Often, workplace conversations about burnout put the onus on the individual to take care of their mental health while ignoring management’s role in solving the problem. A new anti-burnout campaign from the Centers for Disease Control and National Institute for Occupational Safety and Health avoids this typical — and often frustrating — tactic, instead imploring leaders to better support health care workers.
Much of the campaign focuses on what leaders can do to improve the work environment in their organizations, offering tools that include a worker well-being questionnaire, a guide encouraging leaders to share their own struggles with mental health to help encourage staff to do the same, and online workshops on topics like how to support work-life balance, veterans, and sleep.
The initiative goes beyond the token “pizza and donuts” that health care workers typically get from employers in lieu of action, said Vincent Guilamo-Ramos, director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing. But fixing the problem of health care worker burnout, Guilamo-Ramos and other experts told STAT, requires larger systemic change.
“Let’s definitely support the workers,” said Laura Linnan, the director of the Carolina Center for Healthy Work Design and Worker Well-being, one of NIOSH’s Centers of Excellence for Total Worker Health. She was not involved in developing the campaign. “But let’s not fool ourselves into thinking that if we have healthy workers, that’ll be enough. Because if healthy workers go into an unhealthy work environment, they become unhealthy.”
The campaign’s online sleep workshop is a prime example of how important it is to recognize both the individual and systemic factors feeding into worker burnout, said Linnan. “We can’t ignore that there’s some things individual workers can do today, like, ‘Here’s some strategies for better sleep quality.’ But we have to look at, ‘What are the schedules that we’re putting these workers under? What are the number of hours that we’re requiring them from a policy perspective to be on-call as residents?’”
Examining what policies and operational factors make it difficult to get quality sleep is just as important as giving resources to the individual, she said, and the campaign has elements of both.
The most actionable point in the campaign is a push to remove questions about mental health history and status from health care credentialing and licensing applications. Experts said this is especially important because health care workers in the past have been discouraged from disclosing mental health issues for fear that they wouldn’t be able to practice anymore. The campaign includes a toolkit for revamping these applications that was released earlier this year by the Dr. Lorna Breen Heroes’ Foundation, named for a physician who took her own life in 2020.
However, Christine Sinsky, the vice president of professional satisfaction at the American Medical Association, urged people to remember that burnout is not a mental illness.
“Occupational distress, which is known as burnout, is distinct from a mental health condition. And I think they become conflated in people’s minds,” she said. “It’s important to recognize occupational stress and burnout is related to the work environment in which people work, and so there are many things that can be done to improve that work environment.”
The CDC and NIOSH campaign is a great first step, said leaders in health care worker well-being. But there are so many other things that need to be addressed to reduce moral distress — the frustration that health care workers experience when they want to provide the best care for a patient, but are forced to make different choices based on the circumstances. Many experts pointed to prior authorization, unnecessarily complicated electronic health record systems, and the larger structure of reimbursement and insurance plans that fuel those tools, as pain points.
Some organizations have started campaigns to fix these problems. The Hawaii Pacific Health hospital system started a program in 2017 called Getting Rid of Stupid Stuff, or GROSS for short, in which it asked employees to chronicle things that were “poorly designed, unnecessary, or just plain stupid” in their documentation process, then used those triaged categories to re-design how the electronic records system worked.
The American Medical Association has a “de-implementation checklist” that collects similar common issues with the goal of helping health systems to reduce the burden on workers, and a page dedicated to debunking myths about regulations to eliminate inefficiencies based on outdated or misinterpreted policies.
At University of North Carolina Health, the research of Lukasz Mazur, director of the health care engineering department, led UNC to implement a new program across its 17 emergency departments. The program, kicking off in November 2023, encourages health care workers to identify system inefficiencies, brings them to top leadership, and blocks off time on C-suite executives’ calendars to address the problems.
Some of the complaints should be easily addressable, Mazur said, like emergency doctors complaining that they don’t have time to go to the bathroom — not because they don’t have three minutes, but because everyone on the floor is using the same bathroom, and thus it always has a 15-minute line.
The CDC can’t set policy, and there are no consequences if leaders ignore the new campaign. But in some ways, that may make it more efficient, said J. Corey Feist, co-founder and CEO of the Dr. Lorna Breen Heroes’ Foundation, who was involved in designing the initiative.
“What’s critical about this campaign is it doesn’t wait for a federal law to be passed with a bunch of mandates and then all of the negative consequences that may or may [not] be related,” Feist said.
In bringing more focused attention on how organizations can play a role in reducing health care worker anxiety, burnout, and depression, the CDC and NIOSH may also help encourage regulatory changes down the line, said John Howard, the director of NIOSH.
“The maximum we can do is get folks like [the media] to help us in getting the message out so that those entities, state and federal, that have actual levers … can have a basis for saying, ‘We need to change the way we’re doing things.’”