Surgeon General issues advisory on burnout: 9 takeaways for health systems

Hospital leaders and advocates have spoken about burnout and staff shortages, and U.S. Surgeon General Vivek Murthy is warning of grave consequences to the healthcare system.

Murthy issued an advisory Monday on the state of healthcare workers, citing “a moral obligation to address the long-standing crisis of burnout, exhaustion, and moral distress across the health community.” The 76-page report outlines recommendations for healthcare providers, payers and federal and state governments.

U.S. Surgeon General Vivek Murthy

Murthy’s warning comes during Mental Health Awareness Month, and healthcare leaders said the pandemic has taken a toll on doctors, nurses and other healthcare workers.

In addition to the trauma of caring for COVID-19 patients for two years, many clinicians have worked long hours, particularly as staff shortages have worsened. Roughly 1 in 5 healthcare workers have left their jobs since the pandemic began, according to a report from Morning Consult.

• Related story: How the COVID-19 pandemic has affected hospitals

Some warn the crisis could get worse. Many nurses and doctors have said they plan to leave their practice within two years, according to a study published in Mayo Clinic Proceedings.

In a statement with the report, Murthy referenced the crisis.

“COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point,” Murthy said. “Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk.”

• Related story: Why the Lorna Breen Act is just a first step in improving mental health of healthcare workers

The surgeon general’s office also cites a projected shortage of 3 million low-wage healthcare workers within the next five years.

Here are nine key takeaways from the surgeon general’s report aimed at healthcare organizations.

Commit to health and safety

Healthcare organizations must ensure they are taking care of workers and that must come “at the highest levels of leadership.” Such steps should include establishing a chief wellness officer and online safety resources. Organizations should include “well-being metrics” as key performance indicators and tie executive compensation with improvements in the well-being of workers. Systems should form safety teams to identify issues affecting healthcare workers.

Zero-tolerance for violence

Health systems should introduce violence prevention programs, which should address physical threats, as well as verbal abuse and harassment online. Some health groups have backed legislation in Congress requiring healthcare organizations to create workplace violence prevention programs.

Transform workplace culture

Healthcare organizations must empower workers to speak up with ideas to improve the quality of care, patient safety and workplace efficiencies. “We can begin by listening to health workers and seeking their involvement to improve processes, workflows, and organizational culture,” the report states. In addition, organizations can build positive cultures by asking questions of staff in rounding, huddles or one-on-one meetings.

Show workers they are valued

Healthcare organizations have a better chance of keeping workers if they show them how valuable they are. The report said that includes competitive pay, affordable healthcare coverage, including mental health and substance use care, and policies such as parental leave and support for caring for children or older family members. Employers should ensure opportunities for career advancement and mentoring, especially for women and minorities.

• Related story: Many nurses say they don’t feel valued

Promote mental health services

Health systems must reinforce to workers that seeking help isn’t going to damage their careers, because some clinicians don’t seek treatment for fear it will affect their licenses or have other negative ramifications. Healthcare organizations need to ditch punitive policies that can deter workers from seeking mental health services.

Employers should examine job application and renewal forms to be sure questions don’t discourage workers from seeking help for mental health or substance use issues.

Attack bias and discriminiation

Health organizations have to commit to diversity, equity and inclusion. The report notes examples, such as Massachusetts General Hospital adopting a “zero-tolerance policy for discriminatory behavior toward staff.” Penn Medicine is launching a program (“Lift Every Voice”) to allow staff to anonymously report racism in the workplace. Health systems should examine data to notice gaps in outcomes based on race, gender and ethnicity.

Help clinicians focus on patients

Doctors and nurses are burning too much time on administrative tasks, the report noted. Health systems should move to automation for tasks such as prior authorization, which still consume a great deal of manpower.

Hawaii Public Health asked staff for ways to eliminate unnecessary tasks in a campaign dugged “Getting Rid of Stupid Stuff.” The system saved 1,700 nursing hours per month. Look for ways to simplify workflows for electronic health records.

Flexible scheduling

Health systems can help employees who are parents or caregivers by providing more flexibility on when they can begin and end their days. The report notes this can reduce stress on staff and also foster a sense of appreciation for the employer. Employers should also consider giving workers more ability to schedule preferred days to take off.

Take time off

Workers should be wholeheartedly encouraged to take paid leave. Leaders should stress that workers shouldn’t come in when they are sick. Stress to workers they aren’t letting down their employers or fellow co-workers when they need to take some time.

“Paid time off with coverage can help staff refresh and care for themselves as well as family members, while protecting colleagues and patients,” the report stated.