• A Three-Pronged Approach for Tackling Physician Burnout

    Steven Strongwater, MD Feb 27, 2018

    Steven StrongwaterPhysician burnout is rightfully gaining attention as a public health crisis that requires urgent action from healthcare organizations across the country. Currently more than half of physicians in the United States show signs of burnout, putting their health—and potentially the health of their patients—at risk. 

    Last spring, I joined 10 CEOs of leading healthcare organizations in authoring a call to action in Health Affairs, encouraging our colleagues to take several steps toward addressing physician burnout and reducing its occurrence. As part of this effort, we made a commitment to tackling this issue head-on within our own organizations. 

    At Atrius Health, returning joy to the practice of medicine is a key strategy in our mission to provide compassionate and high-quality care to our 720,000 patients. In doing so, we focus on three components that are aimed at ensuring physician well-being: improving practice efficiency across our 32 clinical locations, fostering a culture of wellness for our 900 physicians and over 300 advanced practice clinicians, and promoting personal resilience among our providers.  

    Practice Efficiency 

    Improving practice efficiency is the most important first step to addressing physician burnout in healthcare organizations. Changes in today’s healthcare system have increased performance expectations related to quality, cost, and patient experience, often placing a significant burden on clinicians. 

    Particularly in primary care, many physicians today typically spend one to two hours of their personal time at night completing electronic medical record (EMR) documentation. To address the EMR burden at Atrius Health, we have deployed a series of IT improvements that are designed to reduce the number of clicks per patient encounter (e.g., wide-screen displays, electronic refills of controlled substances) while working to automate previously labor-intensive tasks through voice activation and natural-language processing. In doing so, we expect to eliminate 1.5 million clicks in the EMR per year, allowing our physicians to spend more face-to-face time with their patients. 

    We’re also reducing clutter in physician inboxes by triaging lower-priority notes to folders that another staff member can handle and eliminating duplicate messages that can also cause needed care to fall through the cracks. In addition, physicians have the option to pay for scribes who can assist with documentation and free up physicians’ time to focus on other patient matters. Furthermore, we are launching a program to engage clinicians in identifying and addressing burnout drivers at their specific locations. 

    Another component of improved efficiency involves empowering all clinicians to practice at “top of license,” which enhances nursing and support roles as part of a team-based approach to care. We’re also working to routinize core processes such as patient rooming, prescription refills, referrals, patient onboarding, and chronic disease management. 

    Culture of Wellness

    To improve the overall well-being of our physician workforce, Atrius Health is facilitating a paradigm shift toward a culture of wellness and away from the outdated “physician who does it all” way of thinking. We encourage our physicians to extend to themselves and their colleagues the same natural compassion they show their patients. 

    To foster this culture, we are changing our annual review processes to engage in more reflective conversations rather than focus on traditional metrics and performance criteria. In these conversations, our physicians and practice chiefs can discuss individual professional growth and core well-being as a focus of the review. 

    Physicians value a good relationship with their patients, and research has found that communications training that improves physician empathy also decreases burnout. In 2016, we created and implemented empathy forums—facilitated discussions and training to help clinicians convey empathy to our patients—for 4,000 medical practice employees. We also are working to expand teaching, learning, and research opportunities through our Academic Institute in an effort to rekindle the intellectual and social ties that knit together a community of physicians. 

    Personal Resilience

    While strides in physician well-being are driven by organizational and cultural factors, Atrius Health also recognizes the importance of individual efforts—for example, self-care strategies such as getting optimal nutrition, exercise, and sleep—toward improving personal resilience. We have launched a coaching program for individuals to build the skills, behaviors, and attitudes that contribute to well-being and prevention of burnout. 

    Thirty primary care and specialty physicians are currently enrolled in individual coaching to help improve clinician day-to-day activities. This spring, we are also planning a two-day wellness retreat for physicians and advanced practice clinicians to discuss nutrition, exercise and fitness, rest, and mindfulness. 

    A Worthy Goal

    Institutional changes to prevent burnout will take time and investment, but they are well worth the effort and crucial to the future of our healthcare system. They are also within our reach.

    At a minimum, committing to measuring and tracking improvement and identifying at-risk clinicians are essential. Deploying both system-level and personalized interventions will positively impact burnout. Understanding what is meaningful to clinicians and finding ways to enable these activities will help. 

    Providing care is a team-based endeavor—and solving one of the most pressing issues facing our industry’s workforce will be no different. By collaborating with our colleagues across the country and sharing best practices, we can tackle burnout and return joy to medicine. 

    Steven Strongwater, MD, is president and CEO of Atrius Health, Newton, Mass. 

    Read more from the Leadership Blog, including a previous post from Steven Strongwater in which he and a colleague discuss the Care in Place program at Atrius Health.