The life of a critical care clinician is anything but stress-free. Far from it, in fact. These clinicians routinely face challenges, both physical and psychological, that test their patience and sanity. Despite that, an unfortunate stigma about stress exists among these professionals, at least according to Colin West, MD, PhD, FACP.
“We have largely been trained to bury our heads in the sand and separate ourselves from those challenges,” West said. “It is considered by many to be a sign of weakness to deal with those issues.”
Stress can lead to burnout, and unfortunately, that is exactly what is happening among clinicians across the United States. According to the Critical Care Societies Collaborative (CCSC), up to 45% of critical care clinicians reported symptoms of severe burnout syndrome (BOS), which is “a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress.” Seventy-one percent of clinicians who specialize in pediatric critical care report symptoms.
The CCSC report found that the high BOS rate can be attributed to:
- Stress from working in the ICU, where there is high patient morbidity and mortality
- Challenging daily work routines
- Frequent exposure to traumatic situations and ethical decisions
In 2007, the Mayo Clinic Department of Medicine created the Program on Physician Well-Being to investigate the factors that influence and impact physicians’ health and happiness. In addition to the causes mentioned above, the program organizers discovered that many physicians battle feelings of isolation and a lack of meaning in their jobs—two additional major influencers of burnout.
The program organized professionally facilitated groups for Mayo Clinic physicians, which were productive in helping to reduce burnout among the physicians involved, but it required them to take time away from their practices. So in 2013, West, who is a professor of medicine, medical education, and biostatistics at Mayo Clinic and codirector of the Mayo Clinic Program on Physician WellBeing, began a new trial initiative to help physicians reduce burnout without forcing them to take time away from work.
The initiative centered around COMPASS groups. COMPASS stands for Colleagues Meeting to Promote and Sustain Satisfaction. The idea was to have COMPASS groups of six to 10 physicians meet every other week at a time and place of their choosing to talk about the workplace stresses and challenges they face. The groups were led by physicians, and the Mayo Clinic paid for the groups’ meals.
Each meeting included a curriculum component that touched on one aspect of a physician’s day-to-day life, from major medical errors to frustrations with technology. The goal was to show physicians that they were not alone in the burnout battle.
“Physicians who have struggled with burnout issues or feelings of exhaustion and don’t have a support network generally feel that ‘I’m just not hacking it,’” West said. “‘Everyone else is doing fine, so there must be something wrong with me.’
“Community-building activities promote that you don’t need to beat yourself up about this. You also don’t need to be alone in this. Rather than burying it, maybe we can collectively open up this conversation and support each other throughout the medical profession.”
Satisfied with the results of the trial groups, the Mayo Clinic made COMPASS groups available to all physicians and scientists across all Mayo Clinic sites in 2015. Since then, more than 1,700 physicians have voluntarily enrolled in the groups.
West emphasized two key elements that made COMPASS groups successful: employer support and the meeting structure.
When the Mayo Clinic offered to fund the cost of all COMPASS group meals, it was a clear indication that the organization was invested in the groups—and the individuals within them. For a person who is facing stress or potential burnout, that organizational support is powerful. “It says that we want you to be able to build your community and we want to help support you,” West said.
As for the meeting structure, West explained that the COMPASS groups needed a curriculum to provide a framework for each meeting; otherwise the gatherings would run the risk of turning into gripe sessions or conversations about kids’ soccer games. Curriculum topics can range from lessons learned from a patient encounter to challenges and opportunities that arise from different generations of physicians working together.
“The purpose of the entire program was to have people learn from each other and have focused discussions that are relevant to the physician experience,” West said. The hope is that members will hear what other issues plague their colleagues and develop ways to cope with the stresses they face.
The COMPASS groups spend the first 15 minutes of each hour-long meeting talking about a particular curriculum topic. For the remaining 45 minutes, the group can either continue that conversation or use it as a social time to catch up or connect with one another. Both areas of discussion have value.
Participants have told COMPASS organizers that they appreciate the opportunity to interact with colleagues in a setting that fosters connection and communication. With the stress of life in critical care, it is easy to plow through a workday—or workweek—and focus so much on the job that the opportunity to interact with colleagues is lost. Having a dedicated period of time that is endorsed by Mayo Clinic leadership is empowering; that by itself can help reduce the burnout influencers.
COMPASS has been a resounding success at Mayo Clinic, and there is no reason it cannot be a success at other locations across the country. The biggest caution West offered is to realize that gatherings like COMPASS groups are only one way to try to prevent burnout—and it is not a method that works for everyone.
“The menu for solutions to physician distress needs to be diverse,” West said. “There isn’t one single solution that every physician will say works for them. “Understand that large menu of intervention options, present that menu to physicians, and let them see what makes the most sense for them.”