Industry Voices—Johnson & Johnson series on burnout: Lessons from the fish tank

Doctor pausing with a frown on his face
Those experiencing burnout risk having their symptoms interfere with their ability to perform their job. (Getty/Wavebreakmedia)

Editor's note: This is part 1 of a two-part series.

Healthcare is complex, not just for the patients, but also for the healthcare providers (HCPs) who experience myriad challenges on a daily basis in their daily environment.

The ever-changing ecosystem is filled with quality metrics and reporting requirements, payment models and staffing shortages. As a result, at least half of all U.S. healthcare providers are experiencing one or more symptoms of burnout, a work-related condition characterized by emotional exhaustion, cynicism, decreased efficiency and a sense of inadequate accomplishment. Those experiencing burnout risk having their symptoms interfere with their ability to perform their job.

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Simply put,  HCPs are having trouble staying afloat.

Studies report that providers with poor job satisfaction were less engaged in effective communication, showed little warmth and commitment towards their patients, and received lower ratings of patient satisfaction. Provider burnout has also been associated with negative patient outcomes including longer recovery time, reduced care plan adherence, and higher patient mortality.

RELATED: Burnout, time spent on EHRs top challenges for independent practice leaders

Investing in provider wellbeing is one way to begin combating and preventing the effects of burnout. Wellbeing is a subjective experience based on a personal evaluation of the relative presence of positive and negative emotions, satisfaction with life, fulfillment, and level of functioning. Additionally, wellbeing is impacted at various levels, including the individual level and the interpersonal or organization level, and as such should be intervened upon at each level when possible.

In this two-part series, we’ll dive into HCP burnout and its impact on patients, drawing lessons from another ecosystem: the fish tank, which also functions best when each component is properly cared for.

Care and maintenance

Let’s look at the individual level first. There are five domains which can directly impact an individual’s wellbeing:

  • Vitality: Sleep, movement and nutrition

  • Emotions and attitudes: Mindfulness, acceptance and gratitude

  • Purpose: Values in health, relationships, leisure and work
     
  • Social: Feeling strong social connection
     
  • Growth: Mastery of new skills and personal development  

To address these domains, a combination of mindfulness, self-awareness, and finding value in life and work are growing in popularity. Much like installing a tank filter to help your fish thrive, technology can play a vital role in supporting the wellbeing of HCPs when used appropriately. Recent research suggests a digital intervention may aid in helping a provider achieve and maintain their own wellbeing. But there isn’t a lot available specifically for provider wellbeing or burnout prevention. Smartphone-based applications can offer convenient, private, and accessible wellbeing solutions. We recognize that physicians are inundated with technology, and understand that wellbeing-based technology solutions need to fit into HCP’s current ecosystem of technology—and the larger HCP ecosystem. 

But interventions clearly cannot be focused solely on the individual fish. We make a call to action for interventions focused on provider wellbeing to also consider the cleanliness of the fish tank itself.

Cleaning the Tank

While HCP-directed interventions are more common, they don’t necessarily lead to significant reductions in burnout —largely because provider wellbeing is rooted in the workplace. You can’t put a healthy fish into an unhealthy environment and expect it to thrive. To avoid this, we must also examine the water, ensuring it’s properly maintained and free of harmful contaminants with as little disruption as possible.

It’s essential to cultivate trusting environments, free of fear, and where providers find meaning in their work, while also the skills to collaborate and lead effectively.

RELATED: The high cost of physician burnout: $4.6B a year

Organization-directed interventions may involve changes in workload, improvements in teamwork, and increases in job control and decision-making. The purpose of these initiatives is to build the following:

  • Trust: If HCPs feel comfortable communicating and empowered to deal with mistakes before they could impact patient care, it promotes a healthier environment. They and other fish in the tank can learn to navigate stressful waters. If HCPs are unable to trust one another or their larger support ecosystem they’re more likely to act defensively, make mistakes, and then hide those mistakes for fear of punishment.
  • Structural empowerment: Social structures not only offer guidance from superiors and peers, but also model organizational goals and values, and provide opportunities for learning, growth, and advancement. Ensuring workplace structures foster empowerment is critical for HCPs to embrace such behaviors and model for others.
  • Inter-professional collaboration: Examine leadership style in your “tank.” Both “transformational” and “authentic” leadership styles are associated with improved inter-professional collaboration.

Once the tank is clean and the fish are healthy, what are the best ways to introduce different types of fish (patients) to the ecosystem?

In the next part of this series, we’ll share ways to help many kinds of fish swim harmoniously towards a common goal of health and wellbeing.

Nicole Brainard, Heather Cole-Lewis, Jennifer Turgiss and Raphaela O'Day are all experts at Johnson & Johnson Health and Wellness Solutions.

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