If you're a healthcare leader, taking charge of your well-being is a challenge and responsibility, and is ultimately the key for both self-preservation and organizational success.
This article appears in the January/February 2019 edition of HealthLeaders magazine.
For years, the healthcare industry has recognized the growing effects of burnout on clinicians because of its stressful and complex nature. This has led to an increased push in the industry to promote self-care and provide ample and supportive resources to physicians and nurses.
But burnout is not an issue that solely affects those on the clinical front lines. Burnout is in the C-suite, though it is much less talked about compared to those in rank-and-file positions, and it does not have the same level of academic research as clinician burnout, says Rose Sherman, EdD, RN, NEA-BC, FAAN, professor and program director of nursing administration and financial leadership at Florida Atlantic University. Yet it is a growing problem for healthcare leaders as margins shrink and expectations rise.
A B.E. Smith report discussing trends for 2018 raised concerns over worker retention, specifically regarding gaps in senior leadership, citing the 18% turnover rate among CEOs according to an American College of Healthcare Executives study from 2017.
The report pointed to the importance of continuity in a leadership team and the disruption caused by the departure of a CEO, a move that can lead to the departure of other executives due to the organizational chemistry.
Constant executive turnover driven in part by burnout not only puts the C-suite in immediate risk, it affects the competitive balance and labor makeup of the organization, too. Medical centers dealing with managerial turnover experienced a minimum cost of more than 5% of the annual operating budget, according to a 2004 Health Care Management Review study.
Research portrays executive turnover as a phenomenon that costs healthcare organizations financially by putting them back into the tedious search process but also invites competitors to poach clinical and operational talent at a time of instability.
So how can healthcare organizations proactively address executive burnout and avoid the constant, expensive churn of leadership turnover?
Three experts, including one health system executive who discusses his own experience with burnout and how he coped, advise healthcare leaders to take charge of their well-being as the key for both self-preservation and organizational success.
Why executive burnout is difficult to fix
While there are many factors that can cause burnout, experts suggest four reasons why executive burnout isn't easy to fix.
1.) Financial drivers
"I think the financial drivers are a significant driver of burnout for many executives today because it can be very complex to make some of the decisions that need to be made. Couple that with what's going on in the workforce—because healthcare workforce turnover numbers are up—[and] it's a much trickier place than it's ever been before," says Sherman.
The rise of consumerism has also played a part in the executive burnout trend, according to Sherman, as patients see and demand more from their local healthcare providers, thanks to publicly reported quality rankings, such as the reports produced by The Leapfrog Group.
3.) Limited resources
Sherman says executives realize they are pressed to perform in a challenging industry with little likelihood that more resources will be provided to make the job easier. For some executives, according to Sherman, they don't feel there is any other way to escape the stress than to leave their position.
Sherman says most executives suffering from burnout struggle to openly express what they are going through because of how singular their position is.
"The other thing about being an executive is that it's lonely at the top," Sherman notes. "You may be feeling frustrated, you may be feeling burned out, but you have an executive presence and image that you need to portray regardless of how rough the going gets."
4) Generational differences
Adriane Willig, senior partner at Witt/Kieffer, an executive search firm based in Oak Brook, Illinois, told HealthLeaders that her firm has noticed an emerging trend on how different generations are impacted by burnout symptoms when comparing millennial healthcare executives to Generation X or baby boomer executives.
"It seems like [executives] at a younger age have experienced burnout more so than senior [executives], but also years of experience [plays a role] as well," Willig says. "It seems that executives with fewer years of experience burn out at a higher rate."
Willig adds that this could mean millennial executives are more attuned to burnout or easily admit to feeling its symptoms, whereas baby boomer executives might view candor as a stigma and suffer in silence.
Since leaders serve as the face of their respective organizations and must project an executive presence that defines their internal culture, more experienced executives who are dealing with symptoms of burnout tend to dedicate their energies to maintaining their quality of work rather than their physical and mental health, says Florida Atlantic University's Sherman.
She adds that research has shown millennials have higher stress and anxiety levels compared to other generations, primarily driven by a pursuit of perfection, the fear of failure, and the omnipresence of
Yet, older executives who have served decades in a leadership position are also more capable at establishing boundaries around their work life, according to Sherman, which reduces stress and the potential for burnout. Sherman refers to these baby boomer hospital executives as "survivors," as they have withstood or properly addressed the effects of burnout.
Meanwhile, millennial healthcare executives, some who might be leading their first system, may not be as skilled or natural at creating a well-defined work-life balance, which exposes them to a heightened risk of burnout.
A lingering concern raised by Sherman is that if millennials abandon these executive roles due to burnout and dissatisfaction with their employment, a shortage of health system executives could emerge, and it will cost organizations more in the future to search for leaders to fill those vacancies.
"One problem with executive turnover is that it's almost like organizational whitewater," Sherman said. "[People come in] and say, 'I'm the new executive, and I feel like I have to make my mark on this organization. I'm going to look at this strategic plan, tweak things around, and I'm going to take us in a little bit different direction.' And so the organizations don't have stability in terms of vision and thinking [if there is constant turnover]."
Despite the difficult situation and the reasons for executive burnout, leaders can be assured that there are options available to them. While there is no silver bullet to fix burnout, our experts agree that dedication to self-care and building personal resiliency must be part of a current healthcare executive's skill set.
"I think most people recognize in leadership today that the new competency is resiliency," says Sherman. "If you cannot be personally resilient and develop your resiliency skills, you're probably not going to survive."
One way of developing resiliency skills is hiring executive coaches so that system leaders can learn to lead through difficulties.
Sherman says another key aspect of dealing with stress and avoiding burnout is self-maintenance and for executives to put their issues in perspective, with a particular focus on what they have immediate control over as compared to what they don't. Such examples could be a focus on meditation, mindfulness,
and eating well.
Regardless of what leaders choose to focus on, though, she says it is crucial to find a way to deflect stress for both the well-being of the executive and the health of the larger organization.
Take care of yourself, take care of others
For executives that are feeling burned out, simply sidelining themselves from work or significantly reducing their responsibilities is not always the most effective way to treat burnout. As one healthcare leader shares, reconnecting with their passion or their reason for working in healthcare often works to alleviate the
Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, FAAN, senior vice president, chief operating officer, and chief nursing officer at Midland Memorial Hospital in Midland, Texas, experienced symptoms of burnout while serving as president of the American Organization of Nurse Executives and teaching at a local university, both simultaneous with his role at Midland Memorial.
Dent says that several factors can cause a healthcare executive to experience symptoms of burnout. Working in a rapidly changing, often-volatile industry marked by declining reimbursements, technological advancements, and pressures to meet crucial performance indicators while trying to improve the patient experience are among the many elements that drive leaders to the point of deep exhaustion, according to Dent.
As Dent felt the burden of burnout, he says he decided to step back and evaluate why he was experiencing it. He says he realized that he needed to reconnect with the clinical side of his role and his passion for patient care. In the name of self-preservation, he says he decided to conduct more hands-on work within the system, such as going on rounds to treat patients. Dent says this brought him a revitalized connection to his work beyond the responsibilities and roles he had as an executive.
Outside of work, Dent says he also found relief through physical activity, hobbies, and close relationships. He says he routinely went to the gym, gardened, spent time with his family, and relied on his personal faith.
"It's about creating our own self-care plans that are unique to each of us: not necessarily top down–driven self-care plans, but [rather] what does each of us need to do individually to take better care of ourselves so we can meet the needs of the organization in our community?" Dent says.
Dent says he recognized that the role of an executive is to ensure those working at the system, whether in the C-suite or on the front lines, have ways to address the stress they are feeling.
To help others in the C-suite, Dent says he and the Midland Memorial executive team will be participating in a day-and-a-half wellness retreat to focus on mental health and boost personal resiliency.
Midland Memorial has also implemented flexible time off for its executive team, which allows leaders to take time as they need it, instead of a set amount of days per year, for self-care purposes.
Dent also says that the system executives benefit from looking after the well-being of their own workforce.
In 2017, the Institute for Healthcare Improvement (IHI) published a report offering health leaders ways they could encourage their respective organizations to find "joy in work." Among these recommendations was a commitment to a "systems approach to making joy in work a shared responsibility at all levels of the organization."
This strategy relies on fully engaged workers and focuses on nine tenets to be a happy, productive employee, including "wellness and resilience," "physical and psychological safety," and "meaning and purpose." The IHI study also emphasizes the need for senior leadership to foster a plan to promote joy at work for the sake of maintaining a system's "momentum and sustainability."
More than a decade ago, Midland Memorial instituted fatigue management guidelines for its frontline caregivers, and Dent says he ensures the protocol is reviewed and audited every year. Midland Memorial also administers an employee satisfaction survey on the effectiveness of the guidelines and what could be improved.
In addition, with input from Midland Memorial's nurse staffing advisory council, the system has eliminated 12-hour shifts in favor of more employee-friendly nine-hour shifts and is currently examining ways to further curb fatigue-causing shifts, Dent says.
While there is no exact science to preventing executive burnout, experts agree that effective self-care approaches can help ensure the well-being of both the leaders and the healthcare organizations they run.
“The other thing about being an executive is that it's lonely at the top. You may be feeling frustrated, you may be feeling burned out, but you have an executive presence and image that you need to portray regardless of how rough the going gets.”
Rose Sherman, EdD, RN, NEA-BC, FAAN
Jack O'Brien is the finance editor at HealthLeaders.
Burnout is in the C-suite, though it is much less talked about compared to those in rank-and-file positions.
The rise of consumerism has also played a part in the executive burnout trend as patients see and demand more from their local healthcare providers.
Despite the difficult situation and the reasons for executive burnout, leaders can be assured that there are options available to them.