2016 July/August Coaching Report

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Institute of Coaching

Are you burned out?

Last month HBR featured a blog: Don’t Get Surprised by Burnout. The author, passionate and appreciative of his work, awakened to realize that chronic overwork, even when it’s a pleasure, can become too much of a good thing. It took him five weeks of staying at a hotel in Singapore to realize that it overlooked a beach. The remedy he prescribes is more downtime with no goals or to-dos; time to be, to be alive, to experience rather than act, and accept whatever that feels like.

This month we dive into a much more serious form of burnout, defined and studied for four decades by Christina Maslach and described well by her book title: Burnout: The Cost of Caring. This form of burnout is a real hazard in any role with unrelenting focus on supporting others; for example, parenting, teaching, caregiving, social services, and many, many roles in healthcare and mental health. It starts with a helping soul whose role demands a continual focus on supporting others all day or all night. That scenario combines with a situational bias toward the negative aspects of those cared for, and a leadership context that downplays the impact of unrelenting helping of others. All of this leads the helper first to emotional exhaustion, and then to a hardening of emotions and depersonalization. Even cynicism and hostility can set in rather than empathy and connection. The third and final straw is that performance sinks along with a sense of accomplishment. You may remember the physician’s quote in New England Journal of Medicine that opened our March Coaching Report: “Then I sit at my workstation to document and bill for our encounter, perched at the edge of my seat, on the verge of despair.”

We feature the Maslach book, even though it is not new, because it’s a tour de force on burnout’s deep nature and wide array of circumstances. It draws from a brilliant and perceptive scientist’s multi-decade devotion to lifting the subject up to wide respect and awareness, a subject that had no scientific definition nor literature base when she started 40 years ago. Dr. Maslach also wrote an excellent article for sharing with coaching clients: Reversing Burnout: How to rekindle your passion for work that is a good review of her co-authored book, Banishing Burnout: Six Strategies for Improving your Relationship with Work.

It describes six factors that contribute to burnout in organizational life:
1.   Too much work and too few resources
2.   Too little control
3.   Too little reward, both financial and recognition
4.   People troubles – lack of respect, isolation, or conflict
5.   Lack of fairness
6.   Values conflicts

By now you might be wondering how you would fare on a burnout assessment! Here’s an abbreviated version of the Maslach Burnout Inventory. It’s meant for physicians so do substitute patient for coaching client.

Gail Gazelle’s webinar on July 13, titled Tackling Burnout in Physicians: How Coaching Can Help, will address an epidemic of ever-worsening of physician burnout; physicians are the canaries in the mine for all that ails the healthcare system today. Gail co-authored the first paper addressing the value of coaching to help physicians overcome burnout. Her webinar will discuss coaching strategies to help physicians, and of course, other clients who are feeling burned out.

Our featured research paper chronicles the impact of leadership on physician burnout at Mayo Clinic – basically poor leadership increases burnout and decreases job satisfaction of physicians and their departments.

And last, it goes without saying that coaches are susceptible to Maslach’s form of burnout, too, especially if a coach’s client load is high and unabating, and client needs are intense. Coaches have a dual responsibility, to both model and take good care of our own well-being including minor or major symptoms of burnout, while deepening our understanding of how burnout affects our clients whenever they work with people every day in a challenging context. No better time than summer to invest in recharging our batteries, slowing down to savor the miracle of being alive.

Margaret Moore, MBA, aka Coach Meg
Institute Co-Director

Impact of Organizational Leadership on Physician Burnout and Satisfaction Tait D. Shanafelt, MD; Grace Gorringe, MS; Ronald Menaker, EdD; Kristin A. Storz, MA; David Reeves, PhD; Steven J. Buskirk, MD; Jeff A. Sloan, PhD; and Stephen J. Swensen, MD

Summary by Irina Todorova, Institute Director of Research

The topic of health professionals’ well-being has become increasingly important in this disruptive phase in healthcare. Health professionals’ well-being is also positively associated with quality of care in clinical settings. Most research in this area has addressed job characteristics such as demands, engagement, and culture. By contrast, this article addresses the impact of leadership characteristics of supervisors on burnout and satisfaction of physicians. It emphasizes the importance of relationships in healthcare organizations, particularly the impact on well-being of a relationship with one’s supervisor.

The study reported a survey of 2,813 physicians and scientists of diverse specialties at several Mayo Clinic campuses, 90% engaged in patient care, which included an assessment of burnout (exhaustion, cynicism and professional inefficacy), overall satisfaction, and leadership qualities of the direct supervisor. The leadership qualities were defined as the leader’s ability to “inform, engage, inspire, develop and recognize” employees. While burnout was evaluated with a shortened version of the classic Maslach Burnout Inventory (MBI), and 12 leadership dimensions were assessed by a scale that had not been previously tested, the characteristics of these scales are good and thus the results are compelling.

Thirty-eight percent of physicians were emotionally exhausted - striking, yet similar to the levels reported in other studies. What’s interesting is that better leadership qualities of supervisors correlated with lower burnout and higher satisfaction of their staff. Each 1% increase in the composite leadership score correlated with a 3% decrease in burnout and a 9% increase in satisfaction for physicians. The higher mean composite leadership score of a division leader also correlated with lower burnout and higher satisfaction at the division level.

The article points out that the leadership qualities assessed are based on “teachable behaviors” and include providing supervisors with coaching skills. Hence, coaches can play a valuable role in supporting the well-being of healthcare organizations and professionals through coaching leaders, upgrading leadership qualities and preventing burnout.

While we are talking about research, the journal “Burnout Research” was launched in 2014, led by Editors-in-Chief Christina Maslach and Michael Leiter. As noted in a 2015 Editorial (Maslach & Leiter, 2015) the journal focuses on the practical side of prevention and amelioration: a perfect home for new coaching research on preventing and handling burnout.

Wellmed 2.0: 2nd International Meeting on Well-Being and Performance in Clinical Practice.
by Irina Todorova, PhD, Institute Director of Research

I travelled to Greece in May to attend the 2nd biannual meeting on research and prevention of burnout in healthcare professionals and organizations. Ways of preventing burnout and improving wellbeing, engagement, performance, and resilience for health professionals were explored, including coaching, mindfulness, narrative medicine and organization-level interventions. Keynote speaker Christina Maslach highlighted the increasing problem of burnout in organizations and the systemic phenomenon of "burnout shops" in which the "start-up" mentality has now expanded to be a chronic situation in all kinds of organizations. Upgrading the relational dynamic in organizations is important for preventing burnout; for example, the CREW project on 'Civility, Respect, and Engagement at Work' (Maslach & Leiter) is focused on promoting civility in organizations. Another theme is the greater integration of the patient voice in improving quality of care along with wellbeing of all health professionals.

Maslach, C., & Leiter, M. P. (2015). Editorial: It's time to take action on burnout. Burnout Research, 2(1).

Institute of Coaching

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