High turnover rates among clinicians and nurses are often attributed to burnout, staffing shortages, and violence against healthcare workers — but a significant factor "has gone unspoken in public discussions about why healthcare workers are quitting."

The 'unspoken' factor driving healthcare workers to quit

Writing for  TIME, Gita Pensa, an emergency physician, consultant, and coach for physicians experiencing litigation stress, notes that there are several factors driving healthcare workers to quit their jobs, but one key factor is rarely discussed.

"As a physician who coaches other doctors through the stress of malpractice litigation, I am keenly aware of a truth that has gone unspoken in public discussions about why healthcare workers are quitting," Pensa writes. "[W]hen there is an outcome that causes suffering and grief for patients and their families, we are not only crushed by these failures, but also become the faces of them."

While malpractice litigation is "exceedingly common" among healthcare workers, it remains a sensitive topic and "carries an air of shame and secrecy," Pensa writes.

"Personal experiences in litigation are rarely discussed," she notes. "Many physicians have no understanding of how litigation actually works. But malpractice litigation happens to many good doctors."

Still, the mere accusation  of malpractice ignites a cycle of shame and distress for many healthcare workers, regardless of whether any malpractice occurred, Pensa claims.

Ultimately, it is important to acknowledge that regardless of whether an error occurred or a case's outcome, the stress associated with malpractice litigation is a chief driver of burnout, substance use, divorce, and mental health crises among healthcare workers.

"Adding to the distress of a serious adverse outcome for their patient is now the fear of personal assets at risk, the potential loss of licensure or livelihood, and the stigma of the lasting public record of the lawsuit; worry runs rampant, as does the shame of being judged incompetent by patients and peers alike," Pensa writes. However, many healthcare workers do not openly express this fear.

"Serious medical mistakes do  occur, of course, and the risk increases as our healthcare system frays," Pensa notes.

At the same time, "[m]edical providers are often minimally supported by their institutions during litigation; the result is a general sense of mistrust between hospital administration and staff," she says.

Currently, "dangerously understaffed conditions are leading to more adverse events—and in a vicious cycle, the impact of those events will drive even more of us away," she adds.

"All of this has always been part of our jobs, but the more we are tasked with the impossible, and blamed when unable to achieve it, the more keenly aware we are that every malpractice lawsuit needs a face, and that face will soon be ours," Pensa writes. (Pensa, TIME, 3/31)

How to better support your clinical workforce in challenging times

By Carol Boston-Fleischhauer 

When threatened or met with malpractice litigation, healthcare workers can be profoundly affected and face sobering consequences — even if they are found innocent of any charges. Healthcare workers experience both immediate and long-term effects, including a sense of shame, personal failure, isolation, departure from their roles, and burnout.

To mitigate the personal effects of malpractice claims on healthcare workers, leaders must take steps to support their workforce.

How to support your workforce

Clinicians are often referred to as "second victims" in the wake of adverse events and medical errors.

C-suite leaders are tasked with ensuring that their workforce is supported in the face of any type of adverse event or malpractice threat. Organizations should implement various evidence-based practices to support workers faced with malpractice litigation. However, processes to support affected patients and families are also paramount.

Organizations could also enact temporary work suspension, the provision of peer or professional support, access to patient safety and risk management experts, crisis counseling, external referrals, and additional organizational policies and procedures.

 Leadership should prioritize harm prevention efforts, voluntary reporting, and a strong culture of safety. These strategies are key to ensuring that clinicians trust the clinical practice environment in which they are employed.

How to address clinician burnout

The toll that adverse events or malpractice claims take on clinicians is undeniable, in particular, burnout and the decision to leave the profession.

In the post-pandemic environment, unresolved clinician burnout continues to plague provider organizations nationwide, even when no type of medical error or adverse event has occurred. Higher acuity levels, increased patient volumes, and continued staffing challenges are key contributors — all of which prompt increased turnover, drive decisions to leave the profession, and pose care quality and safety risks.

Our 2023 workforce survey, which will be released later this month, reflects widespread concern about burnout levels. Survey results will be paired with updated insights on options for addressing burnout and the most pressing workforce issues currently challenging executive teams. As C-suites continue to address clinical workforce stabilization, the need to  address clinician burnout more broadly remains crucial. Addressing clinician burnout following adverse events and malpractice claims is only part of the stabilization puzzle. (AHRQ report, 9/7/2019)