Other Than Burnout, What Hurts For Healthcare Workers And Learners?
By Kathy Cox, Chief of Staff

Healthcare workers face diverse and growing on-the-job stress exposures

Clinicians and other healthcare workers, as well as trainees and students, face diverse, cumulative, and synergistic toxic exposures that can lead to distress. While the healthcare industry is focused on burnout – which is no doubt important — many other distressing exposures affect individuals.

These include:

  • microaggressions and open racism
  • sexual misconduct/harassment
  • sleep deprivation
  • hierarchical shaming/hazing/toxic authoritarianism
  • vicarious trauma from patient/family distress
  • moral conflict
  • workplace violence


Our CEO, Dr. Siddharth Ashvin Shah, recently provided a workshop at the 2019 Strategies to Promote the Well-being of Health Professionals in the Learning and Work Environments. This conference is co-hosted by the Center for Innovation and Leadership in Education (CENTILE) at Georgetown University Medical Center and MedStar Health, Georgetown’s clinical partner.

We at Greenleaf are in strong support of the conference goals, which are to “bring together educators, researchers, practitioners, faculty development leaders, and academic policymakers to present and discuss the best practices and strategies to promote resilience, empathy and wellbeing in students, trainees, faculty, practitioners, and caregivers across the health professions.”  

This is the second invitation Greenleaf has had to present; at the previous CENTILE conference, we shared with the audience the Three Essential Skills to Operationalize Healthcare Resiliency: Situational Awareness, Self-Regulation, and Behavioral Leadership.”

In this year’s workshop “Other Than Burnout, What Hurts?,” Siddharth demonstrated how healthcare organizations struggle to keep pace and show leadership in the face of growing distress as a result of incidences (e.g. active shooter events) or cultural change that bring long-standing harms to light (e.g. sexual misconduct via #MeToo). Too many learning and healthcare organizations lack trauma-informed approaches to mitigating the distress from these exposures.  

The negative psychosocial (or mental) health of learners and clinicians is a function of:

  1. genetic and developmental exposures increasing the likelihood for psychiatric conditions
  2. personal life circumstances
  3. work-related drivers of burnout leading to higher emotional exhaustion, higher depersonalization, lower personal accomplishment
  4. several other work-related exposures

Mishandling any of the above exposures leads to additional individual/team distress, costs, and trouble for the entire organization. Mishandling moral injury has infuriated some physician influencers, as highlighted in this video titled “It’s Not Burnout, It’s Moral Injury.”

A particularly pained TEDMED talk suggests that mishandling hierarchical shaming/hazing/toxic authoritarianism is a contributor to medical student [learner] suicide. Finally, mishandling #MeToo allegations can erode entire layers of trust within organizations.

We would do well to update our leadership and institutional approaches in light of these negative exposures and social trends demanding cultural change. In our 2019 workshop, small group exercises put participants in touch with the resources and actions necessary to heal the hurts. While we can’t quite conduct a small group exercise in this blog, here are the calls to action straight from our 2019 workshop:

  1. Maintain awareness of “allostatic load” (i.e. the diverse, cumulative and synergistic toxicities) from several distressing exposures in healthcare environments other than drivers of burnout.
  2. Articulate an elevated, active leadership in learning/care environments that are mishandling the distress stemming from sensitive events.
  3. Integrate trauma-informed design and other institutional approaches in light of social trends demanding cultural change, such as the #MeToo movement.

We appreciate your reading and caring about the subject.  Our goal is to support our collective focus and concerted efforts so that clinician distress is handled with the utmost of compassion and vision.