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Toxic Workplaces

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Toxic Workplaces

Why do we tolerate toxic workplaces?

  • Would patients be admitted, or people be allowed to come to work, in a hospital that had Legionnaire’s disease spreading through it’s HVAC system, or cryptosporidium in its water supply?
  • When there is a unusual smell associated with headaches and nausea in a surgical unit or emergency department, do people continue to work there and show up for their next shift as though this is status quo?

Of course not.

Why is it different for burnout?

Burnout manifests as emotional exhaustion, depersonalization (cynicism), and a sense of inefficacy. It progresses to serious sequelae for clinicians, as they  develop depression, substance abuse, and family dysfunction. For 3-400 physicians each year as these problems worsen, it leads to death my suicide. Shouldn’t workplaces that are causing such significant morbidity and mortality be considered toxic workplaces? Doesn’t this deserve a significant response?

A key cause of burnout is placing highly motivated professionals into a clinical workplace in which they have inadequate support, and in which they cannot care for their patients properly without constant sustained vigilance and focus. The level of vigilance and focus required is unsustainable over the long term. Eventually this takes its toll and burnout ensues.

According to Christina Maslach, PhD the workplace drivers of burnout include:

  • Work overload
  • Lack of control
  • Insufficient reward
  • Breakdown of community
  • Absence of fairness, and
  • Conflicting values

These conditions are endemic in most clinical workplaces. When placed in these conditions, over half of physicians manifest the symptoms of burnout and are at high risk to progress to the serious sequelae noted above. A recent piece in The Saturday Evening Post explores this in great detail.

Why is there so little action by healthcare leaders to address toxic workplaces?

In March of this year 11 CEOs of major US health systems posted a Health Affairs Blog titled, “Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs“. From what I have seen, too many of their fellow health care CEOs have missed this call to action.

I work in many health care systems (30 in the past 3 years), sharing my message about burnout, its root causes, its impact, and, most importantly, what these systems can do to address the root causes and reduce burnout. The chief medical officers and medical directors are all engaged. Most process improvement teams are engaged.

It’s a different story for the rest of the administration, particularly the non-clinical members or the C-suite. More often than not, they are not present or distracted. It’s a bit ironic, as often they have asked for my help to get physicians engaged in process improvement work. They know they need the physicians to help fix problems in their clinical operations.

I can understand some of the reasons why. CEOs are under significant pressure to ensure the financial stability, and enhance the strategic position, of their organizations. They have to make choices about which meetings to attend and which stakeholders to spend time with to address these needs. These become the priorities.

What will it take to get CEOs engaged in burnout?

Most CEOs don’t seem to understand that burnout in their medical staff is one of the greatest financial and strategic threats facing their organizations. Why don’t they respond appropriately? Is it  because:

  • they have not recognized the real impact?
  • they don’t know what actions to take to address the challenge?
  • addressing the challenge will require them to change their management approach?

We all know that change which isn’t easy for anyone. Most of us won’t change until the pain of the current condition is worse than the perceived pain of the change.

How much worse will these toxic workplaces have to get, and how many more physicians will have to experience depression, substance abuse, family dysfunction and suicide, before health care leaders feel enough pain and we see effective responses from all health care CEOs?

What do you think?

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The National Academy of Medicine has launched an Action Collaborative on Clinician Well-Being and Resilience, but there is one missing stakeholder.  Last Friday, July 14th, NAM hosted it’s its first public meeting on establishing clinician well-being as a national priority. The inaugural sponsors include nearly many medical specialty societies, the major insurance companies, the American Associations… Continue Reading

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