To make progress against knotty problems, break them down — dissect the causes and analyze their impact on different groups. That analysis inevitably leads away from dubious “magic bullet” solutions and toward multiple, targeted interventions that are more likely to be effective. The measures and data to perform this type of analysis are now becoming available for burnout, a problem that is growing in all sectors, but is particularly challenging in health care.
To better understand the sources of burnout and resilience against it, we analyzed data for two characteristics associated with burnout for more than 80,000 health care personnel from 40 healthcare systems nationwide (approximately 19,000 nurses, 5,000 physicians and 60,000 non-nurse/MD personnel). The first of these characteristics, “activation,” is the extent to which a person is motivated by his or her work and feels it is meaningful. The second, “decompression,” is the degree to which one can withdraw, recharge and enjoy life outside of work. Our research shows how activation and decompression vary among these different groups, and how they relate to resilience against burnout in each.
To study these issues, we developed and validated an eight-question measure of resilience, with four questions each that gauge the degree of activation and decompression. To measure activation, respondents indicate their level of agreement on a 5-point scale (1 = strongly disagree, 5 = strongly agree) with these statements:
- The work I do makes a real difference;
- My work is meaningful;
- I care for all patients/clients equally even when it is difficult;
- I see every patient as an individual person with specific needs.
To measure decompression, subjects respond to the statements:
- I rarely lose sleep over work issues;
- I am able to free my mind from work when I am away from it;
- I can enjoy my personal time without focusing on work matters;
- I am able to disconnect from work communications during my free time.
The greater a person’s agreement with these statements (that is, the higher their score), the more resilience they currently exhibit in the face of stress, and the more likely they will be resistant to burnout. (Resilience is conceptualized here as a moderator of the growing stress faced by the healthcare workforce. As such, low score on gauges of decompression and activation are meant to serve as flags that workplace stress has become overwhelming rather than as indications of a particular individual’s ability or strength in coping.)
We found the doctors, nurses, and non-nurse/MD personnel all had the same average level of activation (4.5), but physicians had lower decompression scores, showing they were less able than others to withdraw and recharge.
We also found that decompression and activation are moderately correlated: People who are better able to decompress are also somewhat more likely to feel activated in their work.
Decompression, Activation, and Engagement
Decompression and activation are both related to feelings and behaviors that are traditionally used to measure engagement in health care workforces, specifically being satisfied as an employee, recommending the organization as a good place to work or get care, and being proud of the organization. However, the patterns of relationships vary when comparing correlations among these variables in nurses, physicians and the rest of the healthcare workforce.
For the non-nurse, non-physician group, activation was more strongly correlated with engagement than decompression was. Additionally, the correlations between activation and engagement measures were somewhat greater for this group than for either nurses or physicians. This suggests that for non-nurse/MD personnel the feeling of activation — finding meaning in their work — is even more closely related to their overall engagement than it is for doctors and nurses. Many of these personnel could have built a career in another industry, but they have chosen healthcare. This underscores how important it is for this group to feel tied to the mission of care, for their own well being.
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This pattern was distinct from what we saw for nurse and physician respondents. For these clinicians, the relative importance of activation and decompression depends on which kind of engagement outcome is being addressed. Decompression was more strongly correlated with how nurses and physicians felt about their role as employees in an organization (Overall, I am a satisfied employee; I would recommend this organization as a good place to work). In contrast, activation was more strongly correlated than decompression with how these clinicians feel about the organization’s performance (I would recommend this organization to family and friends who needed care; I am proud to tell people I work for this organization). The impact of decompression on engagement was strongest for the nursing group.
Taken together, these findings suggest that while meaning in work is of great importance to everyone in health care, clinicians’ ability to disconnect from work and recharge may be even more critical than it is for others to how they experience their work environment and how they feel as employees.
The science of studying burnout and resilience is young, but our experience suggests that measuring decompression and activation can enrich our understanding of the multiple relevant dynamics and support an array of tailored interventions. While everyone would surely benefit from the ability to decompress more, these analyses suggest that clinicians, and especially nurses, are likely to benefit from programs that enhance their ability to decompress. More importantly, organizations should direct resources and efforts to reducing the stresses that make it challenging for clinicians to decompress. For example, if someone indicates that he or she is losing sleep over work issues (one measure of trouble decompressing), the solution is not simply for them to get more sleep, but to ask, “What is going on in this work environment that is causing people to lose sleep? What can be done to improve that situation? How can we help staff to cope with these stressors as we work to reduce them?” Similarly, if someone indicates that they are unable to disconnect from work communications during free time, leadership must ask why and seek ways to address the sources of the problem. Do they simply not have adequate time to address the demands of their roles during work? Or might they feel there will be some negative consequence for failing to remain connected 24/7?
While physicians, nurses, and other staff showed equivalent levels of activation in our study, all are sure to benefit from initiatives that increase the meaning that they find in their work. But because the correlation between engagement and activation is greatest among the non-MD/nurse workforce, this critical group of employees in particular might benefit from reminders that their efforts are even more important to patient care than they may think — opening up a potential strategy for improving organizational culture that has been largely overlooked up to now.