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Imagining a Future of Greater Support: An Interactive Discussion

Participants became part of the process through an interactive discussion examining interventions to address burnout. In in-person and virtual breakout groups, they were asked to discuss and bring forward ideas in three overlapping areas: (1) ensuring interventions are fair and equitable and help those most at risk without introducing new inequities along the way; (2) implementation of interventions discussed throughout the workshop and what implementation might look like in their own organization; and (3) brainstorming of ideas to target burnout not previously discussed, along with key issues that would need to be addressed. After an hour of discussion, the small groups returned to the main room to share what each had covered.

REPORTS BY THE BREAKOUT GROUPS

Equity

The Equity breakout group discussed the importance of representation at the design phase to ensure those most affected by burnout are at the table to develop interventions to address it. A potential tool is power mapping, which fosters thinking about such factors as career stage, generational differences, and diversity, equity, and inclusion principles. Considering the different levels of interventions discussed throughout the workshop, the group noted that too much focus on individual-level interventions can

reinforce inequity, even unintentionally. When people are pressured to solve the problem themselves, with such examples as yoga and mindfulness training, inequity becomes rife in terms of who has access to and gets rewarded for undertaking these practices. It is critical to acknowledge the power differences between those who do the work and those who have the resources that affect the people doing the work. The language and images behind many of the concepts discussed at the workshop, such as well-being and risk, also have equity implications. For example, looking for images online of who does risk management work results in images of White men, while a search for people who do equity work results in images of Black women. The group also urged using repetition to continually raise the issue of equity and learning lessons from community-based collaboration.

Implementation

The Implementation group divided into two groups—those in person and those online. Each reported back their discussion. The in-person group urged a focus on the organizational level to address burnout. Benefits would include enhanced well-being, a commitment to the organization and its people, demonstrated compliance with regulations and standards, and a reduction in risk. Drawbacks involve potential challenges with creating culture change, which may not be measurable or feasible. It is important to convince an organization that the investment is worthwhile. To deal with unintended consequences for individuals, a safety net or alternative is essential. To build support within an organization, the group said, it is important to make business, moral, and scientific cases. A business case needs clear benchmarks and a return on investments, and a business plan supported by people from all demographics who will be affected. The moral case could show the impact on the health and welfare of individuals but should be supported by data. The scientific case would examine the evidence, both data and practical wisdom. The two main barriers are sustainability and pushback. To overcome these barriers, the group looked to the BUILD process (Buy-in, Understand, Implement, Learn, and Develop Sustainability; see Chapter 6). Vetting and allowing for feedback by the group affected could help address pushback.

The online group called for thinking at multiple levels, collecting data, and holding leaders accountable to act based on the data. They urged interventions that do not add to the burdens of time and money to already busy people and under-resourced institutions. A challenge is not to add more to

the burnout of already burned-out people. They harkened to an acronym brought up by Christina Maslach (see Chapter 2): GROSS, or get rid of stupid stuff.

Brainstorming

The Brainstorming group similarly divided into two groups. The in-person group suggested developing structures and process measures linked to downstream performance metrics, such as physician retention, as well as systems to recognize programs and institutions that are doing things well. Asked to prioritize one idea to share with the group, they suggested a way to benchmark well-being practices, somewhat akin to quality metrics for patient safety. A starting point might be the Joy in Medicine Health System Recognition Program of the American Medical Association.¹ Organizations apply for bronze, silver, and gold status, with criteria at each level. A practical way to get more involvement in such a model would be to get payers or accrediting bodies involved. Challenges to overcome may be an overfocus on particular measures and the need to standardize how well-being is measured across an organization.

The online group acknowledged the fundamental challenge of under-staffing as a cause of burnout and sought to think about interventions that could address this. The easiest solution, e.g., hire more staff, is not always viable. Thus, they looked at what can be meaningful without fully addressing the root cause. Transparency in work responsibilities can help people understand their own and others’ workloads. Training, mentorship, and validation are also important to help people get past the challenging learning curve of starting a new job/working in a new area and acknowledge their efforts. The group also discussed a shift in reward systems so that people feel they can take time off and care for themselves. A complex issue is that when people take on extra work, they receive extra compensation or other rewards, as they should—but that can reinforce a belief that extra work is expected and encouraged.

CLOSING REMARKS

Planning committee chair Reshma Jagsi thanked participants for insights about the critical issue of burnout. She noted that it is important

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¹ For more information, see https://www.ama-assn.org/practice-management/physician-health/joy-medicine-health-system-recognition-program.

to maintain the joy that exists in science, technology, engineering, mathematics, and medicine (STEMM) fields and structure the work environment at every level to facilitate the thriving of the people who choose these fields. Creating a sustainable system can expand access to the full talent pool and strengthen the mission of STEMM. She expressed hope in that the conversation has begun and will continue.