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 profound effects on hospitals and patients.
Decreased quality of care
The Advisory Board, a healthcare best practices firm, found that “physician burnout is linked to a 16% decrease in patient satisfaction.”
Referring to the JAMA Internal Medicine study cited above, the article How Does Provider Burnout Impact Patient Care Quality, Care Access? notes that “providers who felt symptoms of depression associated with their burnout saw more pronounced patient safety risks.” In short, when clinicians are run down, they lack the energy and attention to detail needed to provide top-quality patient care.
Furthermore, burnout prevents clinicians from connecting with their patients on a personal level. The Well-Being Playbook by AHA Physician Alliance and the American Hospital Association urges hospitals and health systems to address burnout because the syndrome “lowers a physician’s ability to show empathy, which can result in poor patient satisfaction.”
Quality of care is also affected by the exodus of clinicians from specific hospitals and the industry as a whole due to burnout. The white paper Win the Talent War: A Proactive Approach to Addressing Turnover Costs in the Healthcare Industry states, “In the healthcare industry, there are other serious ramifications for reduced retention, including the effects on patient care and satisfaction, physician engagement and the ever-increasing demand for services by a rapidly growing aging population.”
With the voluntary turnover of qualified staff, and a lack of engagement from those who are employed, hospitals face a major challenge. Patients have many choices on which health system or provider to use, so patient satisfaction is a high priority. Moreover, in the age of online reviews available for all to see and share, people are making choices in a different way. Reputation matters. An increase in patient safety events and their consequent claims not only can prevent healthcare organizations from meeting their greater goals, but also can result in reputational damage. (Such was the case with Baylor St. Luke’s Medical Center following the release of a report highlighting a series of medical errors.)
Significant financial hits
Beyond negatively impacting patient care and organizational reputation, burnout can deliver hospitals and healthcare systems a financial blow from several directions.
The first is burnout that leads to increased turnover. The article Estimating the Attributable Cost of Physician Burnout in the United States reports, “On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States.” A Washington Post article says this equates to roughly $7,600 per doctor. The National Health Care Retention & RN Staffing Report estimates that turnover from nurses alone causes hospitals to lose between $4.4M–$6.9M.
The second is burnout that leads to an increase in patient safety events. These adverse events in turn lead to increased claims and malpractice lawsuits. The greater the number of claims, the more money a hospital is likely to lose. According to a Modern Healthcare article, “Hospitals across the country lose approximately $262 billion per year on denied claims from insurers,” as payers initially deny 9% of hospital claims. The nationwide malpractice payout amount increased by 2.91% between 2018 and 2019 for a total of more than $4B.
Conversely, hospitals and providers that properly manage burnout and improve physician engagement reap financial rewards. The article Giving physicians what they need to thrive states, “In the most financially successful provider groups in the athenahealth network, 60 percent of physicians met the criteria for capability [feeling they have the tools, resources, and latitude they need to effectively serve their customers], compared with 43 percent for physicians in the lowest performing groups.”
What causes burnout?
Physician burnout stems from several root causes, including “workload, work/life balance, cognitive dissonance, and clerical work,” according to the Immunization Against Burnout survey.
The article Unsustainable Workloads Could Lead to Physician Burnout summarizes findings from an athenahealth survey, noting that workload is a major issue. “Almost half of practicing physicians believe they will have trouble maintaining their workload in the long term, which could potentially lead to physician burnout if left unaddressed by senior leadership,” the article says.
Compounding the issue of heavy workload is the fact that too much of it consists of tedious administrative tasks, taking clinicians away from direct patient care. Nurses and doctors burdened with hours of paperwork and electronic tasks not only become physically run down, but also lose emotional investment in the job.
Finally, complex workflows and poor communication play a role. Too often, clinicians experience poorly executed processes or do not see a process fully completed. They may fill out a form or report an event, only to have it enter a void, never to be seen again. Without receiving progress updates, clinicians fail to see their contribution to broader initiatives. A lack of effective communication forces them to work in isolation with little direction and meaning.
Collectively, these issues create perhaps one of the most powerful causes of burnout: disengagement from the job, or as H. Clifton Knight, MD, FAAFP, told Medical Economics magazine, “the feeling that you aren’t making a difference or being effective in your work.”
Increasing clinician engagement
To bring clinicians back from the brink of burnout, hospitals and healthcare systems can focus on making staff’s work more meaningful. The athenahealth eBook Building capability: Organizational strategies to support physician performance states, “To move beyond simply treating the symptoms of burnout, healthcare leaders should focus on what it takes to foster physician engagement and restore the joy of practicing medicine — putting doctor-patient relationships first and letting physicians do the work that they joined the field to do.”
This starts by reducing administrative burdens and eliminating process inefficiencies for doctors and nurses, which together help to reduce overall workload and allow them to focus on providing patient care. The right technology and tools can help in this endeavor. In fact, the Immunization Against Burnout survey revealed that 46% of clinicians, clinical leaders, and health care executives favored improving the functionality of their organizations’ IT systems in order to scale back burnout.
Here’s how the right healthcare risk management solution can help clinicians feel more engaged on the job:
Improved communication and workflow
As stated in 5 ways healthcare risk management software improves patient safety, “Many healthcare organizations have become hamstrung by convoluted, inefficient processes and poor communication.” When clinicians are overloaded with work, the transferring of vital information can become rushed or missed, compromising patient care. The constant exchanging of information— and the time-consuming follow-ups—also distract from patient care.
The right technology can help streamline communication through structured workflows and automated communication. “With the help of the software,” notes the article How governance, risk and compliance make patient data safer, “predefined rules help to reduce human error and built-in, automatic reminders/notifications for sign-offs and other tasks keep each team member accountable.”
Origami Risk’s healthcare risk management software allows for setting up rules-based automation that triggers alerts and sends messages to the appropriate staff members when action is needed. Hospitals can set up a reporting structure to receive notifications based on any data point or combination of data points. This increases accountability and ensures processes are followed quickly and accurately.
Having automation in place boosts employee engagement in a few ways. First, it can help relieve nurses and doctors of what M. Bridget Duffy, MD, calls “cognitive overload.” The article Reducing clinician burnout starts with a fresh look at healthcare technology says, “Technology can serve a higher purpose in healthcare, enabling clinicians to easily communicate and share information without having to take their hands and attention away from patient care. The right technology can be a valuable tool that fosters human connections at every point of care.”
Second, receiving automatic updates allows clinicians to see how their role makes a difference in the greater process. For example, a nurse who submits a patient safety incident can, through the transparency of Origami Risk, follow how that incident is handled and eventually completed.
Finally, because automation can be set up to send alerts only when action is needed, nurses and doctors can better compartmentalize, directing their focus to patient care—the work they prefer.
Reduced administrative work
Administrative/clerical work has become another pressing issue in hospitals and healthcare systems, taking clinicians away from meaningful work. A NEJM Catalyst survey on healthcare burnout asked the question, “What is the one thing you would do to reduce clinician burnout at your organization?” An executive of a large nonprofit health system in the Midwest responded, simply, “Improve efficiency of busy work so they can focus on the real purpose.” Fifty-four percent of respondents in the surveyed agreed, saying that off-loading clerical tasks was a tool to reduce or guard against clinician burnout. Without these time-consuming clerical tasks, clinicians can go back to treating patients.
Technology has the power to ease this burden. However, as many hospitals have discovered through the adoption of EHRs, when implemented hastily or incorrectly, technology can do the opposite, thereby increasing administrative work. The article Reducing clinician burnout starts with a fresh look at healthcare technology states, “In addition to clinician burnout, ECRI Institute’s top 10 patient safety concerns for the year include improper management of test results in EHR. While it is a needed repository for clinical, financial, and regularity data, the EHR has created administrative burdens for clinicians, turning physicians and nurses into data entry clerks.”
Origami Risk’s flexible healthcare risk management software is designed to reduce the administrative burdens associated with patient safety event reporting by making data entry as simple and efficient as possible. The system’s dynamic forms automatically self-adjust based on the data entered, so users fill out only the fields that apply to their specific circumstances. These smart forms not only reduce the likelihood of data errors, but also eliminate wasted time.
“Documentation assistance — whether in-person or with the help of electronic gadgets — and improved task-sharing have been linked to decreased physician burnout,” writes Daniel Marchalik in the article Why are so many doctors burning out? Tons of real and electronic paperwork. “And while a problem as complex as physician burnout won’t have a single solution, creating a system in which physicians, medical scribes, nurses and administrators work at the top of their skill set represents a step in the right direction. After all, having providers spend more than 20 percent of their work days on patient care should not be a rarity.”
Origami Risk’s healthcare risk management software helps restore clinician engagement
Origami’s software helps structure workflow and streamline communication through automation. Entering patient safety events benefits from smart forms that optimize entry time. The combination of these functionalities frees up doctors and nurses to focus on the work that matters to them, bringing back meaning to their job and staving off burnout.
In the forthcoming second part of this series, we will discuss how recognizing burnout symptoms and responding to them can also help tackle the epidemic—and how a healthcare enterprise risk management (ERM) framework can assist in those efforts.