- Addressing clinician burnout was an urgent task for hospitals before the COVID-19 pandemic and has become even more critical since.
- Strategies to boost clinician well-being require the right kind of organizational infrastructure.
- Another key is to tailor interventions to the specific needs of teams.
As metrics continue to show significant rates of clinician burnout, mitigation strategies are becoming increasingly vital for hospitals to design and implement.
In a Medscape survey of 12,339 physicians, 42% felt burned out during the second half of 2020. Of physicians who reported dealing with burnout, 79% said the problem started before the COVID-19 pandemic. The most frequently cited source of burnout was “Too many bureaucratic tasks” (58%).
The pervasiveness of the burnout epidemic makes clear that the root of the problem is neither innate to certain individuals nor specific to the pandemic, said Elisa Arespacochaga, MBA, vice president of the American Hospital Association (AHA) Physician Alliance. Rather, the issue is with the U.S. healthcare delivery system more broadly and, even beyond that, with a society that values “busyness.”
“This is obviously not a personal issue. This is a system issue,” Arespacochaga said. “We can’t fix it [by] waiting for the system to change. We have people who are burned out right now that we have to help.”
The pandemic certainly has brought additional sources of stress for many clinicians, Arespacochaga said, including seeing more episodes of death and suffering up close and having to serve as “surrogate family members” for patients because of restrictions on visitors.
A playbook for a healthier clinical workforce
Risk of burnout correlates to six domains of “work life,” Arespacochaga said, citing the work of social psychologist Christina Maslach, PhD. The domains are:
Arespacochaga discussed steps to address those domains and promote organizational well-being during a webinar hosted by the AHA Physician Alliance earlier this year. As described in the alliance’s Well-Being Playbook, some common best practices have emerged.
1. Create infrastructure for well-being. “If you don’t have an infrastructure of some sort to make it easy to do the right thing, people are going to revert,” Arespacochaga said.
She cited the example of Rochester, N.Y.-based UR Medicine, where all process improvement efforts that apply to patient experience and clinician well-being are coordinated within the organization’s newly implemented well-being infrastructure.
One key was that the health system didn’t need to create a whole new infrastructure, she said, but instead incorporated it into ongoing quality improvement efforts. That approach made sense given the clear connection between clinician well-being and patient outcomes.
“In those places where you can take advantage of an infrastructure that exists, you can help support this work,” Arespacochaga said.
2. Engage your team. This step may be the most important of all, Arespacochaga said.
“Ask the people doing the work,” she said. “They usually know exactly where the problem is. They probably already have thought about solutions.”
Interventions have a much better chance of succeeding if they are tailored to the specific needs of teams.
“The most effective way to address burnout and improve well-being is to really look at what your own teams need,” she said. “For each [clinician], a different thing is going to be the thing that gives you hope, that revitalizes you, puts a little bit more gas in your tank so that you can go back and continue to do your work. There’s no magic bullet to this.”
3. Measure well-being. “As you design interventions, you need to understand how the individual interventions are helping or not helping, and then have a baseline that you’re monitoring,” Arespacochaga said.
One challenge with conducting well-being surveys, she said, is the need to account for lagging indicators. “Things are going to take a while to show up. So understand how you can do milestone measurement and really understand where the individual activities are.”
4. Design interventions. When Atlantic Medical Group in New Jersey installed a new EHR, the organization realized general educational sessions wouldn’t suffice because challenges varied from one clinician to the next.
Instead, users were presented with a menu of potential bottlenecks and other challenges. They could select the specific issues they were encountering and receive customized assistance rather than attending a general session that would include information they didn’t need.
The approach was about “really trying to fix the problem that needed fixing and not the one that didn’t. By doing so, they actually got much more engagement in their EHR and folks felt like they were empowered to use it as a tool,” Arespacochaga said.
5. Implement programs. A pilot-testing approach is advisable to try out well-being initiatives, and the initiatives that get tested should align with operational priorities. The pilot group should be composed of clinicians who are willing and eager to participate.
6. Evaluate program impact. The evaluation should incorporate metrics that cover both processes (e.g., perception of control over workflow) and the outcomes of the pilot program. Post-event surveys that include open-ended questions are effective ways to assess impact.
7. Create sustainable culture. Establishing and maintaining organizational well-being can’t be either a top-down or bottom-up activity. “It’s got to be both,” Arespacochaga said.
“All of this work is cultural,” she said. “It’s going to take time to really shift. There are a lot of incremental things you can do along the way that can help give you hope and support, but it will take time. And don’t think you’re finishing that by Q2 of 2021. It will take some time, but you can get there.”