Portal de Periódicos da CAPES

Provocative thoughts from COVID-19: physician-centric solutions to physician burnout

2021; Elsevier BV; Volume: 78; Linguagem: Inglês

10.1016/j.clinimag.2021.03.016

1873-4499

Sherry S. Wang, Jennifer S. Weaver, Jonathan W. Revels,

Empathy and Medical Education

"Tend to the people, and they will tend to the business." - John Maxwell. The unfortunate scenario regarding the COVID-19 vaccine roll out at Stanford showcases the importance of the thoughts and actions or inactions of an institution, in regard to physician wellness, and how the former can have a detrimental effect on the latter. One of the protest slogans carried reads, "Healthcare hero. Support Zero" directed at Stanford's leadership.1.Wamsley L. Stanford apologizes after vaccine allocation leaves out nearly all medical residents.https://www.npr.org/sections/coronavirus-live-updates/2020/12/18/948176807/stanford-apologizes-after-vaccine-allocation-leaves-out-nearly-all-medical-residDate: 2020Google Scholar It is now, more than ever, that there needs to be physician-centric solutions from organizational management to combat physician low-morale, burnout, and the feeling that many physicians had, have, and are experiencing during this pandemic- that organizational leaders do not see, hear, or feel their concerns. Sir Richard Branson is an English business magnate who founded the Virgin group. Virgin became a global powerhouse by focusing on customer service; however, surprisingly Branson's philosophy does not put the customer first. In fact, Virgin makes its employees the company's top priority.2.Branson Raymundo O. Richard Companies should put employees first.https://www.inc.com/oscar-raymundo/richard-branson-companies-should-put-employees-first.htmlDate: 2014Google Scholar Branson states that his formula is very simple - happy employees equal happy customers. Happy customers bring more business. More business equals happy shareholders. We understand that using "customers equate to patients" is an over simplified analogy. There is no doubt that radiologists view their relationships with patients very differently than an employee-customer relationship. Yet, the majority of our healthcare systems are based upon a business model. If we use Branson's business model philosophy as a basis for the relationship between the healthcare system/department (company) and the radiologist (employee), it demonstrates how important and essential it is to meet the specific needs of radiologists. It is especially relevant to point out that unlike "customers", there is a population even more crucial at play- patients. Supporting the physician is essentially about the supporting patient care. A recent study from Panagioti et al, demonstrated that physician burnout decreases patient safety, adversely affects professionalism and results in lower patient satisfaction.[3]Panagioti M. Geraghty K. Johnson J. et al.Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysisassociation between physician burnout and patient safety, professionalism, and patient satisfactionassociation between physician burnout and patient safety, professionalism, and patient satisfaction.JAMA Intern Med. 2018; 178: 1317-1331Crossref PubMed Scopus (618) Google Scholar Being physician-focused will bring about the patient-first ethos, patient safety and patient satisfaction which should be the core essentials for any healthcare system. Only when the departmental leadership addresses the issue of burnout and low radiologist morale, can the radiologist deliver optimal patient care; there is perhaps no better time to recognize this, as we begin to enter the second year of this world pandemic. Branson has three focuses to a better work culture.4.Krapivin P. Sir Richard Branson's five billion reasons to make your employees and candidates happy.https://www.forbes.com/sites/pavelkrapivin/2018/07/09/sir-richard-bransons-5-billion-reasons-to-make-your-employees-candidates-happy/#38cc2df06710Date: 2018Google Scholar1.Building happiness.2.Positive feedback.3.Caring culture. One of the reasons why Branson is so successful is that he is truly empathetic and cares about his employees.4.Krapivin P. Sir Richard Branson's five billion reasons to make your employees and candidates happy.https://www.forbes.com/sites/pavelkrapivin/2018/07/09/sir-richard-bransons-5-billion-reasons-to-make-your-employees-candidates-happy/#38cc2df06710Date: 2018Google Scholar One of the strategies Branson is most well-known for is his "walkabouts"- by walking around the office and plane when possible- similar to a gemba walk in quality improvement. It is during these times that he personally engages with and ask for feedback from the employees and customers.2.Branson Raymundo O. Richard Companies should put employees first.https://www.inc.com/oscar-raymundo/richard-branson-companies-should-put-employees-first.htmlDate: 2014Google Scholar Throughout this process, he states that he must act upon the feedback once he is back in his office or on the ground. One should not underestimate the idea of sincere action following feedback. When there is no response to feedback, morale decreases as employees feel that leadership does not actually value their input or care about their problems. As a result, employees will not be innovative with solutions or ideas, nor will they further engage. Workplace culture is one of the hardest things to change. The pandemic has caused widespread alterations in all facets of life and has created a setting in which constant change seems to be the new normal. Creating and sustaining a good and supportive workplace culture within the radiology department is even more important now, during the pandemic, when radiologists are faced with new and never before imagined problems. These problems must be addressed by departmental leadership if we are to mitigate the inevitable physician burnout that will otherwise result. Happiness is defined differently by different people and institutions. During the pandemic, we define "happiness" as feeling "supported and cared for". When radiologists feel supported and cared for by their healthcare system and departmental leadership, there can be a trickledown effect on technologists, administrative staff, other physicians, fellows, residents and medical students. There are several tasks detailed below, that an organization can focus on to foster this in the workplace. No one would like to come to work feeling like what they do did not matter. To achieve this, the organization needs to define the purpose of the organization. Branson discusses that a leader needs to lead from the front, creating and effectively communicating a clear vision as well as aligning the work force with this vision to make it a reality.5.Branson Mistry P. Richard Clients do not come first. Employees come first.https://www.thehrdigest.com/richard-branson-clients-do-not-come-first-employees-come-first/Date: 2017Google Scholar In radiology and health care, this is simple. Our core purpose is excellent and timely patient care, which we cannot achieve as burnt out radiologists. Virgin employees are empowered by their organizational structure where there are small autonomous units which self-manage and set own standards and rewards.5.Branson Mistry P. Richard Clients do not come first. Employees come first.https://www.thehrdigest.com/richard-branson-clients-do-not-come-first-employees-come-first/Date: 2017Google Scholar This is important as teams have to take ownership and be accountable for their performance. However, potential pitfalls in this structure include, appointing inappropriate people to leadership positions and not providing appropriate or adequate support, training, tools and resources. Empowerment should not be without explicit expression of performance expectation of the small autonomous sections of the organization. During the time of COVID-19, flexible work schedules should not be a perk, it is a necessity, and the sooner this is normalized the better. This is a great way to empower your employees, giving them the ability to restructure their days according to caregiver issues. It is important for engagement and optimal patient care that there is frequent communication between the radiologist and leadership, this may work both ways with the leadership needing flexibility from staff to help, when possible, outside of their schedules. Productivity should not be solely based on the time spent at a workstation. Not providing professional development is a sure way of losing your best employees.6.Johnson W. How to lose your best employees.https://hbr.org/2018/04/how-to-lose-your-best-employeesDate: 2018Google Scholar Purposefulness is intertwined with confidence which includes giving employees necessary tools, resources and training for them to grow. During the pandemic, it was and is still essential to help staff learn how to use and engage in technology to allow remote working and teaching to be successful. Radiologists with technical experience in remote working and teaching can also help, along with leadership, other radiologists who are unfamiliar with this. For those in academic institutions, it is also imperative that the department support radiologists' scholarly activities during this difficult time for everyone. "Train people well enough so they can leave, treat them well enough so they don't want to" is something that Branson lives by as a business philosophy. When the focus is on the short-term- "use and abuse" mentality, this further adds fuel on fire in a situation where burnout and low morale is already rife. This leads to a decrease in productivity with people taking sick days, people leaving the organization, and costs associated with high turnover. The flow on effect is that the organization becomes short-staffed which exacerbates the burnout felt by the remaining staff. Money is not the only motivator.[7]Itri J.N. Bruno M.A. Lalwani N. Munden R.F. Tappouni R. The incentive dilemma: intrinsic motivation and workplace performance.J Am Coll Radiol. 2019; 16: 39-44Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar There can be meaningful perks with organizations can offer to make the people working at the organization happy and at the same time feel appreciated which will them further fuel their purpose. Childcare issues were highlighted during COVID; organizational initiated childcare would be meaningful perk, with the added benefit that parents can continue in the workplace which ultimately benefits the organization. Praise and gratitude are not trivial and can enhance appreciation, sense of purpose and confidence. This will also have a trickledown effect- those who are confident and happy will pass positive feedback down the chain. This is of utmost importance during high stress times when sense of happiness and meaning can be lacking. Every year the exemplary employees of the Virgin group of companies are flown business class to a destination and have dinner with Branson. This exemplified how much Branson appreciates and motivates his employees and is well aware the best and most important asset of any company or organization is the human capital. This may not be the perfect fit in our healthcare industry, but in the same vein, recognition from the leadership through department newsletters and departmental meetings, along with a more personalized meeting or engagement would be accomplishable in the radiology organization. During this process, not only is the employee rewarded, motivated, energized and inspired, higher level employee engagement is occurring with additional feedback which can only be beneficial to the organization. Trust and transparency are difficult to build. The former can be through open policies, constructive dialogs and involvement of staff in certain decision making. The latter can be achieved through less micromanaging and at the same time showing that management have confidence in staff, creating accountability to safeguard projects and agendas are done appropriately and timely. Trust works both ways- for the staff to trust management but also for management to trust that the staff is doing a great job. During COVID-19, your radiologists and trainees need to feel safe, know that you will keep them safe, and advocate for them. This ranges from creating extra space with additional workstations, ability to work remotely (home or office), and COVID-19 task forces with radiologists' input. Furthermore, the events throughout the pandemic has put trust, or lack of trust, in the spotlight in relations to adequate personal protection equipment and obtaining the vaccine. Compassion is essential for cooperation and collaboration. This emotion demonstrates to all staff and workers that they matter, and they are integral to the success and the day-to-day running of the organization. This emotion conduces the best version of ourselves. A good example of demonstrating compassion and empathy is the appropriate amount of maternity/parental leave, sick leave and care-giver's leave; this is especially true during the pandemic with its challenges. Branson's ethos extends even to the interview process of potential employees. The philosophy is that many interview candidates are exceptional, thus not all will receive a job. They may however, be customers, potential recruits or recruiters in the future or business partners and it is important that they have positive experience that can be shared with others.4.Krapivin P. Sir Richard Branson's five billion reasons to make your employees and candidates happy.https://www.forbes.com/sites/pavelkrapivin/2018/07/09/sir-richard-bransons-5-billion-reasons-to-make-your-employees-candidates-happy/#38cc2df06710Date: 2018Google Scholar This idea is easily applicable to all of medicine. In times of stress we may unintentionally displace our frustrations onto others that we may need assistance from in the near future. We are all still at risk for contracting COVID-19, and neither we nor our family members are guaranteed a short lived and successful recovery. Therefore, we should be mindful that our actions do not burn bridges, but instead we should continuously try to build them. Emphasis on creating and maintaining a respectful and collegial behavior towards all facets within our departments is paramount. Branson's most important business philosophy of valuing of employees can be utilized to alleviate radiologist burnout during the COVID 19 pandemic. Good and supportive work culture within the radiology department is beneficial to both the employer and employee and will improve productivity and happiness as well as reduce monetary losses associated with burnout. It is to the benefit of healthcare systems to invest in innovative ways to support physicians and counteract physician burnout. The many issues brought forth by the pandemic will not improve or disappear passively. Solving these problems and avoiding burnout will require active engagement of departmental leadership with radiologists to develop physician focused approaches for burnout mitigation, which will positively impact patients, radiologists, the department, and ultimately the healthcare system. SSW- concept, writing and editing. JSW- writing and editing. JWR- editing. The author declare no conflict of interest.