Americans became familiar with new terms such as “social distancing,” “quarantine” and “waves” during the COVID-19 pandemic. Waves referred to rises in the count of people infected with the virus. Now, over three years after the pandemic started, waves have a new meaning for us as we work with leaders in healthcare organizations: waves of languishing and burnout.
Languishing, described two decades ago by sociologist Corey L.M. Keyes as the “absence of mental health,” is a risk factor for developing mental health conditions in the future, like major depression and post-traumatic stress disorder. While languishing affects all areas of life and entails a sense of stagnation and emptiness, burnout is a work-related phenomenon resulting from chronic workplace stress that has not been managed successfully. Burnout is characterized by feelings of emotional exhaustion, depersonalization from one’s job, and low sense of personal accomplishment.
In our work with academic health systems and hospitals, we have observed waves of languishing and burnout. These waves have cascaded through different groups of healthcare workers in steady succession. Earlier waves hit nurses, some allied health professions and then physicians. The most recent wave we are encountering involves administrative leaders.
While front-line workers confronted COVID-19 directly, leaders of hospitals and health systems were simultaneously working to support these caregivers and ensure patient access. As leaders applauded clinicians and clinical support staff, they also carried an enormous burden as they guided organizations through unprecedented challenges.
In many ways, healthcare leaders were and continue to care for the caregivers, and subsequently, are at risk from caregiver burnout, too. Three years into the pandemic, burnout has contributed to high rates of turnover among hospital CEOs and other critical leadership positions in health systems.
These waves of languishing and burnout have been relentless and unforgiving. Many leaders we have talked with describe a peculiar observation: their leadership teams felt most united when they were dealing with the acute crisis of COVID-19. Now that the acuity has eased, their teams are fatigued and otherwise not working together as well as they could be.
This dynamic is evidence of organizational languishing, leaving many leaders with a desire to hit a reset button with their teams. In our experience, this reset button can take several forms, such as the following:
- Slow down and realign on vision, mission, values and strategy. When multiple levels throughout an organization feel overburdened, leaders should consider slowing down and refocusing attention of their leadership teams and next-level managers on the organization’s vision, mission, values and strategy. Under the stress of languishing and burnout, people can lose sight of their organization’s north star. Successful leaders are empathetic in reminding people of the meaning and purpose of work and leadership.
- Leadership team retreat. Under the pressure of diminishing margins, the CEO of a large regional academic health system needed the system-level executive team and the CEOs of each entity hospital to unite on their efforts to eliminate duplication and reduce expenditures across the system. A full-day leadership team retreat, with interviews of each senior leader in advance, identified barriers to cost reductions. Candid and at times difficult conversations about addressing barriers as a team were held. Discussion then moved toward problem solving to avoid a typical characteristic of languishing—procrastination. Concrete next steps for each milestone and the leaders who were accountable for them were created to eliminate uncertainty and ensure progress.
- Team development sessions. The top team of a community health center network was reeling from turnover in several senior leadership roles within a short time period. To address concerns about lack of trust and psychological safety, a series of sessions with the full team was held. These sessions focused on re-establishing norms for how—in regular senior leadership team meetings and using active dilemmas they faced in their work—they prioritize key issues, discuss the issues in productive ways, and leverage the full talent of individual leaders on the team.
- Individual coaching. Senior leaders may feel alone in their roles as they deal with complex organizational dilemmas. Working with an executive coach provides essential time for leaders to reflect and exchange ideas with an experienced professional. Equally important today, coaching also offers a meaningful social connection that can mitigate the risk of burnout.
- Leadership development programs. Executives not only risk burnout themselves, they also must manage burnout among the people they directly lead. Bringing people together through a leadership development program can address both risks. With cohort sessions focused on specific leadership approaches, department leaders and program directors can improve their skill sets while reaping the benefits of professional fulfillment that comes with learning with peers.
While many industries are closing out 2023 with a renewed sense of enthusiasm and a view of COVID-19 in the rearview mirror, healthcare organizations have never had the luxury of relaxing or even slowing down over the past three years. When signs of languishing and burnout are evident beyond isolated situations, proactive attention and action can lower the risk of them becoming performance busters and sources of divisive interpersonal dynamics over the long term.
Jason Pradarelli, MD, is manager, CFAR, Inc., and Jennifer Tomasik, FACHE, is vice president, CFAR, Inc.