It’s imperative that we bring the interests of our stakeholders (patients, providers, employers, and insurance payors) into alignment. In this post, we are going to examine how healthcare leaders can build better systems to reduce clinician burnout and moral injury.
The Problem: Where Burnout Comes From In Behavioral HealthcareBefore diving into the specifics, let’s get clear about the problem. Healthcare workers have faced unprecedented challenges throughout the pandemic. The world responded in a dramatic fashion to prioritize physical health, to the detriment of mental health.
Couple that with the increasing destigmatization of mental health, a wonderful thing, and we’re left with a slew of behavioral healthcare professionals – therapists, counselors, psychiatrists, nurse practitioners, and physician assistants – who are overwhelmed with demand and don’t have the time or resources to adequately care for patients.
What’s worse, they’re often part of a system that doesn’t prioritize provider well-being and they’re receiving the message, “You’re frontline workers; your patients need you,” and they just don’t have anything left to give. Burnout and moral injury were prevalent prior to the pandemic but now it can’t be ignored.
A Deeper Look At What Causes BurnoutPeople choose to become behavioral health clinicians because they want to help others. They spend a great deal of time and money to learn how to address the complex, biopsychosocial needs of their patients, and good clinicians are always refining their skills and adding new tools to their repertoire.
But graduate programs and continuing education rarely prepare clinicians for the business of behavioral health. The business of healthcare needs to be better understood because it’s not just private equity-backed entities that are muddying the healthcare system, it’s also doctor or provider-led organizations that become burnout and moral injury factories.
Burnout is chronic, unsuccessfully managed workplace stress. It causes providers to feel exhausted or depleted, it leads to feelings of negativity and cynicism about their work, and professional burnout reduces efficacy.
Let that sink in: burnout causes clinicians, who got into this line of work to help others, to feel cynical AND it lowers the quality of care patients receive.
Moral Injury In Behavioral HealthcareMoral injury is even more insidious. Moral injury occurs when you commit, bear witness, or fail to prevent an act that conflicts with your deeply held values or beliefs. The term was coined following the Vietnam War and the symptoms are quite similar to post-traumatic stress disorder (PTSD).
Again, let that sink in: the healthcare system is causing clinicians moral injury which is akin to PTSD. “Moral injury describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.”
Please check out the articles I’ve linked to, especially the one in the previous paragraph, which has received a ton of attention (also, if you’re more of a podcast person, check out this ZDoggMD’s episode: It’s not Burnout, It’s Moral Injury).
While I’ve painted a pretty grim picture of the issues facing clinicians, we can change the system. It’s not going to be easy but there is an opportunity.
How To Prevent Moral Injury and BurnoutTo prevent burnout and moral injury, behavioral healthcare organizations must prioritize the wellbeing of their providers. Too often I hear clinicians are pressured to see more patients in a given day, often for shorter durations, which conflicts with their beliefs about how treatment should be rendered.
Often this pressure comes from other providers and the message is, “Patients need you; don’t be lazy,” while the subtext often reads, “if you don’t produce more revenue, you’re not a good provider.” It’s a given that clinicians care about their patients and we know that burnout and moral injury negatively impact the quality of care, so let’s flip the script and focus on clinician well-being so patients receive higher quality care.
A quick side note, I’m a former infantry officer turned law student (dropped out) turned social entrepreneur (psst…that means I’m in the for-profit healthcare world, which we’ll address more in future posts). I have zero clinical training. I’m baffled at the incentive structures and lack of transparency in the business of healthcare, so I figured I’d take a crack at addressing the issue.
Individual clinicians can get stuck wondering who they are serving: their patients, their employer/healthcare system, the EHR, or the insurance payors. We need to bring these stakeholders into alignment.
Next in this series will dig into some practical solutions that you could apply in your organization. The most effective changes in large systems start at the bottom with those who are impacted most.