Healthcare worker burnout has been an increasing issue over the past 15 years, with detrimental effects on physicians, patient outcomes and population health that should concern all occupational health professionals. Although physician-focused and drawn heavily from US experience, many conclusions from physician executive and author Dr George Mayzell resonate with other healthcare professionals and are internationally relevant.
Current dilemmas including inconsistent burnout definitions, variable cut-off values for metrics and their interpretation are discussed and concluded with a recommendation that burnout should be tracked by all hospital boards.
A consistent theme is increasing clinician workload, driven by non-patient care demands that compromise patient focus. The requirements to document compliance with standards (designed by others), navigate workflow bottlenecks and manage poor primary and secondary care IT interfaces are described in a chapter focused on electronic medical records (EMRs); metrics focused on financial productivity over patient health outcomes all add to a business versus mission disconnect for clinicians and increased burnout risk. Societal drivers, correlations with negative organizational outcomes (e.g. retention, patient safety), limited public understanding and decreasing public respect for clinicians merit a deeper dive.
Despite repeated calls for organizational solutions, the book is overly weighted towards individual factors; chapters on individual interventions precede organizational, personal traits precede institutional causes and one chapter concludes that ‘relaxation and mindfulness can be useful, although some evidence would indicate that organisational approaches may be more superior’.
Later chapters shift the balance somewhat towards system change, without losing sight of the individual; systematic on-boarding, mentoring, resilience (for adaptability, as solutions are worked through); addressing stigma and access to care for clinicians with mental ill-health focused all require organizational implementation. The value of team working and re-allocation of team roles to facilitate more purposeful engagement at the ‘top of the license’ are helpfully emphasized as are barriers relating to poor role clarity, professional protectionism and failure to address poor behaviours.
Another consistent theme is the need to increase autonomy. Recommendations include: increased engagement through physician leadership, ‘build the culture you wish to see’; more flexible working and collaboration through autonomous scheduling schemes, such as ‘bank and trade’ at Stamford; and systematic inclusion of clinician ‘users’ in workflow development, the definition of clinical standards and performance metrics; physicians often feel accountable for decisions made with limited evidence derived from consensus studies, extrapolated and conflicting data.
Some recommendations are simplistic—that institutions should be fully staffed to address workload, sleep prioritized for stress reduction. However, many useful references and checklists with universal application are shared.
The concluding chapter moves us beyond burnout management towards fostering engagement and joy. There’s a helpful reminder that a strong business case is needed, together with an inclusive strategy integrated throughout day-to-day operations to reduce clerical burdens; well-being impacts must be measured and tracked by an engaged, accountable leadership.
While modestly priced, and easily read in one sitting, for most, this book is probably best used for reference only.
Rating
★★☆☆ (Reference only)
