'We need to fix the structural problems' — 3 no-cost tools to cut workplace friction

When a practice's staff is exhausted, leaders often reach for pizza, yoga classes or resilience training.

Those are the wrong tools for the job, said Terra Bruns, DBA, author of "The Buffer Effect: How to Escape the Hero Trap and Become a Systemic Leader."

"We need to fix the structural problems, not teach them [workers] to deal with them," Bruns said in her presentation, "The Biology of Burnout: Why 'Self-Care' Can't Fix a Structural Problem," at the Medical Group Management Association (MGMA) 2026 Annual Conference.

A former nurse whose clinical career ended with a back injury, Bruns later owned and operated five companies and now teaches biology and chemistry. She continues work as a scientist, educator and organizational strategist.

What are practices doing about burnout?

In a live poll, 44% of attendees said pizza parties were their organization's most common response to staff burnout. Another 24% said staff are asked to push through, 13% pointed to mindfulness or yoga, and 12% said their organization was making structural workflow changes.

Bruns said self-care has its place, but it cannot repair broken processes. Telling an exhausted employee to be more resilient sends the wrong message. "What are we really doing? We're gaslighting them, right?" she said.

There is a gap between what an organization demands and what people can physically deliver, what Bruns calls the "vertical fissure." Constant demands keep the body's stress response — the hypothalamic-pituitary-adrenal (HPA) axis — switched on. Bruns compared it to being chased by a tiger.

"That tiger is chasing them, and they will win. Just a matter of time," she said.

Leaders aren't indifferent, she said. "It's not that the C-suite or the admin or the leaders don't care," Bruns said. But decisions made from spreadsheets often miss what happens on the front line.

How can leaders reduce friction without spending money?

Bruns offered three tools she said require no budget and no executive sign-off.

• The "context wrapper."

Instead of sending a memo that says "Get it done today," leaders should explain what the task is for, why it matters and what happens if it doesn't get done. She urged attendees to drop "ASAP" from their vocabulary entirely.

"Begin with the why. They buy in," she said. "They buy in when they know why they're doing something, a lot more than if they're just mandated to do something, right?"

• The "capacity ledger."

Every employee has a fixed number of hours in a shift, so new demands have to replace old ones.

"So the capacity ledger is a very simple rule of one in, one out," Bruns said. "If you ask a team to do something in an email, in a memo, in a mandate, what are you also taking out?"

That might mean dropping a weekly meeting or a routine task that no one has questioned in years. Telling staff up front what they won't have to do changes how a new request lands, she said.

"Everyone can take a collective breath, right?" Bruns said.

What is a frontline friction audit?

Bruns called the third tool the most important. In a frontline friction audit, a leader spends two to three hours working alongside team members to see where processes break down.

"It's not going to cost you any money. It's going to save you money, and it's going to build morale," Bruns said.

That could include software that forces staff to click through screens to find a medication or to enter the same patient information in several places.

"I call it death by 1,000 clicks," Bruns said.

Staff notice the effort, she said. Walking the floor lets leaders hear about problems firsthand instead of through frustrated emails, and fix them early.

The audit should produce three things, she said:

• A specific description of the stressor.
• What it costs staff in time and physiological strain.
• What leadership can concretely remove.

Why does it matter for retention?

Bruns said the employees most at risk are often the most dependable ones, whom she personifies as "Nurse Jenny," the people who skip lunch to keep patients moving or sit on hold with IT. She described them as a buffer for broken systems, absorbing problems until they leave.

Bruns said that over two years of teaching the context wrapper, she estimates it has kept at least 200 employees from leaving their jobs.

When leaders take the time to see that work firsthand, she said, the payoff is loyalty.

"You do that, and they're not leaving. They're supported. They're seen. They're heard," Bruns said.