This is the third article in a Series Regarding process-based opportunities as the healthcare industry begins to emerge from the challenges of the pandemic. As noted in Introduction to this seriesEach of these articles will identify a problem, consider the problem and its implications for healthcare, and then offer potential solutions.
Clinical fatigue has been one of the major challenges faced by healthcare during the COVID-19 pandemic – in parallel with Nursing shortage And an expected shortage of doctors looms not far in the future.
While the majority of studies and research on burnout has focused on clinicians, burnout has long been recognized as a problem for the entire care team. Nothing has revealed this truth more starkly than the pandemic, with millions of Americans daily watching images of hospital and health system employees working to death before their eyes.
When we start dealing with the pandemic, things will return to what seems to be normal in hospitals, health systems and doctors’ practices, and care teams will return to their usual operations.
This means that the seeds of exhaustion will still be present in those processes, but they may have a lot more fertile ground to grow in after what we’ve all been through. It will be our job as healthcare leaders to change this.
First, let’s look at what burnout is and what isn’t. Fatigue is not depression or anxiety, although it can lead to some of the same symptoms. It’s not something that takes over your mind quickly, but rather a gradual process that escalates over time, and one of its primary causes is chronic stress. In 2019, the World Health Organization classified burnout as an “occupational phenomenon”, and Define it this way:
“Burnout is a syndrome that is conceptualized as the result of chronic stress in the workplace that has not been successfully managed. It is characterized by three dimensions: feeling depleted of energy or exhaustion; increasing mental distance from one’s work, and feeling negativity or cynicism related to one’s job.”
Implications for health care
In addition to the effects of fatigue on the individual, there are significant implications for health care in general. The National Academy of Medicine describes burnout among clinicians as a serious threat to organizational health. One of the most recent and widely cited studies on provider burnout estimates that physician fatigue costs the US healthcare industry at $4.6 billion annually, mostly due to turnover and reduced clinical hours. This is an annual cost of $7,600 per physician working per year.
The nurses on the care team are also affected. A survey of 1,688 direct care nurses in three hospitals conducted over the course of a year (2018 and 2019, with 3,135 total surveys) found that 54% of nurses experienced moderate burnout, and 28% experienced high levels of burnout.
The surveys also found that scores for emotional exhaustion increased by 10% and sarcasm scores increased by 19% after one year. For every unit increase in the Emotional Exhaustion Scale, the study showed that there were a 12% increase in sales. These surveys were completed just before the pandemic. Imagine what happened in the last two years.
The Medscape 2021 Doctor Burnout & Suicide report, released in January, shows that the pandemic has exacerbated burnout, according to more than 12,000 doctors who participated in the study. In this year’s study, 42% of physicians reported fatigue21% of them reported that their symptoms of fatigue started after the onset of the COVID-19 pandemic.
The top six contributors to burnout mentioned by survey participants are familiar to those who study burnout in healthcare:
- Lots of bureaucratic tasks
- Spending long hours at work
- Lack of respect for administrators/employers, colleagues or employees
- Compensation / reimbursement is not sufficient
- Lack of control/independence
- Increase computing practice
Workplace burnout solutions
The most important thing to take away from the previous definition is that fatigue is stress that has not been “successfully managed.” Just as there are ways in which providers can individually manage chronic workplace stress, there are also solutions that organizations can put process-level on the front end to reduce or eliminate major contributors to workplace burnout and the impacts they cause. You have.
The common denominator that causes clinical fatigue is the many tasks that cannot be done in a limited amount of time. The more we can do to automate and equip the clinician to be flexible, the better. In order to resolve the regulatory and ultimate effects of burnout in healthcare, four areas should be focused:
exercise. Too often we train doctors once in a certain technology, such as an electronic health record, and then let them go for good. If you don’t update their knowledge as jobs change and new promotions happen, they will become exhausted.
judgment. Understanding when new processes and procedures are introduced and their impact on patient rotation and productivity is what good governance is all about. Leaders need to understand the impact of their decisions so that they can manage the flow efficiently and effectively, so that stakeholders are not overwhelmed.
Communication. Involve stakeholders early and communicate with them non-stop, ensuring that they are always aware of what is happening, using different channels and methods of communication.
system building. The term system building may sound technical, but it is not so much about technology as it is about operations. Your goal is to build agile, efficient processes that don’t require your doctor to do the same things multiple times. Anything we can do to reduce the number of clicks, the number of screens you open, or the number of places they have to go for information, will go a long way toward reducing fatigue.
Focusing on these areas can undo some of the human and financial damage to healthcare organizations from years of ineffective processes, outdated technologies, and a lack of integration in care teams.
This will give care team members more time to focus their attention on something they care deeply about and benefit the entire organization – providing high-quality patient care.
Sam Hanna He is an executive resident at American University. Previous roles include being a consulting practice leader, head of strategy and innovations, and digital strategist at global consulting firms such as PwC and Deloitte. He holds a Ph.D. in Transformational Health Sciences from George Washington University and an MBA in Entrepreneurship from Babson College.