Medicine & Health

Q&A: ‘Maybe we should step back from (needing heroes) and create good systems’

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Is the center addressing workplace burnout and staffing issues as a quality and safety concern? And how are you trying to help providers with that?

We work directly on zero-harm issues, which burnout is definitely a part of. … What we have seen is that when organizations focus on burnout, they tend to focus on increasing the skill of the person or the employee. How do you deal with stress? Or how do you increase your own personal resilience? And I think that’s great. It definitely focuses on wellness, but that’s only one aspect of it. 

Burnout is a workplace phenomenon, so it is workplace driven. There’s a lot of room to step back and ask your employees, “What are your barriers to doing effective work? What frustrates you in the workplace?” And then taking that information and getting rid of those barriers and making improvement efforts. So organizations are using their improvement mechanism to work on issues that affect how their employees come to work, how they experience their work and how effective they are in their daily goals and how they work with patients and each other.

How do you see hospitals managing the pressure of treating patients in a pandemic and maintaining their commitment to safety?

That’s the million-dollar question, right? And I think it’s a balancing act that organizations do every day. That’s also changing during the pandemic. What I hear has been working is that healthcare leaders are asking their teams, “What can we do to help you?” And making that the focus, because it has been very clear that you can’t get good patient care if you’re not caring for your own staff. So safety begins at the employee level. That also means it’s not leaders second-guessing what could go wrong, but also asking staff members who are on the front lines, who are on the ground, “What is going wrong? What could go wrong? What would make you feel more comfortable?” And even though there’s a lot of turnover right now, there’s a lot of things happening on the ground. Those conversations are even more crucial because I have been surprised with how long this has lasted. So any expectation that you will have that conversation after (the pandemic), that’s not going to happen. You need to have those conversations now so you can start as quickly as possible to make your safety culture stronger, make your workforce stronger, which will then provide the best care for patients.

Has there been a shift in how providers are looking at quality and safety issues or looking at workplace burnout with each COVID-19 surge? 

Yes. Especially since burnout has been going on even before the pandemic. I think that’s the most surprising thing—that these are issues that have been exacerbated by the disaster and that it has shown a spotlight on various aspects of healthcare that maybe we’ve taken for granted. But if we don’t do something about it now, we know it will get worse, not better. So it’s using the pandemic as a wake-up call, or as an opportunity to say, “this is where we’ve succeeded, this is where we failed, and this is how we can build better.” The whole system doesn’t quite work for us. We were hurting patients and we were hurting our staff.

Are there areas in particular that you see as big wins or areas where we’ve lost in healthcare and we can do better?

I think we know that it’s not bad people, it’s bad systems. So you have people working in systems that are challenging and are still managing to heal and treat millions of people. And that is amazing. Some of what they’ve done is to innovate almost on the fly. The conversations that have been happening between healthcare workers, between healthcare organizations and the innovation that feeds the need to experiment driven by need, but still the need to experiment and to trust each other, to try something new. I was very gratified to see that work.

The opposite side of that, or the other side of the coin, is you can really see bad systems relying on the skills, talent and goodwill of the staff who work in these bad systems. We’ve created a situation where people have to be heroes in order to do a good job. Maybe we should step back from that and create good systems so they don’t have to be heroes every day, because  it’s exhausting to be heroic day in and day out. And I don’t think people are made to withstand that kind of stress every day. And so that is probably part of where the burnout comes from.

That’s such a good point. The pressure associated with being a hero ultimately could lead to more burnout or lead to errors. 

It is very much like the challenges in workplace settings that are not healthcare, with leaders committed to creating environments where their staff bring their best to work. That is the same challenge healthcare has because the heroes are people and they are scared just like the rest of us, they get tired, they have family issues that they have to balance with professional concerns. So let’s think of the person in that system, treating another person or being a teammate to another person and think, “what do these people need? What do we need to thrive?” And it’s really the exact same issue.

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