• Article
  • February 2, 2017

Reducing Employee Burnout Key to Improving Quality and Safety in Health Care

J. Bryan Sexton will discuss surviving vs. thriving at the 2017 Quality and Safety in Children's Health Conference in Orlando, March 20-22.

Sexton's work

  • $3 million grant from NIH for randomized clinical trial of resilience training
  • Studies teamwork, safety and resilience in high-risk environments such as the commercial aviation cockpit, the operating room and the ICU
  • Serves up interventions to smother burnout and boost resilience

How does burnout effect quality and safety initiatives in the health care?

Burnout, at its core, is your inability to do things. It creates a feeling of being alone, thinking no one else feels the same way, which means they're not talking about it. When I was at Johns Hopkins (earlier in my career), we were studying, 'What is the best intervention to reduce bloodstream infections? What is the best protocol, the best procedure, pathway or checklist?'

We were trying to standardize things in ways to make it the most evidence-based as possible. But we hit a point where we realized the perfect checklist or perfect procedure is useless when you are trying to use it on people who are completely fried. When they're struggling and disengaged, they aren't ready to acknowledge the change. So the question becomes…how do we get people back to their fighting strength so they can care about improving quality?

So to successfully create a safety culture, you need to knock out burnout?

You can't measure safety culture without including good metrics on the work-life balance, and the burnout, of your workforce. There's a norm of burnout at the unit level. The longer you work in a unit full of burned out people, the more burned out you become. The longer you work in a unit full of resilient people, the more resilient you become. It's a social contagion.

A big part of what we do is to help people know that when your demands go up and your resources go down, and you're asked to manage that gap for an extended period of time—that's what causes burnout. And that's a normal human reaction in an obnoxious situation that many health care workers find themselves in.

What can institutions do to reduce burnout and keep their teams strong and ready to drive quality and safety improvements?

Slow down the pace of change. The constant pace of change is what's causing the burnout levels to increase. And that's overwhelming to people. And we have to make it easier for busy, tired health care workers to have access to resources as part of their work time, not in addition to their personal lives.

There are patient safety leadership rounds, which have been used for a long time to surface and address quality issues. One of the things we are doing at Duke is called positive rounding where you say, 'What are we doing really well, and are there successes we need to be celebrating?' So employees can be seen by their peers as someone who has really gone above and beyond. That positive rounding has been amazing. Participating staff are fundamentally different in their burnout and in their work-life balance—and in the purpose and meaning that they experience at work.

Are there differences between the adult and pediatric worlds when it comes to managing burnout?

People in pediatrics have a mental toughness that helps us out with burnout in two ways:

  1. They have more access to purpose and meaning than the average clinician
  2. Because of that, they tend to do better with our interventions. The biggest problem we have with our interventions is that people fall out of our studies. But that's part of what goes with that stick-to-it-iveness of pediatricians. They don't fall out of our studies.

What should institutions keep in mind when using interventions to reduce burnout and build resilience on their teams?

There's not a one-size fits all approach. Positive rounding is an example. Peer support groups are an example. Make an intervention to address burnout easy, fun and interesting, and make it seem like all the cool kids are doing it. Offer a buffet of choices—people need to be rewarded for making those choices, and they need to be tied into what you are doing at the institutional level.

What are you seeing in terms of adoption of resilience interventions from an institutional perspective?

There's a lot of variability within an institution, it's not monolithic. The success of most of these interventions depends on departmental and unit-specific leadership more than they depend on the C-suite leadership, so far. I hope that changes.

What do these resilience interventions do for health care professionals experiencing burnout and struggling to perform their jobs?

I refer to it as "skills, not pills." Your perceptions are wildly influenced by how you feel. So if you're burned out, you see the world through a negative lens. The primary thing we're doing with these interventions: we're making it easier for people to find the positive in the world around them. Because when you're burned out, there could be a rainbow right in front of you, but you don't see it to save your life.

Can you provide some proof in numbers?

When we did resilience interventions in our perioperative services, we cut our depression rates in half, and we reduced our burnout rates by two-thirds.

To learn more about these resilience interventions and how you can use them at your own institution, don't miss Sexton's opening plenary March 20. Register for the Quality and Safety in Children's Health Conference.