The Big Idea: 6 lessons on fighting burnout from Boston’s biggest hospital
This article is part two of a series on burnout. See part one here: How the pandemic exacerbated burnout.
Joshua Baugh, Ali Raja
The emergency department team at Boston’s Massachusetts General Hospital is used to stress — but the pandemic has taken things to a whole new level. How can you keep employees from burning out when they’re on the front lines of an ongoing crisis? The authors, two executives at MGH, share the strategies that have worked in their organization. They describe how they have addressed each of the six elements of engaging work identified by Christina Maslach and Michael Leiter, experts on occupational burnout. Although the details of implementation will look different in different industries, their approach offers inspiration for any organization looking to avoid burnout and maintain productivity during a crisis.
Research shows that employee burnout is an organizational issue as well as an individual one. Managing it is challenging enough even when the world isn’t in the midst of a pandemic. If your workers are on the front lines of an ongoing crisis, how do you keep them from becoming exhausted and unproductive?
As leaders in the Department of Emergency Medicine at Massachusetts General Hospital in Boston, we have supported clinicians, nurses and the administrative and support staff as they’ve cared for patients throughout the pandemic. From our past experiences addressing burnout at hospitals, and given the sheer magnitude of the COVID-19 crisis, we realized that burnout was a major risk. So we used what we knew to create pandemic-specific strategies to support our employees. We also conducted an anonymized survey of the 60 faculty physicians in our emergency department, or ED, to better understand how our efforts affected our staff’s well-being.
Our preliminary results indicate that although burnout has increased during the pandemic, the trend at MGH is not as pronounced as in other U.S. hospital emergency departments. Furthermore, many of our physicians actually reported greater job satisfaction, praising the institution’s strong leadership, effective communication and success securing adequate resources.
While there are no surefire solutions to burnout during a crisis, we hope that sharing our approach will help other organizations. The key strategies we’ve used fall into six categories that align with the factors that, according to psychologists Christina Maslach and Michael Leiter, drive employee engagement and reduce burnout: rewarding work, autonomy, fairness and transparency, a reasonable workload, a sense of community and consistent values.
Making work fulfilling is essential to preventing burnout. Financial rewards are part of this, so we’ve maintained salaries and our incentive payment structure. But emotional rewards are also important for keeping employees motivated. Consequently, we’ve made a concerted effort to reinforce the message that everyone’s work is meaningful and appreciated.
We began by providing frequent updates on COVID-19 patients’ positive outcomes after they left our ED and received additional treatment. We also increased our efforts to collect feedback from grateful patients and share it with employees who otherwise might never hear it. Our surveys showed that these efforts have been key to maintaining employees’ resilience.
In addition, we found that physicians reported greater well-being when they were able to have ongoing, rewarding interactions with patients and their families, despite the constraints of physical distancing guidelines. To this end, we implemented a video conferencing system that allowed patients’ families to communicate with our teams remotely.
The restrictions associated with the pandemic have seriously impeded many people’s sense of control over their lives, and that can have a major impact on job satisfaction. To address this, we took a three-pronged approach. First, we implemented basic but vital safety measures: Along with everyone at MGH, all of our staff had access to adequate personal protective equipment, or PPE, and routine COVID testing, and we modified ED operations to decrease the risk of virus exposure as much as possible.
Second, we gave people choices in how they adjusted to the new reality. For example, we introduced a virtual care option to decrease face-to-face contact but emphasized to our team that it was optional. Third, we invited everyone to participate in solving the new challenges presented by the pandemic. When one employee suggested that a plexiglass wall with built-in gloves could help staff care for patients more safely and effectively, we quickly implemented the idea.
Fairness and transparency
Amid the fear and uncertainty associated with the pandemic, people want to know that at the very least, they are being treated fairly. One of the most effective ways to offer reassurance about that is through clear and transparent communication.
Early in the pandemic, we began sending out near-daily email updates to our entire staff. Those updates provided guidance on changes to operations and clinical care practices, explanations of how departmental leadership was approaching the difficult choices we faced, and detailed data on COVID-19 case trends. We also initiated twice-daily in-person “rounds” in which our leadership team checked in with front-line doctors and nurses to address pressing concerns and discuss rapidly evolving protocol changes. Finally, we increased the frequency of virtual faculty meetings and began holding weekly departmentwide virtual “learning sessions,” giving employees at all levels a chance to connect and share new ideas.
When it came to distributing our limited PPE and vaccine supplies, MGH tried hard to avoid even the perception of special treatment for any group, and we broadly publicized the criteria we were using to make decisions. Employees were given PPE solely according to their level of exposure: Senior clinicians received the same PPE as the cleaning staff. When vaccines became available, everyone physically working in our ED was immediately eligible to receive one, regardless of their role. In our surveys, respondents listed frequent communication and transparent, fair decision-making among the key factors that helped them maintain trust in our institution and stay engaged with their work.
Rightsizing employee workloads for maximum productivity is always a delicate balancing act: You want to give people enough to do to avoid boredom, but not so much that they’re overworked. At MGH, with fears about the virus mounting, we began receiving fewer ED patients. Nonetheless, we opted to keep ED staffing levels constant. This meant every physician on our team had fewer total patients and could put more energy into caring for each one. The reduced patient load allowed staff members to mentally recharge, prepare for the tough demands on them and be more effective in the long run.
Community and consistent values
Maintaining a sense of community among employees has never been more important. To that end, we focused on helping our teams feel more connected. In addition to increasing the frequency of formal and informal staff communication, our department launched weekly virtual “wellness” sessions in which employees could freely discuss whatever was on their minds without their managers listening in. We also encouraged greater cross-departmental collaboration, such as a series of meetings where people in less hard-hit parts of the hospital could brainstorm ways to provide help and resources to the ED and other units most affected by COVID-19.
In response, our employees said they felt the organization had successfully fostered a sense of community that went beyond typical work silos, helping them feel closer to and more supported by their colleagues.
Crises always create stress. But even under extreme circumstances, there are actions that can keep stress from morphing into burnout. The fundamental principle is universal: The best way to prevent burnout and attrition — even during a crisis as volatile as a pandemic — is to empower people to perform their jobs effectively, in an environment that is safe and supportive.
This article was originally published at Harvard Business Review and is republished here with permission.