Blog Post

Healthcare Upside/Down: De-Escalating Distress and Burnout

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ECG’s radio show and podcast, Healthcare Upside Down, offers unfiltered perspectives on what’s working in US healthcare and what’s not. Hosted by ECG principal Dr. Nick van Terheyden, each episode features guest panelists who explore the upsides and downsides of healthcare in the US—and how to make the system work for everyone.

The term “burnout” in science refers to the reduction of fuel through the use of combustion. In life, it takes on a similar meaning; but here, the fuel is our well-being and energy, consumed by our work and experiences.

We hear a lot about burnout in the news, particularly in the context of the healthcare workforce battling the COVID-19 pandemic. For the past two-plus years, physicians, nurses, and other clinical and nonclinical staff have endured high levels of stress amplified by staff shortages, lockdowns, and ongoing nature of the pandemic. Their resilience has been remarkable, but exhaustion has prompted many providers to seek work in less-stressful environments—or driven from the field entirely.

Our guests on episode 19 of Healthcare Upside Down are Pennie Sempell, co-founder and CEO of StressPal, and Jen Barna, founder and CEO of DocWorking.

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In hindsight, I experienced my own version of burnout when I started work as a junior doctor. My first shift started on a Friday morning at 9 a.m. and ended on Monday evening at 5 p.m.—some 80 hours later. That pace and demand never let up, and my peers and I had little choice but to normalize the shift work (what was termed a “one in two”) and find whatever coping mechanisms we could to mitigate the sheer exhaustion and fragility of that workload.

Resilience is a psychological phenomenon and is not static; in other words, it waxes and wanes over time, depending on the circumstances you find yourself in. The good news is that resilience is something we can measure—and what we can measure, we can improve with the right treatments.

According to Pennie Sempell, providers need to be able to carve out meaningful time for themselves, and they need access to educational tools, coaching support, and peer support. “These elements are very valuable to individuals to rebuild relationships, defuse tension, and de-escalate the stress response,” she says. “That’s a very exciting piece that Jen Barna and I have independently been working on—how to bring together the science-based approaches that can help defuse distress and build resilience.”

Pennie is a former attorney, mediator, business and life coach, and co-founder and CEO of StressPal, a digital behavioral health platform that supports provider resilience. Jen Barna is a radiologist and the founder and CEO of DocWorking, a physician-led company that offers solutions to prevent physician burnout. They join us on episode 19 of Healthcare Upside Down to discuss how we can turn the tide of burnout that has been affecting healthcare workers for so long. Here are three takeaways from our conversation.

Changing the way respond to stress.

Stress is inevitable, but it doesn’t necessarily have to result in burnout. According to Pennie and Jen, becoming resilient starts with recognizing the way we respond to external stressors and learning to control those reactions.It’s important for us to remember that there is a complex capacity in our brain to change its response to stressors,” Pennie says. “When stress happens, we become worried or angry; we might skip meals; we might engage in all kinds of stress-triggered behaviors. And we think, well, that’s just the way we respond. I think what’s really exciting is to look at how we can change our own stress-triggered behaviors.”

Part of the problem, Jen says, is that our responses to stress have become automatic. A more deliberate approach can help providers not only cope with the symptoms of burnout, but to prevent it. “We’ve internalized [the symptoms of burnout] to an extent that often we’re not even aware that we’re feeling the effects of it,” she explains. What we need to do instead, she says, is “recognize that there are steps that can be taken to stop burnout in its tracks before it gets to a point that it’s a crisis.”

An institutional response.

It’s easy to dismiss stress as a personal matter—everyone experiences stress, so we all need to find ways to move past it, right? But when workplace-induced stress leads to burnout, the consequences aren’t limited to individuals.” It’s such a pervasive problem, it’s become an institutional problem as well,” Jen says.

“We are all aware of the enormous, complex factors within healthcare that are driving distress and burnout,” Pennie adds. “And these have been going on for at least the last decade, much worsened by this pandemic. So how we look at the individual piece and the institutional piece is a very big topic.”

That said, solving for burnout is not just an individual problem but an institutional one as well, and healthcare organizations need to be engaged in fixing it. “Institutions can support their healthcare workforce in such a way that it actually can prevent burnout, which ultimately improves retention and the culture of the institution,” Jen says. “So we’re looking at unique systems that can provide a lasting effect, much more so than a simple workshop or course that you take and then you’re done. We want to make sure that [healthcare organizations] understand that they’re making decisions about how to support their healthcare workers. And that can be all the way from the front desk to the practicing physicians.”

Return on investment.

Jen and Pennie propose an integrated approach that combines continuing education, peer support, and coaching. It begins with giving physicians protected time to defuse stress, and incentivizing them to use that time. “Every physician I’ve spoken with over the past several years has said, ‘I need this, I want this, but I don’t have time for it,’” Jen says.

“If organizations see it as a priority to provide protected time, maybe, 5 to 10 minutes every day,” Pennie adds, then that practice becomes part of the organization’s culture, and “everyone knows the time they’re taking for themselves is valued by the organization.”

Of course, there’s more to it than time, and organizations will need to invest in such programs if they’re to be successful. But given the number of talented clinicians leaving the field, it’s an investment many organizations can’t afford not to make.

“The ultimate benefit to the organization, of course, is both institutional resiliency and improvement in retention, which is a very costly problem for our healthcare institutions,” Jen explains.

“This is going to reap a very good return on [organizations’] investment,” Pennie adds. “Attrition is a serious problem.”

Pennie and Jen discuss more about de-escalating distress and burnout, on the podcast.

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