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By Ella Mitchell, Contributing News Editor • June 14, 2024

Milken launches podcast to increase awareness of moral injury in health care

Cars+pass+by+the+Milken+Institute+School+of+Public+Health.
Hatchet File Photo: Raphael Kellner | Staff Photographer
Cars pass by the Milken Institute School of Public Health.

Updated: May 17, 2024, at 12:25 p.m.

The Fitzhugh Mullan Institute for Health Workforce Equity, which is based out of the Milken Institute School of Public Health, started releasing a six-part podcast series about burnout and “moral injury” in the health care system at the beginning of May. 

Moral Injury of Healthcare co-founder Wendy Dean hosts the podcast, Confronting Burnout and Moral Injury in Healthcare, which features talks with various health care professionals. The podcast marks the two-year milestone of an ongoing three-year research project by the Mullan Institute and its partners called Workplace Change Collaborative, which aims to explore the causes and potential solutions to moral injury in health care workers.

The term “moral injury” has recently risen to prominence in current discussions about wellness among health care workers due to the burdens faced during the pandemic. Dean said burnout can be characterized as chronic exhaustion due to overworking, but moral injury occurs when an individual is forced to act against their own moral code like when they cannot provide care to a patient because they can’t pay. 

Dean said moral injury in health care is widespread, especially in the wake of the COVID-19 pandemic, when hospitals were so inundated with patients that it was not possible to deliver adequate care to all of them. She said moral injury is causing an ongoing mass departure of health care workers. 

“Between 2021 and 2022 — like a 15 month span — 142,000 health care workers left,” Dean said. “Half of them were physicians. That is a lot, and that exodus is continuing.”

Health care professionals faced increased moral injury during the pandemic because they were unable to treat all patients as hospitals were overrun. After the pandemic, medical residents have increasingly started unionizing due to burnout and harder working conditions they faced. 

Dean said the podcast, funded by a $6 million grant awarded by the Health Resources and Services Administration, increases awareness of the project’s findings, especially the role moral injury currently plays in the ongoing departure of health care workers.

“Over the past two years, we have been tasked with supporting 44 grantees who are looking at strategies to address burnout and resilience in health care,” Dean said. “So looking at their work, seeing what they’re finding, and then thinking about the national framework that we were also tasked with delivering, how do burnout and moral injury fit together?”

Dean said insurers who cannot cover necessary medical care because patients cannot afford it may suffer from moral injury. She said nurses in understaffed hospitals may blame themselves for being unable to provide each of their patients with adequate care.

“Moral injury we think about as a relational challenge, or relational rupture. It’s a betrayal by a legitimate authority in a high-stakes situation that leads you to transgress your deeply held moral beliefs,” Dean said. “In health care, those deeply held moral beliefs are the oaths that we took to put our patients first.”

Dean said she believes the new podcast is for everyone, not just health care workers. She said hospital administrators can listen to it to greater empathize with clinicians and legislators should listen to it to inform health care policy. 

“Number one, I would like administrators to listen to it and legislators to listen to it so that they understand the clinician perspective, I would like clinicians to listen to it because they will realize that they’re not alone, and there are some solutions that we that we bring to the table from it,” Dean said. 

Mona Masood, founder and chief organizer of Physician Support Line, a confidential help line where physicians can access psychiatric help, said moral injury can be extremely demoralizing for physicians because they often blame themselves for their patients’ suffering. She said moral injury is common amongst physicians who want to deliver care but are unable to due to factors out of their control, such as patients lacking insurance. 

“It’s really demoralizing, because at some point you believe it, that’s the problem, you do actually believe that you’re not doing enough, that you’re not good enough, that you’re not helping people,” Masood said.

The Mullan Institute produced the series in partnership with the Institute for Healthcare Improvement, AFT Healthcare, and Moral Injury of Healthcare. It is the latest part of a larger project launched in 2022 by Candice Chen, an associate professor in Milken’s department of health policy and management.

Chen said relational solutions, such as working with industry leaders to understand and solve the issue of moral injury, are necessary to find and implement before solving current operational issues like staffing shortages. She highlighted participative leadership — leadership that takes feedback from frontline workers — as a critical step in solving the problem. 

“Participative style leadership doesn’t mean that everybody votes and it’s majority votes,” Chen said. “But it is like, let me understand what is going on in the frontline. Let me create spaces and listen to people and listen to what are the things that are the problems, and then let me create ways where we can engage people to be part of the solution.”

Chen said one of the core parts of the Workplace Change Collaborative’s strategy is to develop a message that will resonate with health care workers and help build public understanding of the issues they face.

“We built a national framework, and the national framework is all about trying to help people understand what is this thing that is health care worker burnout, moral injury, and how does it intersect with mental health?” Chen said. “Because it’s not quite the same.”

This post has been updated to correct the following:

The Hatchet incorrectly reported the name of the Institute for Healthcare Improvement as the Institute for Health Improvement. We regret these errors. 

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