Identifying physician burnout should be a top priority for any healthcare organization since it may lead to adverse effects in physician health, patient care, as well as healthcare system operations.
Because its ramifications and systemic effects are far reaching, it represents a public health crisis. As a result, it’s vital that any healthcare organization take a careful look under the microscope to better understand its culture and whether burnout may be contributing to adverse effects on its patients, physicians and underperformance systemically.
Physician burnout is the result of a combination of factors resulting in emotional exhaustion, a feeling of depersonalization and a sense of reduced personal accomplishment. It is distinct from depression or other psychological factors, but mental health issues can be a contributing factor when it develops.
Drivers of the epidemic of physician burnout are rooted within healthcare organizations and systems and include “excessive workloads, inefficient work processes, clerical burdens [related to electronic health records], work–home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, organizational support structures and leadership culture,” according to research published in the Journal of Internal Medicine.
But there are also contributing factors at the physician‐level, with data demonstrating higher rates of burnout reported in female and younger physicians.
As with any epidemic, solutions to help address the crisis must take into consideration it’s key drivers. At an organizational level, changes in approach to practice with increased support for physicians have led to reduction in burnout. A focus on reduction in hours, increased staffing, and the addition of chief wellness officers to monitor performance have recently been advanced.
Strategies implemented for physicians wellness at the individual level employing mindfulness‐based stress reduction approaches, along with small‐group programs to reinforce a sense of connectedness and community have also been shown to be effective.
Beyond this, the role of the visual arts (drawing) in helping to shape physicians’ thinking and creativity, in addition to its therapeutic effects for burnout has been previously described by physician pioneers such as Dr. Salvatore Mangione, Associate Professor of Medicine at Thomas Jefferson University, who has touted the numerous benefits of medical students engaging in the arts.
Yet, while much has been written about the importance and focus on burnout among physicians and other healthcare providers in the medical literature, there has been less attention focused on the entire healthcare team–nurses, case managers, social workers, respiratory therapists to name a few–that provide critical aspects of care in any hospital setting.
Recognition of all member of this healthcare “team” should also include a patient’s family, since the emotional toll and stress of hospitalization and recovery impacts their ability to provide ongoing support as caregivers in the hospital and after discharge. While we have elaborately described burnout and ways to address it in healthcare organizations, it imperative to address all members who provide care to patients who are at risk of experiencing compassion fatigue.
The concept of utilizing the arts as therapy for those with mental health conditions including depression and PTSD has been well described, but embracing it for the entire healthcare team along with their families also has numerous benefits.
Arts in Medicine
One innovative approach, the Arts in Medicine program of the NYC Health and Hospitals, which seeks to treat healthcare providers, adjunct staff and their families was recently launched at Bellevue Hospital in Manhattan, the oldest public hospital in the U.S., and part of the largest public health system in the nation.
The aim of the Arts in Medicine program is to introduce new initiatives integrating all aspects of the arts to benefit patients and staff at hospitals, community health centers, and long-term care facilities. Its larger goal, however, is to create awareness about programs and other approaches that promote employee wellness and resilience as a way to reduce compassion fatigue or burnout.
Funding for the Arts in Medicine program is provided through the Laurie M. Tisch Illumination Fund’s Arts in Health initiative, which supports organizations using the arts to address health issues affecting New Yorkers, with particular attention to increasing access to care and addressing disparities in health outcomes.
The three-year grant to NYC Health + Hospitals, which is the largest municipal health system in the country and serves approximately 1.1 million New Yorkers annually, will significantly expand the public health system’s arts programs.
While its aim is to serve patients and healthcare providers, the Arts in Medicine program will also have a goal to treat adjunct staff to reduce stress and provide support and attention to emotional health.
“NYC Health + Hospitals is in the vanguard of hospital systems across the country using the arts as a tool for healing,” said Laurie M.Tisch,Founder and President of the Laurie M. Tisch Illumination Fund. “We know from decades of research that the arts have an important role to play in reducing stress and helping individuals in their healing process.”
“We are pleased to be able to help increase access to these services to more patients, and also to the healthcare professionals who are so vital to the system. As first responders, doctors and health professionals are under enormous stress, and these programs are proven tools to support them in their work,” she added.
Ms. Tisch also serves as Vice Chairman of Lincoln Center for the Performing Arts, Trustee and Past Chairman of the Whitney Museum of American Art, Trustee of the Aspen Institute, as well as co-owner and member of the Board of Trustees of the New York Giants.
“When I started the Illumination Fund, we determined that our focus would be to increase access and opportunity for all New Yorkers–this is the largest grant to date in our new Arts in Health Initiative, said Ms.Tisch. Creating four new programs as well as expanding the existing Arts in Medicine programs to more hospitals, and making them available to doctors, nurses and other caregivers, is exactly what we are here to support,” she added.
The Arts in Medicine program will introduce new initiatives such as HHArt of Medicine, an art-observation program, which guides clinicians through intensive art viewing designed to improve focus, communication, and promote active listening, which in turn improves their ability to serve patients. SoulCollage, an initiative involving workshops that facilitate self-discovery through collage composition to help staff express and share their experiences and emotions. Communal Murals represents collaborative projects of hospital artists in residence, staff, and community members to create vibrant works of art inside and outside facilities.
“Studies conducted in 2007 by Repar and Patton demonstrated that arts programs can lower rates of tension, anger, depression, and fatigue—symptoms of burnout and compassion fatigue. We value our staff, and Arts in Medicine will help bring back the joy in work and improve outcomes for staff and ultimately the patients,” said Linh Dang, Senior Director of the Arts in Medicine Program at NYC Health + Hospitals.
“Today, we are re-imagining the role of the arts in our health system to create active programming that will enrich our community,” said Dave A. Chokshi, MD, NYC Health + Hospitals Vice President and Chief Population Health Officer. “ Arts in Medicine is about engaging patients, clinicians, caregivers, and staff in different types of healing connections. Visual arts, performing arts, theater, and literary arts help us tap into imagination, creativity, and expression as part of improving health.”
Engaging in the arts has helped physicians leading to renewed energy and a sense of fulfillment . In fact, research examining outcomes in medical students who experienced art observation training found that observational skills were improved significantly.
“I was first exposed to art in medicine when my residency class participated in an interactive art observation session at the Detroit Institute of Arts,” said Eric Wei, MD, Vice President and Chief Quality Officer at NYC Health + Hospitals. “Even though we were looking at the same painting, we had different interpretations of what was going on. It helped me realize how this happens at the bedside and how important communication is to achieving a shared mental model.”
Regardless of the specific approach taken to address burnout, it should involve shared responsibility of both healthcare systems and individual physicians. The bottom line is that all stakeholders in healthcare need to work together to design and implement effective remedies for burnout in the healthcare setting.