The Cost of Caring - Balancing Provider Stress and Reward

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The Cost of Caring - Balancing Provider Stress and Reward

Last month’s article on patient trust touched on the importance of provider wellbeing in establishing and maintaining those trusting relationships. This month, we want to further home in on provider wellbeing and look at it as the foundation of improved outcomes for the patient, the provider, the practice, and the system as a whole.

I have the great opportunity to facilitate trainings nation-wide around compassion resilience in the health and human services sector and one of my favorite activities to engage in with teams relates to systems drivers of fatigue. It pulls us away from the common focus we so often place on self-care and highlights the reality that if staff continue to enter into work environments and systems that do not support their wellbeing, that drain their ability to show up as their best selves, self-care efforts are unlikely to be effective.

When introducing discussions and activities around systems drivers of fatigue (and resilience), I sometimes find it helpful to start by thinking about the stressors and rewards that are both inherent in caring for patients and clients as well as those that are external to caregiving.

Inherent Rewards & Stresses: The very nature of providing care to others who may be suffering is simultaneously satisfying and draining. It is a source of both rewards and stress which are inextricably connected, meaning you cannot remove one without changing the nature of the provider role.

External Rewards & Stresses: These rewards and stressors arise outside of providing care for patients, they are not connected to some reward with a deeper meaning, and they make many healthcare professionals say, “I did not sign up for this.” Often, this type of stress is related to financial and regulatory aspects of healthcare, such as documentation and electronic health records, as well as poor management, a toxic culture, and disruptive peer behavior.

Take a moment to think about the inherent and external rewards and stressors in your own work. The table below (from Mylod, 2017) lists some common sources of rewards and stressors within the healthcare field. Consider which are present in your work and whether the related statements resonate with you. Ask yourself:

Is there a balance of stressors and rewards that are either inherent to the experience of caring for patients/clients or external to it, arising from the work environment?
Knowing that inherent rewards and stressors are intertwined, how might the inherent rewards in your work be amplified? How might the impact of inherent stressors be reduced?
If you disagreed with any of the statements in the table below, what could be changed in your work environment to allow you to agree? Imagine what that work environment would look like. How would you interact with colleagues? Would your day-to-day change in any way?

INHERENT
	Sources of reward & stress	Sample diagnostic statements (Agreement indicates reward; disagreement indicates stress)
Reward	Ability to impact lives Satisfying challenges Sense of meaning & purpose Feeling appreciated	I like the work that I do. The work I do makes a real difference My work gives me a sense of accomplishment. The amount of job stress I feel is reasonable.
Stress	Bearing witness to suffering Limitation of medicine/care Clinical complexity High-stakes pressure

EXTERNAL
	Sources of reward & stress	Sample diagnostic statements (Agreement indicates reward; disagreement indicates stress)
Reward	Healthy culture & teams Supportive management Effective leadership Privileges of seniority Good pay and benefits	JOB/WORK My practice, team, or organization is adequately staffed I’m satisfied with the electronic health record (or other documentation) system I have adequate input into decisions that impact how I practice COLLEAGUES/PEERS Members of my practice, team, or organization work well together Teamwork between co-workers in different roles (e.g., physicians & nurses) is effective MANAGEMENT & LEADERSHIP The person I report to treats me with respect I have confidence in senior management’s leadership
Stress	Dysfunctional culture and teams Administrative burdens Poor management Weak leadership Excessive policies & procedures Lack of resources Unsafe environments

Source: Mylod, 2017

Examining rewards and stressors is a great way to get teams to think about the system drivers of fatigue (and resilience) that are unique to their own context and culture. Teams can build on this through discussions around where on the spectrum they perceive the locus of control falls for each of these aspects of their work and how they may act on those they can control or loosen their focus and attention on those they cannot.

Written by Katie Ebinger, MPH, MSW - Facilitator, Advancement & Healthcare Transformation, HealthTeamWorks

References

WISE, Rogers Behavioral Health, & Katie Ebinger. (n.d.). Compassion Resilience Toolkit for Health and Human Services Leaders and Staff: Systems Drivers of Compassion Fatigue. Available at https://compassionresiliencetoolkit.org/healthcare/a-toolkit-for-healthcare/

Mylod, D. (2017). One way to prevent physician burnout. Harvard Business Review. Available at https://hbr.org/2017/10/one-way-to-prevent-physician-burnout