How Health Execs Can Take Charge of Provider Burnout

Christine K. Cassel, MD

Physician burnout is a major problem and addressing the epidemic requires systemic changes by healthcare organizations, educational institutions, and all levels of government, according to a new report from the National Academy of Medicine.

Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being outlines six goals that these stakeholders should pursue to prevent and mitigate clinician burnout and foster professional well-being.

Recent studies show between one-third and a half of clinicians report experiencing emotional exhaustion, depersonalization and lack of sense of professional accomplishment: the three major characteristics of burnout, according to Christine K. Cassel, MD, senior advisor for strategy and policy, department of medicine, University of California San Francisco, and co-chair of the committee that wrote the report.

“It is a problem associated with the workplace, not a mental health diagnosis,” Cassel says. “It has consequences both for clinicians and for patients, with studies showing negative impact on quality of care and on patient experience.”  

Burnout is created by inefficient systems of care, where the resources available do not match the requirements of the clinician’s job, according to Cassel. “Many complex interacting factors play a role, at the level of the front-line care delivery, the healthcare system and the external environment,” she says. “Healthcare executives’ leadership is necessary to spur the awareness, the innovation and the culture changes required to address most of the causal factors. Burnout and its human effects on clinicians and on patients is a moral issue, but it is also a financial issue.”

The Harvard Business Review estimates that burnout costs the healthcare system $4.6 billion per year. 

Related: What Physicians Want To Reduce Burnout

There are methods that health systems can use to achieve accurate data about the extent of burnout in the organization, according to Cassel.

• Healthcare systems should use validated instruments to monitor clinician burnout in their systems, and do so in such a way that is non-punitive, anonymous, and does not add additional burdens of measurement and documentation.

“Leaders and managers should consider these reports part of their top line information for running a high-quality healthcare system,” she says. “A senior executive should be responsible for the data and the response to it. Board should receive regular reports on clinician wellbeing/burnout.”

•  There is a paucity of major research on interventions at the system level in healthcare, but useful lessons can be drawn from the human factors and systems engineering literature.  “More intervention research is needed,” Cassel says.

Burnout is as big a problem among students as it is in clinicians, according to the report.

“Some of the causal factors are specific to the learning environment so professional schools and academic health centers also have major opportunities and an urgent need for improvement,” she says.  “While personal characteristics can enhance resilience in a dysfunctional system, personal characteristics alone cannot begin to address the problem. Most clinicians are motivated by higher values of patient care, and many experience moral distress from the daily conflict between what they know they should be doing for their patients and what they actually can deliver given the obligations and constraints of their system.”

Rodrigo Martinez, MD, chief clinical officer of TransformativeMed, says that one of the major factors contributing to burnout is the lack of sensitivity to clinicians’ work flow needs when designing software. “Reducing this workflow friction would go a long way towards decreasing stress,” he says. “Clinicians are trained to identify pertinent positives and negatives, and current designs can overwhelm the end user with extraneous information. Reducing cognitive burden and streamlining manual effort enable more rapid assessments of patient needs and decrease the time needed to take appropriate actions.”
There are six goals that healthcare organizations should pursue to help combat clinician burnout:

• Create positive work environments. Healthcare executives should commit to, and be accountable for, creating a work environment that promotes high-quality care, job satisfaction, and social support, says the report.

• Address burnout in training and at the early career stage. Clinicians often experience burnout early in professional development. The report recommends that schools of health professions alleviate major sources of stress by monitoring workload, implementing pass-fail grading, improving access to scholarships and affordable loans, and building new loan repayment systems.

• Reduce tasks that do not improve patient care. Federal agencies, state legislatures, and other standard-setting entities should identify and address the sources of clinician burnout related to laws, regulations, and policies, eliminating those that contribute little or no value to patient care.

• Improve usability and relevance of health IT. Health IT, including electronic health records, should be as user-friendly and easy to operate as possible to reduce burnout, the report says. Health IT vendors and healthcare organizations should deploy technologies to reduce documentation demands and automate non-essential tasks. In addition, federal policymakers and private sector health IT companies should collaborate to develop the infrastructure and processes that enable shared decision-making between clinicians and patients.

• Reduce stigma and improve burnout recovery services. Many clinicians do not report burnout because they fear the potential consequences, including loss of licensure. In order to eliminate the stigma of getting help and to promote recovery and well-being, the report recommends that state legislative bodies facilitate access to employee assistance programs, peer support programs, and mental health providers without the information being admissible in malpractice litigation.

• Create a national research agenda on clinician well-being. By the end of 2020, federal agencies-including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, the Health Resources and Services Administration, and the U.S. Department of Veterans Affairs-should develop a coordinated research agenda on clinician burnout, says the report. Research priorities should include identifying the drivers of burnout across career and life stages for different types of clinicians; burnout’s implications for the workforce as well as patient safety outcomes; and potential systems-level interventions to improve clinician and learner well-being.

“The National Institute of Medicine’s goals 3 and 4-reducing tasks that do not improve patient care and improving the usability and relevance of health IT-are critically important and closely aligned,” said Jay Anders, MD, chief medical officer of Medicomp Systems. “With the burden that EHRs have placed on clinicians that has fueled high rates of stress and burnout, the key will be to leverage other types of follow-on health IT that help, instead of hurt, work flows and efficiency so that they can focus on the reason they got into medicine to begin with: Patient care. To do that, health IT solutions must give clinicians ready access to the actionable information they need at the point of care for sound clinical decision making. That information must be quickly and easily accessible-and structured in the way that clinicians think and work.”