MGMA Insights: The Psychological Impact of Burnout
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. We are back with another MGMA insights podcast, and we have a return guest, Steve Brewer. Now Steve is a seasoned health care leader, and he has penned another article for MGMA. It's titled, Can Focusing on Burnout Cause More Burnout?
Daniel Williams:And by the time you're listening to this, we believe that that article will be on MGMA.com, and so we'll provide a direct link as soon as we can to that article. So, Steve, we've had you on the show before. You and I have talked. We've met at leaders conferences and enjoyed each other's company there. But just for the sake of our listeners who may not know who you are, just bring us up to speed where you are currently, tell us anything you want to share about your practice, anything else like that.
Steve Brewer:Daniel, thank you for inviting me back on. I really appreciate it, and I hope that the article really resonates with a lot of folks. Thanks for that. By way of background and reminder, I am Steve Brewer. I'm the chief operating officer with GI Associates, independent gastroenterology practice group in Wausau, Wisconsin.
Steve Brewer:So if anybody's looking at my video background, that's not the view from my office right now.
Daniel Williams:Well, Steve yeah. You and I were talking about that offline because I knew you were in Wisconsin the last time I talked to you, and I went, wow. Did Steve move to the Bay Area?
Steve Brewer:Nope. Nope. I'll have to get some pictures of lakes or maybe Granite Peak ski area. That'll be a little bit more representative of our wonderful community here in Wausau, Wisconsin.
Daniel Williams:Alright. Well, it's always great to catch up with you, and looking forward to seeing you at a live face to face event with MGMA, not where we're talking via technology, but we can just sit down and have a good chat. So let's start with this topic. So can thinking of burnout cause more burnout? Where did you get the original idea to research this topic?
Steve Brewer:So it probably occurred to me a number of years ago. And part of it was, as Daniel, you and I have talked, I've been on my own kind of journey you know, I've been in burnout and have felt burnout personally. I've watched it with our clinicians and our leaders, etcetera. So it's been kind of a personal journey for me. And the idea kinda struck me one time.
Steve Brewer:I was in some meetings and we spent most of the time, you know, kind of complaining about, dynamics that we were frustrated with. We were talking about how it was really compounding frustration and burnout, and we didn't really do any kind of, proactive problem solving or anything like that. And then as I kind of got more in tune with that, I started to notice that as being kind of the norm instead of the exception is that folks really just kind of were ruminating and complaining about frustrations. And then as I talked to early careerists and , you know, leaders, managers, physicians, nurses, even some family members that they're really not that far into their career and they're already feeling burned out. And I feel, you know, I think one level that's kind of sad and tragic because, you know, they've gone to school, they have this this passion for helping people and already they're a bit disillusioned.
Steve Brewer:But I also noticed a trend that that's the common theme. The common conversation is how are we frustrated? How burned out are we? And as I've gone through my learnings and my studies, I came across the concept of this repetitive negative thinking and where our minds focus and how our minds can kind of adapt to what we experience and think about, that we almost set ourselves up for failure, that that's what we focus on maybe consciously as well as subconsciously. And that kind of brought forth, I'm like, how do I title this?
Steve Brewer:But it just simply, you know, can focusing on this actually be making it worse? And so that's some of the background and the experience that that brought me to this article.
Daniel Williams:Yeah. I I wanted to ask you a question then. I've brought this up on the, MGMA podcast before. Previously, I I covered the financial services industry. So we've been if we've got 401ks, if we've got investments, we might be a little bit nervous right now.
Daniel Williams:But one of the things there's an economic study. It really looks at the way our brains work, and we look at the power of losses, that we are affected more deeply by loss than we are by gain. And it really speaks to bells are ringing in my ears right now hearing what you're talking about when we get into that repetitive negative thinking can really drag us down there. I don't want to put you on the spot because it's not a question I had planned to ask you, but when you said that, I wanted to ask you what has your research told you about that repetitive negative thinking and how that can really impact us as human beings?
Steve Brewer:Well, so even on the dynamic of, you know, we have our our portfolios and all of a sudden, you know, it's less today than it was yesterday. As as we get into the kind of the natural human condition where our brains are prewired to be kind of on the lookout for something's gonna go wrong. We're predisposed or a negative bias a negativity bias. And when we experience those things, it's been proven that our reactions are quicker to be you know, to react or be negative. They last longer, and it really kind of invades our our mindset some.
Steve Brewer:So when you look at those in that economic example, that's hand in glove with science around psychology and neuroplasticity and that sort of thing. So that is, you know, a non health care related example, but it's true across, different fields. And it's just really, I kind of call it that human condition. So repetitive negative thinking is really kind of the same thing where it's almost kind of the odds are stacked against us a little bit because our minds are kind of prewired to always look out for the next, you know, stock is gonna fall, for example. And then it happens like, see, I told you so.
Steve Brewer:And then when it doesn't happen, it's like, yeah, but it's not gonna last. So we have this kind of almost natural tendency to have these repetitive negative thinkings of something went wrong in the past or I'm gonna be anticipated in the future and we just kinda get stuck.
Daniel Williams:And you always have to consciously really pull yourself out of that spiral. So let's discuss that in more detail then. So there is bringing awareness to a situation like we're understaffed. And so myself, my team, we're overworking. We're overburdened.
Daniel Williams:We're spending all this pajama time going over administrative tasks. You know, we're burning ourselves out. So there's awareness to what's happening. And then there's repetitive negative thinking. So bring us up to speed where how do we sort of bring those together in a way where it can be a net positive for us so we know these things are going on and we can do something about it versus there's a dark cloud over our heads and the sky's falling.
Steve Brewer:Yeah. That's a really nice way, Daniel, to queue that up. And I'll weave in a little bit of personal experiences as it relates to also some of learnings that I picked up on. So as we look at, you know, things aren't going well. You know, we got pajama time, we have all these other kinds of things that are happening.
Steve Brewer:Nothing should be interpreted as we just don't think about that. It'll go away. I think the contrast is true by actually acknowledging it in a proactive way. And I'll take some learnings out of leadership models. So there's transformational leadership or adaptive leadership.
Steve Brewer:One of the core tenants of those two models is you're not afraid to face reality. So if we have too much pajama time, we have things that aren't working well. One of the things is just to pause and acknowledge it. Sometimes we get caught up in, we're just so frustrated. We don't wanna talk about it anymore.
Steve Brewer:We start to feel kind of spiraled or hopeless about it, and we just kind of give up. Well, this is actually a way of acknowledging that and then pausing, rebreathing, re centering, and then kinda like, okay, here's where we're at. What are we gonna proactively do about it in a way that personally fits with what our goals and values are, but also giving each other permission to kinda talk about that in a proactive way and kind of stop that negative negative cycle and then start to build more positive. And that becomes the focus of the conversation because we always are gonna have some challenges or things or obstacles that we have to overcome. It's how we adapt to those and proactively manage them with a more positive mindset that really makes a difference.
Daniel Williams:Let's look at the brain then. What is going on in the brain when we are subject to sustained stress levels? When they're at a high level and it just doesn't subside, what are we talking about in the human brain?
Steve Brewer:Yeah. So I think most folks are familiar with the concept of the mind body connection. And then when we experience chronic stress, it's not good for us physically: heart disease, diabetes, obesity, other kind of things that come from dealing with or trying to manage chronic stress. But in addition to, as I mentioned, kind of the odds stacked against us just a little bit, our brains become, it's called the term is neuroplasticity is that the neuron connections, the receptors and the different synapses, they actually get stronger and more of them develop depending on what our brains are processing at the time. So we are in chronic stress mode, crisis mode, distress mode.
Steve Brewer:Those parts of the brain that are known for having those feelings become stronger. The neurotransmitters that, you know, like norepinephrine are quicker to release that amplifies that. And, again, we think of it like we've had more stronger hardwiring as well as the the grease that that makes that run actually gets more pronounced in our brains and it just continues to make it quicker to react, quicker to go right to that negative part. And it actually can shrink what's called the prefrontal cortex where that part doesn't get activated as much, and it actually starts , like muscles, starts to shrink or atrophy a little bit. And the good news is that you can reverse some of that.
Daniel Williams:Okay. Let's talk about how we do that. So one of the things that was really interesting in the article, I have a early copy of that, you write about something, I want to get this right, called depressive rumination, and how focusing on being burned out can deepen those feelings for some people. Let's talk about the warning signs that someone might be caught in this sort of a mental loop of depressive rumination.
Steve Brewer:Yeah. So I came across that term in the psychology literature as it speaks traditional psychology works on trying to help people who are in that kind of distressed or crisis mode and how do we cope with that. And one of the concepts is this depressive rumination where I almost think of it as you wake up in the morning and then you're like, oh yeah, well, I'm awake. Here's the morning. Oh, that's right. I'm depressed. Today's gonna go bad. It's not gonna work out well. Our thinking kind of gets more narrow. And then sure enough, the way we behave, something's gonna happen.
Steve Brewer:See, I told you it's not gonna work out, and they just kinda have this self fulfilling prophecy. Same thing with burnout. I can see folks, you know you know, metaphorically kinda waking up and going, yep. This is a good night's sleep perhaps. But, oh, that's right.
Steve Brewer:I'm burned out. I'm gonna have a bad day. And that is then they kind of build this cycle that develops. And I think of it a little bit like if you've ever been in the market for a new car and you go, "hey, I'm gonna go buy a new car," and all a sudden you start seeing that same model that you're looking at everywhere you go.
Daniel Williams:Right.
Steve Brewer:You've just become more attuned to that. And that's kind of maybe a goofy example of that, but I think that's kinda how is we attend to what we think about.
Daniel Williams:Yeah. No. The car one is a great example because I bought a car a few years ago, and I'm not sure. I maybe saw this model of car once every couple of months. Then just like what you said, then I'd see one four times a day.
Daniel Williams:And it's like, good gracious. What did everybody get the idea? Did we all read the same article? But it's something going on in the brain then? What else can you tell us about that?
Steve Brewer:Yes. I think that's because we become more attuned to that one. So our synapses are more like, "oh, there's the model. There's a color," whatever I'm looking at. And then same thing on more of these these concepts.
Steve Brewer:So if you are kind of either personality trait wise or you've had this chronic negativity develop in your brain is quicker to activate those parts of your brain and the connections and synapses go along with that, something else happens negative, and then boom, you're right back there. And that just happens to, you're more aware, and that sort of thing. You're actually the contrary. Sadly, you're less aware of the positivities. And so it's the same kind of concept, but with how we internalize and process experiences.
Daniel Williams:You highlight something you call the broaden and build theory of positive emotions. I don't know if it's in the same universe. I was thinking of something like, well, just fake it till you make it. Just build some strength here in looking for the positive, but talk about broaden and build. What is this?
Daniel Williams:What's going on here? And how do we develop this? How do we put this into practice in our own lives?
Steve Brewer:Yeah. This this model again comes out of the positive psychology literature and the studies. And so Barbara Fredrickson is a well known psychologist in the field and developed this broaden and build theory or model in the late nineties. And almost opposite of the effects of repetitive negative thinking, it takes similar mechanisms, but it's actually then in the reverse. So the basic tenet of broaden and build is one with positive emotions , I'm gonna kinda go back to pausing, reflecting, being self aware and just acknowledging, like, well, I'm really kind of stuck in this rut of negativity or this cloud, but it's really giving yourself permission to take a step back and reframe.
Steve Brewer:There's a lot of refraining in these models. What's real? What's more realistic in my situation, my environment, etcetera? And then actually, as we pause and we don't get so stressed out and we have more positive experiences, some of the researchers show that literally our vision broadens, our awareness of our surroundings broaden, our open mindedness to new ideas and concepts builds or broadens. And it starts this kind of catalyst of, oh, actually things maybe aren't quite so bad.
Steve Brewer:And then, you know what? Maybe if I approach this from this way and I start to get positive outcomes from that. And then I start to actually frankly be more open to relationships and things like that. And people like, Hey, you know, Daniel's a nice guy and I'm gonna reach out and maybe give him some help or some thoughts. And you start to broaden and build both emotional resources, but also social networks.
Steve Brewer:And then also physical resources. We need a certain amount of income and other things to kind of build on that. This just kind of starts this it's almost like, think of it as we do positive networking. One person networks with another, you build this kind of network of colleagues or connections. It's the same kind of thing, but on a much bigger scale.
Steve Brewer:But the basic tenet of this is actually if you find yourself kind of in that either natural tendency or that experience of having chronic, you know, negative thoughts, I'm burned out, I'm frustrated, nothing's ever gonna get better, is to actually pause and allow yourself to experience some joy and go, you know what? That actually was pretty nice. And these aren't a one and done kind of exercises. It's almost like any other exercise or fitness routine. It has to become things that you build out in practice.
Steve Brewer:But you could be amazed at how far taking that new approach to things and kinda I don't wanna say shunning, but getting away from always going towards a negative. And you'll be surprised at how much that can change perspective. And then that actually starts to create physical changes in both yourself but also your environment.
Daniel Williams:Yeah. And hearing you talk about this, it reminded me of something that happened over the weekend. I was in line like we are when we go through the drive through at Starbucks, and we got up there. We'd placed our order, and we were handing over well, actually, we have the the app, so we were gonna scan it. And then they said the person in front of you paid for it.
Daniel Williams:And we went, oh my gosh. That was so incredible. We wanna pay for the people behind us. And then the the attendant there said, you don't wanna do that. I think maybe it was a soccer team or something.
Daniel Williams:I don't don't know what it was, but they said, but thank you. It's a nice gesture. But the reason I bring that up is it's that idea of someone does something really nice to us, and we wanna pay that forward or pass it along. What's going on? Is this talking in some of your research, have you come across this where when we find somebody really doing a nice thing for us, then we wanna respond in kind and share that sort of kindness to other people as well?
Steve Brewer:Yeah. It actually that has a kind of a dual effect. So that's actually one of the things they talk about these positive psychology interventions. So one of them is we feel good about ourselves and feel positivity when we have a sense of altruism we're giving to others. So one of those is like, hey.
Steve Brewer:I wanna pay for the car behind me. And so I've now done a good deed, that maybe brightens my day. But I've also now brightened the person behind me today, and that prompted you to go, well, maybe I can kinda build this chain of positivity, if you will. And so there's that that dynamic that is out there. And so I think that's actually both for the individual as well as those that are on the receiving end.
Steve Brewer:And then that's just the way to kinda, you know, kind of a foundational way to kind of build on these kind of things. So exactly. It's a great example.
Daniel Williams:Yeah. One of the other things you bring up in your article is talking about wellness programs at work. And so how does the team, the leadership strike a balance where they can develop some guardrails or some positive programs within the organization but not do what we were talking about at first, like reminding everybody, gosh, everybody's so burned out. How do we strike that balance? What's the tone to get people on board but not kind of reminding everybody how stressed out we are?
Steve Brewer:Right. Well, couple of thoughts on that. One is, you know, from a leadership perspective, one of the things I would strongly advocate for is when we make a work environment or whether that be a single meeting, a team meeting, or, you know, or just how we approach things. When we can approach things from a more relaxed perspective, more supportive, we get others around us to relax and actually enjoy some of their day. They become more creative problem solvers, etcetera, versus that kind of hard driving kind of component to that.
Steve Brewer:So when we look at kind of getting away from burnout, you notice in that example, I never mentioned the word burnout. And we're actually starting to just create a more positive work environment without going, well, I know everybody's stressed or burned out, so we're gonna do a gratitude exercise. So everybody has to name one good thing that went well today. And then now we'll feel better after that. That's similar, but not exact quotes in some meetings.
Steve Brewer:So I'm like, that's not gonna really turn the corner if we're like, you know, hurry up, get past your burnout, and think of something positive. Now let's get on to the regular business. So there's, I'll call structural things that we need to think about and give people the tools, the environment to be successful. But also as we do wellness things, and I know this is kind of a balancing conversation I need to have because I wholeheartedly believe in a lot of those programs, self fulfillness, wellness, well-being, etcetera, obviously. None of it's always coached.
Steve Brewer:We gotta combat burnout, so we're gonna put up a yoga class. We gotta combat burnout, so we're gonna do a healthy eatings class. It's like, well, you know what? We want people to be healthier. We want people to have better wellness.
Steve Brewer:So we have these classes. And that burnout thing will kinda start to take care of itself without always calling attention to it. And really is that the only reason we're doing it is just because people are afraid? Aren't we doing it anyway because it's the right thing to do? There's my dissertation on that.
Daniel Williams:Final thought then. You cite an MGMA stat poll where fewer than half of health care leaders have taken steps to support their own resiliency. If we take a step back and think of that in the bigger picture, sometimes people who are caregivers and others will spend so much time helping others, but they're not helping themselves. What can we do? Any of our listeners right now who are healthcare leaders, what can they do to take steps to make sure, even though they're helping their teams, they're helping family members, they're helping others, but sometimes they neglect themselves.
Daniel Williams:So what can they do to make sure they're taking care of themselves as well?
Steve Brewer:Yeah. I think it's it's a dynamic that's I can't say for sure if it's stronger or more prevalent in health care, but we go into health care to take care of others. And health care workers are somewhat notorious for not taking good care of themselves. They are almost too selfless in that respect. And I think leaders are that way to an extent too.
Steve Brewer:So part of that is like, you know, I have to be that stoic leader. I have to be there for my teams. I have these kind of things. And I think the tide shifting saw that you do some Google searches or research on it. I'm starting to see more about the importance of health care leaders or readers in general need to take care of themselves so they can actually be there for their families and their teams and partners.
Steve Brewer:So it's kind of reframing. You mentioned reframing early on. It's reframing what's the importance for me to take care of myself if I can't do it for myself. You know, sometimes doing it for others is enough what would change or reframe. They're like, you know what?
Steve Brewer:I do need to get better sleep at night. I need you to make better lifestyle choices. It's okay to even talk about. That's also another thing as leaders, similar to like physicians and some other healthcare workers, well, we're uncomfortable even talking about it and acknowledging it. But as I have conversations like this, I hear more and more people saying, well, know what?
Steve Brewer:Nobody's coming to ask me how I'm doing as a manager or director or vice president or whatever that leadership role might be. And I kind of, you know, flippantly say, you know, leaders are people too, and we need that sort of thing as well. So I think that and then it's really giving ourselves permission to take a step back and not necessarily to listen to some of the literature because, you know, early on, it's like, well, as a leader, your job, your number one job is to help mitigate the burnout for your people, for your physicians, your nurses, your worker. But then all that did is really kinda add weight to, like, my shoulders as a leader. I'm like, well, here, I'm not a good leader if I'm not mitigating their burnout.
Steve Brewer:And now the focus is there with more pressure, ironically, instead of like, well, I need to role model that and do my do that myself, and then that'll start to build that positive, you know, broaden and build cuts at the top of it.
Daniel Williams:Alright. Well, Steve Brewer, as always, thanks for joining us on the MGMA podcast.
Steve Brewer:You're very welcome, and thank you so much, Danny.
Daniel Williams:Yeah. We've been talking with Steve Brewer. He's got an article coming out. Can focusing on burnout cause more burnout? That's going to be available on MGMA.com.
Daniel Williams:We will include that in the episode show notes when it's available. Until then, hope all of y'all are taking care of yourselves out there, and thank you so much for being MGMA podcast listeners.
