Paul DeChant MD, MBA
Burnout Shame and Blame
SPOILER ALERT! Leaders, not front line clinicians, are responsible for burnout.
It's not hard to talk about burnout - at least in the abstract. Most people, myself included, find it hard to admit to being burned out.
When we acknowledge our own burnout, it feels like we are admitting to weakness or failure. We feel like we are too weak to handle the stress of the work we do. When our colleagues seem to be handling things well enough, is it our own personal failure when we can't cope?
Our Thinking About Burnout Is All Wrong
According to the World Health Organization, burnout is an occupational phenomenon, not classified as a medical condition.
"Burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed," states the ICD-11 entry. It is described in the chapter: ‘Factors influencing health status or contact with health services’ – which includes reasons for which people contact health services but that are not classed as illnesses or health conditions.
As the burnout trailblazers, Christina Maslach and Michael Leiter say in their landmark book from 1997, The Truth About Burnout, “Burnout is a sign of a major dysfunction within an organization and says more about the workplace than it does about the employees.”
In other words, burnout is a failure of the organization, not of the clinician working in that organization. When we blame ourselves for burnout, we make a common mistake. You are not to blame for being burned out. Your workplace is.
Why We Blame Ourselves Instead of Our Workplace
There are a number of reasons we clinicians blame ourselves.
First, we go into medicine because we have a strong sense of personal responsibility.
Our first tenet in medicine is "Do No Harm". In our training it is drilled into us that we are personally responsible for patient care and outcomes. If anything goes wrong with the patient, it is OUR fault. We have only ourselves to blame. If only we had tried harder, stayed longer, or acted more quickly, things would have been fine.
Yet, when something goes wrong with ourselves, our first thought is that we have only ourselves to blame. Nothing could be further from the truth.
Second, it's hard to overcome this mindset of personal, individual failure.
We began to change our thinking on medical error with the publication of "To Err is Human" in 1999 by the Institute of Medicine. This recognized that the imperfect systems in which we deliver care are more responsible for errors than individual clinicians error.
Over 20 years later, we have partially embraced this message regarding medical errors, but still have a way to go. It's time we realize the same issues regarding burnout, and embrace the message that the clinical workplace, not the worker, is the root cause of burnout. After all, Maslach and Leiter told us this over 20 years ago. Why is it taking so long for us to find solutions fixing the workplace, rather than blame the worker?
What Should You Do?
Let's start with what you should not do if you are burned out. Do not blame yourself! And equally important, remember, there is no shame in being burned out. If you are struggling, reach out for help.
It is getting easier to reach out for help. This blog post is partially inspired by a webinar I attended two days ago presented by the Medical Society of Virginia (MSV) and VITAL WorkLife, introducing their new "Safe Haven" program to provide confidential support to physicians experiencing burnout. MSV worked with Virginia's governor and legislature to get HB115, the law providing protection, signed and implemented on an emergency basis on March 8th.
Dr. Terri Babineau, MSV's Medical Director Physician Wellness Program, has done an excellent job leading these efforts. She is a great resource if you are looking to do something similar in your state.
Who Is Responsible for Burnout?
The real question to ask is when you are burned out is, "If burnout is due to workplace dysfunction, who is responsible for the conditions in the workplace?"
In my view, there are multiple parties responsible:
Organizational leaders - first and foremost, the CEO and their direct reports have ultimate control over the organizational culture, resources, processes, and people that determine how functional the clinical workplace is. With control comes responsibility. If anyone should feel shame, or take blame for burnout, it is the C-level leaders. Despite great opportunities to make a difference, leadership involvement in reducing burnout varies widely. A main focus of my work is helping C-level leaders engage in reducing burnout.
Local leaders - the person who has the most impact on your engagement and professional fulfillment is your direct supervisor. Local leaders, or "middle managers", as they are more commonly described, face many challenges. They also have unrealized opportunities to make their clinicians', and their own, lives better. I focus a lot of my work here as well, supporting middle managers.
Front line clinicians - while clinicians should not be blamed for being burned out, and should not be the primary focus of efforts to reduce burnout, there is a lot you can do to help yourself and your colleagues. These include building friendships with everyone in your workplace to improve collaboration when it is needed, approaching problems by considering potential solutions rather than quickly reacting with anger and victimization, and taking opportunities to contribute your knowledge and skills to the greater good. That said, do not blame yourself, or feel any shame, for experiencing burnout.
Burnout, like other problems, is an opportunity
One reason I love Lean as a management system and culture, it the philosophy that problems are treasures. We can't fix things that are broken if we are not aware of them. Identifying a problem gives us the opportunity to fix it, to make things better.
As hard as it seems to be grateful when someone brings you a problem, the best way to respond is to say, "Thank you." Make the person feel good for bringing it to your attention, and invite them to help the effort to solve the problem. If they also bring a solution, it does not mean accepting that solution as the answer. Most problems we deal with are complex with multiple stakeholders and viewpoints. They will provide one of many valuable inputs to solve the problem.
And so it is with burnout. There is no single solution. Nor are there multiple solutions that, once they are all in place, burnout will go away. It will always be a complex and ongoing challenge in our dynamic world.
Valuing burnout as an opportunity to make the workplace better begins the process of healing the broken workplace, and healing our broken selves. Won't you join in this effort?