Getting Burned-out Medical Practice Staff Back on Track

If the loss of enthusiasm and anger outbursts didn't tip you off, then the palpable silence at your staff meeting should have. Your once-diligent employees have officially checked out. And chances are, it's not their fault. "It's an epidemic out there," says Laura Sachs Hills, a practice-management consultant and author of the recently published book "Climbing out of a Rut." "More people are starting to feel like their jobs are just not working for them anymore. They are going through the motions."

Sachs attributes much of today's occupational angst to economic uncertainty. Many fear losing their jobs, she says, forcing them to work harder and stay later to prove their worth. Others are overburdened, doing the work of two or more as practices fail to replace employees lost through attrition. And some simply reach a point in their lives where they no longer feel professionally fulfilled. "When you are younger, you are on an ascent in your career and trying to gain some traction," says Hills. "But once you're in a groove you may look around and assess, 'Is this all there is?'"

Job burnout occurs in all industries, of course, but healthcare workers are particularly prone because they deal day in and day out with patients who are sick, scared, or injured, says Dike Drummond, a family physician who now provides executive coaching through TheHappyMD.com. "Medical offices are inherently stressful," he says. "It's very different than working at a restaurant, for example, where everyone is coming to you to enjoy themselves."

Know it when you see it

You may never be able to rekindle the enthusiasm your employees brought with them on day one, but there are tactics you can deploy to give their batteries a boost. To intervene successfully, however, you must first be able to spot the warning signs.

According to the Mayo Clinic, symptoms of burnout include fatigue, poor motivation, irritability, sleep disorders, loss of empathy, depression, and physical complaints including headaches and backaches. While most employees experience one or two such symptoms at some point in their career, burnout is defined as a more chronic condition in which prolonged exposure to stress induces emotional, mental, or physical exhaustion that affects performance.

The prevalence of burnout among physicians has been widely documented. A 2012 Mayo Clinic survey, for example, found that nearly half (45.8 percent) of doctors worldwide are suffering from at least one symptom of burnout, far higher than the results of a 2009 study by Hennepin Healthcare System, which put that number closer to 27 percent. There is less on record about the prevalence of chronic fatigue among support staff, but "no reason to believe it is any less common for receptionists and nurses," says Drummond. Why? Workload has nearly doubled amid increasingly complex billing and compliance requirements. Ironically, exposure to stressed out physicians also plays a part, Drummond says. "Nothing turns staff over like a burned-out doctor," he says. "Burned-out doctors are hard to live with."

Indeed, says Liz Ferron, senior consultant and manager of clinical services at Minneapolis, Minn.-based employee assistance program Physician Wellness Services, provider burnout creates a trickle-down effect. "It hugely impacts the staff, which creates safety concerns," says Ferron. "When you are working with someone who is burned out, particularly a leader of a team like a physician, there is a tendency to avoid them and not communicate with them when you really need to." Nurses and support staff should be a second set of eyes and ears for the physician, which helps improve quality of care, but that effect is lost if everyone is too intimidated to communicate effectively, she says.

Find out why

When you notice an employee exhibiting signs of burnout, your first task is to pinpoint the cause, says Drummond. Countless factors contribute to burnout, including workload, family stress (divorce or illness), unclear job expectations, lack of control, work-life imbalance, a dysfunctional workplace, and a mismatch in values, according to the Mayo Clinic. The only way to find out what saps an employee's motivation, says Drummond, is to ask. Conduct job satisfaction surveys regularly, he suggests, and share the raw data at staff meetings so your employees know they've been heard. "Ask them how they are doing and what the biggest hassle is [that] they have to deal with every day," says Drummond. "Provide feedback, and then take action." Convene a working group immediately, he suggests, to identify the central theme of the survey responses and discuss how your practice can resolve staff concerns. "Then, report back your progress on this issue," says Drummond, and continue to survey periodically for wellness, burnout, and system hassle. "When people start to see that you have their back, the whole place can turn around real fast."

Be forthright

A proactive approach is also the best strategy for communicating with stressed-out staff, says Hills. "Address it head on," she says. "Don't dance around it. The best way to approach a difficult conversation is to stick with what you observe, without judging." For example, she says, use language like, "I've noticed…" Pause long enough for the employee to respond. If your comment is met with silence, ask "Am I right?"

"Get them to open up," says Hills. "They may reveal what's really at issue. Maybe their job is boring, they thought they'd advance further, or it's no fun anymore."

If the problem is job-related, work together to find a solution. Perhaps their skill set could be put to better use in a different department, or they'd prefer to report to a different supervisor. Maybe a more flexible schedule would alleviate some the stress of caring for an elderly parent. If the source of their burnout stems from a more personal matter, direct that person to an employee assistance program, which can help them process their stress and create a better work-life balance. Likewise, a career coach can help them explore bigger questions like what excites them, and which career options play to their strengths, says Hills. "Work with them to try to find their passion again, within the practice if at all possible," says Hills. "If you care about your staff, you care about them as whole people, not just employees."

When burnout strikes an entire department, however, or worse, your whole team, it may be time for management to look in the mirror. Perhaps a physician or supervisor is making everyone miserable, holding employees back, or setting unreasonable expectations. Or, more likely, administration isn't cultivating an environment that values the contribution of their staff. "There is much that can be done at the leadership level to set the conditions for their employees to thrive and live balanced lives," says Ferron. "Management needs to understand the bottom line impact of burnout, and be willing to make investments on the front end to set the conditions for success."

Light their fire

One of the most effective ways to keep employees engaged, says Drummond, is to make them part of the process. Ask each department if there's anything you can do to make their jobs less stressful, and invite them to brainstorm solutions for operational improvement, he says. Advertise an open-door policy that encourages employees to air grievances before burnout sets in. And be sure you've communicated expectations clearly, providing frequent feedback on their performance. At the same time, Drummond says you can help create a culture of trust by advocating for your team. Give them the tools and training they need to succeed, make sure workload is evenly distributed, and hold each employee accountable for conduct and performance.

Weekly staff meetings are also an excellent opportunity to relay patient feedback, recognize achievements, both personal and professional, and verbally acknowledge those who provide excellent customer service, says Ferron.

Positive reinforcement is particularly important for those on the front desk, where turnover is often high. While clinical staff can break up the monotony of their day through patient interaction, and providers get the satisfaction of helping patients feel better, receptionists are juggling an endless stream of phone calls, and taking the heat for wait times and billing problems. "Remind them that being on the front line has a huge impact on patient satisfaction," says Ferron, noting you can help make their job more meaningful by engaging them in building and maintaining business. "Get them brainstorming about ways to strengthen customer service."

Office managers who wish to keep burnout at bay should also set measurable goals for their practice and reward staff for meeting or exceeding those targets, says Drummond. "Troubleshoot any efforts that fall short by involving the whole group in brainstorming and selecting how to adjust the program," he says. While some practices reward with gift cards and IOUs for half days off, Drummond says "prizes" directed to one person or a single department can do more harm than good. "It breeds unhealthy competition and resentment if you are not the one who receives a prize," he says, noting simple praise for hard work given in the moment you witness it can be far more effective. "It is important for all leaders, every day to be on the lookout for situations where they can praise and thank the staff - and then do it!" he says.

Put your employees first

Other ways to refuel your troops include building in time for breaks, insisting that staff and providers use all vacation days, limiting their hours, and encouraging them to pursue a hobby in their down time, says Ferron. "Help them put some fun back in their lives, and not just when they're on vacation," she says, noting meditation can also help shift the focus away from work and bring it back to the individual. "It's about giving themselves permission to establish boundaries."

Drummond further suggests practices revise their mission statements to put physicians and staff front and center. "Most organizations don't do this," he says. Instead of a generic one-liner indicating your practice aims to provide the highest quality of care in your community, for example, rewrite it to state that your group strives to offer optimum health to doctors, staff, and the members of your community. "The first thing that goes away when a person feels stress is the ability to be present with patients and express empathy and compassion," he says. "If you don't have a healthy staff, they cannot give good care. It's very linear. The health and wellness of your providers and staff are critically important to quality of care." In today's pay-for-performance world, Drummond adds, practices can no long afford to leave employee satisfaction in their blind spot.

Let them lead

Another effective tool that can help clear out the cobwebs is the opportunity for professional growth. Tap your best and brightest from each department to train new hires. Send your tech-savvy scheduler to a seminar and ask her to share what she learned at your next staff meeting. Invite one of your most effective employees to help find a solution to a work flow problem. Delegate, says Drummond, and then step back. "Get out of their way," he says. "The workplace and its challenges are always changing." Thus, management must give staff the chance to lead and learn. As for providers and clinical staff, you can also encourage them to complete continuing education classes to help hone their interpersonal skills, as most report that patient interaction is the most rewarding part of their job.

Set them free

That said, however, you can't wait in perpetuity for an employee to reengage. At some point, you have to draw the line, says Hills. "If they can't get back that passion, you have to question whether this is the right person for the job," she says. "It doesn't make sense to keep people someplace where they aren't excited, excelling, or enthusiastic." If the employee is a frustrated musician, or wants to go back to school, encourage them to pursue their passion. "You don't want a person who is just a shadow," says Hills. At some point, you have to say this is the performance we need and expect. Don't let the practice suffer."

While a full-blown morale crisis can be difficult for an individual employee, staff burnout can be just as toxic to your practice. You can help inspire your team by creating an office environment that values their input, recognizes their achievements, and gives them a chance to challenge themselves. "Involving employees at all levels help them feel engaged and focused on the greater good of the organization, and makes them feel like valued members of a team," says Ferron. "This is especially critical at a time where teamwork is a focus of healthcare reform efforts, and where patient satisfaction is becoming more important."

In Summary

Staff burnout can reduce quality of care and create safety concerns. Here are some tips to take action before it is too late:

• Use employee satisfaction surveys to pinpoint stress factors in the office, and take steps to correct them.

• Offer positive reinforcement and encourage your staff to lead.

• Craft a mission statement that includes the well-being of doctors and staff; it sends a message that you care.

• Encourage staffers who can't engage to pursue their passion, whether within your practice or without.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 18 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the May 2013 issue of Physicians Practice.