June 16, 2016

Physician Burnout: How to Rekindle Job Satisfaction

Study finds communication training yields enduring improvements


It may not dominate headlines, but physician burnout might be the most pervasive epidemic in U.S. healthcare today. According to one recent study, more than half of U.S. physicians experience at least one of these three burnout symptoms:


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  • Emotional exhaustion
  • Depersonalization (cynicism, negativity or callousness toward patients)
  • Low sense of personal accomplishment

The effects of burnout can be harmful, ranging from lowered engagement to increased errors to lower levels of patient satisfaction and treatment adherence.

In response to this widespread malaise, Cleveland Clinic has examined one method for rekindling physicians’ job satisfaction: relationship-centered communication. The results have been notable. A single training session in relationship-centered communication has helped Cleveland Clinic staff significantly reduce burnout and renew empathy, with effects persisting for months.

Why study relationship-centered communication?

“Few studies have examined interventions that reduce physician burnout,” says Cynthia Kubu, PhD, a neuropsychologist in Cleveland Clinic’s Department of Psychiatry and Psychology. “But relationship-centered communication has a long history of empirical studies that document its benefits for both physicians and patients. Our findings make the connection, showing how relationship-centered communication training impacts physician burnout and empathy.”

Kubu and others from Cleveland Clinic’s Center for Excellence in Healthcare Communication shared findings in a presentation at the 2015 CENTILE Conference, an international meeting designed to “promote resilience, empathy and well-being in the health professions.” Related data were also reported in a recent paper in the Journal of General Internal Medicine.

Cleveland Clinic uses the R.E.D.E.SM (Relationship: Establishment, Development and Engagement) model for teaching and evaluating relationship-centered communication. Rather than being either provider- or patient-centric, R.E.D.E. (pronounced “ready”) focuses on the provider-patient relationship. It’s based on the premise that relationships are therapeutic in and of themselves and, thus, a vital medium of care.

How the three-pronged R.E.D.E. model works

Relationship establishment involves communication skills that help create a sense of safety and trust for the patient. Relationship development skills are focused on helping the patient feel heard and understood while also obtaining the necessary medical detail. Lastly, relationship engagement skills focus on providing patients with a sense of partnership and empowerment.


Cleveland Clinic providers are introduced to the R.E.D.E. model during an eight-hour training that includes didactics, video demonstration and skills practice.

Significant improvements in burnout and empathy

The data presented at the CENTILE conference by Dr. Kubu and colleagues Elaine Thallner, MD, MS, and Amy Windover, PhD, involved 1,409 Cleveland Clinic physicians — ages 28 to 84 years, with zero to 51 years of experience — who completed R.E.D.E. training.

Before training, participants self-reported their level of emotional exhaustion, depersonalization and personal accomplishment using the Maslach Burnout Inventory. They also self-reported their level of empathy using the Jefferson Scale of Empathy. Participants repeated self-assessments immediately after training and again three months later. Data before, immediately following and three months after training were analyzed using paired t tests with careful attention to associated effect sizes.

Analysis of participants’ reports revealed improvements in all three aspects of burnout and empathy scores, as detailed in the graphs below. Changes from pre-training levels to immediate post-training levels were statistically significant for all measures, and the changes remained statistically significant out to three months post-training for depersonalization and empathy relative to the pre-training scores.



“Improvements in empathy and emotional exhaustion were significant, associated with moderate effect sizes,” says Dr. Kubu. “Also notable was how improvements in empathy and depersonalization persisted. One day of R.E.D.E. training resulted in months of positive effects. It’s surprising and encouraging.”

How to maintain good results

Future work is needed to determine if regular “booster sessions” in relationship-centered communication lead to longer-lasting benefits. R.E.D.E. booster sessions — covering topics such as communicating with patients who have chronic pain, delivering bad news and eliciting patient preferences around end-of-life care — are currently available for Cleveland Clinic staff.

“We need to learn how to maintain good results,” says Dr. Kubu. “It makes sense that physicians and patients have more positive experiences during more relational interactions. Our brains respond chemically when we engage in relationships. We just feel better.”

Dr. Kubu doesn’t rule out the impact of the training experience itself: “Removing physicians from clinic for one day, giving them an opportunity to connect with colleagues, also may play a role in refreshing them emotionally.”

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