Chapter 12: Learning about MD Anderson Culture Inspires a Different Perspective on Burnout
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Description
Dr. Holleman begins this chapter by explaining that he was effectively offering the faculty resiliency training. He then devotes the rest of this chapter to explaining the “epiphany” he had as his experience of MD Anderson culture evolved.
Dr. Holleman recounts that, during training sessions, faculty would be “boiling” and would state that offering resiliency training was effectively “blaming the victims”: defining burnout as a personal problem and individual responsibility, when in fact it had been created by systems within the institution. On realizing this, Dr. Holleman explains, he began to research burnout and mentally redefined his role as being an advocate for faculty to the administration. He confesses that he didn’t feel comfortable in this role. He gives examples to demonstrate that burnout is a systemic rather than a personal problem.
Identifier
HollemanWL_02_20170420_C12
Publication Date
4-20-2017
City
Houston, Texas
Interview Session
Warren L. Holleman, PhD, Oral History Interview, April 20, 2017
Topics Covered
The University of Texas MD Anderson Cancer Center - MD Anderson Culture; Personal Background; MD Anderson Culture; MD Anderson History; Leadership; On Leadership; The Researcher; Critical Perspectives; Working Environment
Transcript
Tacey A. Rosolowski, PhD:
Sometimes when you're in it, it's hard to see the changes. But you can see the changes. It's a very—your evaluation of all of this is very valuable. Now, I had a question. You talked about the focus groups and everything, and some of these activities that were existing. How well, how much do faculty take advantage of the kinds of things that were available in 2010, and prior to your arrival? Did people know about it? Did they take advantage of it?
Warren L. Holleman, PhD:
Well, as I said earlier, faculty are very busy people. I can't really comment on how active they were before I came. My sense is probably the way it still is, is they're so busy they can't come to a lot of the things they'd like to come to. It's a little bit ironic when I was comparing to the homeless situation, this is my point, is that their problem is that they're being overworked. That creates challenges for their work-life balance, for their mental health, for their relationships, for their job satisfaction. But the very things that might help address that, they don't have time to do. Or it's hard to find time.
Tacey A. Rosolowski, PhD:
Yeah, and it's a systemic problem. Trying to find time in the cracks to put on Band-Aids, basically.
Warren L. Holleman, PhD:
Right. That's exactly right.
Tacey A. Rosolowski, PhD:
Yeah. Yeah.
Warren L. Holleman, PhD:
So and I should clarify, with the—I never did, I guess, formal focus groups as they had done back in 2002 or so, or '03, whenever that was. But I did various ways of gathering information and assessing needs. I interviewed department chairs. I had a structured interview. I guess that's a needs assessment. I would go to various departments that would invite me, and talk about faculty health, and then open it up for conversation. Pretty much invariably, there would be a lot of angst. Then the other thing I did was, I would have these noon sessions where I would talk about burnout, work-life balance, things like that. But I would reserve a lot of time for discussion. I got a lot of angst there. The other thing I did was, a few times I set up a table in the Skywalk between the hospital and the faculty center. Did I talk about that last time? And people would just sit down and tell me on the fly what was bothering them.
Tacey A. Rosolowski, PhD:
Wow.
Warren L. Holleman, PhD:
And so those were sort of the ways I gathered information. Then, of course, one-on-one counseling, and just hallway conversations. There was a kind of an epiphany that happened. My first year here, I told Katrina, let's just plan as many noon sessions as we can. If 10 people come, that's great, 20 or 30 come, that's great. But not to get big groups, but groups where we can connect in a real way. And so I would come—I think I was hired to do what's now called "resiliency training." Back then, maybe they were starting to call it that. But the idea that if you learn a few stress management skills, if you have good work-life balance, if you take a vacation now and then, then you can do all of this ridiculously hard work and be fine. So I would go in, teach stress management tips and resiliency tips, and invariably, after a few minutes, somebody would start boiling in the room. And they would say something like this: "You say I need to exercise and eat my vegetables. You're not my mother, okay? I believe in exercise, but right now, with my schedule, if I were to exercise, the only time I could possibly do it would be 4:00 in the morning, because I have to be in surgery," or whatever, "at 5:30 or 6:00. And if I do that, I can never leave here before 6:00 or 7:00 or 8:00. If I did that, I would never see my children, because I would be going to bed at 7:00 in the evening," you know. So anyway, there was no time. "How am I going to eat my vegetables when we don't have time for lunch, and the faculty cafeteria we did have was just taken away? The most I can take for lunch is five or ten minutes. It feels like you're blaming the victim. You're telling us it's our problem, and that we need to do all these things so that we can work harder for MD Anderson. Why don't you go talk to our executive leaders and tell them that they're the ones causing the problems and not us, and stop blaming the victims." That really hit home on a number of levels. One was, I had just spent the last eight years directing a clinic that was primarily for women who were coming from situations of domestic violence, as well as childhood abuse, sexual and physical. And so the last thing you would say to a woman who is coming out of a violent situation is, "It's your fault. You should never have been there in the first place." That would be the wrongest thing you could possibly do, right? And I get into a situation that I think's totally different, and I've really made that mistake with them, with the doctors. And so that got my attention. So I started reading the literature on burnout. The most influential book was Christina Maslach's book, The Truth About Burnout, How Institutions Cause Stress in their Employees, the subtitle was something like that. And she said exactly what the faculty had been telling me. She said, "The typical institution has a high burnout rate, and they try to fix it by offering a stress management course, or building a fitness center." And she said, "Fitness centers and stress management are great. But you will not reduce burnout rates by doing that. To reduce burnout rates, you've got to change the working conditions. Burnout is caused by bad working conditions, a bad job environment." That's exactly what the physicians were saying. They were saying, "We used to have time for lunch." "We used to be able to say who was hired in our clinic, or how the clinic would operate. Now we just show up and have to do what they say to do." "We used to have this much paperwork. Now we've got 10 times more paperwork." These are all factors that have to be addressed, and only our leadership has to support that in order to make that happen.
Tacey A. Rosolowski, PhD:
So how did this affect you? You know, starting to do research on burnout, and having that epiphany about blaming the victim?
Warren L. Holleman, PhD:
Well, it meant that I was no longer a wellness coach, and now I had to be an advocate to the administration. And I didn't feel comfortable in that role, and I still don't. I think, frankly, whoever comes after me should be someone who is really good at working with institutional leadership to bring about culture change, not a person who's not solely a, quote, "wellness coach." Ideally you do both. The individual has things they can do, but the institution has to do things. But if you read the literature on burnout the last few years, physician burnout, it's very clear that the key drivers of burnout are controlled by—are the institutional drivers. The systemic drivers, not the individual behaviors. My little joke that I use, I have a couple of examples—putting a fitness center in a health institution and thinking that's going to solve the burnout problem would be the equivalent of putting a spa in a sweatshop, and saying, "Oh, these 18 hours a day you work is causing you problems? Well, go to the spa in your time off." That's going to fix it. That would be very insensitive and dumb. So the fitness center is a great resource. It gives people—if they have, like, a meeting is cancelled, they can run down there for 45 minutes and get on the elliptical trainer and get some exercise. That's great. And that's going to help improve their health. But it's not going to reduce the problem we call "burnout," because that has to do with working conditions. The other example that just has hit me over the years is that if you put me in the boxing ring with Muhammad Ali, you know, at the prime of his career, how long do you think I would last? Maybe eight seconds, six seconds, nine seconds. That's probably what you would guess, something like that. So if I do resiliency training and have the best coach in the world, then how long am I going to last? Well, then I might last 12 or 13 or 14 seconds. But it's not going to—eventually, I'm going to burn out. So when we do all of these interventions, like we try to improve the quality of the food in the cafeteria, we have a fitness center, we have a stress management class—I just taught one yesterday, I believe in it. I believe it helps you manage stress. But I don't think it will reduce burnout in a population that's got a bad working environment. It may delay the onset of the burnout.
Tacey A. Rosolowski, PhD:
Serious problem. Very serious problem.
Warren L. Holleman, PhD:
It will—yeah. It'll help you cope with your stress in your life. But job burnout really is related to your job, not to your mental toughness.
Recommended Citation
Holleman, Warren L. PhD and Rosolowski, Tacey A. PhD, "Chapter 12: Learning about MD Anderson Culture Inspires a Different Perspective on Burnout" (2017). Interview Chapters. 1086.
https://openworks.mdanderson.org/mchv_interviewchapters/1086
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