Even before the COVID-19 pandemic, the National Academy of Medicine found that burnout had reached “crisis levels” among the U.S. healthcare workforce, with 35% to 54% of nurses and physicians and 45% to 60% of medical students and residents reporting symptoms of burnout.1 The pandemic, of course, exacerbated this existing crisis — and today, in health systems across the country, burnout continues to impact retention, reliance on contingency staffing, and increased medical leaves of absence.
In the U.S. Surgeon General’s advisory on building a thriving health workforce, researchers estimated that annual burnout-related turnover costs are $9 billion for nurses and $2.6 billion to $6.3 billion for physicians.2 These estimates don’t even include turnover among other types of health workers across the continuum of care.
High levels of burnout have led to elevated risks of healthcare worker insomnia, heart disease, and diabetes; substance abuse, anxiety, and depression; relationship and interpersonal challenges; and overall feelings of physical and mental exhaustion. And these consequences clearly impact people beyond the healthcare workers themselves. Patients are faced with delays in care and diagnosis, along with an increased risk of medical errors, while health systems are experiencing reduced capacity and margin pressures.
Research is increasingly showing that burnout is due to factors beyond the work environment. A Global Qualitative Nursing Research study found that personal issues such as family problems, personal or family health and wellness concerns, and child or elder care challenges can all contribute significantly to burnout — and all make it more difficult for employees to find balance at work and at home.
Another factor contributing to the problem is the impact of rising inflation. The American Psychiatric Association found that up to 87% of Americans over the past year have been concerned about the impact of inflation and their ability to pay basic housing, food, and healthcare costs.3
The impact of employee burnout on retention and operations requires organizations to invest in strategies that improve their ability to authentically care for and about their employees. This necessitates a genuine re-imagination of wellness and well-being benefits and development of more purposeful programs to support employees’ holistic needs.
An early phase of our redesign work at Guidehouse surrounding employee recruitment, retention, and experience includes empathy mapping with employees in high turnover roles. What we’ve found: While acknowledging that employers have elevated the importance of well-being, many employees feel the programs and tactics offered have been limited, hard to access, and not designed to include what they value most. Using a combination of human-centered design and lean principles, we have partnered with client stakeholders — including human resources personnel, operational leaders, and frontline employees — to understand current offerings and practices, assess gaps and opportunities, and recommend improvements.
As a starting point, we use a framework with these five must-have elements:
Executive and Leader Sponsorship — One critical aspect of this work is for leaders at the top and throughout the organization to talk about the importance of employee, clinician, and leader well-being. This can include leaders sharing authentic personal stories of how they manage well-being and reinforcing that well-being spans their lives within and away from the workplace. It also means committing resources to the right well-being strategies, many of which are focused on initiatives such as healthy workplace culture, electronic health record and other technology improvements, employee assistance programs (EAPs), and flexible scheduling.
Effective Structure and Ownership — This starts with a deep understanding of what employees most value and who owns how tactics are prioritized and deployed. We find that most clients have put well-intentioned efforts into programs that employees ultimately do not access. This is especially true for EAPs. In fact, Mental Health America — a community-based nonprofit that promotes mental health as a critical part of overall wellness — published a report noting that 98% of midsize to large companies offer EAPs, but only about 4% of employees use them each year.4
A lack of understanding of EAPs and other well-being offerings, concerns about privacy, and general stigma for accessing help, further contribute to suppressed participation. And some employees have shared that they have low tolerance for participating if doing so means staying beyond normal work hours. An effective structure with clear owners and role clarity is key to prioritizing ease of access and alleviating privacy concerns.
Relevant Solutions to All — Our listening and design work reveals that employees value flexible scheduling, financial fitness, child and elder care support, and longer-term educational and career development. As employees increasingly report feeling unseen and unheard, the desire for recognition and inclusion programs are frequently cited in our design work. These should be sponsored by multiple stakeholders and feel seamless, comprehensive, and personalized to individual employees. Solutions need to account for the wide range of needs found within today’s five-generation workforce.
Communications and Technology Structure — Email and print communications are insufficient for today’s employees, who often feel bombarded by email or unable to keep up with a constant flow of information. Nearly every function in a health system, hospital, or clinic can influence well-being. Having heightened awareness of how new initiatives or policies impact workload, workflows, relationships, and efficiency is an everyday opportunity to increase well-being. Incorporating well-being as a recurring agenda item in leader and staff meetings can help ensure that it remains top of mind. And making communications accessible through multiple pathways, including mobile devices, is essential to increasing participation and buy-in.
Wellness Metrics that Matter — Measuring the effectiveness of well-being initiatives is key to helping leaders gauge where to spend time and resources so that they can identify which programs are most impactful and enduring. Metrics can include results from employee engagement surveys about well-being and burnout, turnover rates, program utilization, and absence management.
One successful redesign collaboration we’ve been involved with has centered on the development of a “well-being champion network” to foster peer-to-peer support and communication. Called “The Well-Being Champions,” the network includes three to five employees (working across five locations) who are dedicated to:
These champions will maintain a pulse on any concerns employees may have regarding their well-being and ensure that leaders and program advisors understand and respond to emerging priorities.
Although May 11, 2023, officially marked the end of the federal COVID-19 public health emergency declaration, healthcare organizations continue to struggle with the aftereffects on workforce burnout, staffing shortages, workloads, and other complicated challenges with no easy solutions. Workers are ready to hear and see that employers care about the impact of these issues on their well-being, and that they are leaning in on solutions. In our experience, employees want to be a part of the redesign. Including them is the optimal way to develop and accelerate programs that best meet the diverse well-being needs of hardworking employees, both at work and at home.
Co-authors: Martha Davis, Reem Ghoneim, Gloria Gobah, Kevin Adjapong, Muzdalifa Syed
1 HealthLeaders. n.d. “Expert: Healthcare Worker Burnout Trending in Alarming Direction.” Www.healthleadersmedia.com. https://www.healthleadersmedia.com/clinical-care/expert-healthcare-worker-burnout-trending-alarming-direction.
2 “Health Worker Burnout — Current Priorities of the U.S. Surgeon General.” 2022. Www.hhs.gov. 2022. https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html.
3 “Psychiatry.org - Americans Anxious over Inflation; Almost Twice More Likely to Lean on Family and Friends than Speak.” n.d. Www.psychiatry.org. https://www.psychiatry.org/News-room/News-Releases/Americans-Anxious-Over-Inflation-Almost-Twice-Mor.
4 “How Can We Promote Our EAP to Increase Its Usage?” n.d. Mental Health America. https://mhanational.org/how-can-we-promote-our-eap-increase-its-usage.
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