How institutionalized ghosting in healthcare increases burnout

I sent that email message two weeks ago and I’m not sure why I haven’t received a peep from the recipient. 

Possible causes: spam trap, incorrect addressing convention, total lack of interest, laziness, they left for a better job? 

It’s one thing when it’s a commercial correspondence or sales pitch when using email as a marketing strategy. Any of those emails are fair game to the evil delete key if the subject line is not creative. We all do it. 

It’s different when you need help or if you’re making an offer to volunteer that requires no compensation or sales agreement. 

And it’s completely different when patient correspondence is involved! 

However, far too many organizations in healthcare, and every other industry for that matter, have an institutionalized culture of communications lethargy or ghosting which in many cases stems from the top. The problem is that senior leadership always gets quick responses, simply because they have authority. To them ghosting is, no pun intended, invisible. However, as you weave your way through the hierarchies and line staff we see the pyramid of lethargy expanding with some exceptions of highly communicative team members. 

I’ve studied dozens of causes of burnout at the clinical, leadership, and patient levels. Many of them are obviously given the stressors of the modern healthcare enterprise. But communication lethargy is more subtle, and I would argue an endemic problem that results in some very observable negative outcomes. 

One of my academic colleagues offered that one of the causes is in part the result of pop culture given the proliferation of ghosting on dating apps. His view is that in certain generational demographics, ghosting has become normalized and in some ways evolved into a “silent” form of communication. More jolting was his feeling that prompt responses may be something that occurred in “your father’s company” but not in 2024! 

Further, the remote workforce has had a massive effect on enterprise ghosting because you no longer get to look the counterparts directly in their eyes in an office, and zoom filters interpersonal interactions, especially on group calls.

However at the risk of overdramatizing, just like Elisabeth Kübler-Ross’s  Stages of Death and Dying, I would argue that ghosting has the same progression and damaging emotional effects of its own. 

Let me cover a few of what may be referred to as Cutitta’s “Stages of Ghosting and Communications Lethargy.” 

• Anxiety — Could my email about improving a certain process in the healthcare enterprise be viewed as being a complainer? I begin to worry.
• Confusion — My boss says s(he) has an open door policy but despite sending a concern two weeks ago I haven’t heard anything. I begin to worry even more.
• Fear — Does my role in the enterprise pecking order no longer warrant a prompt response from management or from colleagues? I’m starting to lose sleep mulling over my correspondence.
• Distrust — You trusted me to help you through a difficult situation but now I can’t trust you to reciprocate. I’m starting to get angry.
• Anger — There is simply no reason for no response at all, no one is too busy to simply say I’m underwater and I’ll get back to you. I’m getting really pissed!
• Isolation — I’m increasingly feeling lonely. Yes, I have colleagues who do communicate with me but the ones I need to communicate with don’t respond. It’s like being put on hold when dialing 911. 

So what can healthcare leaders do to create a culture of prompt yet efficient communications? 

First, at risk of sounding like “your father’s company,” set a policy that all emails or calls will be answered within 24 hours unless one is on leave or vacation. This does not mean writing a missive in response to the correspondence, but it does require some form of immediate response simply to say “I got your message”. 

Unless one literally does not have access to email, responses should not be an automated “Out of Office” notification. In my opinion, these notifications create the illusion of timely communication, when they are nothing more than contributors to human communications lethargy. 

Senior management needs to consistently set an example by showing signs of over-communication, especially during times of stress, turmoil, or crisis management. To that end, there needs to be a “communications commandment” of sorts that is baked into the corporate values. I’ve worked with companies that have these posted on their employee dining rooms to that they are not something done by HR that never sees the light of day. 

Reward those who show exemplary communications and response skills so that employees can visualize the value of these efforts. In some organizations it’s worthwhile having patients, colleagues, or customers be part of the awards process. 

In all fairness, the originator of the communication must also look closely at their communications style. Is the “signal-to-noise ratio” out of alignment? Does the correspondence look like a manifesto rather than constructive interpersonal communication? Many organizations do in-service training specifically on communications style and timeliness. While these courses can be done online, I highly recommend they be done among real live co-workers for maximum effect and interactivity. 

Finally, most research shows that one of the most profound causes of burnout is a feeling of lack of worth in the healthcare enterprise: “I simply don’t know that I’m contributing in some meaningful way, especially during a period of stress and turmoil in the workforce.”

If senior management does not communicate this sense of worth, the employees will increasingly reach out to their superiors diplomatically to get that confirmation. Said management must be intuitive enough to sense that the workforce will need this moral support. 

Those who ignore it will do so at their own peril and experience the pain of losing valuable workers at a time of already extreme shortages.