Over many years, as the healthcare system has changed and not for the better, much of the joy has gone out of the practice of medicine. Physicians, who may have gone into medicine for good and noble purpose, have seen their dreams shattered, replaced by mostly thankless stress. We all know that stress, especially increasing stress over a long period of time is bad for people at all levels of their being. Physicians, beyond the medical wizardry, are people first and not immune to the long term ravages of stress, which is the principle cause of the spike in physician burnout. With the advent of Covid19, stress levels have gone through the roof for physicians and directed a light on what is becoming a potentially catastrophic problem for healthcare, burnout of our best and brightest physicians.
While the efforts of physicians, especially during the challenging time of Covid19, are remarkable and even heroic, the stresses are taking a huge toll on them. Burnout and other stress related maladies are on the rise at a time when healthcare needs its frontline care providers more than ever. What can we do to reverse burnout of our frontline care providers and bring the joy of helping people back to the work?
As with any problem, the first thing we want to do is understand the problem from a systems standpoint and identify the root cause of the problem. Healthcare has never done this as it relates to stress on the frontlines. If it had, it might have discovered the Nobel Prize winning Law of Dissipative Structures, which describes how systems that resist change in a changing environment become stressed. As systems become more stressed over time, quality of care, safety, productivity and physician morale go down and costs go up. That’s exactly what we’ve seen in healthcare. But that’s not the end of the story.
Stresses in systems are passed on to the care providers who must work in or are affected by those systems, including, physicians, nurses and patients alike. It is these stressed and often broken frontline systems that are the source of the stress that is accelerating burnout in our physicians and other frontline care providers.
Whether it’s burnout or quality of care or safety or cost reduction, problems that have plagued healthcare seemingly forever, the source of the problems is in the systems. The most impactful thing we can do to right now to address these problems is to fix or even transform the frontline systems where care is actually delivered. We know how to do this. Do we have the wisdom and the will? Ready or not, transformation is coming to healthcare,. The Law of Dissipative Structures guarantees it. However, we can be proactive in transforming the frontline systems and avoid what will likely be a meltdown of healthcare as we have known it. I believe the better option is a bottom/up, frontline driven, transformation of systems where care is actually delivered. We can do this!