Workplace burnout has become so common across industries that, as of May 2019, the World Health Organization (WHO) recognizes it as an occupational phenomenon in its International Classification of Diseases Handbook.
In the healthcare industry, burnout is a reality and is described by those on the front line in alarming terms. According to a NEJM Catalyst survey Immunization Against Burnout, “83% of respondents — who are clinicians, clinical leaders, and health care executives — call physician burnout a ‘serious’ or ‘moderate’ problem in their organizations.” Based on survey results like these, a report titled A Crisis in Health Care: A Call to Action on Physician Burnout called physician burnout “a public health crisis.”
Burnout has reached crisis level for many reasons, including its prevalence and its effect on staff turnover. But it’s had unexpected consequences for patient care, as well. A JAMA Internal Medicine study concluded that physician burnout doubled the odds of an adverse patient safety event. According to the report, this includes “unsafe care, unprofessional behaviors, and low patient satisfaction.”
In the first part of a two-part series, we examine the main drivers of hospital staff burnout, its far-reaching consequences for healthcare organizations and patients, and how the right technology can play a key role in reducing its widespread nature.
Understanding burnout and its consequences
The WHO officially defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- feelings of energy depletion or exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
- reduced professional efficacy.”
Burnout affects clinicians on an individual level, delivering the mental and physical exhaustion mentioned above. Far from being only a staff issue, burnout has serious effects on hospitals and patients in profound ways.
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In November 2018, Baylor St. Luke’s Medical Center in Houston made two medical errors, the second of which lead to the death of a 75-year-old patient. After an investigation by the Houston Chronicle and ProPublica, the Centers for Medicare and Medicaid Services issued a report in early 2019 that outlined a pattern of blood labeling errors at the hospital. A ProPublica article on the report states:
Dr. Ashish Jha, an expert in hospital quality, reviewed the government’s findings and said it appeared St. Luke’s was struggling to meet basic care standards. The labeling mistakes, he said, seemed indicative of ‘a broader systemic problem.’… St. Luke’s appeared to miss warning signs in the months prior to the deadly mistake, according to the government report.
The “broader systemic problem” Dr. Jha mentions is, unfortunately, not unique to St. Luke’s. Many hospitals and healthcare systems face organization-wide, process-related issues, especially in a modern healthcare landscape that’s rife with change. Mergers, multiple technology platforms, and changing healthcare policies, to name just a few, contribute to widespread miscommunication and a lack of transparency. This, in turn, jeopardizes the overall quality of care within these organizations.
Hospitals can stem the scope of these issues by implementing a healthcare enterprise risk management (ERM) program. Healthcare ERM establishes a standardized framework for identifying risk across an organization, encourages cross-departmental collaboration, and shifts hospitals from a reactive clinical risk program to a proactive holistic risk management program. A straightforward process, along with the right technology the leverages healthcare analytics, can help to make this shift effective.
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As hospitals and healthcare organizations work toward better patient care, they can begin by taking a closer look at their internal processes and technology. A reliance on disparate systems that fail to share data efficiently puts organizations at risk of falling short of the demands of modern healthcare. The Agency for Healthcare Research & Quality stated that one of the three most critical challenges facing today’s healthcare organizations in their mission to improve patient care is “establish[ing] an integrated data, analytics, and information platform, along with the necessary technical expertise, to capture a 360° view of the healthcare system.”
The healthcare claims process, too, can benefit from a single integrated healthcare risk management system. Having incident reporting and claims management functionalities working seamlessly in one platform offers three major advantages.
1. Increased efficiency and accuracy
Just as working with a single insurer is easier than working with several, integrating healthcare incident reporting and healthcare claims administration into one system can be easier than tracking each in separate systems. But unlike insurance, where receiving multiple coverages from the same insurer may not be possible, hospitals can integrate incident data and claim data with ease through healthcare risk management software like Origami Risk.
Having all data in one system adds convenience for healthcare risk managers who may have previously had to toggle between systems to follow along with the claim lifecycle—from the initial reporting of an incident to the closure of the claim. A daily reality that the article Improving Claims Management with Advanced Integration summarizes as “the need to switch between multiple software systems in order to find all the relevant information on a specific claim. It’s critical to have all pertinent data in one spot to reduce and/or eliminate this quest for data.”
Navigating between two systems also results in detrimental switch costs, the fractions of seconds that occur when moving back and forth between systems. These switch costs rapidly compound, leading to wasted time and increased errors, including misaligned data. With an integrated healthcare risk management system, healthcare risk managers no longer have to bounce between systems throughout the claim lifecycle. If an incident turns into a claim, they can monitor it or move it further along in the process without losing the original incident record.
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Adverse safety events—some that lead to serious harm—occur every day, affecting people across entire health systems. The ability to collect and analyze this data is crucial for preventing future incidents and improving patient safety. Yet, according to a 2008 study, “only 13% [of U.S. hospitals] have broad staff involvement in reporting adverse events.”
With a full schedule of patients and life-or-death situations a part of daily life in hospitals, reporting efforts, not surprisingly, may end up taking a back seat. Sometimes, however, the issues that impact reporting run deeper. Hospital staff may fear repercussions from reporting safety events. In other instances, the reporting process may be so convoluted and time consuming that, despite good intentions, staff is discouraged from doing so. Or maybe, the biggest issue comes after reporting, with hospitals failing to share or apply healthcare analytics in a way that positively impacts the quality of care provided and makes staff feel a part of something bigger.
No matter the reason, any issue that negatively impacts patient safety event reporting has consequences for every person associated with a hospital or health system—especially the patients. In fact, the ECRI Institute listed “standardizing safety efforts across large health systems” as one of the top 10 patient safety concerns for 2019. Even events that seem minor have the potential to result in grave harm. The Joint Commission reported medication error and product and device events in the list of top 10 most frequently reported sentinel events in hospitals in 2018.
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The healthcare industry has especially high stakes when it comes to risk management. The risks aren’t simply business- or reputation-related, though those are important. The most significant ones can be a matter of life or death. Patient safety is at the heart of every hospital’s risk management program and, because of this, a generic risk management information system (RMIS) may not be up to the challenge.
Hospitals and healthcare organizations may consider using a generic RMIS for a variety of reasons. Perhaps another part of the organization is already using one, so it seems simpler and cheaper to stick with the same system. Although using a single platform across an organization is typically a logical approach, given the healthcare industry’s uniquely critical needs, this approach may not cover the healthcare setting’s unique needs and thus can fail, adding more hassle, expense, time, and risk not only to your organization, but also to your patients.
In terms of both the software and the service team supporting that software, a dedicated healthcare risk management solution offers clear advantages over a generic RMIS. This gives healthcare organizations greater insight for staying on track and, ultimately, improving patient safety.
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A 2016 analysis published in BMJ revealed that medical error is the third-leading cause of death in the United States. This includes process errors, planning errors, and failures to act. Martin Makary, a health policy expert at Johns Hopkins and an author of the analysis, explains that the “complex medical system” in the U.S. “sometimes lacks transparency that results in the wide variation in quality of medical care that is the endemic problem in safety.” Makary also notes that “safety nets are missing and standardization is lacking.”
At the heart of this standardization problem lies outdated technology and confusing systems. Many healthcare providers continue to use lagging systems that don’t efficiently collect or analyze data. Furthermore, a mix of legacy and new systems makes for potential conflicts that add to the confusion and fortify workplace silos. Without the sharing of information, organizations fail to see big-picture strategies and solutions that could help prevent medical errors and increase patient safety.
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Data Breach Today offers predictions in What’s Ahead for Health Data Privacy, Security in 2019? While the article focuses primarily on health data, a few key trends apply more broadly and are likely to resonate with all types of organizations.
Prediction: Disruption from regulatory changes is likely
Rebecca Herold, author of 19 books on information security and CEO of The Privacy Professor consultancy, begins the list of predictions by examining the potential for agency updates to HIPAA. “Based on continued pressure from local, state and federal government agencies, law enforcement, researchers and others to ease the sharing of patient and mental health data by removing the need to obtain patient consent, I expect to see OCR issue proposed HIPAA updates,” she notes.
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Risk management in healthcare is a topic that is gaining increasing importance. A large driver of this attention is the shift from fee-for-service to value and outcome-based models. An article in the New England Journal of Medicine’s (NEJM) Catalyst blog notes, “For these reasons, hospitals and other healthcare systems are expanding their risk management programs from ones that are primarily reactive and promote patient safety and prevent legal exposure, to ones that are increasingly proactive and view risk through the much broader lens of the entire healthcare ecosystem.”
This demand for an expanded view of healthcare risks has fueled the demand for Enterprise Risk Management (ERM) solutions. The road to fully functional ERM programs, however, has proven to be a challenging one for most healthcare organizations. The NEJM Catalyst article cites a report from Healthcare Financial Management Association (HFMA) that states, “Despite the growing importance of programs today, and the raised awareness of their importance, many healthcare providers have been slow to adopt a more sophisticated approach… The current state for most providers falls between ‘basic’ and ‘evolving’ maturities for ERM programs.” … read more
Origami Risk’s 2018 User Conference, held last week, utilized a new format that not only placed a premium on client presentation of use cases, but also focused on digging into “how” presenters managed to implement their specific solutions. Listening to a diverse set of cases, several common trends emerged.
1. Transparency is key
Many of those presenting echoed the need to establish transparency and accountability in their processes. You can’t measure what you can’t see, and you can’t improve what you don’t measure. The most obvious culprits were paper-based procedures—everything from workplace safety “coaching cards,” to incident intake reports. Spreadsheet-centric workflows, such as data-heavy values collection efforts, also failed to identify the “who, what, when, and where” type of information required to make any process fully transparent.
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The pressure to do more with less is constant. But delaying an honest evaluation of your risk management information system (RMIS), while an understandable temptation, can lead to compressed timelines, rushed decisions, cost overruns, and additional grey hair.
Industry consolidation is forcing changes both good and bad. Regardless of whether you elect to stay with your current system or make a move, the worst-case scenario is to find yourself boxed in because you ran out of time.
There are a few critical factors a risk manager should take into account to ensure they are in the driver’s seat. Your time is limited, but your options don’t have to be.
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