Training and Leading Physicians for the Fight Against Moral Injury

Note: This is part two of an ongoing blog series on burnout vs. moral injury. In the first installment, we learned that almost no one wins in our current system. Here, we will discuss how the Quadruple Aim is the most effective in achieving a more efficient and sustainable solution.

It is pretty clear we have an injurious healthcare system that overburdens healthcare professionals and under-provides for too many patients. The Triple Aim, Introduced in 2008 as a means to improve patient care, while commendable, fails to account for important players in the healthcare system. It is hard to argue that improved outcomes, better patient experience, and lower costs are important goals. If we were to achieve them our healthcare system would make vast improvements. The problem with the The Triple Aim is it doesn’t adequately address the full scope of the problem. In this article, we argue the Quadruple Aim is a better model for improving healthcare, and we offer three steps leaders can take in the fight against moral injury and burnout.

Post-Fight Analysis - Who Is The Real Opponent

In Part 1 the decision was unanimous - there is no winner in the fight arguing over the terms moral injury versus burnout. Instead, the fight should be against moral injury. The opponent IS burnout. With that in mind, how do we move forward? I strongly believe the path forward is to allow physicians to continue to fulfill their mission to provide high quality care (improve patient outcomes), to provide personal care (improve patient experience), and to encourage self-care, well-being, and anything that will enhance the healthcare professional’s experience or satisfaction. The fighter must be and stay healthy. If we are not healthy, how can we deliver the best care? If we are to encourage health for our patients, what if we actually modelled it?!

Once again, I commend the authors for advancing the discussion. The first key is to raise awareness and understanding.


 
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Training Physicians for the Future Fights

The second key to achieving the Quadruple Aim is training. How do we train and empower our physicians for future fights? Training physicians should be ongoing, rather than just at the beginning of a career. Training needs to include the awareness and understanding of burnout and the effects of moral injury. Training must include management as well as prevention of burnout. How should we allow rest and recovery in our “fighting” career? How does one dodge the punches, avoid the many cuts, and at worst, the knock-out blow?

In my opinion, training should include burnout prevention, self-care, wellness, and positive resilience training. Our existing training focuses way too much on negative resilience training techniques! Burnout is not a failure of resourcefulness or resilience. Burnout is the result of our resourcefulness and resilience at the expense of our own well-being and satisfaction.

The way to achieve wellness and healthcare professional satisfaction is to PRACTICE it.

Who are Our Coaches, Managers and Leaders?

The third key is that our leaders must embrace healthcare professional wellness and satisfaction. I agree with the authors that simple wellness programs and wellness officers will not solve the problem. I do know from my experience that mindfulness, positive resilience training, and forms of cognitive behavioral therapy are proven wellness strategies. The fighter will benefit by practicing many of these techniques that were not part of traditional medical training.

However, we need outstanding coaches, managers, and leaders who understand that physicians are not weak and do not lack resilience. We will see the greatest impact on wellness and burnout prevention when our leaders understand what causes moral injury and take steps to avoid the counterproductive actions that burden physicians. Establishing wellness programs and training wellness officers / leaders will be an investment of time, energy, and money to be effective. We must train wellness officers who are strong health professional advocates and enlist wellness programs that challenge old ideas.

It is time for our leaders to embrace the fourth aim and start championing physician well-being and satisfaction. If we do, we can reverse the current trends and fight moral injury and burnout.

If we do, patients, health professionals, and the healthcare system will win.

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