by Dr. Kenneth H. Cohn

In "Hospital CEO burnout on the horizon: Look for successors now," Karen M. Cheung describes the challenging conditions healthcare leaders face as they move forward in an uncertain environment.

According to the September/October issue of Healthcare Executive, there was a 17 percent CEO turnover rate in 2009, compared to 14.6 percent in 2001.

I am pleased to see reports like this, because we need to bring attention to burnout at all levels in the healthcare profession to make it better.

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As I wrote in a previous Hospital Impact blog post, burnout affects physicians as well--often with devastating consequences for patient care outcomes and for nurses and allied healthcare professionals who may feel caught between working with angry, overworked healthcare professionals and having a mission to be patient advocates.

And as I mentioned in the book "Better Communication For Better Care: Mastering Physician-Administrator Collaboration," burnout occurs when work and/or personal demands exceed one's ability to cope. It involves a continuum of responses ranging from acute exhaustion to mood swings, impaired performance, or suboptimal coping strategies, such as disruptive behavior and/or substance abuse. The Maslach Burnout Inventory defines three components: emotional exhaustion, decreased empathy and lack of personal accomplishment.

It is in the best interests of patients, employees and healthcare professionals for institutions to take an active role in monitoring and improving the well-being of their workforce. Approaches can be both universal (i.e., applicable to all healthcare professionals) and personal (i.e., customized to each person's needs). The program must be developed with worker input rather than imposed upon people. Handled in a sensitive, confidential and caring manner, supportive measures can calm anxieties that "Big Brother is watching" and that measures will be used for political purposes. A range of tools can include:

• Regular monitoring of team, unit and individual staff morale via anonymous surveys
• Appointment calendar review at each hiring/rehiring interval, so healthcare professionals can connect the dots between their activities and their wellness
• Access to coaching and private counseling, scrupulously maintaining confidentiality
• Provision of confidential hot-line for reporting behavior that has patient safety or team safety implications

Some remedies we have found helpful at U.S. healthcare organizations include:

Interpersonal

• Watching out for productive, "go-to" colleagues, respecting their time off
• Sharing feelings with others who have shared a stressful event
• Showing concern when colleagues exhibit stress symptoms and helping them obtain assistance before care suffers

Intrapersonal

• Sense of perspective and humor (i.e., watching reruns of TV series MASH)
• Vacation
• Exercise: aerobic, muscle strengthening, stretching and deep breathing
• Attention to personal hygiene, nutrition and hydration
• Meditation and biofeedback, (bathroom) breaks*, periodic walks
• Frequent self-monitoring for symptoms of physical and psychological stress
• Seeking counseling when feeling that life is out of control and the need to treat symptoms with alcohol or other habit-forming substances

*By "bathroom breaks," we mean that breaks do not need to be long, but should be frequent and that focusing on deep breathing in the privacy of a closed stall helps to relieve chronic stress before the stress becomes overwhelming

A final prescription deserves its own paragraph. Start now to develop trusting relationships with physicians who allow you to admit safely that you do not have all the answers and you welcome assistance. Physicians have experience in making major decisions based on limited information and, as such, can help hospital leaders deal with 21st century complexity and overload.

Ken is a practicing general surgeon/MBA and CEO of HealthcareCollobration.com, who works with organizations that need to engage physicians to improve clinical and financial performance in this era of healthcare reform. His latest book, Getting it Done, celebrates healthcare heroes who broke down silos and improved care for their communities. Please learn more about what he does by visiting http://gettingitdonebook.com.