|Year : 2018 | Volume
| Issue : 5 | Page : 611-613
Healing the healer: Burnout prevention and rescue strategies
Santosh G Honavar
Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana, India
|Date of Web Publication||20-Apr-2018|
Dr. Santosh G Honavar
Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Honavar SG. Healing the healer: Burnout prevention and rescue strategies. Indian J Ophthalmol 2018;66:611-3
In the last issue of Indian Journal of Ophthalmology, we discussed a pervasive problem that plagues almost every medical professional at some point in their career – workplace burnout. We also provided easy online tools to self-assess professional psychological wellbeing. In this issue, we intend to discuss some of the self-preservation measures to minimize the risk of burnout and recuperate back into professional vigor.
| Canary and the Coalmine|| |
To understand the concept of burnout rescue, the Canary and the Coalmine analogy seems appropriate. Coalminers deep in the pit often hit on pockets of carbon dioxide or carbon monoxide, both colorless and odorless, impossible to identify early, but potentially fatal. Coalminers would habitually carry a canary in a cage to check the air quality. Canaries were ideal for the job because of their two qualities – they never stopped singing unless they got sick, and bad air would rapidly make them sick much before the coalminers. Miners would work carefree as long as the canaries continued to sing but would rush out of the coalmine if the canaries stopped singing. Canary thus became the indicator of the condition of the coalmine. Similarly, physicians are considered the indicators of the health of the health-care industry. A sick health-care professional environment often hits the physicians first. Burnout prevention or rescue should address the health of the canary as well as the condition of the coalmine and help create a resilient physician in a conducive professional environment.
While efforts to address burnout have typically focused on bolstering individuals' resilience skills, the need is to concurrently optimize the work environment. A Canadian study of physicians identified resilience as a dynamic, evolving process of positive attitudes and effective strategies. The study found four main aspects of physician resilience: (1) attitudes and perspectives (valuing the physician role, maintaining interest, developing self-awareness, and accepting personal limitations); (2) balance and prioritization (setting limits, taking effective approaches to continuing professional development, and honoring the self); (3) practice management style (sound business management, having good staff, and using effective practice arrangements); and (4) supportive relations (positive personal relationships, effective professional relationships, and good communication)., A positive work environment is defined as one “that attracts individuals into the health profession, encourages them to remain in the health workforce and enables them to perform effectively, including professional development programs to facilitate better adaptation to the work environment.”
| Burnout Prevention Matrix|| |
Dr. Drummond prescribes a holistic multi-level strategy to prevent burnout or recuperate. His matrix addresses augmentation of physician resilience and simultaneous organizational effort – a combined strategy that helps make a stronger canary and a less toxic work environment. Some of the tools that may be relevant to us are listed below.
- Personal tools to decrease the stress and energy drain 
- Practice conscious stress release and mindfulness – indulge in any form of meditation and breathing exercise of your choice 
- Make gratitude and celebration a habit – gratefully appreciate good work and celebrate accomplishments by the members of the team 
- Acquire leadership, delegation, and patient flow management skills – lead from the front, choose, and train immediate assistants such as optometrists, nurses, and counselors to meet your requirements, delegate specific responsibilities to each of the members of the team and empower them to perform, and shift to a team-based care where everyone plays a predetermined specific role to seamlessly sustain the workflow.
- A quick briefing (huddle) can set the pace for the day, while debriefing at the end of the day can be useful to appreciate the good work and acknowledge and resolve problems. A chartered monthly staff meeting helps engage the team to discuss outstanding issues and constantly improve the system
- Systematize your practice – all routine chores such as mandatory documentation, patient counseling, referral tracking and acknowledgment, and correspondence with patients should be completely systematized with minimal need for you to supervise 
- Master your documentation system – be it paper charts, clinical photographs or electronic medical records, complete documentation, and retrieval of the same at follow-up visits will help optimize patient care and guard against medical malpractice suits 
- Understand and master your personal and professional finances – hire a good chartered accountant, but invest time to understand the process. Build a good accounts team and make billing, payment, insurance processing, tracking of receivables, etc., foolproof 
- Build a team to handle home chores – do not waste time and energy in home chores that can be conveniently outsourced 
- Personal recharge activities 
- Build your off switch and create and practice a boundary ritual between work and home – a typical example is the popular old TV serial Mister Rogers' Neighborhood (1968–2001) where Mr. Rogers started every show with a boundary ritual once he returned home from work – he changed his sweater, changed his shoe and sang a song., Listening to good music on the way to work and way back from work can do wonders and help switch on and off. Interfacing an exercise or a shopping routine between work and home helps too. Try and compartmentalize and never take pressures at home to work or bring work pressures home
- Respect your life outside of medicine and do what it takes to protect your me-time 
- Create and implement a personal nutrition and exercise program 
- Prioritize, schedule, and invest time for all the people who you love – spending quality time with family and friends should get a top priority 
- Inculcate hobbies, interests, and other creative and personal spiritual pursuits 
- Schedule and take a regular vacation 
- Have good food, spend time with people you love, keep pets, and plants that you can care for, read good books, listen to music that you like, watch films, games, and shows that entertain, and simply get more sleep 
- Volunteering to deliver professional service to needy communities locally and elsewhere can be a stress-buster and can also help reconnect with the very reason why we became physicians in the first place.
- Organizational support to decrease stress and energy drain 
- Ensure organizational and leadership commitment to staff wellness 
- Create a Physician Wellness Group within the organization to plan and oversee efforts geared toward alleviating burnout 
- Conduct regular surveys to get feedback and understand the current level of the problem 
- Provide excellent technical support and well-trained paramedical staff to take pressure off the physicians 
- Be equitable in distributing cross-consultations, leave coverages, and calls 
- Support flexible hours and part-time work when required 
- Be transparent in reporting the financial health of the organization to physicians working in the group 
- While it is important to optimize physician productivity, it is best not to set a monthly financial target for every physician. A logical and budget-based realistic financial goal set after an open discussion on the financial health of the organization may help raise individual sensitivity to the issue of organizational stability
- Ensure fair remuneration based on the current market standards and other necessary professional attributes, and a healthy performance-based annual increment
- Incentive-driven remuneration should be fair and logical and should not result in unhealthy competition and untenable workload
- Create situations for off-work physician interactions – a scheduled monthly informal group lunch or dinner can help team-building and can also be therapeutic 
- Provide unconditional and immediate organizational, logistical, communicational, and medicolegal support to physicians involved in an adverse outcome or a major complication, while rest of the analysis and implementation of preventive strategies and can happen parallelly.
- Organizational recharge activities 
- Establish onsite exercise, mindfulness, and wellness programs 
- Ensure periodic organization-centered social activities – staff birthday celebration, staff retirement/send-off treat, celebration of staff accomplishments/awards, annual picnics and dinners, movie nights, etc.
- Establish and maintain a physician and staff recognition program to acknowledge and appreciate good work 
- Establish a culture of caring and build and maintain a culture of gratitude.
The listed measures are only indicative. One can create a customized list based on the type of practice and work environment. It is essential, however, to list out and address 4–5 of the points that significantly matter in the immediate and the intermediate time frame, thus setting a positive cycle of burnout prevention and rescue.
| Physician Ecosystem|| |
Clif Knight, Senior Vice President for Education, American Association of Family Physicians (AAFP) rightly states that “Burnout is the problem. The system is the cause. We are the answer.” The solution for burnout must come from us. AAFP has created a robust wellness program that identifies and addresses the five components of the physician ecosystem – (1) Health care system (advocating to improve regulation and documentation burdens that impact physician well-being and quality patient care); (2) organization (promoting leadership skills to help physicians succeed within organizational practices and policies); (3) practice (improving efficiencies to optimize physicians' time and promote a more sustainable practice); (4) individual (focusing on individual well-being habits to address physician fatigue with awareness and mindfulness techniques); and (5) physician culture (addressing the mindset of physician self-sacrifice as a cultural norm, and encouraging self-care and peer-to-peer support). Organization-driven programs such as these may hopefully bring in sustainable change.
| Your Health Before All Else|| |
Physicians are indeed a vulnerable group for burnout, and ophthalmologists are not an exception. Burnout leads to poor patient care and pushes the physician into a vicious cycle. Measures to enhance physician resilience and create a positive work environment do help prevent burnout. However, once it has set in, burnout rescue is a time and resource-intensive multimodal engagement, often with suboptimal outcome. Individual and organizational investment in prevention of burnout thus seems to be a sound strategy. “Your health and happiness before all else” must become the guiding principle in our lives and times.
| References|| |
Jensen PM, Trollope-Kumar K, Waters H, Everson J. Building physician resilience. Can Fam Physician 2008;54:722-9.
Kumar S. Burnout and doctors: Prevalence, prevention and intervention. Healthcare (Basel) 2016;4. pii: E37.
Wiskow C, Albreht T, de Pietro C. How to Create an Attractive and Supportive Working Environment for Health Professionals. Copenhagen, Denmark: WHO; 2010. p. 1-37.