Recently, colleagues asked me how I solve burnout with communication. From the tone of their voice, they thought I was in over my head, and this was never going to work. I thought, wow, this is a great opportunity for me to share.

I came into the field of burnout through bullying. I’ve been the victim, and I’ve been the bystander-more times than I can count. I’ve been a locums physician for roughly ten years, and I’ve seen bullying occur across geographic areas in all different economic and racial environments. It’s always ugly. When I’ve called it out, someone inevitably says, “That’s not bullying. That’s just the politics of medicine.”

What? No, it’s not. That’s not logical. It’s bullying. When someone is treated like less because of their race, gender, religion, or country of origin, that’s bullying. When that same person is given a greater workload, or lower-paying patients, or denied certain bonuses, that’s bullying.

In the spring of 2021, the AMA published a series of articles that stated bullying in medicine exists, why it exists, and their plan for how to combat it. These articles were based on a study they had been doing since the early 1990s. In other words, they had been studying this for nearly my entire career, and not saying anything about it. Think about that for a minute. An entire generation of physicians endured bullying while the AMA studied it and said nothing. Bullying is causing people to leave the fields of Medicine and Nursing. It is a driver of burnout. I know firsthand that bullying is a driver of suicide.

I could stop right here, but I won’t. That’s not what I’m here to discuss today. I’m here to discuss burnout and communication.

When the AMA revealed their findings, they made some recommendations. They recommended programs for both bullying and burnout, not communication. When you were a child, and you got in a fight at school, there were two things your teacher and parents asked you to do. The first was that they asked you to apologize, whether it was your fault or not. The second was they asked you to sit down with the bully and talk out your differences. They asked you to communicate.

So, the AMA gave vague guidelines about changing your policies, something about making sure people felt safe speaking out about bullying, but nothing where the victim and the bully sat down and spoke. There are no concrete guidelines about culture change because that’s hard. No two organizations are going to do it the same way. What came out of all this was a rash of new trainings on resilience and mindfulness. Studies have since shown that health care workers are some of the most resilient people on the planet. We go into our professions knowing that we will be dealing with death on a regular basis, sometimes the deaths of our own colleagues and family members.

As for mindfulness, well, I like mindfulness. I usually do an hour of mindfulness every morning. The problem here is two-fold: First, mindfulness will only affect 20 percent of the things that cause burnout. The other 80 percent are organizational. Let me say that again. Eighty percent of what causes burnout is organizational. You can’t make it go away with meditation and yoga, no matter how much you may want that. Secondly, mindfulness doesn’t work if it’s forced upon you. Even if you are interested in mindfulness, if you are not seeking it out, you aren’t going to get the expected gains. That’s just the way it works. There are some people who say that if it is forced upon you, it may do more harm than good. We are starting to see some of that with workplace mindfulness programs.

Therefore, you must have a culture change. I bring a system of communication that brings about culture change. That’s how I’m battling both burnout and bullying. Perhaps you’ve heard the phrase, “Culture eats strategy for breakfast.” When I said that, another friend came back with, “You rise to the level of your goals, but fall to the level of your systems.” Yes, I get it. Your strategy is your system. As I’ve said twice now, I have a system of communication that brings about culture change. If you follow the system, that becomes sustained culture change.

How does it work? We teach people to speak to one another’s values. Have you heard of listening to answer vs. listening to understand? Well, we take that one step further. We teach first to use personality science to find the values of everyone around you, then listen to, and speak to their values. Don’t speak in your code of values. Speak in the code of values of the other person. Do you know what this does? First, it makes the other person feel valued. Secondly, it causes you to place more value on that person. You value them more as a person! This is huge. We spend a lot of time on just this concept. This alone can turn a dysfunctional physician into a leader.

Once you’ve mastered this, we introduce you to some expert boundary setting and negotiating skills. In health care, administrators appear to have all the negotiating power. They seem to hold all the cards. However, they have no organization without physicians to manage patients and write orders, nurses and RTs to do bedside care, lab techs, phlebotomists, X-ray techs, housekeepers, unit clerks, security guards, and so many others to make the hospital whole. Administrators are more aware of this than ever. If you have the administrators’ value codes, value words, and negotiation skills, you can set boundaries and level the playing field. Know what you want and ask for it while speaking in a way that values everyone at the table. This is how you get sustainable culture change. This is how you fight burnout. Communication is everything.

Nanette Nuessle is a pediatric hospitalist and physician coach. 

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