One physician practice is seeking to counter both external factors and internal characteristics of  clinicians that may contribute to burnout.

Nov. 9—Healthcare researchers and employers are increasingly focused on burnout—usually affecting physicians—and are finding some practical ways to reduce it.

One anti-burnout approach is to encourage physicians to drop their habit of maintaining a permanent “perfection mode,” said Tom Jenike, MD, senior vice president of Novant Health, a North Carolina-based medical group.

 “What we’re asking them to be is versatile” and to drop perfectionist tendencies when they are off from work, Jenike said during an Alliance for Health Policy briefing in Washington, D.C. The hope is that by reducing the energy they expend seeking perfection during their non-work hours, physicians may reduce their overall exhaustion.

Such efforts are needed, said Robert McNellis, senior adviser for primary care at the Agency for Healthcare Research and Quality (AHRQ). Burnout affects 25 percent of physicians and 20 percent of nurse practitioners and physician assistants, according to AHRQ-funded research.

A common culprit of burnout, as cited by physicians, is electronic health records (EHRs).

“There is no going back [on EHR use], we get that,” Jenike said. But organizations need to reduce the time involved and the mental burden on physicians through practical steps, like greater use of medical scribes.

Since 2001, AHRQ has been funding research on physicians’ working conditions to determine what causes burnout and to explore interventions that can combat it.

AHRQ-funded studies have found that stress levels for primary care providers initially worsen with the adoption of EHRs, before improving—but never return to pre-EHR levels.

Some primary care offices curb burnout by emphasizing communication among their staff, promoting a culture of quality rather than focusing on the number of patients seen, and targeting the hectic office environment for quality improvements. AHRQ’s TeamSTEPPS program provides guidance on that last approach.

One Provider’s Effort

Over the last five years, Novant has battled burnout with efforts that aim to counter both external factors and issues stemming from the internal characteristics of clinicians.

“We’re going to confront and admit that the changes [in health care] are not going to stop happening, so if we’re just going to try to damp down the changes in hopes that it makes you feel a little bit better, we know that the next change is going to happen,” Jenike said.

Novant’s approach includes guiding physicians to examine their own thought patterns to identify how they feel about the ongoing change and how it affects the way they experience their work, and to understand that as physicians they may have a tendency to drive their own “hamster wheel.”

“We want people to stop and look at what is their own contribution to their own burnout,” Jenike said. “You would think that would be met with a lot of resistance and hostility, and, ‘Oh, you’re blaming me?’ But what we find is that people feel a new sense of meaning, they can reconnect with why they went into health care, they can now find things that recharge and restore them outside of the healthcare world, and we’re building communities of physicians who are looking out for each other.”

The approach has helped physicians and led them to become participants in helping also to mitigate the external forces fueling burnout, Jenike said.

Novant also has gotten good results from expanding the anti-burnout approach to advanced practice clinicians and nurses.

Team-Based Approach

Healthcare organizations also can combat physician burnout by moving toward team-based care.

“It really does help lessen that burden,” said Ann Greiner, president and CEO of the Patient-Centered Primary Care Collaborative. “We all want change in the system, and that means we’ve all got to do this collectively and it’s no one person’s job. It really can help when people feel like they are not in it alone.”

Even though team-based care may be able to lift mental burdens on physicians, physicians are usually the chief obstacle to implementing it, Jenike said.

“Even though it’s the best thing for them, they have a mindset for control,” Jenike said. “They may have to grapple with it for a little bit because it’s been that way for so long.”

One challenge to moving toward team-based care is that physicians may not know how to operate in that environment. Keys to team-based care include relationship building, good communication, and accountability, said McNellis of AHRQ.

Another obstacle is the lack of education and training that clinicians receive on team-based care.

“By and large, health professionals are trained in their silos, and then we ask them to go work in a team,” Greiner said. “Well, they don’t know how to work in a team.”

Among the approaches that can encourage team-based care is to get team members to identify their core competencies, McNellis said. During medical training, another effective approach is having various types of clinicians work together in a student-run clinic.

“And then you can see how that plays out with shared responsibilities,” McNellis said.

Another area where more training is needed is in “quality improvement science,” or how clinicians can best use the detailed data that is newly available via EHRs, Greiner said. Such training may also improve their outlook on the use of time-intensive EHR systems.

“I see the quality improvement science as really just a crucial piece of what we need to do to help professionals be prepared for this new world we’re in,” Greiner said.

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Thursday, November 09, 2017