Kill Workflow Inefficiencies to Combat Clinician Burnout

Time spent on needlessly laborious or unnecessary tasks can silently ratchet up job dissatisfaction rates among physicians and nurses.

Healthcare is an industry where seconds count, and not just in the case of saving lives.

Imagine the simple act of walking down the hall to collect a piece of paper from a printer. "It might only be an additional 30 seconds each time, but if [clinicians] visit that printer 20 times in a day, that's an extra ten minutes daily," says John Jenkins, MD, vice president and executive medical director of the primary care collaborative at Cone Health in Greensboro, NC.

That time could turn in to almost an hour after just a week, and an entire extra eight hours after as little as a month.

Physician dissatisfaction has increased in recent years, with six in ten physicians saying in a 2012 survey that they would leave the profession if given the opportunity for a career do-over.

The knee-jerk reaction to physician dissatisfaction is often to improve compensation or benefits, but Jenkins believes that the secret to burnout prevention is simpler and more cost effective than you might think.

The key, Jenkins says, is to identify inefficiencies that clinicians encounter daily and, with their help, create a more efficient workflow that will shave time off of those tasks.

"Many physicians are experiencing a lack of doing what they feel they were trained to do," says Jenkins. "Quite a few of them feel they have become very highly paid scribes, not doctors… we've also seen more box checking and proscribed steps that physicians are required to take with every single patient than we used to."

Physician Compensation, Dissatisfaction Ratchet Up

Unsurprisingly, the lack of physician job satisfaction is not good for retention numbers. "We're seeing physicians retiring early," says Jenkins. "Physicians used to often work well in to their late sixties, but we're now seeing them seek retirement in their early sixties" Physicians who are too young to retire are considering alternate careers in greater numbers earlier generations, he says.

Those who remain in the profession may exhibit negativity, which in sufficient quantities, has the potential to cascade through an organization, and turn it into a toxic work environment.

Hidden Inefficiencies
Soon after Jenkins began his job at Cone Health, he encountered many physician complaints about the amount of time spent on tedious tasks and not enough time spent helping patients. Jenkins began looking for ways to improve efficiency and morale within the organization. He decided on Lean process improvement, which Jenkins says led to creating a dialogue with clinicians around how to improve their roles.

Chances are, there are many time-wasting inefficiencies hiding in your hospital, each draining productivity from clinicians' days, causing them to feel like the work never ends—feelings that can easily lead to physician burnout, says Jenkins.

"Many providers take between one and two hours of paperwork or documentation-related work home with them each evening," says Jenkins. A worthy goal for any healthcare organization is for clinicians to be able to complete their work during their workday, rather than taking it home with them.

Creating Efficiencies
Adding medical scribes to a hospital's lineup is a solution many healthcare leaders like using to ease physician workload woes, but be aware that under Medicare regulations, there are some EMR-related tasks that scribes are not allowed to complete, and scribes are not a panacea for all data-entry related ailments.

Creating an improved workflow so that the organization's staff will close gaps in efficiency and allow the clinical team can focus on caring for patients and creating care plans. "That creates a better flow so the cycle time is reduced," says Jenkins. "There's less burden on the provider."

Other steps Jenkins suggests are ordering medical supplies that are geared toward cutting down on prep time (pre-filled syringes, for example), improved pre-appointment planning, and implementing patient engagement tools. Ergonomic equipment and workflow software can be helpful, too—anything that takes seconds and minutes out of a busy physician's day can help.

But Jenkins also says it's even more important that healthcare leadership engage with clinicians regarding efficiency. "You must involve the physicians in the solutions. The people who actually do the work are going to be the most valuable for spotting the inefficiencies," says Jenkins, who says town hall style gatherings and small focus-group meetings helped his organization to identify areas that need to be addressed.

"That's where the solutions approach comes from, and how you step someone through the process of improvement," he says. Physicians often love finding solutions to efficiency problems and will usually run with process improvement once they get started, he adds, and that becomes an added small benefit of a hospital's culture.

It's the little things that add up the most, says Jenkins, harkening back to those 30-seconds saved by moving a printer. "What we have to realize is that small increments of improvement [can] make maximal change over time."