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The Cost of Burnout: Why Vitality Is Now a Workforce Strategy · Becker’s Healthcare Podcast

0:00
- Hi, everyone. This is Brian Zimmerman with Becker's
0:02
- Healthcare. Thank you so much for tuning into
0:04
- the Becker's Healthcare podcast series.
0:07
- Today, we're gonna talk about the cost of
0:08
- burnout, why mental health is now a workforce
0:11
- strategy.
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- Joining me for this discussion is doctor Stuart
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- Lustig,
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- national medical executive for behavioral health strategy and
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- product design at Cigna Healthcare. Doctor Lustig, thank
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- you so much for being on the podcast.
0:24
- My pleasure, Brian. It's great to be with
0:25
- you today.
0:27
- And and we'll we'll dive right in here.
0:28
- So can you just talk a bit about
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- how the conversation around workforce mental health has
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- evolved in recent years as you have you
0:36
- as you've seen it? And how are leaders
0:38
- sort of, I guess, reframing it as a
0:40
- as a strategic priority connected to to physical
0:43
- health as well?
0:45
- Yeah. Brian, you know, I think over the
0:47
- past few years, the conversation
0:49
- has really shifted from mental health as an
0:52
- individual issue
0:54
- to mental health as a workforce
0:56
- culture business issue.
0:58
- And the pandemic
1:00
- has really made something visible that's been building
1:03
- for years, which is a lot of different
1:05
- things influence whether people can thrive at work.
1:08
- And those are things like work structures,
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- workload,
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- social connection,
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- financial stress,
1:15
- caregiving demands, psychological
1:17
- safety.
1:18
- There was a recent US Surgeon General's framework
1:21
- for workplace mental health and well-being report that
1:24
- I think really captured this well by describing
1:27
- workplaces as needing to be centered around these
1:30
- five essential things, which are protection from harm,
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- connection and community,
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- work life harmony or balance as we typically
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- call it,
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- mattering at work essentially is the work meaningful
1:44
- and also opportunity for growth for employees.
1:47
- And I I think what's different now is
1:49
- that many leaders are no longer viewing workforce
1:52
- mental health
1:54
- only through the lens of EAP utilization or
1:56
- wellness campaigns.
1:58
- They're really beginning to see workplace mental health
2:00
- as part of a talent strategy and retention
2:03
- and productivity,
2:05
- innovation and organizational resilience.
2:08
- WHO also has guidelines on mental health at
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- work that similarly
2:12
- emphasized that employers need to address psychological
2:16
- or psychosocial
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- risks such as heavy workloads and irregular shifts.
2:21
- And also they need to train managers and
2:23
- support workers with mental health conditions.
2:26
- So for the past few years at Cigna
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- and Evernorth, from our perspective, we've been studying
2:30
- and quantifying the concept of vitality,
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- namely the ability to
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- pursue life with health, strength and energy.
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- And it's connected to health, but it's it's
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- more than just physical health. It's also emotional
2:44
- and occupational,
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- financial,
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- social well-being, all of those things. And most
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- of our clients are small and large employer
2:51
- groups, and we believe that employers
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- are really uniquely positioned to help people
2:56
- access the services and support that they need,
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- to be at their jobs with optimal vitality.
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- So
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- the most sophisticated employers are also moving from
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- reactive to proactive. So instead of waiting for
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- someone,
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- until someone is in crisis, they're asking earlier
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- on, what can our managers do? How can
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- we train them to recognize stress? How do
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- we reduce stigma?
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- Are our benefits easy to navigate?
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- And are we measuring
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- access outcomes, employee experience? So essentially, are we
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- designing work in a way that supports
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- and doesn't undermine mental health? And that's really
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- the mind shift, I think,
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- the mindset shift that we're seeing this. Behavioral
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- health is not a side benefit. It's really
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- an integral part of how organizations
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- sustain performance.
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- And I appreciate sort of this,
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- overview of some of the frameworks that are
3:46
- available day today. And I wanna get into
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- some of the the research you you mentioned,
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- doctor Lustig. But first, I I would love
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- to hear more about the the idea of
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- measuring vitality because I think we hear the
3:57
- word burnout a lot, and it it's it's
3:59
- real. Burnout is real, but we hear it
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- so often that sometimes
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- it it's it's hard to make it tangible.
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- You know what I mean? And and I
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- think measuring vitality just seems like a really
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- interesting way to go about trying to understand
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- this. Can you talk a little bit about
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- how that came together, how how that choice
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- came to be?
4:17
- Yeah. We see vitality as intimately connected with
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- health overall. It's one of the reasons that
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- for the past few years, Cigna and Evernorth
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- have been studying vitality.
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- It it's really integrally connected. And so we've
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- looked at vitality on a population basis. We've
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- looked at vitality,
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- among workers. We have a recent
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- reassessment of vitality among health care workers in
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- particular.
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- And, it it's not the same construct as
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- burnout, although in some ways they are related.
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- When we look at burnout specifically, we find
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- that a third of working adults say they
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- feel burned out at work.
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- And there was also a recent Medscape physician
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- burnout and depression report
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- from this year, 2026.
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- It showed that just half of all physicians,
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- just under half reported feeling burned out. And
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- I'll talk about the connection with with vitality
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- in a second.
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- And they can they
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- see that burnout as related to job stress
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- as opposed to their personal lives instead.
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- And the evidence is really clear,
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- on how burnout impacts people. They miss work,
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- they're present, but they're not functioning at their
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- best. They disengage and sometimes
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- ultimately they leave. And by the way, concern
5:31
- about AI and job eliminations
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- really contribute to burnout.
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- You know, the other thing, in addition to
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- vitality
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- and burnout that we've been looking at at
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- Cigna is loneliness. We've done a lot of
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- work with loneliness
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- since even before the pandemic. And we've found
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- that loneliness at work also contributes
5:49
- to turnover intentions. So we really need to
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- figure out, I think, on both counts how
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- to keep people meaningfully engaged at work, and
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- also engage with their colleagues while keeping the
6:00
- work manageable at the same time.
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- And in my profession,
6:04
- medicine, physician burnout can lead to turnover intention
6:07
- and job dissatisfaction
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- and even,
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- career regrets. So, you know, feeling like, oh,
6:13
- I wish I'd chosen another career instead of
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- medicine.
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- And we know back to vitality from our
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- recent research on vitality among health professionals,
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- that physicians have higher levels of vitality compared
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- to other health professionals such as nurses and
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- pharmacists.
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- And by the way, health professionals have high
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- levels of vitality anyway compared to
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- other professionals that aren't in health care. But
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- burnout is still a risk for, the helping
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- professions.
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- And so we've seen,
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- among our customers,
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- among our members, that when patients are newly
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- diagnosed with a behavioral health condition such as
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- depression,
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- and they receive treatment,
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- that medical cost savings can be really significant.
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- And when depression is, when depression is addressed,
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- productivity at work can improve. And simply, by
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- the way, with anxiety, workers with anxiety drive
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- higher health care costs, and they're less productive
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- and they turn over more.
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- And anxious employees are more likely to experience
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- burnout.
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- So the business case is not just that
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- mental health matters. It's really that untreated and
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- poorly supported,
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- mental health needs show up in the core
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- metrics that executives care about.
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- Yeah. The the it it it's easy to
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- sort of, imagine how the the knock on
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- effects of these can really, really impede an
7:36
- organization's strategic priorities.
7:40
- That said, many organizations have rolled out, I
7:43
- think you you mentioned before, like, EAPs. They've
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- also apps, awareness campaigns.
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- Yet employees often
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- struggle to get help or struggle to even
7:52
- leverage the resources that are actually already available
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- to them. So
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- from where you sit, doctor Elastube, as you
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- see with your research and in the work
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- you're doing, where do these mental health strategies
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- most often fall short? And I guess what
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- separates
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- an organization that's able to give more of
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- their employees meaningful support,
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- versus,
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- some some some apps or or things that
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- are just
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- available but not widely used?
8:19
- Yeah. Brian, I I think you're absolutely right
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- about the EAPs. And and I I think
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- it's an insightful question about where do we
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- go from here? Because many organizations
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- have made,
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- real progress, I think, by offering EAPs and
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- not only that, but other digital tools or
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- trainings or awareness campaigns. But
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- I think where things fall a bit short
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- is if the support that is offered is
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- either fragmented on the one hand or hard
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- to find or not really well integrated
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- or somehow disconnected
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- from the day to day work experience.
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- And that's where there's a bit of a
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- disconnect. I think generally, too, employers believe that
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- they're doing a better job of creating a
8:57
- healthy workplace
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- with appropriate
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- benefits than employees believe to be the case.
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- We've seen that in different types of research
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- over the years. And so, we really need
9:07
- to move beyond mental health awareness. And that's
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- certainly important. But awareness without access,
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- timely access or confidentiality
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- or the ability to navigate to what you
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- need can be really frustrating.
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- So it's gotta be more than just here's
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- a resource.
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- It really needs to be we've designed a
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- system so people can use that resource
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- safely, quickly, appropriately.
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- And I I just add, you know, one
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- other thing that I think the best
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- strategies also recognize the role of managers and
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- what team norms are within the organization. So
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- the manager doesn't need to be a therapist,
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- but they do need to know how to
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- how to create psychological
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- safety
9:50
- and to notice changes in functioning among their
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- employees and how to respond without judgment and
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- help employees to connect with those appropriate resources.
10:01
- And
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- organizational
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- culture and manager behavior are really essential, I
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- think, in developing an environment that addresses
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- mental health and vitality.
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- And one thing I've advocated for for a
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- while is really something simple like ensuring
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- five minutes for people to take care of
10:17
- basic needs between otherwise back to back meetings.
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- That can help. So if it's a thirty
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- minute meeting, you know, make it twenty five
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- minutes.
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- If it's an hour, shorten it to fifty
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- minutes. And, you know, therapists have known that
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- for years, right, for decades, the importance of
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- the fifty minute hour.
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- And in a corporate environment, it's so people
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- can,
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- use the restroom or return a really urgent
10:39
- personal phone call or stretch or hydrate or
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- or grab a snack or or whatever it
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- is.
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- No. It's really, really important. And then thinking
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- here too about
10:51
- to to your point, there's there there there's
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- more awareness
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- these days. Right? And,
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- stigma is maybe less of an issue now
10:58
- than than it was before, but I imagine
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- there's still some of that attached to some
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- of these services.
11:04
- How how can, I guess, culturally speaking, in
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- an organization,
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- can you mentioned that the managers really have
11:10
- to embrace it? They have to, you know,
11:12
- create a place of of psychological safety. But
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- to do that across managers, you need a
11:17
- model from the the the top down. Correct?
11:19
- Or how how can you, I guess, create
11:21
- a space where there where stigma isn't an
11:23
- issue? You make sure you're getting that out
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- of the way so people aren't afraid to
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- go seek and ask for help.
11:30
- Yeah. I think stigma still is an issue.
11:33
- And to your point,
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- it does need to be from the top
11:37
- down where the culture is creative and created.
11:41
- And it it's both, you know, top down
11:43
- and bottom up, certainly.
11:45
- I I think, you know, if there's a
11:47
- silver lining to the pandemic, it's that it
11:49
- is now okay to not be okay. Right?
11:53
- And we've seen an enormous
11:55
- growth in the utilization of behavioral health care
11:58
- services. And I think much of that,
12:00
- is is entirely appropriate utilization. We want people
12:03
- to get in and use services. And we've
12:06
- found in in fact, as I mentioned earlier,
12:08
- that when people get in to treat their
12:10
- depression or their anxiety,
12:12
- they're better able to take care of their
12:14
- medical issues and so medical spend goes down.
12:17
- But, I think, you know, the issue of
12:20
- trust and access and stigma reduction,
12:23
- I think that, you know, if we can
12:24
- get those right, then we get to the
12:26
- difference between a benefit that
12:28
- exists and a benefit that actually helps somebody.
12:32
- Right. So employees need to believe that the
12:35
- care they get is going to be timely
12:36
- and confidential and affordable
12:39
- and and culturally competent
12:42
- and and also easy to navigate.
12:44
- And I think although many working adults know
12:47
- how to access mental health services through their
12:50
- work,
12:51
- many worry about retaliation
12:54
- or being fired if they took time off
12:56
- for mental health or sought mental health care.
12:58
- There are many professions,
13:00
- where that's, you know, even more true than,
13:03
- the the general population of working adults. So
13:06
- this is, I think, really a powerful reminder
13:08
- that resources alone are not enough,
13:11
- if employees do not trust the environment around
13:14
- those resources.
13:16
- And,
13:17
- I'll state the obvious. I guess I I
13:18
- think stigma reduction,
13:20
- is especially important because mental health conditions,
13:24
- can affect confidence and and identity and perceived
13:27
- employability.
13:29
- So internally, we have found in our research
13:31
- that anxious employees feel isolated and misunderstood,
13:36
- but supportive relationships with managers and coworkers can
13:40
- increase vitality
13:41
- and job satisfaction. And yet many anxious employees,
13:45
- although they can
13:47
- identify the accommodations that would help them, they're
13:49
- reluctant to ask for them. Right? So we
13:52
- we see that gap between what they need
13:54
- and and the help seeking behavior that, you
13:56
- know, should go along with it. So I
13:58
- think, you know, leaders need to normalize help
14:00
- seeking,
14:01
- and make the help easy to use. So
14:03
- again, clear navigation,
14:06
- leadership support. Again, Brian, to your point about,
14:08
- you know, from the top down,
14:11
- manager training,
14:12
- confidentiality
14:13
- messaging,
14:15
- benefit designs that reduce affordability
14:18
- barriers. All of those things are are really
14:20
- important year round and not just, you know,
14:22
- during mental health awareness month.
14:24
- Yeah. Sir certainly. And I wanna get to
14:26
- another component of this too, which is
14:29
- you need, solutions that can go across an
14:32
- organization scale, so to speak. But the the
14:34
- workforce is also so unique to these days.
14:38
- It's multigenerational
14:39
- workforce.
14:40
- It's, you know, there's there's remote employees,
14:43
- hybrid employees, in person employees in various different
14:46
- organizations.
14:48
- So I guess my question is, how do
14:49
- you how do you create solutions and,
14:51
- create resources for,
14:53
- an entire organization that can also kinda be
14:56
- tailored, I guess, so to speak, for for
14:58
- certain people to meet their needs where where
15:01
- they're at?
15:02
- Yeah. That's, I I think, a really insightful
15:05
- ask because we have to remember that it's
15:07
- not one size fits all. Right? So,
15:10
- if you take a one size fits all
15:12
- approach, you're gonna miss some really important differences,
15:15
- across age and role and work setting and
15:18
- and, you know, other things that people are
15:20
- dealing with in their lives. Right? Caregiving or
15:22
- their own health status or their own, comfort
15:25
- with technology
15:26
- and so forth. So you really have to
15:28
- kind of segment needs and listen to where
15:30
- employees are at individually.
15:33
- And so, for example, some younger employees,
15:36
- they may be more open to talking about
15:39
- mental health. They may be less focused on
15:41
- privacy per se, but they may be more,
15:44
- in need of support around loneliness. Our loneliness
15:47
- research has shown that the younger you are,
15:50
- the more likely you are to be lonely.
15:52
- They may need more support around uncertainty
15:55
- or financial
15:56
- stress, particularly in these times
15:58
- of what's perceived as decreased opportunity for younger
16:01
- people. Career development, you know, that's gonna be
16:03
- big for younger people.
16:06
- By contrast, mid career folks, you know, they
16:08
- could be balancing work and parenting and caregiving.
16:12
- And then older employees, it's different for them.
16:14
- They they may have more chronic
16:16
- health conditions or other transitions in work and
16:19
- life.
16:19
- And then there's a whole issue of distributed
16:22
- work. So remote
16:23
- hybrid employees,
16:25
- they may value the flexibility that they have,
16:28
- but they also may struggle with connection or
16:30
- boundaries and access to informal support.
16:34
- And I, you know, I think remote work
16:36
- during the pandemic had
16:38
- both positive and negative implications.
16:41
- So flexibility on the one hand, but also
16:43
- challenges related to mental health and presenteeism
16:47
- or outright absenteeism,
16:49
- work life balance,
16:51
- difficulty
16:52
- disconnecting,
16:54
- blurred boundaries between work and home. So all
16:57
- of those things, I think, you know, really
16:58
- need to be considered. And our vitality research,
17:02
- really underscores the importance of tailoring support to
17:05
- the specific workforce
17:07
- segment that you were asking about. So,
17:10
- you know, for example, we found that vitality
17:12
- scores vary by occupation
17:14
- and different groups may need different types of
17:16
- support to thrive even if everybody's working in
17:19
- the same organization.
17:20
- So, you know, practically, you gotta meet people
17:23
- where they're at,
17:24
- have multiple entry points. So for some folks,
17:27
- digital self guided tools, if you want privacy,
17:30
- convenience,
17:31
- virtual and in person therapy options, coaching, peer
17:34
- support where appropriate.
17:36
- And then for managers, consultation,
17:39
- crisis support,
17:41
- family caregiver resources, all of these things. Right?
17:44
- So it's, also about designing communication differently because
17:48
- someone who's burned out may not actually read
17:50
- the benefits email. Right? And someone who's anxious,
17:54
- you know, may not,
17:55
- take that first step without a lot of
17:57
- reassurance
17:58
- about confidentiality.
18:00
- Yeah. A a lot of communication and communication
18:04
- designed to build trust, which which I think,
18:06
- doctor Lustig, you just you established is so
18:08
- important
18:09
- for folks to go out and and and
18:10
- make sure they're they're using the resources that
18:12
- are available to them. Yeah. Absolutely.
18:15
- What I wanna close here by maybe
18:18
- getting in the shoes of an executive listening
18:20
- to this who is bought in, wants to
18:23
- make mental health a real part of their
18:24
- retention and performance strategy.
18:27
- Where should they start? What what would you
18:29
- what advice would you give them, doctor Lustig?
18:32
- Yeah. Boy, from from my mouth to God's
18:34
- ears. Right? Well,
18:36
- you know, I would advise them to start
18:38
- by treating mental health as an enterprise
18:42
- operating priority. Right? Not just a a benefit
18:45
- line item. And I think that really begins
18:46
- with looking at data. So looking at claims
18:49
- and disability and
18:51
- absences, turnover,
18:54
- engagement,
18:55
- how are people using the EAP,
18:57
- network access,
18:58
- manager feedback? I mean, there's so many data
19:00
- points and then identifying where the biggest friction
19:03
- points are. So is it access or is
19:05
- it low trust or difficulty navigating,
19:09
- high burnout roles,
19:11
- caregiver strain, right?
19:13
- Toxic team dynamics,
19:15
- you know, so much of how we
19:17
- feel at work is related to the team
19:19
- that we're on. Right? And and what those
19:21
- dynamics are like.
19:22
- So the mind
19:24
- mindset shift, I think, that matters most is
19:26
- really moving from how do we offer mental
19:28
- health resources
19:29
- from that to
19:31
- how do we build a work environment and
19:33
- health ecosystem
19:35
- in which people can actually thrive?
19:37
- And that US Surgeon General's framework for workplace
19:41
- mental health and well-being report that I mentioned,
19:44
- again, makes the point that organize organizations
19:47
- must protect workers from harm, first off. And
19:49
- that's like basic stuff, safe equipment or, you
19:53
- know, not having to fear retribution if you
19:55
- say something you're concerned about. So, you know,
19:58
- that needs to be there, but also those
20:00
- connections again
20:01
- and respecting work life balance as I mentioned.
20:04
- And,
20:05
- again, people need to feel that they that
20:07
- their work is meaningful. And when you feel
20:09
- like your work is meaningful,
20:11
- you're much more likely to,
20:14
- you're much less likely to burn out, I'd
20:16
- say, and you're much more likely to stay
20:18
- at your job.
20:19
- So all of that really matters. And then
20:21
- how do we support the growth of our
20:23
- employees? So these aren't really peripheral things.
20:26
- Yeah, these these are central to whether people
20:28
- stay at their jobs, perform well, innovate,
20:31
- and really bring their full
20:33
- capability
20:34
- to to work. So I think
20:36
- for health care executives specifically,
20:39
- and they may be listening to our conversation
20:42
- today,
20:42
- the stakes are even higher because burnout and
20:45
- mental health,
20:46
- it's not just affecting the workforce,
20:49
- and retention. It's also affecting the patient experience.
20:52
- So quality, safety,
20:55
- continuity of care. So mental health strategy is
20:57
- also a quality strategy.
21:00
- So, you know, in conclusion, I think I'd
21:03
- say that the starting point should be a
21:04
- focused, measurable plan with managers being trained and
21:08
- ensuring timely access, of course, to evidence based
21:11
- care,
21:12
- simplifying navigation,
21:14
- measuring outcomes, right, and creating a culture where
21:17
- people can ask for help without fearing any
21:20
- kind of retribution.
21:21
- You know, our our vitality work reinforces
21:24
- that employers
21:25
- can improve performance and organizational
21:28
- outcomes by understanding
21:30
- the needs of the workforce and investing in
21:32
- vitality and health,
21:34
- creating supportive workplace
21:36
- cultures. So, you know, to put it simply,
21:39
- the goal is not to make employees more
21:41
- resilient so they can tolerate broken systems.
21:44
- The goal is really to build healthier systems,
21:47
- which make resilience
21:48
- and performance and retention,
21:51
- ultimately
21:52
- more sustainable.
21:54
- Doctor Lustig, thank you so much. And I
21:56
- really appreciate you bringing up that point too
21:58
- about, ultimately, this this does have implications in
22:01
- health care, implications for patients, which is when
22:03
- we're talking about performance, we're talking about, you
22:05
- know, care delivery, how you're navigating patients through
22:09
- their journey. So appreciate you flagging that before
22:11
- we signed off here. Thank you so much.
22:13
- Brian, thank you. What a pleasure.
22:15
- We also wanna thank our podcast sponsor, Cigna
22:18
- Healthcare.
22:19
- You can tune to more podcasts from Becker's
22:21
- Healthcare by visiting our podcast page at beckershospitalreview.com.