereotype but to scale and sustain wellness efforts. With these archetypes, leaders get a guide to understanding and improving their team's wellbeing when almost everyone has at least one symptom of burnout.
The most important aspect of this approach isn't actually the archetypes—it's the way leaders use the archetypes to make small but meaningful wins for their physicians and APPs.
To learn more about archetypes of burned-out physicians and how to help them, read Dr. John Sawyer’s publication in the American Association for Physician Leadership | AAPL Journal.
Over the last year physicians have been at the forefront of unrelenting change—and unimaginable challenges. And even with vaccine rollouts well underway, many of the experiences providers have encountered over the last year can have a lasting psychological toll. Data from past experiences with viral diseases, such as SARS, shows that affected health care workers experienced significantly higher levels of burnout, psychological distress, and posttraumatic stress for up to years after the fact. And perceived adequacy of support—through actions like unpacking traumas—has been found to be preventative of these negative posttraumatic effects.
To learn about how organizations can create a space for physicians to reshape traumatic narratives, we spoke with Ochsner Health's Nigel Girgrah, MD PhD, the Chief Wellness Officer, and John Sawyer, PhD ABPP-CN, Medical Director of Professional Staff Experience, about its structured debrief model—and their advice for how leaders can help their teams unpack the experiences of the last year.
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