In recent years, the term ‘clinician burnout’ has become a core part of the healthcare IT vernacular. For care providers, it’s a battle cry; for CIOs, CMIOs and other leaders, it’s a constant reminder the technologies that were designed to improve processes are often perceived as having the opposite effect.
“It’s an uphill battle,” said Peter Canning, MD, Medical Director of Informatics at Asante Health Systems. “Any technology or IT workflow that gets in the way of efficient patient care is going to lead to some form of burnout.”
The primary culprit? EHRs, he said during a recent webinar. “They remain incredibly navigation-heavy, oftentimes with cluttered interfaces and frequent, intrusive alerts” that can diminish the quality of patient interactions. “We’re experiencing death by 10,000 clicks.”
What’s worse is that encounters are often interrupted by non-urgent notifications, which only amplifies the dissatisfaction. “Doctors and nurses want to be in front of patients,” said Jose Barreau, MD, CEO at Halo Health, who also spoke on the panel, along with Shafiq Rab, MD, Chief Digital Officer & System CIO, Wellforce. Therefore, “it’s important to get the pain solved. The number one thing is taking care of patients, and taking care of the people who are taking care of patients. That’s why we exist.”
Once leaders can pinpoint the key sources of frustration, they can take the necessary steps to alleviate them. Assessing burnout, however, has proven more difficult than expected, according to the panelists. Below are some of the best practices they shared for how CIOs, CMIOs, and others can obtain an accurate pulse of where users stand.
- Walk the floor. The first thing his team does with a new customer is to walk the floors, said Barreau. “Just by doing that, we learn so much,” including how many alerts nurses receive, and from where they originate. “You can get a really good sense of what somebody’s shift looks like in terms of alert fatigue, interruptions, and those types of things,” he added, and it doesn’t take very long. “If you spend five minutes with a nurse or doctor, you’ll know where the pain is coming from.”
- Talk to practice managers. Although surveys have traditionally been used to sniff out problems, Canning advised against it. Instead, he recommended forming relationships with practice managers and medical directors. “They tend to know their groups pretty well, and can usually give you a sense of who they think may be struggling with burnout.”
- Utilize training teams. Canning also relies on EHR training teams, who can offer “a wellspring of information,” he noted. “They’re out in the clinics and they get to know these providers incredibly well. They know who is struggling,” and can relay that information.
- Establish councils. At Asante, providers are invited to join the clinical advisory councils that have been set up — one for acute and one for ambulatory care — to hear about the organization’s strategy and offer input. “Having a robust group of provider informaticists who can weigh in and help facilitate those changes and reach out to their colleagues is really powerful,” Canning said.
- Look at metrics. Another method is to utilize event reporting to identify problematic behaviors such as workarounds, which can lead to errors. “If you dive into your event reporting, you will very oftentimes find patterns of behavior among certain providers,” he noted. “And it’s not because they don’t care; it’s that they’re burned out. They’re tired of all the clicks and the work it takes to do things the correct way.” However, by detecting these activities early, leaders can “reevaluate workflows and see if there’s a better way.”
Last, but certainly not least, Rab urged attendees to keep an eye out for providers who appear to be depressed or have decreased energy, which can often signal burnout. “When physicians get trained, we are taught that the patient comes first, and we’re taught to never show weakness,” he said. The onus falls on leaders to be aware of the stress facing healthcare professionals, and work to create a healthy working environment.
According to the panelists — all of whom are physicians — one of the biggest issues in alleviating burnout is the fact that many providers feel “powerless,” noted Canning. “They don’t feel like they have a voice in the decision-making process.”
Clearly that needs to change, but it won’t happen overnight, said Rab, who believes that empowering clinicians is a process. And the first step is to go beyond simply inviting clinicians to participate in committees. “If you truly want to listen to caregivers, then it should be their committee and their decision,” he said. “They should be in control.”
Canning agreed, noting that the conversations should be driven by frontline providers, rather than IT leaders. “It’s a good way to disseminate information. We hear their main concerns and we can work with our technical teams to see what we can change within our system, but they’re able to diffuse that information into their own groups.”
There are, of course, other ways to communicate information, such as emails, newsletters, and old-fashioned word of mouth. “We try to use multiple pathways to constantly send out information about what’s coming and what we’re working on,” he said. “We want providers to know that we hear their concerns and we’re doing our best.”
This, according to Barreau, is where leadership can play a pivotal role.
“When you have great leaders in these health systems who take the bull by the horns, and aren’t afraid to make hard decisions instead of letting point solutions and prompts pop up everywhere, that’s what I’ve seen be the most successful.”
The bottom line? Providers, like anyone, want to feel heard — and not just by anyone, but by those who have the power to improve the situation. “If people know you’re working on a problem, even though you haven’t solved it yet, they feel good. And if they feel like they have strong leadership that’s listening to them, it can go a long way.”
To view the archive of this webinar — Optimizing Clinician-Facing Applications to Reduce Burnout (Sponsored by Halo Health) — please click here.