Understanding the burnout epidemic
Provider burnout has reached concerning levels at health systems across the world. When burnout leads to the permanently damaged morale of an educated and trained provider, who was once enthusiastic and dedicated, it threatens the quality of care that provider’s patients receive. In turn, patient satisfaction suffers, HCAP scores go down and reimbursement rates plummet causing additional stress on an already overburdened health system.
Burnout in the workplace can be detected wherever there is a loss of enthusiasm for work, emotional exhaustion, cynicism, loss of personal and professional investment, or a lowered sense of accomplishment. Physician burnout rates increased 28 percent in just four years, from 2012 to 2016, and they have been correlated with a decline in patient satisfaction by 16 percent, an increased risk in patients changing providers, and lower reimbursement rates. The quality of care ramifications have shown higher rates of self-reported medical errors, contributing to longer post-discharge recovery time.
One leading source of provider exhaustion is an overabundance of taxing administrative duties. Charting, integrating EHRs, and other tasks outside of direct patient care are overburdening physicians, who are working longer hours with less direct patient care. For many, this is enough to elicit a sense of disenchantment with the practice of medicine and even to justify a career change.
New research – conducted by the American Medical Association, Mayo Clinic, and Stanford University – indicated that one in five physicians would reduce their clinical work hours in the coming year, and one in 50 physicians reported a high probability or certainty that they would leave clinical practice for another career in the next couple of years. Provider burnout is worsening the existing provider shortage problem, further crippling access to care.
While workload is a clear cause of burnout, it is not necessarily ranked higher than other contributing factors. One Scientific American quiz prompts professionals who are potentially experiencing burnout to, “Assess yourself in six areas to identify potential problems in the workplace.” Participants can screen for whether or not they are on the road to burnout by self-reporting qualitative data in six areas: workload, control, reward, community, fairness and values. Second to workload on the quiz, the ‘control’ category explores and gauges a professional’s sense of authority, their perceived opportunities to exercise professional judgement, ability to participate in decisions that affect their work, and the amount of information provided to them on major developments within the organization.
The highest correlation to physician burnout is found in engagement scores, with engaged physicians reporting lower burnout rates, a greater sense of accomplishment, and improved efficiency implementing process changes, compared with ambivalent physicians reporting higher burnout rates, lower efficiency and perceived support. In addition, organizations have greater success managing change when staff are engaged in the decision-making process. Engagement is the ultimate remedy to burnout.
Examining patient flow
Implementing flow offers a viable solution to engaging and empowering your staff to make the changes that will alleviate their workload and improve the quality and value of patient care they are delivering. Correcting the design of processes and workflows allows your health care team members to more effectively and efficiently manage their tasks. Productivity increases the joy in work and decreases the threat of burnout in your environment. Patients and their families stand to benefit the most as patient throughput increases.
Optimizing the flow of patients not only reduces overcrowding and bottlenecks, but also creates a system to support smoother handoffs and fewer delays in patient care — all factors that directly affect timely access to care. A number of strategies are being deployed to address patient flow in hospitals and health systems, including better anticipation and coordination of check-in and discharge processes, as well as attention to patients waiting to be admitted, transferred, or seen in other hospital units.
Many professionals facing burnout struggle with too many bureaucratic tasks, spending too many hours at work, and feeling like just a cog in the wheel rather than a valued, contributing team member. This information raises a red flag around the dire need for more efficient processes in the health care space, and the elimination of waste from non-value-added activities.
Opportunity for lean
The successful implementation of flow, a patient-centered, team-based approach, creates the foundation for transformation on the primary care front. Frontline staff are directly involved in testing and implementing process improvements, and tracking operational and performance metrics reflecting more efficient care, as well as greater patient and staff satisfaction.
Virginia Mason Institute has had great, measurable success coaching clients worldwide to optimize flow. Results we have seen in our own organization and with clients include:
- Improved patient access, measured by volume of patients seen daily and weekly
- Meeting greater patient demand without adding additional resources
- Reduction, and even elimination, of wait times
- Improved patient satisfaction
- Better quality scores in both inpatient and outpatient settings
- Reduction in time patients spend in the emergency department
- Cost reductions related to supplies and medications
- Shorter hospital lengths-of-stay
- Productivity and performance improvement, including better skill-task alignment of staff
Addressing flow should be a priority for every health care organization seeking to improve the quality of care, provide a superior patient experience, and support more reliable outcomes. By removing inefficient processes and waste, organizations can alleviate, and even eliminate, the stressors hurting their health system. Only through optimized flow can health care teams thrive in their work, and provide patients with better access to the quality of care they need, when they need it, at a lower cost.