Index
- Absenteeism, 22
- Adams, Henry, 41
- Adaptive capacity, personal passion and (tools for), 259–268
- “deep joy, deep need” tool, 260
- gratitude journal, 266–268
- guilt, eliminating, 266
- hot buttons, disconnecting of, 263–264
- legacy, 264–266
- “love, hate, tolerate” tool, 259–260
- reducing burnout in others, 268
- strategic optimism, 262–263
- stress tolerance level, 261–262
- using love to define meaningful work, 260–261. See also Personal passion and resilience, sustaining of
- Advanced practice provider (APP) workforce, 245
- Aiken, Linda, 15
- Allen, Terry, 145
- American Recovery and Reinvestment Act, 179
- APP workforce. See Advanced practice provider workforce
- Arendt, Hannah, 58
- Argyris, Chris, 79, 137
- Aristotle, 159
- Armato, Carl, 195, 196, 203
- A-team/B-team concept, 54, 71, 269–272
- Auden, W. H., 33
- Aurelius, Marcus, 12, 135, 266
- Badenowski, Ralph, 84
- Bae, Jonathan, 219
- Barkley, Charles, 38
- Batalden, Paul, 65
- Baudelaire, 36
- Beamon, Nicholas, 67, 92, 194, 200, 234, 240, 246
- Berwick, Don, 185
- “Big Six” solutions, 108–115
- Block, Peter, 73, 92, 145, 191, 285
- Boarder Patrol concept, 79, 80
- Bohr, Niels, 287
- Brady, Tom, 123
- Branding costs, 23
- Branson, Richard, 142
- Brasher, Chris, 146
- Breathing techniques, 122
- Brees, Drew, 121
- Brennan, John, 21, 66, 238
- Breshears, Ryan, 238, 239, 244
- Bridges, William, 145
- Brigham and Women’s Physician Organization (BWPO), 206–218
- Brigham to Table, 217
- B-Well Brigham, 217
- defining and measuring burnout and fulfillment, 208–211
- dichotomy in defining burnout, 211–212
- EHR (Epic) solutions, 213–214
- Faculty/ Trainee Mental Health Program, 216
- Female Faculty initiative, 214–216
- governance structure, 207–208
- initiatives, 212–217
- local department solutions, 217
- Professional Fulfillment Index, 208
- results, 218
- starting the journey, 206–207
- survey results, 209
- Browne, Jackson, 66
- Brutal optimism, 114, 115
- B-team members, nicknames for, 72. See also A-team/B-team concept
- Burn-in, burnout versus, 3, 65
- Business case for burnout, 20–23
- BWPO. See Brigham and Women’s Physician Organization
- Calculus of burnout and leadership, 65–74
- A-team/B-team concept, 71–73
- burning in, 65
- case study, 70
- change strategy elements, 68–74
- changing the system, 67–68
- connecting the gears, 69
- data, delta, decision, 67–68
- functional silos, 68
- healthcare as complex, adaptive system, 68–69
- insufficient of current work methods, 70
- intrinsic motivation, 70–74
- passion disconnect, 65–67
- proactive leadership, 66
- questions, 71
- resilience, 66
- “running on empty,” 66
- Cantor, Richie, 110
- Carver, George Washington, 265
- Case studies: causes and drivers of burnout, 58, 62, 63, 64
- change and mutual accountability, model for, 77–78, 80, 81
- culture, organizational solutions for improving, 143, 144, 149, 155
- defining and modeling burnout, 39
- hardwiring flow and fulfillment, 165, 167
- importance of burnout, 27
- leadership, calculus of burnout and, 70
- Novant Health System, 193
- personal passion and resilience, sustaining of, 112, 113, 114, 117, 130, 131
- six Maslach domains, 43, 44, 45, 46, 47, 48, 49
- Case-Wirth, Jill, 238, 240
- Causes and drivers of burnout, 53–64
- Change and mutual accountability, model for, 75–90
- adaptive capacity, 75
- Boarder Patrol concept, 79, 80
- case studies, 77–78, 80, 81
- complex, adaptive system (culture in), 78–79
- core elements, 76–87
- culture of passion and fulfillment, 77–81
- efficiency, maximizing of, 85–87
- hardwiring of flow and fulfillment, 76, 82
- Mutual Accountability Jumbotron, 77, 88, 89
- necessary burden, example of, 84
- organizational resilience, 76
- personal resilience, 76
- scorecard, 75, 89
- “Seven Rights” in healthcare, 86
- six domains of burnout, 87
- systemic/ organizational factors, 76
- value, defining and creating, 82–83
- “words on the walls,” 79, 81
- Change strategy elements, 68–74
- Chataway, Chris, 146
- Chief nurse executive (CNE), 131
- Chief operating officer (COO), 140
- Chief wellness officer (CWO), 153
- Churchill, Winston, 253
- Clay, Henry, 59, 150
- Clinical huddles, 282, 283
- CNE. See Chief nurse executive
- Cochrane, Archie, 85
- Collazzo, Lucas, 235
- Collins, Doug, 196
- Community, lack of (Maslach domain), 45–46
- Compassion fatigue, 15, 26
- Confucius, 11
- Connor-Davidson Resilience Scale, 35, 103, 243
- Control, loss of (Maslach domain), 43–44
- COO. See Chief operating officer
- Copenhagen Burnout Inventory, 97, 101
- Coronavirus pandemic, 11
- Cost of burnout, 17–25
- Cota, Norman, 146
- Covey, Stephen, 134, 285
- COVID-19 pandemic. See Coronavirus pandemic
- Crantz, Robin, 60
- Creative energy, 117, 262
- Csikszentmihalyi, Mihaly, 159
- Culture, organizational solutions for improving, 137–158
- budgeted time, 155
- case studies, 143, 144, 149, 155
- chief wellness officer dilemma, 153–157
- commitment, 149–151
- compliments and complaints, 152
- deep joy, 157
- defining burnout, 142
- dynamic tensions, 140
- empowerment solutions, 151–152
- financial aspects, 141
- job stressors, 142–143
- leadership candor, 139–140
- leadership development, 141–146
- leadership levels, 139
- leadership self-assessment, 140–141
- leading from the front, 145–146
- passion reconnect, 149
- performance assessments, 145
- point-of-impact intervention, 151–152
- resilience, 143–144
- returning from burnout, 144
- servant leadership, 147–149
- signal of hope, 152
- taking on EHRs, 152–153
- vision, 146–147
- words on the walls, 141
- Culture change, tools for, 269–276
- CulturePulse (DUHS), 223
- CWO. See Chief wellness officer
- Cynicism, description of, 32–33
- “Cytokine storm,” 64
- Dalai Lama, 126
- Dante, 1, 3
- Deao, Craig, 34, 141
- Deep joy, deep needs, 2, 109–110, 260
- Defining and modeling burnout, 29–40
- case study, 39
- definition driving solutions, 29–30
- depression, 38–39
- distress, 37, 38
- eustress, 37
- fundamental futility, 30
- individual strain dimension, exhaustion as, 30
- interpersonal dimension, cynicism as, 30
- pointlessness of work, 36
- positive experience, 34–36
- resiliency, 29
- rustout, burnout versus, 36
- self-evaluation dimension, loss of meaning in work as, 30
- stress, role of, 36–38
- symptoms and strains of burnout, 30
- three-dimensional model, 30–34
- de Gaulle, Charles, 45, 146
- Depression, 38–39
- Dinotopia, 122
- Drivers of burnout. See Causes and drivers of burnout
- Druckenbrod, Glenn, 133
- Drucker, Peter, 68, 128, 137, 145
- Drummond, Dike, 245
- Dudley, Jessica, 206
- Duke University Health System (DUHS), 219–232
- advice for CEOs, 231
- assessment of awareness, 222–225
- caring for each other, 225–227
- CulturePulse, 223
- Dr. Bae’s story, 220–221
- Dr. Sexton’s story, 219–220
- DUHS story, 221–222
- Enhancing Caregiver Resilience course, 224
- finding joy, meaning, and purpose, 230–231
- Healthy Duke, 221
- leadership, 227–229
- measuring burnout, 222–223
- pulse surveys, 223
- Well-Being Ambassadors course, 223–224
- Well-Being Toolkit, 227, 228
- WISER, 128, 225–226, 268
- work improvement, 229–230
- Dyrbye, L.N., 57
- Dzau, Victor, 20
- Eappen, Sunil, 206
- EHRs. See Electronic health records
- Einstein, Albert, 91, 92
- Eiseley, Loren, 288
- Electronic health records (EHRs), 3, 178–189
- augmented intelligence, 186–187
- case studies, 49, 77–78, 143
- clinical decision support, 187–188
- coaching, mentoring, and education, 183–184
- computer keyboard issues, 184–185
- inbox “abscess,” 185–186
- leadership mandate, 178–182
- mobile phone use, 188–189
- “note bloat,” 181
- patient story, incorporation of, 188
- screen switching, 185
- senior leadership efforts, 184
- solutions, Brigham and Women’s Physician Organization, 213–214
- solutions summarized, 283–284
- speech recognition technology, 185
- supposed benefits of using, 180
- taking on, 152–153, 178–182
- teamwork, 186
- unintended consequences of using, 180–182
- work-life balance issues, 186
- Elevator speech, 133–134
- Eliot, T. S., 212
- Elite athletes, 37–38, 58
- Engagement, definition of, 34
- Ensor, Phillip, 68 133
- Erikson, Eric, 73
- Essential services: ancillary services as, 15–16
- Eustress, definition of, 37
- Exhaustion, description of, 31–32
- Fairness, lack of (Maslach domain), 46–47
- Flow, definition of, 82
- Flow and fulfillment. See Hardwiring flow and fulfillment
- Foch, Ferdinand, 2
- Foxworth, Domonique, 38
- “Framingham Study,” 17
- Frankl, Victor, 29, 35, 73, 107
- Fredrickson, Barbara, 219
- Freudenberger, Herbert, 41
- Friday Night at the ER, 68
- Functional silos, 68
- Hanh, Thich Nhat, 126
- Hardwiring flow and fulfillment, 159–177
- case studies, 165, 167
- culture and, 76, 82
- diminishing workload demands and increasing adaptive capacity, 162–166
- fulfillment in healthcare, 160–161
- increasing rewards and recognition, 168–171
- questions, 89
- reestablishing fairness in an unfair environment, 174–175
- regaining or seizing control, 166–168
- restoring values in the workplace, 175–177
- returning community to the team, 171–174
- Hardwiring flow and fulfillment, tools for, 277–284
- Health Information Technology for Economic and Clinical Health Act, 179
- Hecato of Rhodes, 107
- Hesselbein, Frances, 148
- Hippocrates, 115
- Hope, creating, 103, 152, 277
- Hot buttons, 120, 263
- Importance of burnout, 11–28
- absenteeism, 22
- burnout assessment tool, 25
- case study, 27
- cost of burnout, 17–25
- definition of burnout, 11
- implications for solutions, 25–26
- insights, 11–12
- insufficient of current work methods, 11–12
- patient burnout, 26–28
- presenteeism, 23
- prevalence of burnout, 12–17
- reasons that burnout matters, 12
- Inova Health System, 233–237
- Intrinsic motivation, 70–74
- Landy, John, 146
- Leadership: “Big Six” skills, 108–115
- candor, 139–140
- chief storyteller, 112–113
- deep joy, deep needs, 109–110
- EHR mandate, 178–182
- eliminating guilt, 110–111
- essential tool of, 273–274
- failure of, 49
- goals, 51
- importance of, 12, 50
- levels, 139
- making the patient part of the team, 111
- metrics and, 91–92
- Novant Health System, 202
- precision or personalized patient care, 111
- responsibility of, 4, 53, 73
- servant, 147–149
- six Maslach domains and, 48–51
- skills, 51
- strategic optimism, 113–115
- Leadership, calculus of burnout and, 65–74
- A-team/B-team concept, 71–73
- case study, 70
- change strategy elements, 68–74
- changing the system, 67–68
- connecting the gears, 69
- data, delta, decision, 67–68
- functional silos, 68
- healthcare as complex, adaptive system, 68–69
- insufficient of current work methods, 70
- intrinsic motivation, 70–74
- passion disconnect, 65–67
- proactive leadership, 66
- questions, 71
- resilience, 66
- “running on empty,” 66
- Legacy, 136, 264–266
- Leiter, Michael, 9, 41, 56
- Lewin, Kurt, 145
- Linzer, Mark, 100
- Lombardi, Vince, 125
- “The Man in the Arena” speech, 286–287
- Maslach, Christina, 9, 41, 56, 87
- Maslach Burnout Inventory (MBI), 15, 50, 222
- Maslow, Abraham, 41, 73, 145
- Mattis, James, 7
- Mayer, Thom, 171, 285
- MBI. See Maslach Burnout Inventory
- McCain, John, 114
- McCullough, David, 7
- Measuring burnout, 91–104
- burnout plus well-being surveys, 98, 101–103
- burnout surveys, 97, 98–101
- Connor-Davidson Resilience Scale, 103
- Copenhagen Burnout Inventory, 97, 101
- creating hope, 103
- face validity, 94
- free-form surveys, 96–97
- Maslach Burnout Inventory, 97, 98
- metrics and leadership, 91–92
- Oldenburg Burnout Inventory, 98, 101
- Physician Worklife Survey (Mini-Z), 97, 100
- resiliency, measurement of, 103
- Stanford Professional Fulfillment Index, 98, 102–103
- survey preparation, 94–96
- survey selection, 93–94
- Well-Being Index, 98, 101
- Medical errors, cost of, 22
- Merton, Robert, 180
- Metrics mania without means, 46, 61
- Mindfulness, 108, 126, 160, 229
- Mini-Z Burnout Survey, 97, 100
- Model for change. See Change and mutual accountability, model for
- Modeling burnout. See Defining and modeling burnout
- Montgomery, Bernard, 145
- Moral injury: compromising values in, 48, 62
- Motew, Steve, 66–67, 233
- Mutual Accountability Jumbotron, 77, 88, 259, 269. See also Change and mutual accountability, model for
- “Namaste,” 127
- Narang, Steve, 137, 257
- NCharge, 243
- Nietzsche, 19, 70
- Novant Health System, 193–205
- batting cage, 194–195
- case study of burned-out doctor, 193–194
- changes arising from work, 199–200
- community approach, 201
- developing programs, 203
- implementation tips, 203–204
- leadership, influential, 202
- Novant Physician Leadership Development Program, 196–198
- operational efficiency, 201–202
- organizational resiliency and performance, 202–203
- personal well-being, approach to, 200–201
- philosophy, 195–196
- results, 198–199
- Nurse burnout; differential causes of, 55
- Palmer, Parker, 41
- Paradox of burnout, 54
- Passion. See Personal passion and adaptive capacity, tools; Personal passion and resilience, sustaining of
- Passion disconnect, 1–7, 65–67
- Patient, as part of the team, 111, 280–281
- Patient burnout, 26–28
- Patton, George, 145
- Pauli, Wolfgang, 287
- Personal passion and adaptive capacity, tools for, 259–268
- “deep joy, deep need” tool, 260
- gratitude journal, 266–268
- guilt, eliminating, 266
- hot buttons, disconnecting of, 263–264
- legacy, 264–266
- “love, hate, tolerate” tool, 259–260
- reducing burnout in others, 268
- strategic optimism, 262–263
- stress tolerance level, 261–262
- using love to define meaningful work, 260–261
- Personal passion and resilience, sustaining of, 107–136
- “Big Six” solutions, 108–115
- breathing techniques, 122
- brutal optimism, 114, 115
- case studies, 112, 113, 114, 117, 130, 131
- chief storyteller, 112–113
- community, 131–132
- creative energy, 117
- deep joy, deep needs, 109–110
- elevator speech, 133–134
- eliminating guilt, 110–111
- fairness, 132–134
- hot buttons, 120
- legacy, 136
- making the patient part of the team, 111
- mindfulness, 126
- multitasking strategy, 128
- patient journal, 135
- precision or personalized patient care, 111
- regaining control, 118–128
- reigniting passion and personal resilience, 107–108
- rewards and recognition, 129–131
- sensemaking, 113
- six Maslach domains, solutions focused on, 115–136
- strategic optimism, 113–115
- values, 134–136
- workload demands, 116–118
- Peters, Tom, 108, 145
- PFI. See Professional Fulfillment Index
- Physician burnout: challenges of, 194
- Physician Worklife Survey (PWLS) (Mini-Z), 97, 100
- Precision (or personalized) patient care, 28, 111, 281–282
- Presenteeism, 23
- Prevalence of burnout, 12–17
- Professional Fulfillment Index (PFI), 208, 209
- Purpose, reconnecting passion to, 285–289
- PWLS. See Physician Worklife Survey (Mini-Z)
- Quality indicators, decline in, 21
- Racial disparities in burnout, 16–17
- Reason, James, 13
- Reputational costs, 23
- Resilience, personal passion and (sustaining of), 107–136
- “Big Six” solutions, 108–115
- breathing techniques, 122
- brutal optimism, 114, 115
- case studies, 112, 113, 114, 117, 130, 131
- chief storyteller, 112–113
- community, 131–132
- creative energy, 117
- deep joy, deep needs, 109–110
- elevator speech, 133–134
- eliminating guilt, 110–111
- fairness, 132–134
- hot buttons, 120
- legacy, 136
- making the patient part of the team, 111
- mindfulness, 126
- multitasking strategy, 128
- patient journal, 135
- precision or personalized patient care, 111
- regaining control, 118–128
- reigniting passion and personal resilience, 107–108
- rewards and recognition, 129–131
- sensemaking, 113
- six Maslach domains, solutions focused on, 115–136
- strategic optimism, 113–115
- values, 134–136
- workload demands, 116–118. See also Personal passion and adaptive capacity, tools for, 259–268
- Return on investment (ROI), 113
- Rewards and recognition, lack of (Maslach domain), 44–45
- Rhoads, Harry, 92
- ROI. See Return on investment
- Roosevelt, Franklin, 253
- Roosevelt, Theodore, 6, 36, 146, 286
- Rustout, burnout versus, 36
- Santee, Wes, 146
- SARS-CoV-2 virus, 4, 53, 64, 184
- Schein, Ed, 138, 139
- Selye, Hans, 37
- Senge, Peter, 68
- Sensemaking, 113
- “Seven Rights” in healthcare, 86
- Sexton, Bryan, 12, 128, 219
- Shadow-shifting tool, 274–276
- Shakespeare, 60
- Shanafelt, Tait, 25, 42, 208, 247, 259
- Siegel, Daniel, 126, 127
- Singer, Michael, 126, 127
- Six Maslach domains, 41–52
- (1) workload demands and capacity, mismatch in, 42–43
- (2) control, loss of, 43–44
- (3) rewards and recognition, lack of, 44–45
- (4) community, lack of, 45–46
- (5) fairness, lack of, 46–47
- (6) values, loss of, 47–48
- case studies, 43, 44, 45, 46, 47, 48, 49
- causes of burnout across, 56–64
- leadership, 48–51
- moral injury, 48. See also Maslach Burnout Inventory; specific domains
- Sleep, role in performance and recovery, 125
- Snyderman, Ralph, 28
- Sotile, Wayne, 110
- Spinoza, 148
- Spiva, LeeAnna, 238
- Stanford Professional Fulfillment Index, 98, 102–103
- STL. See Stress tolerance level
- Stockdale, James, 114, 127
- Stokes, Chuck, 14, 260, 265
- Storyteller, 112–113
- Strategic optimism, 113–115
- Stress tolerance level (STL), 37, 38, 261–262
- Stupid stuff, smart stuff versus, 6
- Surveys: free-form, 96–97
- Surveys, burnout, 97, 98–101
- Surveys, burnout plus well-being surveys, 98, 101–103
- Swensen, S. J., 42
- Unfairness. See Fairness, lack of (Maslach domain)
- “Uninterrupted ennui,” 36
- Waldinger, R., 109, 110
- Wasson, John, 86
- Well-Being Index, 98, 101
- Wellstar Health System, 238–251
- COVID-19, wellness during, 247–249
- future directions, 250–251
- leadership style, charge nurse training in, 243–244
- mission, 238
- nursing resiliency and leadership development experience, 239–244
- organizational contributions to burnout, 247
- physician wellness, journey toward, 245–247
- post-COVID-19 priority, 244
- removing barriers, 249–250
- retreat, 239–242
- training measurement and results, 242–243
- vision, 238
- Wellstar Physician Resiliency and Leadership Development Experience, 246
- Wellstar Quadruple Aim, 239
- workshops, 242
- Williams, Sandy, 28
- Words on the walls, 79, 81, 141
- Worker compensation claims, 23
- Working wounded, 2
- Workload demands and capacity, mismatch in (Maslach domain), 42–43
- Wright Brothers, 35
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