One of the first clinical departments I managed as a healthcare administrator was Neurology, which according to many studies ranks as having one of the highest rates of burnout of any medical specialty. What I observed was that patients with complex neurological conditions need a lot more time with their doctor and the neurologists were only given 15 minutes to see their follow ups. I have heard many of them express that they do not feel adequately respected for choosing one of the most challenging and dynamic specialties in medicine where the favor in most health systems lies with the proceduralists and surgeons over cognitive specialties such as neurology.
Burnout continues to be a pervasive issue in medicine and a significant problem in the U.S. In a recent article published in U.C. Berkeley Psychology, experts are saying that many well-intentioned health system administrators and physician leaders have failed to accurately measure and confront the rising epidemic. The reason stems from the way some surveys define and measure burnout that don’t entirely address depersonalization, emotional exhaustion and a low sense of accomplishment.
Social psychologists Christina Maslach, PhD, and Michael Leiter, PhD, professors of psychology at UC Berkeley and Wolfville, Canada-based Acadia University, respectively, are considered the pioneers of organizational burnout research. They define people’s relationships with their work as a “continuum between the negative experience of burnout and the positive experience of engagement,” according to their jointly authored article, “Early Predictors of Job Burnout and Engagement.”
Drs. Maslach and Leiter state that there are three interrelated dimensions of the burnout-engagement continuum: “exhaustion-energy, cynicism-involvement and inefficacy-efficacy.”They define exhaustion as the “feelings of being overextended and depleted of one’s emotional and physical resources”, cynicism or depersonalization as to having a “negative, callous or excessively detached response to various aspects of the job” and finally inefficacy or diminished accomplishment referring to a “self-evaluation dimension of burnout and includes feelings of incompetence and lack of productivity in one’s work”.
But, how are administrators and physician leaders failing to address the problem? The experts say that before hospital administrators can find a solution to the problem, they must first understand how to assess it properly. I recall this very vividly in my administrative meetings and discussing problems in the clinic, where the assessment of a physician or clinical professional who was burned out was their engagement level. This is not wholly accurate. In fact, Drs. Maslach and Leiter state that with the understanding that engagement is the main objective of any burnout intervention and that burnout and engagement operate on a continuum, many leaders turn to engagement surveys to deduce burnout levels.
According to the authors, engagement surveys “measure one’s level of commitment to the organization and satisfaction with the work environment, which do not cumulatively produce engagement.”However, for physician and health system leaders to use engagement surveys to measure and assess burnout among their staff is not effective as it does not address what Drs. Maslach and Leiter define as “the intersection of energy, involvement and efficacy.”
If a hospital or health system’s objective is to accurately diagnose the rate of physician burnout so they can intervene appropriately, their best bet is to administer both engagement and burnout surveys, and not rely on the results of engagement surveys alone to suggest the rate of burnout.
Engagement surveys that are not psychometrically validated — meaning they are not developed based on the definition of engagement that was established by Drs. Maslach and Leiter and verified by research cannot be used as a de facto measure of burnout, according to Monique Valcour, PhD, an executive coach, keynote speaker, management professor and contributor to the Harvard Business Review.
Dr. Valcour suggests administrators use the Maslach Burnout Inventory. Developed by Drs. Maslach, Leiter and other colleagues, the MBI is validated by 25 years’ worth of research and is recognized as the leading measure of burnout. It surveys respondents on the three burnout components — exhaustion, cynicism and inefficacy — to provide a comprehensive and accurate burnout assessment.