The burnout problem in health care today

Burnout is increasingly an issue for healthcare professionals, with consequences for their patients and organisations. Evidence-based coaching is one approach that can help turn this around.

There seems no doubt that burnout is endemic amongst healthcare professionals in Australia and across the world, and the evidence seems clear that burnout is linked to poorer patient outcomes.^1,2

Burnout is typified by feeling emotionally exhausted, depersonalisation, cynicism and a feeling of lack of accomplishment. It’s not surprising there can be serious professional and personal consequences, including increased medical error and patient mortality, reduced patient satisfaction and increased health professional depression and anxiety, lack of confidence and imposter syndrome, substance abuse and suicide.^2-4

As burnout amongst individual health professionals increases, health system costs rise too, in no small part due to increased staff turnover and the high costs of replacing staff, higher rates of investigations and referrals, absenteeism and reduced job performance.^2,3

Contributing system factors include excessive workloads and inevitable work/family conflicts, tension between disciplines, little opportunities for autonomy and perceived powerlessness, loss of meaning in work and poor leadership behaviour.

That means interventions for addressing burnout are required at an individual and system level. This is a complex and multifaceted undertaking that requires health service commitment to system redesign and development of a culture of wellbeing.¹

Combating burnout

A common starting point is raising awareness and developing interventions focused on individual wellbeing, usually via oft-used strategies such as mindfulness and support for improving exercise, sleep and nutrition.

Kindness initiatives are taking off in various departments and hospitals, and there has been a recent call for formally including kindness in clinical handover^.5 These are the beginnings of an important and positive journey in Australian health care.

Related interventions include providing clinicians with coaching and training in a range of developmental areas, including career development and work-life balance, addressing related issues such as poor confidence and imposter syndrome, and developing leadership and participatory management skills.¹

The potential contribution of coaching

Evidence-based coaching is a systematic activity for promoting positive, goal-focused change, aimed at promoting professional and personal development.⁶ In the business and professional services world, evidence-based coaching has a track record for helping staff deal with change, develop leaders and improve wellbeing.⁷ Despite this, coaching has had a much slower uptake amongst health professionals. Nevertheless, there is mounting evidence from Australia and internationally that coaching can be effectively used in the health sector.

For example, a recent six-month leadership coaching program in an Australian hospital helped executives, senior managers and senior clinicians develop improved stress management skills, improved work-life balance and home relationships, greater confidence in leadership abilities and ability to manage complexity, ambiguity and uncertainty.⁸

Meanwhile, in the UK, a six-session coaching of a multidisciplinary team improved teamwork in a radiology department.⁹ Similarly, a US clinician leadership program helped participants increase self-awareness, build relationships across the organisation, undertake behaviour change in areas such as communication style and improve self-confidence.¹⁰

Given coaching has been shown in at least one paper to have a positive impact on people close to those coached,¹¹ it is plausible that implementing a carefully targeted coaching program across a healthcare organisation may have important impacts for individuals and across the system as a whole. As such, coaching is a relatively simple and well-tested intervention that shows much promise in helping health service organisations, together with health professionals, work towards creating a healthier healthcare system.

*Dr Jocelyn Lowinger has an Honours degree in Medicine (1994) and a Masters of Science in Coaching Psychology (pending 2019). A former GP, Dr Lowinger now works in medical professional development including coaching health professionals. Visit www.coachgp.com.au

References

1. Shanafelt, T., J. Goh, and C. Sinsky, The Business Case for Investing in Physician Well-being. JAMA Internal Medicine, 2017. 177(12): p. 1826-1832.
2. Dyrbye, L.N., et al., Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. National Academy of Medicine, 2017.
3. Shanafelt, T.D. and J.H. Noseworthy, Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 2017. 92(1): p. 129.
4. LaDonna, K.A., S. Ginsburg, and C. Watling, “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Academic Medicine, 2018. 93(5): p. 763-768.
5. David, J. and B.P. Waxman, Adding kindness at handover to improve our collegiality: the K-ISBAR tool. Medical Journal of Australia, 2018. 209(11): p. 482-483.
6. Grant, A.M., An integrated model of goal-focused coaching: An evidence-based framework for teaching and practice. International Coaching Psychology Review, 2012. 7(2): p. 146-165.
7. Theeboom, T., B. Beersma, and A. van Vianen, Does coaching work? A meta-analysis on the effects of coaching on individual level outcomes in an organizational context. The Journal of Positive Psychology, 2014. 9(1): p. 1-18.
8. Grant, A.M., et al., The impact of leadership coaching in an Australian healthcare setting. Journal of Health Organization and Management, 2017. 31(2): p. 237.
9. Woodhead, V., How does coaching help to support team working? A case study in the NHS. International Journal of Evidence Based Coaching and Mentoring, 2011. 5: p. 102-11
10. Throgmorton, C., et al., Evaluating a physician leadership development program–a mixed methods approach. Journal of health organization and management, 2016. 30(3): p. 390-407.
11. O’Connor, S. and M. Cavanagh, The coaching ripple effect: The effects of developmental coaching on wellbeing across organisational networks. Psychology of Well-Being, 2013. 3(1): p. 1-23.

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