Sailing Through Burnout: What Healthcare Can Learn from Cruise Ships

David Epstein, MD, MS, FAAP discusses the observations of how operations on a cruise ship may help the battle against fatigue and burnout in healthcare.

August 5, 2023

Cruising and Customer Service: A Surprising Encounter


While enjoying a vacation on a cruise ship, I was struck by the level of customer service and engagement by the staff.


Since most of the activity centers around eating on the ship at the various restaurants and the buffet, I took particular notice of the waitstaff.


Never a moment passed that was not punctuated by smiles from the staff and a greeting of “Good morning!” or “Enjoy your meal!”.


I understand the importance of customer service in the cruise industry, but I also understand how grueling the work hours are on the ships.


Yet, the staff maintained a very upbeat, approachable, engaging demeanor throughout the entirety of the cruise.


Drawing Parallels: Cruise Industry vs. Healthcare


As a physician, I couldn’t help but reflect on how burnout and fatigue have plagued the healthcare industry due to the work, compensation, satisfaction, and other variables that healthcare providers encounter.


But, how does this relate to work on a cruise ship?


While the cruise business and healthcare are different in many ways, they are both service industries.


One deals with the stresses of health and illness and the other deals with the stresses of managing the expectations of a well-orchestrated vacation.


Nevertheless, the staff in both industries work extremely hard and are confronted with environments that are quite physically and emotionally taxing.


So, knowing healthcare and observing how the cruise staff behaved, I asked myself, “How does the cruise staff maintain such enthusiasm, friendliness, and energy so consistently?” and “Don’t they burn out from doing the same thing, day in and day out?”


While the actual work on the ship is a major factor in considering how to maintain the staff and create a hospitable environment for the guest passengers, it is not the only thing to consider.
"I asked myself, “How does the cruise staff maintain such enthusiasm, friendliness, and energy so consistently?”"
- David Epstein, MD, MS, FAAP

Work at Sea


With regards to the work on the ship, it really is something to behold.


The staff does have adequate downtime to rest and take breaks, but they work almost every day.


The length of the individual cruises varies being a few days to weeks in duration.


The staff often starts work early in the morning and labor into the evening. And, when a particular cruise trip is completed, they quickly ready the ship for the next group of passengers later, the same day, after the last group left.


So, it almost doesn’t matter the length of the cruise because the entire staff works constantly to maintain the services on the ship as long as there are passengers on the ship.


There are other variables involved in the complexity of leading the staff on the ship. While the staff works on the ship, they actually live on the ship for months at a time.


Furthermore, the staff on the ship is extremely diverse. They represent many countries around the world and many different cultures and languages as well.


Finally, as many employees as there are on the ship, there are as many different personal goals and aspirations.


The cruise ship really exemplifies the idea of diversity and presents a particularly complex case example of the need for leadership flexibility.



Unraveling the Mystery: How Cruise Staff Stay Energetic and Engaging


Returning to my original questions, “How does the cruise staff maintain such enthusiasm, friendliness, and energy so consistently?” and “Don’t they burn out from doing the same thing, day in and day out?”, I needed to speak with someone on the ship and this led me to search for the director of hospitality to satisfy my curiosity.


After finding out who the director of hospitality was on the ship, I made a quick phone call. I was surprised at how willing the director was to share her perspective on their approach to staff well-being, customer service, and burnout while dealing with the ship’s rigorous work schedule and daily routines.
She had some very insightful and well-thought-out, deliberate strategies for leading her staff to reduce the strains of the job and keep the staff engaged and enthusiastic.




The first thing that she mentioned was that they emphasized the concept of a team.


They work with each other for months at a time. But, it is not only a place where they work. They also live with each other.


So, it is imperative to support one another and create a place where everyone wants to be and feels respected.


Mutual respect and building trust are key precepts to their program and a culture is built around putting people first, so the team develops a sense of belonging in their environment.




Putting people first applies to the staff and the clients as well.


With this emphasis on ultimate customer service, the leadership looks to things that the staff does right in this regard.


Recognition programs are set up by the leadership to identify crew members who do things well.


Crew members are not only recognized and rewarded by management but also by their peers and guest feedback.


Every effort is placed on catching crew members doing the right things and being rewarded to get buy-in to the mission of the company and create a healthy, supportive culture amongst the staff on the ship.


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The opportunity for career advancement is an important motivation for the staff to excel in their work as well.


There are trainings to help the staff learn and develop in their area of interest on the ship.


Also, the leaders on the vessel are always with their team and easily accessible to help the staff grow and learn as they go, as well as improve on the things that don’t go so well. ‘


There is an emphasis on learning from each other as well because there are many people from many different backgrounds with their own experiences and expertise.




The differences within the crew are celebrated.


An important aspect of working with such varying cultures, experiences, motivations, languages, and other aspects is learning the teams’ needs.


The leaders investigate and find out what the staff needs to be successful in their jobs.


This changes as the crew changes. The leaders of the ship recognize the power of diversity and really try to take advantage of the wealth of knowledge and experience from their crew that represents so many countries throughout the world.


The leadership emphasizes referring to the crew on how to make the ship a better place because of their diverse backgrounds and because of their constant interactions with the diverse group of guests that arrive and depart from the ship so frequently.


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While the interactions with individuals vary due to the diversity of the crew and the guests that travel, the tasks and procedures that need to be performed to keep the ship running can become very mundane and routine.


So, there is also an emphasis on breaking the routine at times and doing things a little differently to keep the creativity and enthusiasm of the team.


Work meetings occasionally take place in the town where the ship docks for a brief change in scenery.


Furthermore, events are planned for the crew to celebrate cultural festivals recognized by the culturally diverse crew.


Every effort is made to break the monotony and give the crew something to look forward to.



Translating Lesson Across Industries: Applying Cruise Strategies to Healthcare


While a ship and a hospital are two very different settings, the common denominator is people.


People are people and they pretty much respond to similar things in any work environment.


The lessons that I learned from the director of hospitality on a vacation vessel are lessons that can be applied to a medical team as well.


While there are other variables in the medical system that may need to be considered, the lessons of building a supportive, respectful, diverse, and celebratory culture aboard a cruise ship, where staff maintain unwavering enthusiasm and friendliness despite the daily grind, serve as a remarkable blueprint that transcends industries.


Applying these principles in healthcare could unlock the potential to foster a vibrant, engaged, and resilient medical team, ensuring top-notch patient care while safeguarding against burnout and fatigue.


Are there other industries from which the medical field can borrow strategies to prevent burnout and fatigue? If so, which industries and what strategies can be adopted?

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. For more information, or to submit your own opinion, please see our submission guidelines or email opmed@doximity.com. Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.

All opinions published on SomeDocs-Mag are the author’s and do not reflect the official position of SoMeDocs, its staff, editors. SoMeDocs is a magazine built with the safety of free expression and diverse perspectives in mind. Do you have a compelling personal story you’d like to see published on SoMeDocs? Submit your own article now here.


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