It’s a VUCA Time in Healthcare

I don’t have to tell you that these are complicated times in the world. The pandemic. Global warming. The war in Ukraine, and violence in many other parts of the globe. Inflation. Growing levels of inequity. The Great Resignation.

In healthcare, in particular, these are very complicated times. The pandemic has brought to light many of the problems that were already brewing below the surface. Under resourcing. Shortages in staff. Negativity and discord. Burnout.

 It’s no surprise that the term VUCA is being used more and more to describe what’s occurring in healthcare. It’s a term that first arose in the military following the 9/11 attacks, and the same term is all too applicable to healthcare, everywhere on the globe.

What Is VUCA

We can think of VUCA as a big, tangled mess. A mess that is occurring in healthcare and elsewhere.

V is for Volatility

Upon an already stressed healthcare system, the pandemic brought with it many rapid and challenging changes in healthcare. Volatility is at bay in many ways but is most evident in the high levels of attrition and turnover we’re seeing — in physicians, nurses, technicians, therapists, and even in those who clean patient rooms.

Indeed, a recent article in the Mayo Clinic Proceedings shed light on this issue. Looking at more than 20,000 respondents at 124 institutions, the study revealed that one in five physicians are planning on leaving their position in the next twelve months. For nurses, intent to leave was present in 40%. For advanced practice providers, 33%. This means a great deal of turmoil in hospitals and outpatient medical settings. It also raises questions about the sustainability of the entire enterprise.

This “Great Resignation” in healthcare is something I was quoted in earlier this year in over half a dozen major news venues. While I was happy to be involved as an expert on the topic, I, like others in the field did not have a lot of tangible solutions to stem this tide.

U is for Uncertainty

With all this change, there is a massive sense of unpredictability and uncertainty about what will happen next.

When will the pandemic end?

What difficulty will come next?

How will we do our jobs without adequate staff to support our efforts?

What will the new normal be?

C is for Complexity and Chaos

The level of complexity in healthcare these days is almost inconceivable. So many moving parts. So much dissatisfaction and burnout. So much chaos. And the complexity and chaos have contributed to what can only be thought of as a giant vortex of negativity pulling all of healthcare into its hold.

Additionally, there is so much change occurring that it has the makings of a dark joke:

You work in a major urban area where you are in competition with the other major medical practice across town. You leave for a well-needed vacation on a Friday and return a week from Monday only to find that your health system has been acquired by your that practice. Guess what? Now you have to work side-by-side with the clinicians who were just 2 weeks ago, your biggest adversary.

I hate to say it but, it can seem that, with all this VUCA, the joke may be on all of us in healthcare…

A is for Ambiguity

At the end of the day, we don’t know what all the changes in healthcare mean.

What does all of this mean for my current situation?

What does it mean for my future?

If this continues, who will be left to take care of me and my loved ones?

It is truly an ambiguous situation.

Since many of us are experiencing a VUCA reality, it’s important to understand the impact it has.

Certainly, a VUCA environment is both a disrupted and a disruptive one. It impacts all of us, doctors, nurses, technicians, therapists alike. Patients are certainly not spared. It can leave us:

  • Feeling unstable and ungrounded
  • Unsure of how to react to all the changes that are occurring
  • With lack of clarity on what our role is in a rapidly changing system
  • With reduced motivation to take actions that contribute to the greater good

Most importantly, living and working in a VUCA environment can leave us fearful, reactive, and feeling out of control. This means that our limbic system is frequently activated, taking us into a fight/flight/freeze state. Unfortunately, in this state, we’re trapped in survival mode. And survival mode means that our world narrows, and that we are reduced to looking out for #1, ourselves. When we’re looking out for #1, we invariably have less left over to give to others. And yet, perhaps VUCA times require a greater degree of leaning into connection and shared community than ever.

So, what can you do? 

Let’s Look At 4 Ways To Overcome Uncertainty

While the challenges of a VUCA world can seem inescapable and insurmountable, there are a number of steps you can take to manage yourself so you still show up in ways that you feel good about. So you can look back and feel proud about yourself and your actions.

A mindful approach can help you hold steady amidst these challenging times. Here are 4 mindfulness strategies you can employ.

How to Respond to Physician Burnout in a Colleague

Physician Burnout in a Colleague

Dealing with physician burnout in a colleague

Two hours of administrative tasks for every hour with patients. A proliferation of non-physician administrators deciding how the day is going to run. Little in our training about how to cope with uncertainty and change. It’s no surprise that physician burnout rates are approaching 60%. Despite being so common, when we see a colleague struggling with physician burnout, we may not know what to say. Responding appropriately can bring someone back from burnout and may even save a life. Here are some tips to help with physician burnout in a colleague.


Approach the situation with compassion

Burnout is often referred to as erosion of the soul, and for good reason. With it comes a great sense of despair, hopelessness, and isolation. We lose our perspective.

Often there is no better remedy than the kindness of a colleague, someone who has walked in our shoes and knows what we’re experiencing. Approach the colleague with the empathetic aim of letting them know that you care about them, you’ve noticed that they are struggling, and you’re there for them. Afraid of saying the wrong thing? Here are some ways to convey your concern.

“I can see you’ve had a rough week.”
“I’m concerned about you.”
“I get why you’re feeling this way.”
“I don’t have answers but I want you to know I’m here and I care about you.”
“You deserve to feel better.”
“I know these feelings will pass.”


Normalize the experience

With burnout comes a sense of personal inadequacy. Everyone else seems to be coping with all the stress. What’s wrong with me? Tell your colleague that what they’re experiencing is normal and that many physicians are having the same feelings. Let them know there’s nothing wrong with them. Make it clear that these harsh feelings do not mean that they are a failure. And, no matter what they’re thinking, that experiencing physician burnout is a normal response to the stressors of modern practice and doesn’t mean they’re in the wrong career.


Don’t problem solve or give advice

As physicians, we’re conditioned to fix whatever problem the person in front of us has. It is quite literally what we are trained to do. But with burnout, we need to suspend our desire to problem-solve. Instead of doing something, we need to focus on simply being present with a colleague’s suffering.

On that same note, we also need to avoid giving advice. Giving advice sends an implicit message that the person doesn’t have the inner resources to solve their problem. Not only that, but the last thing someone wants to hear when they’re low on energy, overwhelmed by demands, and disconnected from any sense of meaning is “I know how to solve your problem, here’s what you should do.”  Simply listening without suggesting any action can help someone in burnout begin the critical step of gaining perspective on their situation.


Help them connect with their accomplishments

When we’re in burnout, we’re focused on everything that’s wrong, with the workplace and with ourselves. We’re disconnected from meaning and purpose. Positives slide off us like Teflon and negatives stick as if attached by Velcro. Whatever our strengths and accomplishments may be, we believe we have none. It’s critical to find a way to reconnect with the things we are accomplishing.

Ask your colleague if they’d consider keeping a running list of three things they accomplish every day. This simple exercise can provide ballast against the pull to inadequacy and negativity, and potentially help relieve some of the symptoms of physician burnout.


Let them know seeking help is not a sign of weakness

We learn early in training that seeking help is a sign of weakness. We’re the head of the team and we’re supposed to have all the answers. Yet, we can’t solve every problem by ourselves (no one can.) Reassure your colleague that asking for help is a sign of health, not weakness. Recommend that they speak to loved ones and other colleagues. Encourage them to seek coaching or other professional help.
While you can’t change the external landscape, know that applying these tips can make a big difference in a colleague’s ability to see a way forward.

In summary, remind yourself to listen compassionately. Normalize their experience. Avoid the temptation to give advice or problem-solve. Help them see their strengths and accomplishments.  Let them know that seeking help is often vital and is not a sign of weakness. Reassure that they can find a way to meet the intense demands of practice with much less anguish.

Get more resources on physician burnout.

Physician Burnout: Are You Engaged Yet?

When you wake up in the morning, are you ready to take on the day, or do you want to pull the covers up over your head and crawl into a cave?

As noted in a recent  New York Times  article, “Why You Hate Work,” a 2013 Harvard Business Review study of 12,115 white-collar workers revealed that 70% of workers do not have time for creative or strategic thinking at work, and 50% do not find meaning and significance in their workplace.

This problem of finding purpose or engagement at work affects all white-collar workers, including physicians in nearly every specialty and field. A pioneer in burnout research, Christina Maslach defines burnout as a three-dimensional syndrome made up of exhaustion, cynicism, and lack of sense of meaning and accomplishment. Does any of this resonate for you or the physicians you know?

As a physician coach, I have worked with many clients suffering from physician burnout who are not only dissatisfied in their work, but feel disillusioned and without purpose.

I recently worked with a mid-career neurologist who was frustrated by the never-ending changes in her workplace. It seemed as if the rules changed by the week, with hard-to-understand updates to the EMR, and rotating practice managers, one more challenging to work with than the next. My client became so lost in frustration and negativity that she wondered why she was even practicing medicine anymore.

Engagement is the antithesis of physician burnout, and is defined as a positive, fulfilling, state of mind characterized by vigor, dedication, and a sense of flow in one’s day.

The New York Times article points out that employees are more satisfied and productive when their foundational needs are met, including creativity, value, and a sense of connection and purpose at work.

When engaged, white collar employees are more motivated, feel more personally invested, and tend to become absorbed in their work. When they come up against challenges, they are inspired to find creative ways to problem-solve. In addition, these employees find greater work-life balance, and have an overall sense of optimism and happiness. This is critical for physicians, given that they experience levels of burnout of 30-60%.

Engagement is increasingly recognized as vital for self-determination and productivity in the workplace. Organizations that encourage employee engagement are experiencing higher profits, improved safety records, and higher retention rates. Simple workplace measure such as providing breaks and acknowledging hard work can go a long way in increasing engagement.

Through physician coaching, my neurologist client experienced renewed motivation to effect change in her workplace.  She pushed leadership to develop a wellness committee. We worked on many strategies to help her manage the changes and stresses of her position. Over time, she learned to focus more on her strengths, celebrate small daily accomplishments, and gradually re-engage.

If you find yourself overcome by disengagement and burnout, please check out my new FREE ebook, Building Your Resilient Self: 52 Tips to Move from Physician Burnout to Balance. I created this resource specifically for physicians. In the book you’ll find specific strategies to prevent and counter physician burnout.