The Fitzhugh Mullan Institute for Health Workforce Equity, based at the Milken Institute School of Public Health, began releasing a six-part podcast series on burnout and “moral injury” in the health care system in early May.
Wendy Dean, co-founder of Moral Injury of Healthcare, hosts the podcast “Confronting Burnout and Moral Injury in Healthcare,” which features conversations with various medical experts. This podcast explores her ongoing three-year research project called the Workplace Change Collaborative with the Mullan Institute and its partners, which aims to explore the causes and potential solutions to moral injury in health care workers. This is a turning point in the second year.
The term “moral injury” has recently gained prominence in the current debate on the health of healthcare workers due to the burdens they face during the pandemic. Dean said burnout is characterized as chronic fatigue due to overwork, but moral injury occurs when an individual is forced to act contrary to their own moral standards, such as when they are unable to provide care to a patient because they cannot pay. He stated that this would occur.
The dean said moral injury in health care was widespread, especially after the coronavirus pandemic, when hospitals were overwhelmed with patients and unable to provide adequate care to everyone. . She said there continues to be a mass turnover of health care workers due to psychological injuries.
“In 2021-2022, 142,000 healthcare workers retired in approximately 15 months,” Dean said. “Half of them were doctors. That's a big deal, and that exodus continues.”
During the pandemic, medical professionals faced an increase in psychological injuries as hospitals were full and unable to treat all patients. Post-pandemic, medical residents are increasingly unionizing as they face burnout and harsh working conditions.
Dean said the podcast, which was funded by a $6 million grant awarded by the Health Resources and Services Administration, highlighted the project's findings, particularly the role moral injury currently plays in the continued turnover of health care workers. He said it would raise awareness about the role.
“Over the past two years, we have been tasked with supporting 44 grantees who are considering strategies to address burnout and resilience in the healthcare sector,” Dean said. “So if you look at their work, look at what they discovered, and think about the national framework that is tasked with providing us as well, how do burnout and moral injury connect? Is it?”
Mr. Dean said that insurance companies that fail to cover needed medical care because patients cannot afford it could suffer moral damages. She said nurses in understaffed hospitals may be blaming themselves for not being able to provide proper care to individual patients.
“We think of moral injury as a relational challenge or rupture. It is a betrayal by legitimate authority in a high-stakes situation, a violation of deeply held moral beliefs. “We're going to do that,” Dean said. “In medicine, a deeply ingrained moral belief is our pledge to put patients first.”
Dean said she believes the new podcast is for everyone, not just health care workers. She said hospital administrators can listen to this audio to increase empathy for clinicians, and lawmakers need to hear this audio to inform health care policy.
“First of all, I want administrators and legislators to hear this story to understand the clinician perspective. I want clinicians to hear this story, too, because clinicians are not alone. , because we realize that there are some solutions that we bring to the table from there,'' Dean said.
Mona Massoud, founder and lead organizer of Physician Support Line, a confidential helpline where doctors can access psychiatric help, says doctors often blame themselves for their patients' suffering, so they don't have to worry about mental illness. He said that physical injuries can be extremely demoralizing for doctors. She said moral injury is common among doctors who want to provide treatment but are unable to do so due to factors beyond their control, such as the patient not having insurance.
“It's really demoralizing. At some point, you believe that and that's the problem and actually believe that you're not doing enough, you're not good enough, you're not helping people. Because there are,” Masoud said.
The Mullan Institute produced this series in collaboration with the Institute for Health Improvement, AFT Healthcare, and Moral Injury of Healthcare. This is the latest part of a larger project launched in 2022 by Candace Chen, an associate professor in Milken's School of Health Policy and Management.
Before solving current operational problems such as staff shortages, Chen said, we need to find and implement relational solutions, such as collaborating with industry leaders to understand and resolve moral injury issues. He said there is. She emphasized participative leadership, or leadership that incorporates feedback from frontline employees, as a key step to solving problems.
“Participatory leadership doesn't mean everyone votes, it's majority voting,” Chen said. “But I'm like, let me understand what's going on on the front lines. Let me create a space, listen to people, hear what's wrong, and invite people to be part of the solution.” Please let me create a way for you to participate.”
Chen said one of the core of the Workplace Change Collaborative's strategy is to develop messages that resonate with healthcare workers and promote public understanding of the issues they face.
“We have built a national framework that will help people understand what health worker burnout and moral injury is and how it relates to mental health. The aim is to help people understand this,'' Chen said. “Because it's not exactly the same.”
