Rising Like a Phoenix: Leadership Tips for Restoring Inpatient & Outpatient Palliative Care Teams' Morale & Purpose

Key Message: As inpatient and outpatient healthcare delivery becomes increasingly complex, the ability to provide high-quality, agile, and compassionate palliative care is more important than ever. Our presentation explores the vital connection between skilled leadership and interdisciplinary team engagement. Through diverse insights, we demonstrate how human-centered leadership creates sustainable, high-performing PC teams.

Abstract: Palliative care (PC) teams experiencing low morale and burnout often exhibit emotional exhaustion, detachment, and a diminished sense of accomplishment (1). Continuous exposure to suffering, high patient mortality, and heavy workloads can lead to compassion fatigue and frustration leading to low morale; this can cause team members to feel unsupported, overburdened, or undervalued, affecting collaboration and patient care quality. Over time, burnout can erode job satisfaction, leading to high turnover rates & emotional distress (2). The clinical and administrative leaders of our PC teams were aiming to address the demoralization and low staffing they came upon when starting in their roles.

Addressing these challenges required strong leadership, peer support, self-care initiatives, and organizational commitment to fostering a resilient and well-supported team environment for both inpatient and outpatient groups, despite the operational and logistical differences inherent in the work of each group (3). Through strategic planning with key stakeholders, ongoing advocacy efforts, and prioritization of educational initiatives, process standardization has occurred on many fronts, increased investment in team members has enhanced perceptions, and overall performance was optimized. We advocated for certain resources to be assigned, or in some cases, reallocated and secured, to be leveraged on both teams for ongoing improvement efforts.

We observed and measured, in parallel groups, that team culture, morale, and engagement increased significantly through qualitative and quantitative indicators. Our annual employee survey demonstrated unprecedented year-over-year improvements in both teams’ reported leadership and engagement scores. Furthermore, team turnover is at a historical low for both teams. Absenteeism has dropped considerably, while peer recognition has strengthened, and collaboration and patient quality metrics are at all-time highs. Finally, more staff than ever before have expressed interest in pursuing advanced training, teaching opportunities, research efforts, and other initiatives that demonstrate increased bandwidth because of improved team morale and work conditions (4).

References: 1. Maslach, C. The Measurement of Experienced Burnout. Journal of Occupational Behavior. 1981; 2:99-113.
2. Harrison KL, Dzeng E, Ritchie CS, et. al. Addressing Palliative Care Clinician Burnout in Organizations: A Workforce Necessity, an Ethical Imperative. J Pain Symptom Manage. 2017 Jun;53(6):1091-1096. doi: 10.1016/j.jpainsymman.2017.01.007. Epub 2017 Feb 11. PMID: 28196784; PMCID: PMC5474199.
3. Shanafelt TD, Gorringe G, Menaker R, et.al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015 Apr;90(4):432-40. doi: 10.1016/j.mayocp.2015.01.012. Epub 2015 Mar 18. PMID: 25796117.
4. Horn DJ, Johnston CB. Burnout and Self Care for Palliative Care Practitioners. Med Clin North Am. 2020 May;104(3):561-572. doi: 10.1016/j.mcna.2019.12.007. Epub 2020 Mar 2. PMID: 32312415.