Hi, everyone. Welcome for joining us today. We are looking forward to speaking with you about how to combat laboratory burnout and stress. So my name is Dr. Lotte Mulder, and I'm the Director of Empowerment and Leadership at AACP. So some of the issues that I work on are research, leadership through the Leadership Institute, patient education and advocacy, and diversity, equity and inclusion. Today, I'm joined by Dr. Srinath Rapan, who will introduce himself. Hi, everyone. I'm Joe Srinath Rapan. I am at Memorial Sloan Cancer Center. I'm the Director of Pathology Informatics and a general urinary pathologist, but I'm also been a long time interested in workforce issues and burnout. Neither of us have any relevant financial relationships with commercial interests to disclose. All right. So the course objectives for this course are for participants to understand the unique pressures of COVID-19 and challenges and solutions specifically related to burnout, to develop strategies to advocate for work-life balance within institutions, and to create transparency and engagement to mitigate burnout and toxic organizational cultures. Please note that this course mentions concepts such as stress, burnout, anxiety, and suicide. If you need to talk to someone immediately, the National Suicide Prevention Lifeline provides 24-hour, 24-7 free and confidential support for people in distress, prevention and crisis resources and best practices for professionals. In the US, you can call the number that you see here at 1-800-273-8255. So a little introduction and some data. Burnout is characterized by three dimensions. Feelings of energy depletion or exhaustion, increased mental distance from one's job or feelings of negativism or cynicism related to one's job, and reduced professional efficacy. Basically, I think of burnout is that you know it when you feel it and you experience it. This is actually a sad post just recently by a medical technologist and I'll let everybody read it. As you can see, this person is quite burned out and it's very sad because what you're seeing is someone who's leaving the lab professional field for another job and you know the hope is with this course that we can avert such a feeling among the laboratory professionals as well as others in pathology. So we're going to talk a lot about some data from a survey that was done just last month in August and I wanted to thank a lot of the participants who got the email and actually participated in the burnout. We'll call this the COVID burnout survey because there's a lot of very interesting data and we're only going to highlight a very small proportion of it. Some of the demographics because you'll see I want to point out a couple things about the demographics is that it's heavily on the lab professional side. You can see that 86% are and pathologists being the next demographic and also when you look at the, according to gender, that it's overwhelmingly female. This may be a reflection of the number of lab professionals that we actually had in the survey. Another important thing is the generational aspect of the survey. When you look at lab professionals as well as the pathologists over there, it's overwhelmingly younger. If you look at it, there's millennials and Gen Xers and then the baby boomers are actually a very small proportion of it. One thing to point out is that particularly with pathologists and lab professionals is that the majority of the demographic is actually in the baby boomer generation and yet on the survey it's mainly the younger folks that are answering the survey. This is actually true of maybe a previous survey that we had pre-COVID as well. So when it comes to surveys, it tends to be the younger generations that answer it. Here are some highlights. For those that are experiencing burnout, we asked it in two ways, present and past. If you experienced it now in the past and if you look at the numbers, they're very high. Particularly with lab professionals, over 50% have experienced it at some point. Now when it comes to in the past versus present, you can see that it's still significant but lab professionals are still the higher proportion. Another question that we'll highlight was that was burnout actually caused by the pandemic? As you can see over here, the lab professionals, it's a significant proportion. Yes, it's 27%. For pathologists, a little bit less so. I think the next question here as you look at is was your burnout worsened by the COVID-19 pandemic? You can see that overwhelmingly, particularly on the lab professional side, it really was worsened. From the pathologist side, a little bit less so. If anything, from the COVID-19 pandemic, you can see that it really took a toll on the lab professional workforce. I'm sure for those that are on the audience, they're probably experiencing it now that in terms of those working in the lab, it's really the workload and everything has definitely taken its toll. Before we dive deeply into how to mitigate burnout on an organizational level, we want to discuss burnout and its relation to organizational culture. Now, know that we can talk for hours on this topic alone, so we will really just only focus on some of the highlights in this section. First, let's all get on the same page on what exactly organizational culture is. Organizational culture, as you see here, is the agreement within organizations on the behavior that is necessary to fit in and belong in the organization. Organizational culture is an important topic to mention when discussing burnout because organizational culture informs employees' effectiveness, retention rate, satisfaction. It is important to understand the culture of an organization in order to determine how to optimize its performance and then to reduce burnout. Let's dive into what organizational culture is a little bit more. As you see on this slide, organizational culture is made up of all the aspects that you see here, so structure, systems, hierarchies, language, behaviors, beliefs, and values. All of these aspects form the culture of an organization, which then in turn influences how people believe they're expected to behave and think in order to belong. Let me give you a brief example. From the moment you begin a new job, you are assessing and trying to fit in into the organizational culture. You see if you can bring personal items to work to decorate or personalize your workstation. You pay attention to how others talk to or disagree with our supervisors and you try to adjust your own behavior. You will learn if being on time is valued or if you can be 10 minutes late to meetings without any issues. All these little things are really important for you to fit in and you either unconsciously or consciously assess these every single day. This is actually one of the reasons why it's so exhausting to start a new job because you are constantly learning all these things in addition to learning your new job. Finally, note that there are also organizational subcultures within organizations. With a different department, a different team, a different project, and so forth. You're likely dealing with multiple organizational cultures simultaneously. Here, as you see on this slide, all these aspects influence how people believe they're expected to behave and think in order to belong within a team, department, organization, etc. All these things influence people's feelings of energy depletion or exhaustion, their mental distance from their job, or feelings of negative negativism or cynicism in their professional efficacy. Now you can clearly see how organizational culture influences and causes burnout. Next, I want to dive a little bit into some data points as you can see starting here. In the survey that Dr. Sertropan mentioned, when we asked laboratory professionals how they ranked the quality of their workload, 77% stated that they were overworked. 77% of laboratory staff in our survey said that. So that is a lot. Now this might not come as a surprise to you, but it is indicative of a potential crisis that is occurring right this minute. I'm sure I know that you are all aware how essential the laboratory is to provide high quality patient care, so we all need to work together to ensure that our laboratory staff is not overworked, but that their work and their life is balanced, exactly as about 20% indicated here. That's what we want. So here are some factors that survey participants mentioned that contributed to their burnout. All these factors are part of organizational culture, but there are really a few that I want to point out. You see them, some of them are bolded here, so poor management culture, which was around 50 and 37% for lab professionals and pathologists respectively, and then toxic work environments, so around about 30% for both. And these stand out because they can be fixed through leadership training, effective communication, and feedback. So in other words, on some level, those can be and feel more in our own control, and they have tremendous impact on organizational culture. And yes, there's actually a lot that you can improve through the bottom-up approach here as well. So even if you're not in management, as we are all, we all contribute to the organizational culture. Finally, the last thing that I want to mention on this slide is that there are also some DEI factors that contribute to burnout. This came from our survey as well, but do know that the vast majority of survey respondents that we've had so far identified themselves as white and or Caucasian, so we predicted these percentages are significantly higher when asked people who do not identify as such. But you see here that 7% of lab professionals and 16.5% of pathologists stated that discrimination, sexism, racism, and microaggressions are contributing factors to their burnout. Additionally, around 8% and almost 6% mentioned grief and or trauma. So if you take into consideration how many people in this survey identified as white and or Caucasian, these numbers are actually incredibly high. And that should hopefully not come as a surprise anymore, although of course it is sad to see and to know and to experience. So it is obvious that lots of work still is and needs to be done to create work environments in which all people are respected, included, and appreciated, valued, heard, all that good stuff. So next we want to talk about how to mitigate burnout, because that's really the crux of this presentation. We want to provide you with some details and some toolkits, if you will. So first I'm going to talk about discussing mitigating burnout from this bottom-up approach, and then Dr. Soren Trappen will discuss the top-down approach. Of course, first I want to say we all know that burnout is a complicated issue, both from an individual and also an organizational perspective. So there's not one solution for everything, and it really can take a person a long time to overcome burnout. You know, so in a similar way, reducing burnout in organizations or professions does not happen overnight either, but I think it only goes to show that it is even more important. It shows how important it is that we do the work to mitigate it. So when you see here, there are really four different areas that I want to cover, because these areas can be really helpful when you either have a presentation or proposal to your organization of how to mitigate burnout from the bottom-up approach. Now, of course, there's overlap between these areas, as for example, some data will connect to the heart or some data will connect to cost, but just keep these four areas in mind when we're going through this section. So there are many ways to connect to the heart of your audience, and the more you know your specific audience, the better you can tailor the information. Especially in our professional lives, we can have been encouraged to disconnect from the heart, and I imagine that is even more the case in healthcare. So when connecting to the heart, try to cover some of these points. First, that a culture of wellness is essential. Explain why wellness is important for your staff, and especially for those who are underrepresented in medicine. Secondly, explain that burnout is preventable. We can actually do something about it. This point will connect you to specific suggestions and solutions as well. Also explain that burnout is caused by work environments and work circumstances. There's a reason why we see so much more burnout now than we did 30 years ago. I mean, partly that is because we are aware of it more, but the demands of all of our jobs have also increased significantly. And then, of course, add the last year and a half, that clearly adds a whole nother additional emotional, physical, and mental burden on all of us. And that really brings us to the most important point to cover, which is that personal solutions to burnout are kind of a band-aid solution. We need to actually mitigate burnout, or in order to actually mitigate burnout, we need organizational support and change. So ideally, you tailor the data you're providing to your audience and to what you are referring to, or at least partly. But of course, you can always add some data about burnout in general, as you see on this slide as an example. Here, as you see, organizations that do not support well-being for employees have increased turnover, a decrease in productivity, and higher health care costs for their staff. Getting a little bit more specific, health care workers are most susceptible to burnout, and women are more than twice as likely to state well-being as the reasons for quitting a job. Finally, burnout and suicide rates among caregivers, which of course includes health care workers, are 40% higher for men and 130% higher for women. That is a lot. So in terms of pathology and laboratory medicine-specific data related to burnout, here are some resources for you to reference. The first three articles reference a study on burnout on pathologists, laboratory professionals, and trainees. But note that these studies were conducted prior to the COVID pandemic, so we can actually expect to see a significant increase in those numbers. As you've already shared a little bit throughout this course, we are currently conducting a burnout survey related to organizational culture, and we've been sharing some preliminary data with you. And that survey actually has some COVID-specific questions. We're really hoping to relaunch the survey again in November of this year, so if you have not yet taken it, stay tuned and let us know. Another way to gather data, of course, is specific to laboratory medicine and pathology, and really specific to your team, department, or organization, is to ask staff to conduct voluntary burnout self-assessments. Now, as you see on this slide, these are just some examples, some options for these assessments. As you can see, some of them are free and others are not. I've actually not personally taken any of these, so you'll have to conduct your own analysis about which one would work best, but I wanted to provide you with some suggestions and options. Do know that, of course, there are multiple ways to go about this, but this really should be both a voluntary and confidential process, so just keep that in mind. Now, connecting to the costs is always helpful when creating any proposal for your leadership at institutions. Not only will they want to know how much something is going to cost, especially if you have a specific solution or suggestion, but it can also be helpful to know how much money they can potentially save or how much money an issue such as burnout is currently costing them. So know that things like burnout can cost organizations other things than just money, so those are also important to mention. So here you see that burnout costs organizations disengagement, turnover, there's an increase in recruitment because of that turnover, and then, of course, additional training needed for either the new current staff or for both. This is because burnout staff, as you see, are 2.6 times more likely to be actively looking for a different job, sometimes in a completely different field. They're 63% more likely to call in sick and 23% more likely to visit the ER, so it is clear that there are huge costs associated with that for organizations, both in terms of healthcare costs, but then also in terms of current staff and their retention, productivity, and wellness. As you see here at the bottom, the average cost of recruiting, hiring, onboarding, and training new staff is 34% of that staff's annual salary per person, so this is a tremendous expense, so even if just looking at this number alone, it makes so much sense to invest in employee wellness and retention, and we haven't even mentioned that it's also the right thing to do. We spend so much time at work, and even when we're not at work, we're often thinking about work, so it's absolutely the right thing to do to make your staff healthier, happier, less stressed, and to do everything we possibly can to avoid burnout altogether. So as with any problem, issue, or challenge, it is important to offer specific solutions and suggestions, so here we have two suggestions that can have a tremendous impact if implemented effectively. Now, of course, we all know that there's a staffing crisis in the laboratory field, so some of the deeper underlying issues cannot be solved overnight. In fact, like I said, nothing about burnout can be solved overnight, but there are some things that we can begin today, tomorrow, or at least this week. So first, we can create wellness groups and a program that addresses physical, mental, and emotional wellbeing. Studies have shown that the more organizations focus on wellness for their employees, the fewer burnout staff they have, and it's also really just important to talk about it, to talk about our mental health, to talk about our emotional health. The more we talk about it, the more open these conversations become, the more we can actually do something about it. Additionally, we can create inclusive work environments for all. This will help reduce burnout as people who feel that their whole authentic selves are accepted and celebrated are more likely to have stronger social connections at work. They will feel more engaged, they will feel less stressed, and they're less likely to experience burnout. But then also, if they do end up experiencing burnout, they already have these social structures in place at their work in order to help them through it, because social support is one of the keys of helping people overcome burnout once they have it, one of the keys, there are many, but it's an important one. Finally, I want to talk about that concept of belonging and how it relates to inclusion and wellness. So as you see here, when people are more engaged, they feel more loyal, they have stronger internal relationships and camaraderie, have a sense of belonging, they're more creative, innovative, productive, they're less likely that they feel burned out. So this framework here proposes that uniqueness and belongingness create feelings of inclusions together. So as you see, if there's a high uniqueness and high belongingness that creates the optimal environment for inclusion, you see it in the bottom right corner. So this in turn, of course, increases group performance. But if you have high belongingness and low uniqueness, that creates a culture of assimilation in which individuals conform to the group or dominant culture. There's this less authenticity and less unique attributes shared to help the group perform. On the other hand, low uniqueness and low belongingness, then there is exclusion. So this is where individuals are not treated as having a unique value in the group, but that there are employees who are considered insiders. So in other words, this is really where you have insiders and outsider groups, the them versus us. Finally, when there is low belongingness, but high uniqueness, people feel that they can be unique, or at least to a moderate degree, but they're not part of the insider group. So in this case, they're outsiders, but they are comfortable displaying their uniqueness to a certain degree. So this framework is really helpful when creating or working to create organizational cultures in which inclusion is the norm and is promoted, accepted, expected, fostered through all of our organizational culture framework. So through all our actions, behaviors, language, beliefs, system, processes, and norms. This portion of the talk, it's additive from maybe some of the other conversations we've had on burnout. And I'm sure people have had some courses on this or may have seen some talks. And I wanted to bring this approach about a top-down approach, which we're gonna see in the next few slides. One of the things to note is that there really isn't a single solution. It's a very complex problem. Dr. Croft, who was a past ASCP president, has acknowledged this in one of the publications, and it's true. Burnout is driven by a lot of personal and organizational factors, and it's very complex, as I had mentioned before. Poor management culture is one. I think a lot of people can actually attest to this, a heightened focus on efficiency and productivity. Treating everybody as numbers. I think everybody can feel that. When you're treated like a number, there's a certain deterioration in mental rigidity or robustness to that. There's growing administrative concerns, poorly designed information systems. You can imagine if you have a bad LIS that makes you click through a million clicks for every test that you have to go through, it's definitely not gonna make your day smoother. Loss of autonomy, loss of empowerment. And then the big one, of course, and this has shown up in the survey, is increasing workload. And I think this portion of talk is gonna try to address that, particularly to the powers that be. Some questions to ask. And this is actually both from the workforce standpoint, but also from those that are gonna be the audience that are gonna be the leaders of the organizations. These are things to ask themselves. Is the organization focused on the bottom over the process of making things better? Those bottom line organizations in the long run actually don't have a sustainable model in terms of burning out their workforce and having an engaged workforce. You can imagine for those industries that are bottom line, there are many out there where they're just treated like numbers. There's just not gonna be a sustainability. Is there a safe space and a privilege to raise questions and make changes? Dr. Mulder has mentioned things like toxic work environments. You can imagine if you're not allowed to raise questions, there's a certain disempowerment that comes from that. Can technology be leveraged in a certain way to help? Well, I'm a pathology informatics expert, and I can tell you, there's a lot of technologies in healthcare that are not optimized in a way that are seen in the consumer industry. Things don't work like iPhones and other technologies in the consumer industry in healthcare. There are a lot of clicks. There's a lot of things that actually lead to a lot of extra unneeded work. Are you or the people you know in position to bring attention to leadership of the problem? So this goes back to the type of culture that you have. So this is an interesting data point. Is burnout talked openly at your institution? And I was surprised by this. I mean, overwhelmingly, even though I'm sure a lot of us have heard this, there's an overwhelming no, particularly with the laboratory professional workforce. Almost two thirds don't actually have it openly spoken about. Over half as well, but it's a surprising thing. And for the yeses, it's even smaller proportion. So I found this rather surprising. We'll come back to this later, why this is important. This is actually a rank of the recent survey as well, is what did people find most helpful? You can think of it as one being the most helpful, six being the least helpful. So the more to the left you are, the better you are. And you can see for lab professionals, time off, time off, reduced work hours, those are kind of the big ones in terms of being most helpful. You know, there are other things here, something I found very surprising is that therapy actually didn't really help as much. It really was the time off and reduced work hours. Reduced work responsibilities also was somewhat. When you go to this next survey, pathologists wise, similar, time off. Time off really helped. But in a sense for pathologists, the work responsibilities was a big factor as well. So, and again, another surprising thing, therapy didn't seem to help as much. In the survey that we had recently, there was a large comment box. People were able to express whatever thoughts that they had. So basically went through all those thousand responses and try to condense them down in terms of themes and concepts. And so I created a word cloud about what an organization, if you were a leader that be, in charge of the organization, what are the things you can do to empower, you know, and deal with this problem about workouts? So I'm speaking for the most part, if you're in a position to actually make a change, what are the things to do? And you can see here, this kind of cognifies everything. You know, there's balance, adequate staffing, particularly in the professional workforce, on the lab professionals. Many are understaffed, they're overworked. They don't have the right work-life balance. The hours are too long. One thing that wasn't mentioned too much is also the compensation, which also might be a contributing factor of why it's very hard to attract those to come in. You know, we need to compensate better, staffing. And this all might be a reflection of what many of us have known for many years, the cost center model of many laboratories. They're seen as a cost center, but when you're seen as a cost center, and this goes back to metrics, treating people as numbers, you forget the human face, that the people that are actually really handling the specimens, they're not robots. They're, you know, there's a lot of automation, but in the end, there's still a human component to it. And being treated like metrics and numbers has a detrimental effect. So this word cloud basically encapsulates basically what needs to be done to be able to handle a lot of the issues about burnout. And you can see in terms of the number of responses of those who actually free texted their responses. So, as I mentioned before, this is a top down section and, you know, recognition is needed from those, you know, within the lab, lab leaders, but also outside. In terms of being a leader, you know, how to figure out how to do stress reducing measures, giving opportunities for the lab workforce to feel ownership. You know, as I mentioned, being treated like a number is a disempowering thing, but how do you allow them, enable them to actually feel ownership? And also, you know, how to engage the healthcare leaders, the professional organizations and other vocal supporters of labs to champion wellbeing. This is a big problem, particularly with the lab professional workforce. And, you know, being mindful of that, you know, we're dealing with one of the older workforces out there. If you look at pathologists, we are the third oldest profession out there with two thirds over age 55. And likewise on the lab professional side, even though the survey has mostly younger generation, Gen X, Gen Zs, so forth, the baby boomers are actually the majority of the lab professionals and much of them are actually retiring. So here's one strategy that we've thought about here. We're approaching the organizations you see here, the American College of Healthcare Executives, the Association of Pathology Chairs and the American Medical Association. So this is one way to sort of spread the word about this really impending crisis for the lab. We have an older generation that's going to retire. They will do it. And we have a younger generation that is clearly burned out, but very engaged in letting people know they're switching careers and such. And this is actually very detrimental for the field itself. Like who's gonna handle increasing volume of specimens. There's molecular testing, there's COVID. On top of that, there's precision medicine. There's all these overwhelming things that are on the horizon that requires more personality and we're just not getting them there and keeping them there sustained to keep them within the profession. And for all the cost that Dr. Mulder has mentioned, these are all important considerations. So as part of this, we wanna actually spread the word out to the leaders of these organizations. So we will be approaching them to actually have them view our presentation and be aware of the metrics there in a dialogue to have a conversation about burnout in the laboratory. So some other things about advocating a work-life balance and addressing lab workforce burnout. Going back to the survey, it was surprising to see that many institutions don't address burnout. But for the institutions that do have resources, they had a lower proportion of burnout. Bringing attention for the lab forces issues of burnout is something that we're doing. As I mentioned, we're gonna approach professional organizations. It's hard to go to every C-suite, but at least we're gonna tackle it as part of a strategy. We'll highlight the institutions which give support and creating communities to support. Embed this as part of the culture that's out there. The positive part of it is that in none of these surveys, and this is actually data from maybe the pre-COVID survey, people actually like their jobs. If you look at this, pathologists and laboratory professionals really enjoy their work. It's the amount of work and the type of environment and the demands that are placed on them, the hours, the different things. But the work itself, people are actually very, very happy about. They feel valued by their colleagues. They're satisfied with their job. Internally with the work itself, it's not the work itself. It's the volume and the other factors that were just highlighted. And we can talk about that more in the dialogue and some of the round tables that are following. Recognition support within the lab is very clear. In conclusion, transparency. Recognizing imperfections exist and cultures of improvement over the bottom line. As I mentioned before, bottom line has a detrimental effect. I know it's an easy thing for leaders to look at that at different metrics, but there's a human face behind all these different things. And there are things that are occurring beyond the bottom line that are there, that are happening in the lab, important things. And to recognize that. Creating a culture of transparency, allowing dialogue to happen, bringing issues like inefficiency, which has a corrosive effect and burnout, doing a lot of unnecessary work. The high workloads. It's overwhelmingly in the surveys about how high the workloads have been, particularly for the laboratory workforce and a lot of the overwhelming administrative duties. And then creating safe spaces are all part of the transparency. Some takeaways. Employees are more productive, committed, and engaged. There's a higher quality of output. There's reduced absenteeism and turnover. And then as you can see, we're trying in terms of taking a top-down approach. We're partnering with professional organizations and recognizing the problem and advocating for doing something. The hope is to bring the data, to bring the acknowledgements out there. It's very clear from the data and the surveys that are there, but also bring it, spreading the message of how important it is for workforce sustainability in pathology in the lab. And finally, burnout is preventable. Thank you. We'll leave the rest for any questions.

laboratory burnout

stress management

work-life balance

COVID-19 impact

organizational culture

wellness programs

policy advocacy