Extinguish Physician and Nurse Burnout: How Health IT Can Help Clinicians Love Their Jobs Again
October 04, 2017
Physician burnout is a hot term in healthcare right now, but it’s much more than a buzzword: It’s a massive issue. A letter written by CEOs of some of the top health systems in the country asserts that burnout is becoming a “national public health crisis.” More than half of 14,000 doctors surveyed in 2017 said they experienced burnout—an increase of 25 percent in just four years. Top reasons for burnout included too many bureaucratic tasks, spending too many hours at work, feeling like just a cog in a wheel, and increased computerization of practice.
Physicians aren’t the only ones experiencing burnout: Over a third of nurses reported being burned out as well. Doctors and nurses alike are working longer shifts, caring for more patients, and completing more documentation for those patients. This all happens while being intensely scrutinized and measured, adapting to new technology, and generally feeling like they have less control over practicing medicine.
In an effort to raise awareness about physician and nurse burnout during National Health IT Week, we will explore what burnout means for caregivers, hospitals, and patients; detail technology’s role in burnout; and most importantly, share how health IT can actually help reduce and prevent burnout to help physicians and nurses love their jobs again.
The Symptoms of Burnout
We’ve discussed several of the reported causes of burnout, but what does burnout look like? How can you tell if your staff or your colleagues are experiencing burnout? The leading measure of burnout for more than 25 years, the Maslach Burnout Inventory (MBI), has been adapted for medical personnel. The survey addresses three scales:
- Emotional Exhaustion: measures feelings of being emotionally overextended and exhausted by one's work. This could range from feeling consistently anxious and stressed to clinically depressed.
- Depersonalization: measures an unfeeling and impersonal response toward patients. This could be illustrated by “cynicism, sarcasm, and the need to vent about your patients or your job,” and has also been described as “compassion fatigue.”
- Personal Accomplishment: measures feelings of competence and successful achievement in one's work, or lack thereof. Clinicians may begin to feel that no matter how much they do, it’s not good enough, or may doubt the meaning of their work.
Burnout can be prompted by a significant event, like a malpractice lawsuit, devastating medical error, or personal tragedy, but for most, it’s a slow grind that may take a long time for clinicians themselves or others around them to recognize.
Why Everyone Needs to Care About Burnout
It’s obvious that burnout is undesirable for any healthcare professional—it can take a serious toll on their physical, emotional, and mental health. But its effects reach far beyond the individual level and can directly impact colleagues and patients. Burnout can lead to reduced focus, effort, empathy, and bedside manner, which in turn, “could foster misdiagnoses and other medical errors and suboptimal care.” The adverse effect on care delivery underscores the importance of taking measures to prevent burnout in addition to responding to it.
Health IT’s Role in Clinician Burnout
When it comes to burnout, health IT gets a bad rap. EHR systems are often cited as a primary cause of burnout since they’ve increased the time caregivers have to spend in front of a screen and decreased the time available to spend with patients face to face. A time-motion study by the American Medical Association and Dartmouth-Hitchcock Health Care System found only 27 percent of a physician’s time is spent on direct clinical care, and for every hour of face time with patients, they spent nearly two additional hours on their EHR and other clerical work.
Similarly, a Mayo Clinic study of over 6,500 physicians directly pointed to the clerical burden of EHRs as a contributor to burnout. The researchers also correlated their results with the MBI, and found computer ordering to be “the driving factor”: Physicians indicated frustration with trying to efficiently schedule exams, tests, and procedures while preparing to move on to the next patient. The American Medical Association recently demanded EHR overhaul, calling them “poorly designed and implemented.”
EHRs in particular had high expectations to make clinicians’ lives easier, and when it became apparent that the opposite was true, most soured on not only EHRs, but also other healthcare technology solutions.
How the Right Technology Can Help
Clearly, technology can’t fix everything, and EHRs have yet to fulfill their promise of making clinicians’ lives easier. There’s no silver bullet, no matter how shiny the software seems. But there are ways technology can enhance clinical workflows and give valuable time back to physicians and nurses. As Dr. Rasu Shrestha, chief innovation officer at University of Pittsburgh Medical Center, recently said: "It's not just technology for the sake of technology.” Here’s how technology can be part of the solution:
1. Connect Care Teams
Technology can help eliminate the silos of information within a hospital by supporting centralized sources of information that are accessible by all and are updated in real time. For example, an enterprise-wide directory that can reference up-to-date contact information and on-call schedules for everyone in the hospital makes it much easier to find the right person, even if you don’t know their name. With a communication platform like Spok Care Connect, an admitting physician can easily look up and connect with the ED physician for a patient admit, even if they don't know the ED physician's name. They can also close the loop by viewing the status of the message delivery to ensure it was read—message accountability helps close potential holes in the Swiss cheese model of patient safety errors.
2. Save Steps
All of the little manual steps in a workflow can add up to a lot of time. Reporting critical results of tests and diagnostic procedures on a timely basis is a Joint Commission National Patient Safety Goal. Yet the most common problem with critical test results is that the patient didn’t receive the test results, and the second-most common problem is that the clinician didn’t receive the test results. With over 400 million medical imaging procedures and 13 billion lab tests performed annually in the U.S., that’s a lot of missed results. Communication failures and delays are commonplace in this workflow because it tends to be manual at most hospitals: The physician orders an X-ray, the results come back critical, and then the radiologist and the physician (and sometimes the nurse) play phone tag until they can discuss the results—delaying treatment for the patient and frustrating the clinicians. Critical test results management software can automate this process so when the results come back critical, the information is immediately sent to the ordering physician’s mobile device. From there, the physician can view the results in the mobile PACS viewer, and their acknowledgement of the results is noted in the patient record.
3. Gain Focus
Constant interruptions are a big part of day-to-day clinician frustration. Technology can help limit that by providing an indicator to your colleagues when you are unavailable. With a secure messaging solution like Spok Mobile, you can set your status so your colleagues know when you are off work, in a meeting, in surgery, busy with a patient, or something else. This helps prevent interruptions when you are enjoying some well-deserved time off or are having a difficult conversation with a patient. Your organization can build in escalations to ensure that if your status is unavailable and the message is critical it can be addressed by another caregiver.
4. Delegate Non-clinical Tasks
Technology can help doctors and nurses “practice at the top of their license” when it comes to patient care by sending patient requests and alerts to other staff members when applicable. For example, a patient may request a glass of water while a nurse is with another patient. Rather than receiving an alert with no context and having to leave the room to see what the request is, the nurse can see that the request is for a glass of water on his mobile device. He could forward that request to a non-clinical staff member to address. Another scenario is a battery low alert on a telemetry alarm. Technology can route that alert directly to a biomed staff member so they can evaluate and fix the alarm without ever interrupting the patient’s nurse.
5. Give Time Back to the Bedside
As previously mentioned, one of the biggest contributors to burnout is clerical work and other items that detract from the face-to-face time with the patient. Technology can help allocate more time at the bedside by delivering actionable information—information that has clinical context—and facilitating care team conversations. For example, a patient alert can provide clinical context from the hospital’s admission, discharge, and transfer (ADT) system so the caregiver doesn’t need to stop and look up additional information and can treat the patient more quickly. Secure messaging technology also helps all members of the care team connect about the patient’s treatment, so decisions can be made more quickly. For example, if a nurse has concerns about her patient’s sudden change in status, she can quickly and easily contact the right team member to discuss what she’s seeing. She doesn’t have to leave the bedside and waste valuable time searching for the right contact information to start this conversation and get help for her patient right away.
Technology Alone Can’t Extinguish Burnout
In addition to technology, process and culture are key to helping reduce and prevent burnout. We highly encourage hospitals to take steps to make sure physicians and nurses are at the table for technology decisions that impact their workflows and patient care. This not only includes evaluating new tools, but also making changes to existing ones. Determine what challenge you are trying to solve, then work with your clinicians to find out if the technology change, and the supporting process change, have the right components to solve the challenge and truly affect that change. If it doesn’t, it’s just adding to the clinicians’ workload and is unlikely to have a positive impact on patient care.
While the focus of this article is technology, measurement, ongoing education, and visible support are also critical to preventing and reducing burnout. How are you extinguishing the flames of physician and nurse burnout at your hospital? We’d love to hear what’s working—health IT or otherwise—to help clinicians at your organization love their jobs again.
By Dr. Nat’e Guyton, RN, MSN, CPHIMS, NE-BC and Dr. Andrew Mellin
Dr. Nat’e Guyton is Spok’s Chief Nursing Officer. She is a nurse and clinical leader with more than 15 years of healthcare and technology experience that includes clinical workflow redesigns, EHR and health IT implementations, and pursuing interoperable, patient-centric, and user-friendly technology for quality outcomes. Guyton holds a bachelor’s and master’s degree in nursing, post graduate degrees in healthcare administration and healthcare informatics, and a doctorate in management-organizational leadership. She is an advocate for patients, for nurses, and for healthcare organizations.
Dr. Andrew Mellin has almost 20 years of experience as both a practicing physician and healthcare executive. He brings an extensive background in health information technology, including leading physician adoption programs for new technologies and developing innovative clinical solutions. Before joining Spok he was VP, Medical Director at RedBrick Health, where he helped health systems drive employee engagement of consumer-oriented population health and well-being solutions. Prior to RedBrick Health, Dr. Mellin spent 15 years at McKesson in various positions where he served as Medical Director for McKesson’s population health analytics solutions, developed a new real-time quality solution for hospitals, and led physician strategy and product management for the electronic health record. He previously served as Medical Director for Allina Health’s Davies Award-winning implementation of an electronic health record at nine hospitals and 60 clinics across Minnesota. Dr. Mellin received his medical degree from Duke University in Durham, North Carolina, and his MBA from the University of Minnesota, Carlson School of Management. He trained in Internal Medicine at Barnes Hospital in St. Louis, Missouri, and is board-certified in Internal Medicine.