Critical Care Burnout: A Look at Global Burnout Initiatives

• In ICU
• Mon, 10 Mar 2025

An overview of literature surrounding the effectiveness of burnout initiatives and implementation of successful programmes from Emory Critical Care Center.  

Burnout, a chronic condition of emotional exhaustion, depersonalisation and reduced professional accomplishment, has plagued the global health system for years (Alahmari et al. 2022; De Hert 2020; Moll et al. 2022). Research describing the pervasiveness of burnout in healthcare professionals notes a high prevalence in critical care (Kleinpell et al. 2020; Moss et al. 2016), which is likely due to a confluence of factors that are unique to critical care such as end-of-life care (Burghi et al. 2014), communication between multiple teams involved in complex patients (Johnson-Coyle et al. 2016), and high acuity. One study by Mehta et al. (2022) found that patient factors, team dynamics, and hospital culture all played an interconnected role in burnout for critical care nurses and physicians. The toll on the human experience is well documented, and concern for the well-being of the healthcare workforce has grown exponentially over the last few years. Understanding that burnout impacts both the healthcare professional and, subsequently, patient outcomes, most critical care organisations have implemented burnout and wellness initiatives targeting the multi-professional team (Aiken et al. 2012; De Simone et al. 2021; DeChant et al. 2019; Lilly et al. 2020; Wei et al. 2020; West et al. 2016). This article will discuss the literature surrounding the effectiveness of burnout initiatives and will introduce successful programmes from our local institution.

The COVID-19 pandemic brought widespread attention to burnout in the healthcare workforce. However, the problem continues to grow with no documented reduction in symptoms, suggesting that the COVID-19 pandemic was not the root cause of burnout but rather, the issue was well ingrained in healthcare for many years prior. The World Health Organization reports that between 2020 and 2022, almost 25% of all healthcare workers experienced either anxiety, depression or burnout (World Health Organization 2024). A more recent study by the Qatar Foundation and the World Innovation Summit for Health found that 50% of all healthcare workers describe burnout symptoms, with almost 66% of global nurses and physicians suffering from burnout (World Economic Forum 2023).

Burnout is pervasive in the entire critical care team, with 28-42% of nurses, 25-51% of physicians (Pastores et al. 2019) and half of pharmacists (Smith et al. 2021) suffering from burnout syndrome. Many healthcare professionals feel hopeless, and unfortunately, some cases end in suicide (Dr Lorna Breen Heroes’ Foundation n.d.). The impact is immense and sometimes unrecoverable. To counter this tragic reality, many organisations have implemented burnout and well-being initiatives. Programmes combatting burnout can include staff recognition awards, team-building exercises and streamlining electronic documentation. Programmes promoting well-being include stress reduction training, meditation and healthy eating initiatives (Panagioti et al. 2017; West et al. 2016). Some programmes are organisational focused while others are unit based or individualised.

In addition to the human cost, burnout produces a substantial financial burden. In the U.S. alone, physician burnout costs the healthcare system over 4.6 billion USD annually. This cost results from turnover and reduced work hours only and does not account for poor patient outcomes, which can result from burnout (Garcia et al. 2019; American Medical Association 2024). Nursing burnout is equally devastating, whereas a health system can estimate a cost of between $11,000 and $16,000 USD per nurse who leaves the workplace due to burnout (Muir et al. 2022). Advanced practice provider (APP) turnover can cost between $85,832-114,919 per provider (SullivanCotter 2020). This financial burden is not sustainable, which has led to the development of programmes to reduce burnout. Collectively, the global cost of burnout and wellness programmes is estimated to reach 94.6 billion USD by 2026, per a recent report released by MarketsandMarkets (n.d.). This cost has risen by 33 billion in five years alone. As organisations continue to spend money on efforts to combat burnout, the question arises: "Do these programmes work? Do they reduce burnout?”

A systematic review and meta-analysis conducted by West et al. (2016) found that both individualised burnout initiatives and those directed by organisational sponsored initiatives led to a clinically significant reduction in burnout for physicians. Furthermore, a systematic review conducted by DeChant et al. (2019) described four major themes contributing to physician burnout: Teamwork, Time, Transitions and Technology. This review found that interventions targeting team-based approaches to work and improved processes with electronic medical records, such as the use of scribes, reduced physician burnout significantly. A systematic review and meta-analysis conducted by De Simone et al. (2021) found similar reductions in burnout of physicians, with organisational-directed interventions having a moderate reduction in physician burnout compared to individualised physician interventions which produced only a small reduction in burnout. Work-life balance can also reduce burnout. A study by Mikkelson et al. (2019) found that intensivists who worked seven consecutive days on service in the ICU versus 14 days experienced significantly less burnout. Regarding nursing burnout, a systematic review conducted by Wei et al. (2020) found that leadership styles significantly impact nurse burnout. Leaders who empower and promote their nurses through engagement can substantially reduce nurse burnout. Transformational and authentic leadership styles may improve feelings of burnout in nurses, and creating a healthy work environment may also significantly reduce burnout. Much like nursing, supportive leadership and opportunities for advancement can reduce burnout in APPs (Kapu et al. 2021). 

Emory Healthcare is a health system located in Atlanta, Georgia, United States. Our system includes seven hospitals and many primary care practices. The Emory Critical Care Center operates 12 intensive care units (275 beds), with nearly 100 physician intensivists and 200 advanced practice providers. In 2022, Emory Healthcare, as a part of Woodruff Health Sciences Center, established an Office of Well-being (EmWELL) with the goal of creating system-wide change to promote and ensure staff well-being. In collaboration with this effort, the Emory Critical Care Center added its first Director of Well-being position to work in conjunction with EmWELL to support the unique needs of critical care APPs and physicians.

The first initiative was to distribute a survey on critical care well-being and create a group of "Well-being Advocates". The informal survey was completed by 68 APPs and 16 physicians and asked participants what supports or hinders their work well-being. Many themes were extracted from the survey, including leadership, recognition, compensation, and communication and the feedback was used to create programme initiatives. A team of APPs and physicians called “Well-being Advocates” now meet quarterly to discuss well-being successes and opportunities for improvement in real time and also provide guidance on well-being initiatives. This group is diverse and has a representative from each hospital, including both dayshift and nightshift providers, and a range of years of experience. 

Additionally, we looked at improving leadership and staff relations and promoting positive co-worker relationships. To do so, we created a Reverse Mentorship programme in which senior leadership from Emory's Critical Care team were paired with junior faculty who served as mentors. The goal of this programme was to flip the traditional role of mentorship with the focus on well-being. At the conclusion of the Reverse Mentorship programme, multiple ideas for well-being initiatives were generated and are now in the process of being researched for the next steps. Secondly, co-workers were identified as an area of strength and support for one's well-being, and we chose to support this further by offering social events outside of work. One of our more successful activities is our "Alyssa Majesko 5K" run/walk event. During this event, we invite all critical care employees, previous patients and family members for a run/walk event and celebration. Building on the success of this event, we held an employee kickball tournament, which has proven to be both fun and successful in reducing levels of burnout among our colleagues. 

Research on burnout strongly suggests that the problem continues to grow (World Economic Forum 2023). However, both organisational and individualised programmes targeting burnout and wellness do have a significant impact (De Simone et al. 2021; DeChant et al. 2019; Wei et al. 2020). To our knowledge, there have been no multicentre, multi-professional studies targeting and improving burnout specific to critical care staff. Due to the unique stressors on the critical care team, it should be a priority to conduct research on the effectiveness of burnout interventions on our teams. To control this growing crisis, it is imperative for healthcare organisations and government entities to create programmes targeting burnout and wellness. Such government-sponsored programmes already exist in the United Kingdom through their National Health System Suicide Prevention Programs. Addressing the cause of burnout, implementing organisational-led programs and supporting individualised programmes can become the triad to overcoming this tragic crisis. 

Conflict of Interest

None. 

References:

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