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Understanding Burnout Understanding Burnout
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Understanding Burnout
A Collaboration between KLAS and the Healthcare Logistics Think Tank

author - Kyle Chilton
Author
Kyle Chilton
 
September 21, 2022 | Read Time: 6  minutes

Current Time Inside Cache Tag Helper: 10/2/2022 8:51:33 PM and Model.reportId = 3014

Over 50% of clinicians experience at least one symptom of burnout, a problem that has been exacerbated by the COVID-19 pandemic. This paper explores some of the key drivers of burnout as well as strategies for reducing it.

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HtmlReportContent Current Time Inside Cache Tag Helper: 10/2/2022 8:51:33 PM and Model.reportId= 3014 and Model.HtmlReportContent_LastWriteTimeUtcInTicks=637993774895298387

hltt logoThis white paper is the first in a series published in partnership by the Healthcare Logistics Think Tank (HLTT) and KLAS. These papers will address key issues in healthcare and look at how technology, data, and workflow innovation in logistics can improve the patient and provider experience, lower costs, and improve outcomes.

The Collaborators:
Healthcare Logistics Think Tank (HLTT), powered by The Krinsky Company KLAS Research
Paul DeChant, MD, MBA, Speaker, Coach, Author, and Leader of Advanced Organizational Well-Being
Neal Patel, MD, CIO, Vanderbilt University Medical Center
Dara Mize, MD, MS, Assistant Professor Biomedical Informatics Vanderbilt University Medical Center

Understanding Burnout

Emergency department and critical care specialists face the highest rates of burnout, while women experience burnout at a higher rate than men—56% to 41%. Bureaucracy is one of the biggest drivers of burnout, and technology can either help or hinder in this area—while technology can bring efficiencies and improve patient safety, it can also contribute significantly to burnout if it lacks usability, disrupts workflows, or creates one more task to complete.

In general, clinicians get personal fulfillment from providing and improving care through engaging with patients, teaching, and researching. Currently, only one-third of clinician time is spent in these pursuits; the remaining time is spent on administrative duties, working in the EHR, and other challenges.

ICD-11 classifies burnout as an occupational phenomenon, not a medical condition, and defines it as including three dimensions:

  1. Exhaustion: Depleted emotional resources to cope with the work environment; a loss of enthusiasm for work; nothing more to give
  2. Cynicism/depersonalization: Self-protective mechanism of distancing oneself from patients or the organization
  3. Inefficacy: A combination of the previous two dimensions resulting in a sense of low personal accomplishment or feeling ineffective at work

From the KLAS Arch Collaborative

The KLAS Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, over 250 healthcare organizations have surveyed their end users and over 240,000 clinicians have responded. A December 2021 report from the Collaborative found that reported levels of burnout are increasing. The following factors are among the primary contributors:

  1. Chaotic workplace
  2. After-hours workload
  3. Too many bureaucratic tasks
  4. Lack of teamwork
  5. Lack of shared values with organization leadership
  6. No personal control over workload
  7. EHR or other tools hurt efficiency
arch collabrative logo

How to Address the Problem: the Stanford Model

The Stanford Model of Professional Fulfillment proposes that professional well-being is driven by three factors, two dependent on the employer organization and one dependent on the individual. These tenets and how they relate to healthcare organizations are outlined below along with commentary from Dr. Paul DeChant, a thought leader on advanced organizational well-being.

Culture of Wellness (dependent on the provider organization)

What is the tone of the work environment and who has ownership for setting it? This encompasses factors such as rewards, compassion, flexibility, meaningful work, peer support groups, and so on.

Dr. DeChant’s take: “The most important factor in a culture of wellness is organizational leadership and their control over resources, processes, staffing, and setting the cultural tone. Understanding and ownership at the senior level, followed by alignment throughout the organization, is paramount. Implementing ways to connect leaders to the front line, and thereby connect the front line to the rest of the organization, will significantly contribute to reducing burnout.”

Efficiency of Practice (dependent on the provider organization)

Are efficient practices supported when it comes to tools and technology, the EHR, staffing, team-based care, regulations, and so on?

Dr. DeChant’s take: “Adding workflow efficiency to clinician well-being can have tremendous cultural impact. This includes redesigning workflows, optimizing the EHR, and using simple techniques like frontline office huddles to manage the day; these things lead to lower staff turnover and better patient engagement.”

Personal Resilience (dependent on the individual)

Personal resilience is the clinician’s responsibility through things such as nutrition, resiliency training, and exercise.

Dr. DeChant’s take: “The standard activities to support clinician resilience are vital, but on their own, they are insufficient because we deal with life-and-death issues.”

Discussion Commentary

The insights below were shared by industry thought leaders during the HLTT Physician Burnout webinar held in April 2022.

“Parts of the equation are the EHR, cell phones, more and more inboxes, remote access to work tools, and the always-on culture. The EHR gets a bad rap, but there is so much more to this than clicks.”
—Sarah Kier, VP Enterprise Access, Emory Healthcare

“We have funded two specific positions (medical directors) for wellness: one for specialty and one for primary care. They are charged with finding unique ways to improve burnout from the wellness perspective.”
—Theresa Meadows, Senior Vice President & CIO, Cook Children’s Health Care System

“Nurses are under even greater bureaucratic load than physicians—everything falls to them to do.”
—Neal Patel, MD, CIO, Vanderbilt University Medical Center

“Like other professionals, physicians come with a mix of backgrounds and interests. There is no one culture of medicine, but there are many subcultures. Some resist change, and some advocate for change. The leader’s job is to work with the physicians in their organization, supporting those who are collaborative and forward thinking, and engaging with the naysayers and saboteurs and listening to their concerns as a part of working to bring them on board. That is why culture change takes time. My recommendations are geared toward working through these challenges more quickly. . . . Organizations like AWS can enhance their value proposition by helping their health system leadership partners work through these challenges.”
—Paul DeChant, MD, MBA, Speaker, Coach, Author, and Leader of Advanced Organizational Well-Being

“Emory has formed a funded office of well-being, two medical directors, and a focused DEI office to help with burnout. I agree with the sentiment that things are fragmented and likely not enough to get our arms around all the issues.”
—Sarah Kier, VP Enterprise Access, Emory Healthcare

“All the vendors have to prioritize caregiver time as a design measure.”
—Jeff Terry, Founder and CEO, Clinical Command Centers, GE Healthcare

“When a driver feels the need to look backward while in reverse instead of relying 100% on the sensors and cameras, despite the well intentions of the technology provider, the driver now utilizes twice the mental energy versus half. We see this in healthcare IT all the time. Solutions must be so trustworthy that it doesn’t even occur to the driver to look backward!”
—Neal Patel, MD, CIO, Vanderbilt University Medical Center

“Certainly the EHR is not the sole cause of burnout, but it can be a contributor. Mastery of the EHR via training does have a relationship with burnout. Per recent KLAS Arch Collaborative findings from several thousand survey responses, those who strongly disagree that their ongoing training is helpful and effective are 3.5 times more likely to state that they are completely burned out and are 4 times more likely to state that they are planning on leaving the organization in the next two years.”
—Jason Hess, Executive Vice President of Provider Sales & Success, KLAS

Key Questions to Consider

How are vendors and clinicians focusing on the usability and the efficiency aspects of the systems in place to create ecosystems of technology that are pleasurable and efficient to work and interact with?

We changed quickly during the COVID-19 pandemic. Are we going to go back to the way things were, or will we keep the things that we learned and have proven to work better?

Technology helps us increase volume. Is it overwhelming us with information, widgets, and tools, and does it force us to constantly process more information? Are we allowing for pauses? Are we using technology to increase value?

Are there tools that help reduce burnout and/or elevate clinician joy? Are there dashboards and feedback loops that can improve satisfaction and demonstrate how many people clinicians have helped and lives they have improved?

Does burnout differ in a system where there is more equalitarian compensation and where you are not necessarily paid to do more?

If clinicians had more feedback on the long-term well-being of their patients, could that help reduce burnout? If the EHR or other solutions could flag patient milestones and send out alerts of those successes, would that nourish the soul of providers?

Current Time Inside Cache Tag Helper: 10/2/2022 8:51:33 PM and Model.reportId = 3014

hltt logoThis white paper is the first in a series published in partnership by the Healthcare Logistics Think Tank (HLTT) and KLAS. These papers will address key issues in healthcare and look at how technology, data, and workflow innovation in logistics can improve the patient and provider experience, lower costs, and improve outcomes.

The Collaborators:
Healthcare Logistics Think Tank (HLTT), powered by The Krinsky Company KLAS Research
Paul DeChant, MD, MBA, Speaker, Coach, Author, and Leader of Advanced Organizational Well-Being
Neal Patel, MD, CIO, Vanderbilt University Medical Center
Dara Mize, MD, MS, Assistant Professor Biomedical Informatics Vanderbilt University Medical Center

Understanding Burnout

Emergency department and critical care specialists face the highest rates of burnout, while women experience burnout at a higher rate than men—56% to 41%. Bureaucracy is one of the biggest drivers of burnout, and technology can either help or hinder in this area—while technology can bring efficiencies and improve patient safety, it can also contribute significantly to burnout if it lacks usability, disrupts workflows, or creates one more task to complete.

In general, clinicians get personal fulfillment from providing and improving care through engaging with patients, teaching, and researching. Currently, only one-third of clinician time is spent in these pursuits; the remaining time is spent on administrative duties, working in the EHR, and other challenges.

ICD-11 classifies burnout as an occupational phenomenon, not a medical condition, and defines it as including three dimensions:

  1. Exhaustion: Depleted emotional resources to cope with the work environment; a loss of enthusiasm for work; nothing more to give
  2. Cynicism/depersonalization: Self-protective mechanism of distancing oneself from patients or the organization
  3. Inefficacy: A combination of the previous two dimensions resulting in a sense of low personal accomplishment or feeling ineffective at work

From the KLAS Arch Collaborative

The KLAS Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, over 250 healthcare organizations have surveyed their end users and over 240,000 clinicians have responded. A December 2021 report from the Collaborative found that reported levels of burnout are increasing. The following factors are among the primary contributors:

  1. Chaotic workplace
  2. After-hours workload
  3. Too many bureaucratic tasks
  4. Lack of teamwork
  5. Lack of shared values with organization leadership
  6. No personal control over workload
  7. EHR or other tools hurt efficiency
arch collabrative logo

How to Address the Problem: the Stanford Model

The Stanford Model of Professional Fulfillment proposes that professional well-being is driven by three factors, two dependent on the employer organization and one dependent on the individual. These tenets and how they relate to healthcare organizations are outlined below along with commentary from Dr. Paul DeChant, a thought leader on advanced organizational well-being.

Culture of Wellness (dependent on the provider organization)

What is the tone of the work environment and who has ownership for setting it? This encompasses factors such as rewards, compassion, flexibility, meaningful work, peer support groups, and so on.

Dr. DeChant’s take: “The most important factor in a culture of wellness is organizational leadership and their control over resources, processes, staffing, and setting the cultural tone. Understanding and ownership at the senior level, followed by alignment throughout the organization, is paramount. Implementing ways to connect leaders to the front line, and thereby connect the front line to the rest of the organization, will significantly contribute to reducing burnout.”

Efficiency of Practice (dependent on the provider organization)

Are efficient practices supported when it comes to tools and technology, the EHR, staffing, team-based care, regulations, and so on?

Dr. DeChant’s take: “Adding workflow efficiency to clinician well-being can have tremendous cultural impact. This includes redesigning workflows, optimizing the EHR, and using simple techniques like frontline office huddles to manage the day; these things lead to lower staff turnover and better patient engagement.”

Personal Resilience (dependent on the individual)

Personal resilience is the clinician’s responsibility through things such as nutrition, resiliency training, and exercise.

Dr. DeChant’s take: “The standard activities to support clinician resilience are vital, but on their own, they are insufficient because we deal with life-and-death issues.”

Discussion Commentary

The insights below were shared by industry thought leaders during the HLTT Physician Burnout webinar held in April 2022.

“Parts of the equation are the EHR, cell phones, more and more inboxes, remote access to work tools, and the always-on culture. The EHR gets a bad rap, but there is so much more to this than clicks.”
—Sarah Kier, VP Enterprise Access, Emory Healthcare

“We have funded two specific positions (medical directors) for wellness: one for specialty and one for primary care. They are charged with finding unique ways to improve burnout from the wellness perspective.”
—Theresa Meadows, Senior Vice President & CIO, Cook Children’s Health Care System

“Nurses are under even greater bureaucratic load than physicians—everything falls to them to do.”
—Neal Patel, MD, CIO, Vanderbilt University Medical Center

“Like other professionals, physicians come with a mix of backgrounds and interests. There is no one culture of medicine, but there are many subcultures. Some resist change, and some advocate for change. The leader’s job is to work with the physicians in their organization, supporting those who are collaborative and forward thinking, and engaging with the naysayers and saboteurs and listening to their concerns as a part of working to bring them on board. That is why culture change takes time. My recommendations are geared toward working through these challenges more quickly. . . . Organizations like AWS can enhance their value proposition by helping their health system leadership partners work through these challenges.”
—Paul DeChant, MD, MBA, Speaker, Coach, Author, and Leader of Advanced Organizational Well-Being

“Emory has formed a funded office of well-being, two medical directors, and a focused DEI office to help with burnout. I agree with the sentiment that things are fragmented and likely not enough to get our arms around all the issues.”
—Sarah Kier, VP Enterprise Access, Emory Healthcare

“All the vendors have to prioritize caregiver time as a design measure.”
—Jeff Terry, Founder and CEO, Clinical Command Centers, GE Healthcare

“When a driver feels the need to look backward while in reverse instead of relying 100% on the sensors and cameras, despite the well intentions of the technology provider, the driver now utilizes twice the mental energy versus half. We see this in healthcare IT all the time. Solutions must be so trustworthy that it doesn’t even occur to the driver to look backward!”
—Neal Patel, MD, CIO, Vanderbilt University Medical Center

“Certainly the EHR is not the sole cause of burnout, but it can be a contributor. Mastery of the EHR via training does have a relationship with burnout. Per recent KLAS Arch Collaborative findings from several thousand survey responses, those who strongly disagree that their ongoing training is helpful and effective are 3.5 times more likely to state that they are completely burned out and are 4 times more likely to state that they are planning on leaving the organization in the next two years.”
—Jason Hess, Executive Vice President of Provider Sales & Success, KLAS

Key Questions to Consider

How are vendors and clinicians focusing on the usability and the efficiency aspects of the systems in place to create ecosystems of technology that are pleasurable and efficient to work and interact with?

We changed quickly during the COVID-19 pandemic. Are we going to go back to the way things were, or will we keep the things that we learned and have proven to work better?

Technology helps us increase volume. Is it overwhelming us with information, widgets, and tools, and does it force us to constantly process more information? Are we allowing for pauses? Are we using technology to increase value?

Are there tools that help reduce burnout and/or elevate clinician joy? Are there dashboards and feedback loops that can improve satisfaction and demonstrate how many people clinicians have helped and lives they have improved?

Does burnout differ in a system where there is more equalitarian compensation and where you are not necessarily paid to do more?

If clinicians had more feedback on the long-term well-being of their patients, could that help reduce burnout? If the EHR or other solutions could flag patient milestones and send out alerts of those successes, would that nourish the soul of providers?

author - Elizabeth Pew
Writer
Elizabeth Pew
author - Jessica Bonnett
Designer
Jessica Bonnett
author - Andrew Wright
Project Manager
Andrew Wright
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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2022 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.