Kara Zivin, PhD, MS, MA
ANN ARBOR, MI — For the past five years, Kara Zivin, PhD, MS, MA, has been “chasing burnout,” working to understand what causes it, how to measure it and what are the truly impactful measures that a healthcare system can take to combat it.
The way she came to the subject was both oblique and personal. She’s spent the last 20 years studying population health and public policies and how those policies affect people with behavioral health conditions, focusing specifically on subpopulations like veterans, older adults, pregnant women and different racial and ethnic groups.
A professor of psychiatry, obstetrics and gynecology, as well as health management and policy, at the University of Michigan in Ann Arbor, Zivin is also a VA Research Career Scientist.
“If you’re interested in healthcare and health policy, VA is the largest integrated healthcare system in the country. Not only do they have tons of data, there’s the feeling you could potentially make a difference,” Zivin said.
As a pure researcher—Zivin is not a clinician—the adage of “publish or perish” is very familiar to her. Throughout her career, she has found herself applying for one grant after another, trying to find that magical intersection of a topic organizations are interested in and one she is passionate about exploring.
“I had gone through a period a few years before [2017] where I’d submitted 10 grants in 18 months, or maybe 18 in 10 months. It was hard,” she explained. “I had a 2-year-old; I was trying to pay my mortgage and childcare; and none of the grants were hitting. I wondered how I was going to persist on this endless treadmill that I couldn’t get off of. And so I started thinking about it.”
Specifically, she started thinking about professional exhaustion and how it presents very strongly in some clinical professions and even more so at VA.
“In VA, psychiatry and other mental health providers have really high levels of burnouts, whereas in the community they’re mid-packs among physician burnout,” Zivin said.
So around 2017, Zivin began exploring employee burnout at VA and found that many foundational questions had yet to be fully answered.
First, there’s the challenge of measuring burnout in staff. For that, you need an agreed-upon definition of what constitutes burnout. But different organizations have different definitions.
“There’s also a debate about the extent of how much burnout is depression under another name,” Zivin noted. “Some people may feel more comfortable saying ‘I’m burned out’ instead of saying ‘I’m depressed.’”
Depression and job-related burnout have some shared symptoms: emotional exhaustion, depersonalization and a lack of personal achievement. Zivin’s research includes pinpointing how much the work environment contributes to those symptoms for VA staff. Consequently, she and her fellow researchers in the field are getting better at measuring burnout and understanding exactly what contributes to it.
Some of those factors include:
- too-high workload;
- too many hours;
- not enough time for patients;
- poor supervisor relations;
- not feeling supported by the organization; and
- a lack of opportunity to grow professionally.
“We understand the problem,” Zivin explained. “Now what do you do about it? What actually works?”
With the advent of COVID-19, that question has become more and more pressing for healthcare organizations. While the pandemic did not really change the mechanism of burnout, it did accentuate the existing problems and turned physician burnout into a dinner-table topic.
“COVID really just revealed the underlying challenges that were already there,” Zivin declared. “Providers not having enough time to document their work. Issues of whether you need to be present in the office, or can work remotely. A disconnect between what the people on the ground would like and what leadership is trying to create.”
What the pandemic also accomplished was to shine a very bright light on the problem of physician burnout for healthcare organizations nationwide. Throughout the pandemic, facilities were scrambling to put together wellness programs designed to relieve employee stress.
However, these programs do not always address the actual underlying causes of burnout, Zivin noted. Initiatives that put the onus on the employee might actually cause more stress than they relieve, asking them to fit one more thing into an already too-full day.
“I get a little concerned by some of the wellness efforts—the resilience and yoga meditation approach,” Zivin said. “I would rather see systematic and organizational approaches to making work more palatable, rather than assigning you a training module on how to be more resilient. It feels like a Band-Aid.”
However, even these programs provide invaluable data that will help researchers understand burnout, what works and what doesn’t.
“Can we use that data to differentiate between places that have high and low burnout rates? How do people feel about proposed solutions? Does that alienate them or make them feel better?” Zivin said. “However, there are not as many answers as I would like to see.”
As provider turnover increases, Zivin worries that healthcare organizations will try any and every solution to retain staff.
“I’m worried we’re going to throw everything at the problem and hope something sticks,” Zivin said. “I would like to see some evidence of an intervention that has a proven impact on reducing burnout.”
The consequence of addressing burnout incorrectly could easily be increased frustration among staff, which would lead to more people leaving, upping the workload for the remaining employees and resulting in more burnout.
“It’s a vicious cycle,” Zivin said. “The question becomes are organizations willing to be more creative about how to really make things better in a more lasting fashion.”
