Elsevier

Mayo Clinic Proceedings

Volume 92, Issue 1, January 2017, Pages 129-146
Mayo Clinic Proceedings

Special article
Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout

https://doi.org/10.1016/j.mayocp.2016.10.004Get rights and content

Abstract

These are challenging times for health care executives. The health care field is experiencing unprecedented changes that threaten the survival of many health care organizations. To successfully navigate these challenges, health care executives need committed and productive physicians working in collaboration with organization leaders. Unfortunately, national studies suggest that at least 50% of US physicians are experiencing professional burnout, indicating that most executives face this challenge with a disillusioned physician workforce. Burnout is a syndrome characterized by exhaustion, cynicism, and reduced effectiveness. Physician burnout has been shown to influence quality of care, patient safety, physician turnover, and patient satisfaction. Although burnout is a system issue, most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work. There is a strong business case for organizations to invest in efforts to reduce physician burnout and promote engagement. Herein, we summarize 9 organizational strategies to promote physician engagement and describe how we have operationalized some of these approaches at Mayo Clinic. Our experience demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Many effective interventions are relatively inexpensive, and small investments can have a large impact. Leadership and sustained attention from the highest level of the organization are the keys to making progress.

Section snippets

The Challenge Facing Health Care Executives

This is a challenging time for health care executives. Increasing price competition, narrowing of insurance networks, and a greater proportion of patients with noncommercial insurance (eg, Medicare, Medicaid) due to the Affordable Care Act have all resulted in declining reimbursements. In parallel, requirements for “meaningful use” of electronic health records have resulted in large capital expenditures and dramatically increased clerical burden for staff.1, 2 These financial challenges have,

Implications of Physician Burnout

There is a moral and ethical imperative to address burnout in physicians. Physician burnout contributes to broken relationships, alcoholism, and physician suicide.10, 11, 12, 13, 14, 15, 16 In addition to the moral-ethical argument, there is a strong professional and business case to reduce physician burnout and promote physician engagement. Studies indicate that physician burnout influences quality of care, patient safety, and patient satisfaction.17, 18, 19, 20, 21, 22, 23, 24 Physician

A Shared Responsibility

Given the professional repercussions of physician satisfaction and burnout, health care organizations have a vested interest in cultivating physician engagement. Engagement is the positive antithesis of burnout and is characterized by vigor, dedication, and absorption in work.40, 41 Any health care organization that recognized it had a system issue that threatened quality of care, eroded patient satisfaction, and limited access to care would rapidly mobilize organizational resources to address

Nine Organizational Strategies to Promote Physician Well-being

Although the framework of shared responsibility and the need for system-level solutions have begun to be recognized, 2 pervasive myths have been barriers to organizations taking effective action. The first is the belief that the steps necessary to cultivate physician well-being will conflict with other organizational objectives. The second is the assumption that all effective interventions to reduce burnout will be cost prohibitive. The reality is that an engaged physician workforce is

The Mayo Clinic Experience

Our experience at Mayo Clinic demonstrates that deliberate, sustained, and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Between 2011 and 2013, the rates of burnout among our physicians went from lower than average to similar to that of physicians nationally.7 In response to this increase, a host of changes were pursued, including several of the strategies articulated herein (Figure 5). In the following 2 years, the absolute burnout

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  • Cited by (0)

    Grant Support: This work was supported by the Mayo Clinic Program on Physician Well-being.

    Potential Competing Interests: Dr Shanafelt is co-inventor of the Physician Well-being Index, Medical Student Well-being Index, and Well-being Index. Mayo Clinic holds the copyright for this instrument and has licensed it for use outside of Mayo Clinic. Dr Shanafelt receives a portion of any royalties paid to Mayo Clinic.

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