Tuesday, December 31, 2019

Bridge over troubled water (Musings on how to prevent burnout in transfusion professionals)

Updated: 20 Feb. 2020 (Fixed typos)
As the decade comes to an end, some musings on how to be happier and prevent burnout. The idea for December's blog began this morning with a CBC radio interview with its workplace columnist. She mentioned a study of physician burnout that showed enabling Drs. to devote 20% of their work activities to the part of their practice that is especially meaningful to them had a strong inverse relationship to their risk of burnout (Shanafelt TD,et al, Further Reading).

Physician burnout is often in the news these days and spoken of as an epidemic. It made me wonder about other transfusion workers such as nurses and medical laboratory technologists/scientists. The blog's title derives from a 1970 Simon and Garfunkel ditty (changed the tune - this one fits better) .

Took a peek at some of the literature on physician burnout. Must be said up front that burnout varies by specialty (nice chart in Rothenberger DA, Further Reading), and many other factors including sex, specifically that women are more likely to experience burnout. (Further Reading)

Factors that contribute to work burnout are nicely summarized in Rothenberger's  paper (Table 2) and include
  • Work overload 
  • Lack of control 
  • Insufficient reward 
  • Lack of fairness 
  • Breakdown of community 
  • Conflicting values between job requirements and personal values 
Please consider which, if any, play a role in your workplace.

See the Engagement column of Table 2 for ideas that lessen factors that contribute burnout. Think if these are possible in your workplace and, more importantly, which, if any, you can affect positively. (Click to enlarge)

One of several scales used to assess burnout is Maslach’s triad of emotional exhaustion, de-personalization or cynicism, and feelings of diminished personal competence and accomplishment at the work. (Further Reading)

Recently, I saw burnout in a hospital where my spouse spent 33 days this summer. One of his nurses was clearly burned out. We know because my husband often talks to healthcare providers, asks them about themselves, etc. Many find this refreshing and tell him all kinds of personal things about their backgrounds. One evening one of his RNs opened up to him and mentioned that she was stressed and might leave the profession soon. That formed a bond between them. As a daily visitor, I noticed how under-staffed and over-worked nurses often were, literally run off their feet at times.

Much earlier I saw burnout among medical laboratory technologists (aka biomedical scientists) when restructuring occurred in Alberta combined with a massive laboratory budget cut. 

The powers that be wouldn't come clean about what was happening and lab staff were left feeling totally out of control. Uncertainty ruled, unproductive incessant gossip ensued.

Those staff who remained had to compete for remaining positions, setting colleague against colleague, friend against friend. Often the process was viewed as unfair by losers and the winners felt guilty. Lose-lose all around, including the organization.

Fewer jobs existed, indeed lab jobs disappeared in Alberta and those who could had to uproot and find work in the USA, NZ, etc.

With budget cuts, continuing education opportunities dried up and staff were left feeling unappreciated.

Today, more than 25 years later, something similar is happening in Alberta.  The provincial government changed and what had been planned has once again been ditched. Local lab staff experienced so much change over the years and now uncertainty reigns once again. 

For transfusion labs an added factor includes automated testing, which lessens the hands-on factor many who gravitate to serology and immunohematology love. Plus the modern computerized, high-tech work environment makes patients seem more remote and e-mail is so overused, it numbs the mind. I know of lab staff whose mailboxes are full of 100s of messages, most of them irrelevant.

Have no idea how much of this currently relates to transfusion physicians, nurses and lab staff elsewhere, but I suspect some aspects must apply. 

So....to steal from journalism, please consider the 5 Ws and one H on how to lessen burnout: 

WHO needs to act? 
All of us. It we owe it to ourselves and colleagues in our transfusion family and most of all to our patients.

WHEN should we act? 
Now, the sooner the better. Make it a New Year's resolution, if you're into that and it motivates you. 

WHERE should we act?
In our workplaces dealing with patients; in staff meetings with colleagues; at lunch, coffee breaks, other outings; training students and new staff; collaborating with administrators and  health professionals in other disciplines; representing our profession and ourselves at meeting; meeting with those we perceive as our  bosses. Bottom line: Everywhere in work related roles.

WHY should we act?
Not just to retain health professionals so the number doesn't wane with possible shortages or to recruit successfully as aging professionals retire in increasing numbers. As important, if not more crucial, is we act to keep our mental health, which affects physical health. 

Our health and attitudes affect all around us, including our family, colleagues, students, patients, and their health too. Face it, no person wants to be in the presence of negativity and with burnout we exude it. 

WHAT do we need to do?
This may seem the tough question but I see it as relatively simple. For ages I've realized that what we remember in life is a series of short interactions with others, perhaps only lasting seconds or minutes.  First, remember that every conversation you have, every word or phrase uttered, may be remembered by the recipient of the communication forever, and have an effect either as a positive force or, gawd forbid, life-defining in a negative way.

Second, respect yourself and your work (meaning do your best, especially when it's hard) because only when you feel good about yourself can you help others. It's similar to the Buddhist core concept of  self-love, whereby you must love yourself before you can extend love to others.

Third, if in any position of power, do what you can to delegate to subordinates (under supervision remote or close depending on where they're at), which will increase their self-worth and confidence. Most every health professional has some power, e.g., in training and mentoring students and staff; in influencing colleagues to be their best by being a role model. One way is not to gossip maliciously, another is to be true to those who are absent, which builds trust in all present. 

Tidbits: Genuine praise goes a long way for a job well done. If high up on the chain of command, remembering staff names is always appreciated. 

Corollary: Take every opportunity to convince those above you of ways to make the workplace better because it's win-win for them, you, the staff, and patients. If unsuccessful as will inevitably occur at times, be creative and find work-arounds to improve your work environment tangibly or spiritually. 

HOW to do it?
Have fun and be happy in your work as it's infectious and will spread to others. Give of yourself and others will pay it forward. Resolve to be the best you can according to your abilities. You owe it to yourself.

As in the research paper, one way to decrease burnout is to spend 20% doing what you best love about your job. Must admit I was very fortunate because I loved ~99% of my job, what I've always said was the best job teaching transfusion science in the world. Students were a diverse group of delightful characters, smarter than I was, had more comprehensive knowledge, and kindly tolerated me calling them 'kids', something I do to this day. Also fortunate with colleagues, who generously helped me overcome my deficiencies. 

What did I least love? Staff meetings that were not needed, and when they were, hearing 'We tried that, it didn't work', thereby shutting down discussion. 

Learning Points
If you love nil about your job, best to pack it in and try another career or retire. As someone who experiences the health system a lot, I see burnout in some health staff. Also as an educator, I've seen the rare colleague who became jaded and really needed to quit before doing more damage. 

Doing more of what you love and enjoy makes sense and helps decrease burnout. When work is fun, we stick with it and create an environment where everyone improves, including patients. Just like when learning is fun, students tend to do much better.

Wavered between 2 songs, but in the end chose a very old ditty, many will think is dated:
When you're weary, feeling small,
When tears are in your eyes, I will dry them all.
I'm on your side. When times get rough
And friends just can't be found,
Like a bridge over troubled water
I will lay me down.
As always, comments are most appreciated. 

Shanafelt TD, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009 May 25;169(10):990-5. 

Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum. 2017 Jun;60(6):567-76.

CBC Edmonton AM Workplace Column: New Year at Work (31 Dec. 2019 - 7:06 mins.)

Berg S. Why women physicians are more likely to experience burnout (9 Sept. 2019, AMA)

Templeton K, et al. Gender-based differences in burnout: issues faced by women physicians (30 May 2019, NAM)

Maslach C, Jackson SE. 1981. The measurement of experienced burnout. Journal of Organization Behavior;2(2):99-113.