Why do health care CEOs permit toxic workplaces?


Would patients be admitted, or people be allowed to come to work, in a hospital that had Legionnaires’ disease spreading through its HVAC system or cryptosporidium in its water supply?

When there is an 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 300 to 400 physicians each year as these problems worsen, it leads to death by 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 where they have inadequate support and 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, Ph.D. 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 circumstances, 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, eleven CEOs of major U.S. 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 three years), sharing my message about burnout, its root causes, its impact and, most importantly, what these systems can do to address the 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 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 or 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?

Paul DeChant is a health consultant who blogs at Preventing Physician Burnout through Lean Done Right.

Image credit: Shutterstock.com


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