Healthcare Worker Burnout - Strategies to Save Clinicians
Author: Sergio Carmona
BEFORE THE COVID-19 PANDEMIC, several studies stated that electronic health records (EHRs) play an important role in clinician burnout due to a variety of reasons including low user intuitiveness, high number of steps required to document and find information, clinical data fragmentation (as often different electronic documentation systems exist with little to no interoperability or interfaces) and rigid documentation requirements.
In addition to the labour-intensive working hours within the healthcare centers/hospitals, physicians and other clinicians spend anywhere between 60 to 120 minutes in retrospective documentation, patient communication or other administrative tasks before finishing their day.
What is burnout?
Burnout has been defined as emotional exhaustion, great detachment, and a reduced sense of personal achievement. If we add to the already heavy workload clinicians have, the extensive amount of documentation they have to consume and create for each patient or shift, it’s understandable the load will not decrease but increase and worsen the sense of burnout for the users. This is the case unless we have efficient and integrated health information systems in place.
In 1974, clinical psychologist Herbert Freudenberger identified the presence of emotional and physical exhaustion along with emotional detachment in his co- workers¹. He referred to this experience as “burnout.” Since then, the topic has been researched extensively and more notably by Christine Maslach. In 1981, Maslach published a methodology to understand the variables causing burnout syndrome2. Current research validates this, evidenced by epidemic proportions of burnout among clinicians, resulting in overwhelming feelings of frustration in their careers and a loss of professional fulfillment stemming from factors ranging from loss of autonomy to decreased efficiency.
In 2019, the World Health Organization (WHO) officially recognized occupational burnout as a disease by assigning it an ICD-11 diagnostic code. Accordingly, the WHO notes that burnout is characterized by 1) feelings of energy depletion or exhaustion; 2) increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and 3) reduced professional efficacy3.
According to the latest physician survey by the Canadian Medical Association (CMA) approximately 53% of Canadian physicians are experiencing burnout, and 46% are thinking of cutting back their clinical workloads4.
The COVID-19 pandemic completely transformed the way things are done all over the world. People, businesses, and public services had to quickly change and adapt to ensure both service providers as well as consumers could continue doing priority tasks as safely and efficiently as possible given the new circumstances.
In the case of healthcare services, acute care systems and centers were forced to cancel non-urgent surgeries, procedures and appointments and repurpose spaces and staff to accommodate surges in the emergency departments and critical care units.
Impact of clinician burnout
Burnout leads to job dissatisfaction and has the potential to increase adverse patient outcomes. Resulting feelings of disengagement, physical and emotional exhaustion, loss of control, decreased productivity and cynicism can be transferred to other co-workers, teams, units and patients, ultimately affecting the organization’s very culture.
With patient safety initiatives at the forefront of modern health care delivery, clear evidence shows that disproportionately higher staffing ratios and dissatisfactory work environments are highly correlated to poor patient outcomes, reduced patient satisfaction and shorter tenure of the clinical workforce. Lower staff-to-patient ratios results in lower burnout rates, less chance for error and decreased incidences of hospital-acquired infections. Lighter staff workloads also afford more time and attention to the patient and lift the burden of feeling mentally and physically stretched.
Strategies to reduce burnout
Engagement level and resilience plays a significant role in clinician retention. Research points to a combination of individual programs and an organizational approach to creating less stressful work environments. Focusing on staff wellness and safety enhances health system improvements and performance. Staff wellness proves to be most impactful when hospital leadership emphasizes their commitment to employee wellbeing.
- CULTURE - Unfavorable organizational culture is an important predictor of clinician burnout. Clinician engagement is related to the practice of participative management, social support, and team interaction.
- TRAINING AND EDUCATION - Provide consistent and efficient training sessions and targeted ongoing education when needed.
- CLINICIAN ENGAGEMENT IN INNOVATION - encourage clinicians to participate in EHR design, system workflow correlation to clinical practice and testing, giving them a seat at the table. Best practice is to support standardization of technology and care process workflows which allows for the best possible adoption outcomes, as well as a more seamless transition when taking new updates to EHR software.
- STREAMLINE PHYSICIAN DOCUMENTATION/IMPROVE CLINICIAN WORKFLOW - Four major factors influence satisfaction with electronic documentation tools, they are: time efficiency, availability / accessibility, expressivity, and quality.
How is Oracle Cerner Helping?
All of healthcare is moving at a rapid pace from digitized healthcare (a substitution for paper) to data-enabled transformational changes in the industry. As we enter a new age promised by artificial intelligence (AI), machine learning, blockchain and other advancements, Oracle Cerner will continue to lead the industry in reducing clinician burnout. We have pivoted from simplified documentation and order entry to truly intelligent systems that leverage patient data to recognize sepsis, SIRS, obstetric emergencies and many others.
A well-designed system, with proper end-user input and appropriate governance structures for configurations, updates, and optimizations, in addition to appropriate end-user training with personalization and time-saving documentation workflows will contribute to increased engagement and proper adoption while reducing burnout.
The use of clinical dashboards or tracking shells proved especially useful in the last two years in displaying relevant and critical information for health teams regarding COVID-19 status for admitted patients. These tools allow quick display and reference of data elements like diagnosis, risk factors, key lab results and vital signs that usually have to be searched for within the patient’s chart through several clicks.
In the ambulatory space, healthcare providers have been forced to reduce in-person appointments in favor of virtual visits enabled by phone or video calls. A recent joint survey by Canada Health Infoway and the Canadian Medical Association on the use of digital health and information technology among physicians in Canada showed that phone calls were among the most highly used resources by physicians, followed by video visits and secure email communications. Most physicians believe virtual care improves patient access, enables quality and efficient care for their patients.
While burnout in the ambulatory care venue may not be as evident or widely publicized as in the acute care and inpatient spaces, providers struggle with similar challenges: retrospective documentation, fragmented systems and paper-electronic hybrid workflows. Some physicians and ancillary healthcare team members spend considerable amounts of time after hours to ensure tasks are completed and especially reaching out to patients to provide necessary updates or follow ups to the virtual care visit.
Recent technological innovations are making their way into the healthcare space that will greatly help streamlining physician and other clinician’s workflows, while reducing burden and burnout: remote and home patient monitoring, wearable devices that can upload data directly to the patient record, natural language processing, AI assisted patient visit documentation and more. At Oracle Cerner we are embedding these new technologies in our solutions while we continue to work on providing a consistent and optimal experience regardless of the devices healthcare providers are using. Our goal is to enable all clinicians with the resources to do their job efficiently, facilitating an efficient electronic documentation workflow and enabling more and better time spent interacting with their patients.
To learn more about strategies to prevent healthcare worker burnout, visit: nap.nationalacademies.org
First published on Health Matters Bulletin - Issue 4, article 10.
1. Reith, T.P. (2018) Burnout in United States Healthcare Professionals: A Narrative Review. Cureus 10 (12): e3681. DOI 10.7759/cureus.3681
2. Maslach, C, Jackson, S (1981). The measurement of experienced burnout. Journal of Occupational Behaviour, Vol. 2, 99-113.
3. WHO classifies burnout as ‘occupational phenomenon’ related solely to work.
4. Canadian medical association press release March 23, 2022