Stop Stress

Helping Health Care Workers Avoid Burnout

Original post on: Harvard Business Review
By: Deirdre E. Mylod and Thomas H. Lee, MD

To make progress against knotty problems, break them down — dissect the causes and analyze their impact on different groups. That analysis inevitably leads away from dubious “magic bullet” solutions and toward multiple, targeted interventions that are more likely to be effective. The measures and data to perform this type of analysis are now becoming available for burnout, a problem that is growing in all sectors, but is particularly challenging in health care.

To better understand the sources of burnout and resilience against it, we analyzed data for two characteristics associated with burnout for more than 80,000 health care personnel from 40 healthcare systems nationwide (approximately 19,000 nurses, 5,000 physicians and 60,000 non-nurse/MD personnel). The first of these characteristics, “activation,” is the extent to which a person is motivated by his or her work and feels it is meaningful. The second, “decompression,” is the degree to which one can withdraw, recharge and enjoy life outside of work. Our research shows how activation and decompression vary among these different groups, and how they relate to resilience against burnout in each.

To study these issues, we developed and validated an eight-question measure of resilience, with four questions each that gauge the degree of activation and decompression. To measure activation, respondents indicate their level of agreement on a 5-point scale (1 = strongly disagree, 5 = strongly agree) with these statements:

  • The work I do makes a real difference;
  • My work is meaningful;
  • I care for all patients/clients equally even when it is difficult;
  • I see every patient as an individual person with specific needs.

To measure decompression, subjects respond to the statements:

  • I rarely lose sleep over work issues;
  • I am able to free my mind from work when I am away from it;
  • I can enjoy my personal time without focusing on work matters;
  • I am able to disconnect from work communications during my free time.

The greater a person’s agreement with these statements (that is, the higher their score), the more resilience they currently exhibit in the face of stress, and the more likely they will be resistant to burnout. (Resilience is conceptualized here as a moderator of the growing stress faced by the healthcare workforce. As such, low score on gauges of decompression and activation are meant to serve as flags that workplace stress has become overwhelming rather than as indications of a particular individual’s ability or strength in coping.)

We found the doctors, nurses, and non-nurse/MD personnel all had the same average level of activation (4.5), but physicians had lower decompression scores, showing they were less able than others to withdraw and recharge.

We also found that decompression and activation are moderately correlated:  People who are better able to decompress are also somewhat more likely to feel activated in their work.

Decompression, Activation, and Engagement 

Decompression and activation are both related to feelings and behaviors that are traditionally used to measure engagement in health care workforces, specifically being satisfied as an employee, recommending the organization as a good place to work or get care, and being proud of the organization. However, the patterns of relationships vary when comparing correlations among these variables in nurses, physicians and the rest of the healthcare workforce.

For the non-nurse, non-physician group, activation was more strongly correlated with engagement than decompression was. Additionally, the correlations between activation and engagement measures were somewhat greater for