Rania Habib, MD, DDS (Host): The American Medical Association reports that at the end of 2021, 63 percent of physicians reported symptoms of burnout, which is up from 38 percent in 2020. This is Transformational Pediatrics with Children's Mercy, Kansas City. I'm your host, Dr. Rania Habib. Joining me today is Dr. Stephanie Burrus, a Pediatric Hospitalist who also serves in the role as Chief Wellbeing Officer.

Join us today as we discuss this very timely topic of provider burnout and prioritizing your wellbeing. Welcome to the podcast, Dr. Burrus. We're excited to listen to your expertise on this very important topic.

Stephanie Burrus, MD (Guest): Thank you Dr. Habib, I'm happy to be here.

Host: Let's begin by just a very simple question. What is burnout and is this a regular occurrence in the medical field, Dr. Burrus?

Stephanie Burrus, MD (Guest): Yeah, that's a great question. I think that the word burnout has been used extensively in our society, but if you really go back to its roots, its true definition comes from describing the feelings of stress that we have as it relates to our work. And I think that's the important piece. It is specifically as it relates to our work.

It is really the chronic and repeated exposure to stressful situations or can be a result of chronic workplace stress that is due to an imbalance between the job demands and maybe the resources that you have in your job that you're doing.

So I think it's often the state of complete mental, emotional, and physical, or sometimes all of the above, exhaustion. And it has occurred in any discipline in healthcare, definitely in the physicians, but a large impact has been on nursing, et cetera, in the medical field. But in particular, since we started to recognize it, for what it is and openly talk about it.

As you mentioned, burnout rates have skyrocketed over the last few years and some of those are really as a result of the COVID pandemic. But really, the COVID pandemic only brought to light much of what we were already seeing in medicine and that people were suffering. But now with staffing shortages and people leaving medicine because of burnout and those things, we're finally open to talking about it.

And when we're open to talking about it is when we can really apply the true interventions that we need to combat it. Most of those interventions come in the workplace and not from the individual themselves.

Host: Well, now that we've addressed the definition of burnout, what are the most common signs of burnout, Dr. Burrus, as you said, related to workplace stress?

Stephanie Burrus, MD (Guest): Yeah, as I mentioned before, it can come across in a variety of different ways and can be different for different people. So it can be mental or emotional exhaustion, as I said, or sometimes physical exhaustion, but it typically can manifest itself as fatigue. Of course, that exhaustion we talked about, it can be a physical ailment, that may be a headache for someone, maybe muscle pains for others, definitely changes in your physical abilities.

 It can be a change in your sleep cycle, right? If you're stressed and worried about things, you're not probably sleeping as well or as soundly as you should be. It can even be a change in appetite. Most of the time, because it's work related, it can show up to us as leaders as maybe a lack of motivation or low motivation from those that are working for us, or a lack of engagement.

It can be a change in that person's demeanor from what you typically see them as. And then some people hit a point of such exhaustion that they become unable to work.

Host: That's terrible. And it's now why we really need to start recognizing this and addressing it. So you did mention that it sadly is a regular occurrence in the medical field. Dr. Burrus, are there certain types of providers that seem more susceptible to burnout?

Stephanie Burrus, MD (Guest): Yeah. As I mentioned, I think this first came about in specifically talking about physicians, but as we know, our nursing colleagues, our social workers, many other disciplines are at risk. I think oftentimes, no matter what discipline you're working in, you're exposed to many distressing situations and, or having a hard time grappling with not being able to get your patient the things that they need. But by and large, the disciplines that have higher physical demands of the job or work in environments that disrupt their normal sleep wake cycle, meaning they're working daytime and then they're working nighttime, the next shift, or they're working in environments where there's a higher cognitive load.

So you don't know what's coming to you next. You don't know what's going to happen while you're at work. And so those are often the ones that have higher rates of burnout. So, you know, top of mind and well studied, those in emergency medicine can be adult and peds alike. Those in hospital medicine programs like myself and many of the surgical specialties, just to name a few.

Host: So, unfortunately, no one is um, everyone can be at risk for burnout.

Stephanie Burrus, MD (Guest): Absolutely.

Host: Dr. Burrus, you serve in a very unique role as the Chief Wellbeing Officer, and honestly, I think not many hospitals have implemented that role, so congratulations. Could you tell us about the Center for Wellbeing and how it is addressing concerns just like this?

Stephanie Burrus, MD (Guest): Yeah. As you mentioned, I feel very fortunate to have this position and be able to influence on the work needed to combat burnout and uh, really put the wellbeing of our people first and foremost in our mind. So we've done a lot of different things, but this is long. I like to call this long game work. You know, never are quite done.

So I think first and foremost, when you have organizations that are willing to discuss burnout, and are willing to have the conversation to put people and resources towards it and to mitigate burnout; you have to first get a sense of what the burnout is like in your own organization. As you mentioned at the top of the podcast, you know, there's many national studies and burnout rates are skyrocketing, but you also have to understand your own organization. And that really starts with internal assessment. Are you asking your people the right question? Are we getting the information that we need? And I think one of the exciting things that we did with over the last year is we assessed burnout in our entire organization.

We have done it in the past as it relates to our trainees and our physicians, but this is the first year that we said, you know, we really need to understand the pulse of the organization and where we're at, if we're really going to put in strategies to mitigate it.

And so then we took that information and we started work with local leaders to apply workplace improvements. As I said, much of burnout has to do with the workplace itself. And so by and large, you need to make improvements, those pebbles in your shoe, those thorns in your side. At times, there are larger systemic barriers that I lovingly call boulders on your back that may take more of a thoughtful, strategic approach from leaders in the organization than more than just your local leader can handle.

So we really started to say, Hey, what are those workplace stressors and barriers? And let's try to work together to mitigate them. And it's been a wonderful collaborative opportunity with many throughout the organization. I would say the other piece beyond assessing your people is really working to influence and improve your culture surrounding wellbeing.

I think oftentimes when people think about wellbeing, they think about the low hanging fruit or what we used to call kind of wellbeing 1.0 where we put in a few personal resilience programs like a gym or we offered an employee assistance programs or things like that. But it's really influencing the culture of your organization.

So here at Children's we're positioned to influence and to have everybody realize that our people are our most important asset, and so that they feel welcome, they feel their voices matters, and that they have a say in how the work is done. I would say, back to kind of the distressing events and things that I mentioned before that we know are just going to naturally occur in healthcare, I think one of the most impactful things that the Center has done is that we provide support for those that have been exposed to or are experiencing stressful events.

We offer one to one support as well as team support. It really just depends on the situation and what the needs of the of the person are. So we have a program called Aligning Support Across Providers. We call that ASAP for short. And this is really where we do come ASAP to a team or a group and gather them together to have a reflection session after witnessing or experiencing a devastating event.

This could be a loss of a patient. It could be experiencing a traumatic code event. It could be the loss of a team member. And that really gives the space for people to process and understand that they're not alone, as well as it brings a sense of connection to others around them. And, you know, you really need to build that culture of connection in the workplace.

In addition to that, we know that we are a small but mighty team. And again, we are very fortunate to have a team. but we're small and we know that we can't get to the needs of everyone in the organization. So we are currently in the process of developing a more robust peer support program in addition to this ASAP program where we're training others in the organization to be those peer supporters.

Host: That is fantastic.

Stephanie Burrus, MD (Guest): Yeah, very exciting work. And I think when you bring together a peer support program like that, it really allows others that want to support their peers or their colleagues in a way; it really allows them to do that and creates a space for that, which is another win.

Host: Absolutely.

Stephanie Burrus, MD (Guest): I would say another initiatives we have are, we have created a what's called a WOW cart, a wellbeing on wheels cart. And this is equipped with snacks and some self care items and notes of gratitude that, that our colleagues can give to others. That is by far one of our number one, asked for initiatives, but we know that that's not going to mitigate, it's just going to make you feel better in the moment, but really does also create that environment where people feel seen and heard and we go to them and we talk about what they're experiencing.

I would say our very, very most popular program is called Pause with Paws. And we are very fortunate to have a facility dog dedicated to staff support. And Hunter is by far our most popular team member in the center and well loved. But we also, in that Pause with Paws program, sometimes we'll call on our other facility or volunteer dogs and our staff just love it. You know what's better than to have a little snuggle or a scratch with a furry friend.

Host: Absolutely.

Stephanie Burrus, MD (Guest): I think for me personally, one of the things that we have done, you know, I've worked in healthcare for a number of years and have witnessed firsthand what our workforce is going through. And so one of the interventions that I am most proud of is we have created a method for proactively reaching out to an individual after they've been part of any of those distressing events, so you name it; experience with a safety event, a workplace violence event. We also know that workplace violence is on the rise and we need to support our people. They may have been involved in a code event, as I mentioned before, or a patient death, as mentioned. And really what we do is we proactively offer support. And again, that goes back to the culture of wellbeing and belonging.

Sometimes just knowing that someone's there and understands what you've just witnessed or what you've gone through can really go a long way. It really comes to understand our shared humanity.

Host: Absolutely. I mean, your center is amazing and I wish all hospitals had it because you're not only recognizing that the hospital has a role to play in creating a more nurturing environment, but you're actually focusing on the individual as well. So, what recommendations do you have, Dr. Burrus, for when healthcare workers are feeling burnout, how can they, what can they do in their daily lives to help reduce those feelings of burnout or maybe to help avoid it altogether?

Stephanie Burrus, MD (Guest): Yeah. I think this can be different for different people, right? And honestly for those in health care, we come into this environment with the goal of caring for others. So it can be really difficult to step back and say, huh, I need to take care of myself. And with that, I think just the recognition that you need to take care of yourself like the old adage of put your oxygen mask on first, can be a first good step.

And then trialing what works for you. So of course, exercise and sleep are key for anyone. The important thing there really to try to make small and subtle changes with both of these and, just understand that, hey, I might need to improve in one of those areas. I think learning the practice of mindfulness is a great technique for many people.

We didn't talk about that before, but our center offers many mindfulness classes. In fact, we're in the midst of training to offer an additional one that's about 12 minutes a day, which I think will be a great uptake for healthcare providers that are busy. Journaling and things like gratitude practices, so for instance, Three Good Things, where you take a moment and honor kind of three good things that have happened during your day can really shift your mindset and, those have been very popular for many. Connection with family and friends. We talk about how important connection is in the workplace. It's also important outside of work and being purposeful in creating time for those people in your life that are the most important. I know it sounds cliche, but we all need to do it. And that oftentimes gets forgotten about.

We're social creatures and we need that social connection. And then I think the biggest takeaway for this piece is really for everyone to just extend yourself some grace. If you don't always do the things you know you need to do, we just try again and try to improve a little bit as we go. I think the important thing off of this is that many of these things are really important and they're all things that we need to do personally and we know we need to do them.

But really to get to the core of burnout, we need to improve the workplace as we talked about before. We can do all of these things on a personal level outside of work, but if you continue to come to work and experience the same distress the individual may not make as much headway.

Host: Dr. Burrus, you have provided us with such a wonderful wealth of information from the definition of burnout to how we can mitigate it as the individual provider, but also how the workplace has to really create an environment that's nurturing for the employee. So as we wrap up, what is your final take home message for our audience today?

Stephanie Burrus, MD (Guest): Yeah, you know, the one thing that I get so often is as you started out, wow, you all have an abundance of resources. And so when you're in a landscape where you may not have the privilege of those resources, where do you start? And I think the first thing that's easy, it's free, is to assess. Where are you at as an organization as it relates to burnout?

And some of those assessment tools are free. There's many of them out there that will assess burnout and are free of charge. And so start there. And then really looking at how you can create that culture of wellbeing and belonging again, right? Influencing and continuing discussing it and being open about it are also free.

And, any of us can do those where we feel we're making a difference in our employees lives and we're making them feel welcome.

Host: Right.

Stephanie Burrus, MD (Guest): I would say from there, start small. The initiative that is practiced or is the most evidence based as creating an impact, is a peer support program. So, maybe you as an individual organization look into that and see how you can implement one in your own. And it can, it can look a number of different ways. And then, last but not least, I think it's really being the voice of our healthcare workforce.

And having our organizational leaders understand that really we need to shift the recommendations, that combating burnout isn't necessarily an individual problem, it's a workplace problem. And the Surgeon General has many wonderful quotes, but the one that I love is we need to shift burnout from a me problem to a we problem, and all of us need to lean in to combat it.

Host: Absolutely. Well, thank you so much for that wonderful wealth of information. It was so great to hear about the amazing things you're doing at the Center for Wellbeing and addressing burnout and really helping to keep your population very happy. So thank you for sharing that.

Stephanie Burrus, MD (Guest): Thank you for having me. It's been wonderful.

Host: Once again, that was Dr. Stephanie Burrus, a Pediatric Hospitalist and the Chief Wellbeing Officer at Children's Mercy, Kansas City. To refer your patient, or for more information, please visit childrensmercy.org to get connected with one of our providers. I'm your host, Dr. Rania Habib, wishing you well.

This has been Transformational Pediatrics with Children's Mercy, Kansas City. Please remember to subscribe, rate, and review this podcast and all other Children's Mercy podcasts.