How Workflow Optimization Addresses Physician Burnout

At physician practices affiliated with Virginia Mason Medical Center, effective workflow optimization addresses burnout challenges with a team-based approach.

Through workflow optimization, physician practices can create a team-based approach to care that alleviates physician burnout, a Seattle-based internist says.

Inefficient workflows contribute to physician burnout in several ways, says Richard Furlong, MD, an internist affiliated with Virginia Mason Medical Center.

"The elements of physician burnout that are impacted by a flow that is not optimized are waiting unnecessarily, having a visit that you are conducting not set up for you, having a schedule that is mismatched relative to the demands upon you, and having a sequence of tasks that you are burdened with that are not matched with your skill level," Furlong says.

Effective workflow optimization addresses burnout challenges with a team-based approach, he says.

"Optimization initiatives that address flow are usually targeted at those categories—lack of set up, mismatch of supply and demand, and poor skill-task alignment."

Furlong and his care team colleagues have focused primarily on three workflow optimization tactics that foster team work: spreading the work burden among physicians, adoption of standardized work roles, and colocation of team members when feasible.

"We have team members who can help us, but we have to organize the work so that can happen," he says.

Data collected by The Advisory Board indicate that the workflow optimization efforts are having a positive impact on the employment satisfaction of physicians, advanced registered nurse practitioners, and physician assistants at Virginia Mason Kirkland Medical Center, where Furlong is based.

For the past two years, 100% of physicians, APRNs, and PAs surveyed have reported they were engaged or content with their workplace. Engagement is considered an indication of a staff member's dedication to the organization and willingness to go above and beyond on the job.

Spreading responsibilities
 

To prevent physicians from burning out, and to help them work at the top of their license, patients in Furlong's practice are often seen by caregivers other than the physicians, including clinical pharmacists, care managers, RNs, physician assistants, and nurse practitioners.

For example, diabetic patients can be seen by care managers and nurses who can help the patients manage their chronic condition.

"We have a process in place where the patient can be referred to a care manager, and the care manager becomes a co-owner of that patient. We'll make phone calls in between visits, and patients will have nurse-only visits for insulin teaching and lifestyle modification," Furlong says.

Advanced practitioners such as physician assistants also get involved in diabetic care.

"The physician is not out of the loop but is not involved in every one of the care touches. When the patient comes back after three months to have their A1C checked and their meds reviewed, we have done some focused training with our APs to handle those follow-up visits," Furlong says.

Clinical pharmacists have been playing an increasingly important role in spreading the workload, he says.

"What a lot of clinics have not done is to take some of their staff—especially the clinical pharmacists—and plug them into the workstation of the provider who is out of the office on any given day. That has been successful for us because a lot times the clinical pharmacists have capacity in their day to help physicians," Furlong says.

The role of clinical pharmacists has been expanding steadily at Furlong's practice.

"They are involved in seeing patients in face-to-face, direct care. They started out seeing our coagulation patients—our patients on Warfarin. Then we had them see our hypertension patients. Now, we have them seeing patients on antidepressants and chronic opiates," he says.

Most primary care practices could benefit from utilizing clinical pharmacists, Furlong says. "They are in the mix in primary care in a big way. A lot of other healthcare institutions are getting onboard with using clinical pharmacists; and if you are not, you are behind."

Standardized roles
 

Establishing standardized roles can ease the workload burden on physicians, Furlong says.

For example, his practice has established new standardized roles to limit the number of patient portal and phone messages that are handled directly by physicians.

"The intent was to discern which messages could be handled by someone other than the physicians. So, we had a meeting with the pharmacists and asked them what kind of questions they would be willing to field and bypass the physician," Furlong says.

Medical assistants have also adopted a new standardized role to help manage patient messages, he says.

Colocation
 

Having care team members located at the same site can enable workflow optimization and ease physician workload, Furlong says.

Having pharmacists on-site can be particularly helpful in giving physicians timely support. For example, they can help review the medications of patients after discharge from a hospital.

"The patient could have 15 medications and there is often confusion about what they were discharged on. The pharmacists are good at digging in and sorting all that out. Sometimes, they can jump in and help on the spot," Furlong says.

And if it isn't possible to have all team members on-site? From a workflow optimization standpoint, it is possible to overcome the lack of care team colocation, he says. "Every health system has an electronic health record, so there are communication tools within the EHR."