Redesigning Clinical Workflows to Return Joy to Patient Care
The Hamster Wheel – Shorthand for Physician Burnout
The Hamster Wheel – Shorthand for Physician Burnout

As I delve deeper into the world of healthcare worker burnout, there is one image that appears too commonly.  Physicians say they feel like they are a hamster running on a wheel, or express a desire to “get off the hamster wheel.”

It seems that everyone can relate.  I’ve opened conferences on improving practice workflow with a video of a hamster running on a wheel, going so fast he ends up trapped spinning around while the wheel keeps going, and eventually falls off.  The audience members have a good laugh.  Later, many will tell me privately how strongly that visual resonates for them.

Hamster Wheel

How has this image become our shorthand for burnout?

I did some digging on Google, and found the following definitions:

From Wiktionaryhamster wheel (plural hamster wheels):

  1. circular cage for a hamster or other small rodent, which rotates vertically as the animal runs at the bottom.
  2. (figuratively,by extension) A monotonousrepetitiveunfulfilling activity, especially one in which no progress is achieved.

From the Urban Dictionarywhen someone just keeps running in circles (and making the same mistakes) in their life, instead of progressing

It’s depressing to think that highly trained medical professionals are describing their work lives this way.  I understood why when, on Wikipedia, I found this picture with the following caption:

Hamster Wheel 20150311

“Like other rodentshamsters are highly motivated to run in wheels.”

As caregivers, do we accept a workplace with unrealistic external demands and broken workflow processes because we are “highly motivated” to care for our patients and don’t see an alternative?

We chose health care as a profession because we were “highly motivated” to make a difference, to do something significant for our fellow humans.  We paid the price of sacrificing our 20’s with long hours of training to ensure that we could be trusted with other people’s lives.

Has our acculturation through medical or nursing training worn us down so that we simply accept whatever obstacles are put in our way?  Too many of us experience burnout.  It takes its toll in many damaging ways.

Drivers of Burnout

According to Maslach and Leiter in The Truth About Burnout, the drivers of burnout are six key mismatches between the worker and the workplace.  Let’s see how our hamster running on the wheel is impacted by these:

  • Work Overload – with too much to do, he can never get off the wheel
  • Lack of Control – he can’t stop the darn thing, and runs till he falls off
  • Insufficient Reward – he gets no special recognition or additional resources for this effort
  • Breakdown of Community – if two or more hamsters are in the cage together, they often end up running over each other o n the wheel. You can find videos of these on YouTube
  • Absence of Fairness – do hamsters feel it is unfair to put in all that effort with nothing to show for it, or do they simply enjoy it?
  • Conflicting Values – Hamsters seem to value running on the wheel, physicians who are feel that productivity requirements are superseding quality care do experience a mismatch

It’s time to stop sacrificing ourselves. It’s time to create healthy clinical cultures that respect dedicated hard-working professionals.

Lean Done Right is an effective approach to creating that culture.  It is based on two key principles – Respect for People and Continuous Improvement.

Respect for people means creating a workplace where we don’t have “highly motivated” people endlessly following the same routine and making the same mistakes, only at a faster pace until we collapse. We provide the right opportunities for the physicians on the front lines to get help implementing their ideas to fix problems effectively.

Huddles give us a chance stop and reflect, to address problems, to experiment with new ideas, to recognize and to appreciate our colleagues.

Designing flow cells around pull, rather than pushing more work into an already stressed system, results in a much less chaotic workplace.  Flow cells and pull systems drive quality and continuous improvement.  And yes, this does work in busy and productive hospitals and clinics.

What do you think?

Will you join us in transforming healthcare with Lean Done Right and returning the joy to patient care that we aspired to when we began our careers?

Are you ready to get off the hamster wheel?

2 Responses to The Hamster Wheel – Shorthand for Physician Burnout

  1. Hi Dr. DeChant,

    I think it’s pretty clear that most primary care docs would be delighted to get off the hamster wheel, but making the wheel spin is the only way we can get paid.

    Better care (fewer visits)=> less money=>office closes.

    So we’re doing the best we can in a broken system over which we have almost no control.

    For what it’s worth, insurance companies’ profits are a percent of their total premium, so the higher costs go, the higher their premiums get, and the higher their profits go. Cutting total expense would reduce their profits. Why would they tolerate that?

    • Peter, thank you for your thoughtful comments. Most docs are overworked in a system in which there is little control and a significant mismatch of values.

      You’re right, you can’t just hop off the wheel without significant short term risk. The current system is unsustainable. Change is coming, but it is coming slowly, and will likely come with some missteps along the way.

      There are options whether you work in a solo or small group, or in a larger group practice.

      Look at the AAFP’s Transforming Clinical Practices Initiative Member Interest Group if you are in a small practice. There is an engaged group of colleagues there doing good work.

      If you are in a larger group, engage with the leaders regarding your challenges. If they are not supportive, at some point you may need to make a change to take care of yourself.

      With over half of physicians experiencing burnout, it’s important to take care of yourself. There are a number of excellent physician burnout coaches who can help you better cope with your current situation and figure out options for a better future. You can find them easily with a Google search.

      Even when you may not feel like it, know that you are doing important work that your patients appreciate. We don’t receive that validation often enough.

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