ORLANDO, Fla. — Maybe, in order to deliver safe and truly patient-centered care, doctors and nurses need to be just a little bit more selfish.
It's a gross oversimplification, but that was the gist of keynote speaker J. Bryan Sexton's closing keynote Friday at the 2014 NPSF National Patient Safety Congress. Sexton — an associate professor and director of patient safety research and training at Duke University Health System — laid out a detailed case for why burnout seems to be increasing in the field. And he questioned how clinicians are supposed to deliver high-quality care when they're stressed out, operating on few hours of sleep and resenting every moment of their work? Sexton's presentation was appropriate, given a major theme of the meeting was operationalizing joy and meaning in health care.
Burnout has played a factor in the deaths of countless patients, including that of 15-year-old Lewis Blackman, which was heartbreakingly detailed during a separate session by his mother, Helen Haskell, president of Mothers Against Medical Error. In for a routine elective procedure to address a cosmetic defect in his chest, Lewis died from septic shock following a severe medication reaction. The aftermath of his surgery was disorganized and chaotic, Haskell said, and the attending intern was at the tail end of a 36-hour shift when her son died.
Sexton cited study after study pointing out how others in the field are feeling the same. Some 30 to 40 percent of doctors meet the diagnostic criteria for severe emotional exhaustion. Another study found that on average about 50 percent of medical residents meet the criteria for burnout, before even finishing their residencies. And in yet another, among 27,000 nurses, 34 percent met the criteria for burnout syndrome."
All told, about one-third of heath care workers are burned out, "and if you think this doesn't get in the way of getting your quality improvement stuff done in your job, you are crazy," Sexton said. Burnout is the greatest predictor of clinical and quality outcomes. Depressed residents make six times as many medication errors as their non-depressed counterparts, another study found.
"Health care depletes your reserves of four primary buckets. You go from draining encounter to draining encounter without an opportunity to recharge or to refill your buckets — your cognitive bucket, your physical bucket, your emotional bucket and your spiritual bucket. And when you go from draining encounter to draining encounter without time to reconnect with what's meaningful to you and what gives you a sense of purpose, you end up being depleted," Sexton told attendees. "It doesn't matter if you work in IT or you work in the C-suite or you're a charge nurse in the ED. It doesn't matter what kind of physician you are. When you work in health care, you're vulnerable to burnout in ways that other industries simply aren't."
Sexton's solutions to avoiding burnout in your work were simple yet profound. Expose yourself to new ideas. Read more and listen to TED Talks. Studies have shown, Sexton said, that learning can help to keep burnout and dementia at bay.
The brain is hard-wired to remember the negative and so you have to force it to focus on the positive sometimes. Go around the table during your next meeting and ask folks to point out something positive that your hospital is currently doing, rather than focusing on the doom and gloom.
The Duke Patient Safety Center is conducting a neat study to help individuals do this, called "Three Good Things," where participants are prompted to write down three positive occurrences in their life every day for two weeks. To participate, you can go here. Sexton said that, after less than a week, you'll start thinking about positive occurrences throughout the day. Some 98 percent of participants in the last cohort finished within three minutes, and they estimate that participating has twice the efficacy of Prozac on the brain, Sexton said.
Random acts of kindness, too, can help with burnout, Sexton said. In the published comments from a previous round of Three Good Things at Duke, he detailed one anecdote about a nurse who was having a rough go, but was heartened when a co-worker brought her a pumpkin-spiced latte. Scroll a little further down in the comments, and another participant related how her co-worker was having a rough day, she thought of her at the coffee shop, and brought her a drink. Seeing her face light up made her day.
If hospital leaders feel as if they're short-staffed, fixing burnout in their institutions can be like adding workers to the mix.
"You want to talk about problems with staffing levels? When you're not bringing your whole self to work, that's a problem with staffing levels, automatically," Sexton said. "We would rather go into one of our units that is incredibly high on burnout any day of the week and work with them than go into a unit full of lazy people because burned out people just need the light switch turned back on. They're amazing, productive people who have been exhausted and they need our help, just as our patients need our help."