Healthcare worker burnout: What does it cost the industry and how can we truly measure its detrimental effects among the workforce? Since the beginning of the COVID-19 pandemic, rates of burnout among healthcare professionals have skyrocketed. Healthcare providers and staff have been stretched perilously thin. As ICUs overflowed with patients, providers did their best to deliver the best possible care—in many cases without sufficient equipment for their patients or personal protective equipment (PPE) for themselves.
The strain placed on providers and healthcare workers only increased with each surge—and now lingers as a new strain of COVID-19, the Delta variant, proliferates.
From June to September 2020, Mental Health America surveyed more than 1,000 healthcare professionals about their mental and emotional state, and a staggering 76% reported feelings of exhaustion and burnout. Historically, burnout rates have been in the 50% range for physicians and the 33% range for nurses. During the third major surge in new Coronavirus positives, Stat News argued that healthcare workers were actually past burnout and had reached a new, previously unseen depth that it termed “burnover.”
The COVID-19 vaccine distribution has helped ease the strain on healthcare workers. But even without a global pandemic, burnout among healthcare professionals persists—and carries significant costs to providers, patients, and organizations.
Burnout doesn’t just afflict long-practicing healthcare providers. Medical students, residents, and early-career physicians report feeling symptoms of burnout, depressive symptoms, and recent suicidal ideation at higher rates than peers in the general U.S. population. Institutional approaches to medical training (i.e., residents’ long work hours) appear to make training a peak time for distress among medical students.
The various costs of burnout in healthcare
Healthcare burnout carries a number of costs. A June 2019 study in Annals of Internal Medicine calculated that physician burnout costs the healthcare industry $4.6 billion per year. There are some caveats to this figure. For one, this is a pre-COVID figure that will almost certainly rise as we begin to calculate the effects of the pandemic on the healthcare industry. For another, the potential future costs of work environment burnout are impossible to calculate. It is clear that burnout in healthcare affects organizations’ bottom lines, but how it does so depends on a variety of factors. On the surface, these variables have little to do with money, but as you’ll soon see, they all carry an inevitable financial cost.
How burnout costs providers
For healthcare professionals and medical students or other healthcare trainees, stress is a part of the job in their chosen work environments. And while some stress is normal and even a healthy human response, the law of diminishing returns applies: If the stress is too severe or persists for too long, any benefits it may provide are undone. On a long enough timeline, the type of stress healthcare workers experience every day can quickly turn to burnout. The results of that are damaging, and come in the form of emotional exhaustion, depersonalization, and/or a reduced sense of personal accomplishment.
The COVID-19 pandemic brought burnout levels to new heights as providers were overwhelmed by the sheer volume of patients, while contending with the looming possibility that the entire healthcare system could collapse at any moment. The worst of the pandemic appears to be behind us, and many people are getting back to their normal routines. But healthcare workers who were on the front lines throughout the pandemic have a much longer road ahead before they can return to normalcy.
A Yale study found that rates of depression and post-traumatic stress disorder (PTSD) have spiked among healthcare professionals since the pandemic hit, with nearly one quarter of healthcare workers showing signs of PTSD and almost half exhibiting signs of alcohol use disorder. Clearly, burnout doesn’t just affect patient care and the physical health of providers and staff (particularly their cardiovascular health); it can also be damaging to their mental health.
Burnout among nurses
A recent study of over 3,000 nurses by The Joint Commission cited common signs that nurses are feeling burned out, among them constant exhaustion, heightened anxiety, negative reactions to change, and seeming disengaged. Anyone who has visited or stayed in a hospital can attest that it can be a chaotic place. Patients arrive for wide-ranging reasons, from needing an outpatient procedure or surgery to requiring critical care after an accident. Tracking the comings and goings of patients and attending to their varying needs moment by moment is a challenge, and it's the primary responsibility of nurses.
For most people, the average workday consists of eight hours on a predictable schedule that usually includes a nice midday break. For nurses, it’s not uncommon to work 12-hour shifts by default, with breaks being dependent on patient needs. Nursing is also an around-the-clock profession, so many individuals work odd hours and night shifts.
Not surprisingly, in hospitals in which nurses regularly work more than 13 hours, patients are known to be less likely to recommend that facility to others. Also, when rating hospitals with longer shifts for nurses, patients tend to give lower HCAHPS ratings overall. This information indicates that patients are aware that they’ve received lower-quality care, even if they don’t know the root cause of the issue.
At large, busy hospitals and healthcare systems, a single nurse may be responsible for up to eight patients at a time. Providing each patient with the correct medication, monitoring their vitals, and keeping them safe and comfortable can be stressful and confusing.
The patients that a hospital nurse cares for can completely change from one day to the next, depending on which ward they are working in. Just as a nurse becomes familiar with a patient’s name, needs, and risks, they may never see them again, and instead get a new assignment with a brand new set of patients.
The constant juggling of patients and their records can be mentally, emotionally, and physically exhausting for nurses. Even under the best of circumstances, the demands that are constantly placed onto hospital nurses are overwhelming. This creates an environment in which patient safety isn’t prioritized as highly as it should be and makes burnout among nurses more likely.
How burnout costs patients
From the patient care perspective, there are obvious dangers related to provider burnout, such as the risks to patient safety. An overwhelmed, detached, or otherwise distracted provider is more likely to make mistakes. A 2010 Annals of Surgery study measured the three key areas of burnout (emotional exhaustion, depersonalization, and personal accomplishment) and found that for every one-point increase in depersonalization, there was an 11% increase in error reporting.
Burnout in healthcare affects patient outcomes and exposes healthcare organizations to legal liability arising from avoidable errors. But providers don’t need to make patient care mistakes to cost organizations money. Even if a patient’s case is well managed, burnout can contribute to a negative overall patient experience, which can lead to patients seeking care elsewhere.
Provider burnout can also contribute to an individual patient’s unwillingness to seek care. A recent survey found that 39% of respondents avoided going to the doctor because of poor previous experiences with a healthcare organization or provider. This affects both patient and provider. For the patient, it means that by the time they do need treatment, the problem is likely more significant—and more costly—than it would have been if they had taken a preventive approach to their health. And for the provider, it means an uptick in complex cases that require more time, more effort, and more stress, all of which contribute to future burnout.
How burnout costs healthcare organizations
Burnout in healthcare carries a variety of heavy costs to facilities and organizations. Increased provider turnover is one significant expense. According to estimates, each instance of physician turnover costs at least $500,000, and each instance of staff RN turnover costs $40,038. Even if providers and staff don’t actually leave an organization, they often need to reduce clinical hours to lighten their workload, which means fewer patients, lower billing, and in many cases a diminished quality of care.
Errors stemming from burnout can also carry a heavy financial burden: A recent study found that errors in hospitals and clinics cost about $20 billion per year overall and result in approximately 100,000 deaths annually. In addition to the cost of malpractice suits or financial damages, correcting these errors means increasing the patient length of stay (LOS)—sometimes at no cost to the patient, depending on the error. As a result, staff and providers are spending valuable time providing care for which they cannot bill, and the patient is occupying a bed that would otherwise generate revenue. And this is in addition to the increased LOS carrying a corresponding increased risk of infection or adverse outcomes for the patient.
How leaders can minimize the cost of burnout in healthcare
Even before COVID-19, healthcare leaders were searching for ways to minimize burnout rates and avoid costly and dangerous medical errors, and the pandemic has underscored the urgency of this need. We have previously discussed ways healthcare organizations can help ease the strain on providers and staff and minimize burnout, and there are additional structural and system-wide steps leaders can take to tackle this problem head-on.
An effective workforce management strategy is a valuable tool for early identification of symptoms of burnout and fighting burnout. Having the right resources in the right places can help providers do their jobs more efficiently and more effectively, thereby removing some of the stress and potentially minimizing burnout rates.
The pandemic also demonstrated the importance of ensuring providers and staff feel safe at work, especially in terms of PPE and organizational adherence to disease-prevention protocols. Supply chain management and visitor management play critical roles in creating a safe and minimally stressful environment for staff and providers.
Burnout in healthcare is like an infection: Left untreated, it can spread and affect every aspect of a healthcare organization’s operations. The effects of COVID-19 burnout are significant, and they will likely linger long after the pandemic is fully behind us. That’s why it’s so important for healthcare leaders to be proactive in identifying the symptoms of burnout and protecting providers and their organizations from its harmful effects. Software solutions can play a valuable role in the process. If you need help building a burnout-resistant environment that benefits your patients, your providers, and your organization, get in touch with symplr’s experts for a free assessment of your needs.