I was recently required to take an online training module on burnout for physicians and allied professionals. It was the first time in 20-plus years that I’d received a formal message about self-care from any long-term care institution (aside from yearly staff appreciation barbecues and survey completion parties).
While I was impressed and grateful for the focus on caregiver well-being, a couple of points bothered me.
The questionnaire asked readers to select the phrase they most associated with provider burnout. There were options such as “workplace dissatisfaction” and “challenging patients.” I chose “changes in the healthcare system,” which triggered a pathway specific to that option.
I was guided through a series of vignettes discussing issues old-timers might have trouble with, such as adapting to the electronic medical record. Following the vignettes, helpful strategies were offered to manage stress.
Then came the part I found disturbing: The details of the “changes in the healthcare system” choice included “the emphasis on the healthcare experience of consumers” and “the shift from volume to value.” Let me explain why that irks me.
The experience of healthcare
Regarding consumer experience, most of my direct care team members and I have been very focused over the years on accommodating the needs of residents. It’s become more difficult, however, to maintain care quality and orderly surroundings in a healthcare environment where financial pressures have led to staff reductions and increased turnover amidst higher acuity residents.
Trying to deliver a decent customer experience without the necessary tools is part of the change in the healthcare system that induces my feelings of burnout — not the “new” attention to perceptions of consumers.
I’d be gratified to see a genuine, top-down focus on the healthcare experience of residents and their families — complete with Resident Experience Officers in every long-term care facility (sign me up!). Such an emphasis would realign resources with a mission of care that can stabilize staffing and sustain facilities over time.
Volume to value
“The shift from volume to value” stresses me in a different way.
Part of my role as a psychologist in the “volume” approach has been to aid residents in negotiating their illnesses and treatments.
If necessary, I could help them stop a lucrative but unwanted onslaught of painful medical interventions by fostering communication with their physicians and families. I worked with my team members to estimate the likelihood that the medical procedure would be successful, addressed end-of-life issues with residents and tag-teamed with social workers to complete advance directives.
While I know I can assist my patients in managing a system that tends toward too much rather than too little care, I’m not sure how to help my patients navigate the “value” approach where facilities have a capitated rate and profit from fewer procedures.
The wariness of residents and their families regarding healthcare decision-making has shifted with reports suggesting, for example, that the focus on preventing hospital readmissions may have increased heart attack deaths, and with articles such as this one in the Washington Post about short-term corporate profits being prioritized over resident care.
Residents used to complain about being a revenue source for the healthcare system, but what if their care becomes a drain?
In the past, I knew I could count on the integrity of the members of the multidisciplinary team to place clinical necessity over financial gain. As I noted in a previous column, however, a high staff turnover environment makes it more difficult to establish the necessary level of trust and communication with teammates.
Team building and staff retention
It takes a lot of effort on the part of the healthcare team to remain stalwart in their professionalism in the face of corporate financial pressures. I’m convinced, though, that it’s the clinical focus that will save the field. It’s unlikely to surprise anyone providing direct care that the company in the Washington Post article filed for bankruptcy after shortchanging care quality.
Investing in teams pays off by reducing the costs for continually hiring and training new staff. Teamwork and training decreases the need for expensive medical interventions when early warnings signs of illness were missed because nobody knew the resident or knew whom to tell about the problem or what an early warning sign was because they hadn’t been properly onboarded. Investing in teams reduces the likelihood of a disastrous malpractice lawsuit.
Coping with stress
The aspect of a changing healthcare landscape that most increases my likelihood of burnout is the prioritization of short-term profits over the care needs of residents and the preservation of a tolerable workplace.
I manage the stress as best I can through my three-step plan:
- Exercise, healthy eating and crossed fingers to make it more likely that I’ll remain a healthcare provider and not a healthcare recipient.
- Doing my part to be a good team member.
- Following the old adage to light a candle rather than curse the darkness, though sometimes I do both.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.
