Many healthcare organizations measure employee engagement. In fact, some have integrated engagement into their organizational success metrics. Each year, organizations spend hundreds of thousands of dollars on survey vendor fees, consultants, internal man hours and sweeping initiatives to measure and move the needle on engagement.
A broad description of an engaged employee means the person actually cares about their company and work quality. It means their job is more than a paycheck, and they are intrinsically motivated to work hard to help the company meets its goals.
Employee engagement is associated with retention, and improved patient experience, patient safety and quality. Seems great, yes? What company would not aspire to that?
But what if, instead of focusing on the presence of engagement, healthcare organizations aspired for the absence of burnout?
Why is burnout the new engagement?
Here’s what we know: burnout is pervasive. It’s everywhere and all the time.
Roughly 50% of physicians and nurses are currently experiencing burnout symptoms. And guess what? Lower burnout is associated with the same metrics as engagement: less turnover and absenteeism, decreased patient mortality and infections, better patient experience, reduced medical errors, and lower likelihood for malpractice claims.
Lower burnout is associated with less turnover and absenteeism, decreased patient mortality and infections, better patient experience, reduced medical errors and lower likelihood for malpractice claims.
For many years there was thinking that burnout and engagement were polar opposites, that they each lay on opposite ends of a spectrum. The early research defined burnout as an erosion of engagement. And yes, though that can be true, there is definitely such a thing as too much engagement.
A 2018 Yale study found that 1 in 5 highly engaged employees are at risk of burnout. They have both high engagement and high burnout and are referred to as the “engaged-exhausted”. These folks are passionate but stressed and frustrated. In the study, these people report the highest turnover intentions.
Physicians:
The costs associated with replacing a physician can cost an organization $550k – 1M.
Lost revenue is estimated at $900k.
Nursing:
The cost to replace a nurse is estimated as much as $82,032 per experienced nurse (RN)
and $88,006 per new nurse (RN)
Similar examples of the “engaged-exhausted” are perfectionists who often experience what’s called “Frustrated idealism”. For new graduates it may be experienced as “naïve idealism”. All of these groups are at higher risk for burnout because the reality of healthcare is that perfection is non-existent. The U.S. healthcare system is chaotic and messy with good people many times working in challenging and exceedingly imperfect processes
When does engagement cross the line to burnout?
Morera LP, Gallea JI, Trógolo MA, Guido ME, Medrano LA. From Work Well-Being to Burnout: A Hypothetical Phase Model. Front Neurosci. 202; 14: 360 Published online 2020 Apr 30. doi: 10.3389/fnins.2020.00360So, what does the tipping point from engagement to burnout look like? A 2018 Brazil study offers a conceptual model on the trajectory from well-being to burnout. The study investigated cortisol differences across the mental states and the progression from work engagement to burnout. Not surprisingly they found that with the higher demands of engagement, cortisol increased, but with increasing strain arose a hallmark of burnout: cynicism, which soon progressed to burnout.
Cynicism is described as a feeling of detachment from patients or feeling less empathetic. Used as a coping mechanism, caregivers report feeling numb to patients and perceive them less as individuals with feelings, concerns, and fears, but instead view them as objects.
Engagement is not the inverse of burnout. In fact, healthcare organizations should watch out for their Rockstar employees because 20% are at risk for burnout. Prevention of burnout is far more cost-effective and reduces the likelihood of the myriad downstream consequences.
Louise Fletcher as Nurse Ratched in the 1975 film adaptation of One Flew Over the Cuckoo’s Nest. Wikipedia. September 29, 2020.
Many times, the onset of burnout is a slow progression with thought that individuals progress through stages, in which case early identification is critical. Research shows that intervention strategies and training are most effective early in careers. Early training facilitates development of a robust skill set and provides an effective “inoculation” against professional demands and circumstances that may make them more prone to experience burnout during their career.
Nonetheless, and contrary to common belief, there are effective strategies against burnout (both individual and system-based) that are effective and based on evidence. Further, resilience can be learned – it’s never too late for caregivers to integrate new and adaptive strategies into their skillsets.
Transitioning a focus from creating engagement to preventing burnout can transform the health and happiness of the front-line providers, allowing the organization to reap the rewards of superior performance under a more efficient system of care and a more supportive work culture.
