We must take care of them so they can care for us 

The pandemic was a crushing blow. Trying to cure financials has piled on more pressure on clinicians, and organizations need to intentionally care for their workforces.

This article is part of the February 2023 COVERstory.

Doctors and nurses remain at the top of the list of the most respected professions. Their popularity increased further as the country witnessed their selfless efforts during the pandemic's peak. 

Researchers estimate that more than 3,600 healthcare workers died because of COVID in 2020 alone. Many more were left with debilitating illnesses that are ongoing. 

For those who escaped severe illness, the suffering of their patients during that dark time remains. Many struggle to manage periods of PTSD that are much similar to that experienced by soldiers who fought on the battlefield.  

Caregivers also endure unmerited abuse as fallout from the pandemic. COVID insults continue today as new variants arise, and many Americans refuse to be vaccinated or boosted. In addition, new stressors, such as the outbreak of respiratory viruses, RSV and flu, further strain overworked clinical professionals. 

For many, the same old story 

But the increasing demands on clinicians are not new. In the past decade, provider organizations focused on cutting costs to align their budgets with smaller payments from government and private insurers. Rather than revising processes and improving workflows to increase efficiencies, many organizations cut staff.

According to a 2022 investigative report published in the New York Times, “Looking to bolster their bottom lines, hospitals sought to wring more work out of fewer employees.” 

After COVID cases exploded, many hospitals did not have enough staff to care for the surge in sick patients. Hospitals and their emergency departments overflowed with patients placed in every available room and hallway. While patients suffered from lower quality of care because of these staffing shortages, so did clinicians. 

While the demand for healthcare services caused by the pandemic has decreased, overall demand for services has not. Many patients who delayed treatment during the pandemic now are seeking care. Provider organizations that ran large deficits during the pandemic because of a decline in profitable inpatient services are now cutting costs to balance budgets and improve their financial position. 

And for most of these organizations, cutting costs means cutting staff. 

Even in a complex industry like healthcare, the basics of supply-and-demand economics still apply. Fewer clinicians mean a decrease in supply, and more patients represent an increase in demand. This imbalance has resulted in an increase in wait times for appointments – a form of rationing services to patients – and an increase in clinical tasks for clinicians assigned to short-staffed environments. 

Because of these pressures, doctors and nurses more frequently are switching to non-patient care jobs or leaving the profession. And it is not easy to rapidly increase the supply of clinicians. In particular, these shortages create a sellers’ market for nursing services. Nurses leave their regular jobs to take temporary positions at the same facility for two to three times their previous salary. Hospitals find themselves competing with themselves and each other for staff.  

And the EHR has played a role in driving clinical staff away from patient care. These systems, efficiently designed to optimize coding for reimbursement, should have been more focused on documentation to support patient care. This demand for increased reimbursement documentation decreases the time these clinicians have with patients while extending the workday beyond regular hours to complete the documentation.  

Burnout is the result 

The triple assault of sicker patients, understaffing and inefficient workflows makes the work environment of the average clinician unsatisfying and unhealthy. No wonder clinicians are increasingly burning out and quitting. 

We are increasingly understanding what happens when there are not enough doctors and nurses to provide care. Therefore, we must work to change the healthcare system to deliver high-quality, safe, effective and accessible care at a cost that we can afford while also caring for those workers who provide the care. We need to fix the working environment problem before improving healthcare quality, safety, access and cost problems. 

Some might think the solution is to hire more workers, but that carries problems of its own. How do we find these professionals? How can we afford to pay them? 

We must redesign the clinical working environment. If we improve the work of these professionals, some may return to the profession, while others will decide not to leave. Improving the work environment includes revising processes and workflows using information technology to increase efficiencies while focusing on the patient and their experience. 

Information technology can help through the automation and standardization of processes. Standarization improves safety and quality by reducing variation. It also offers data to continually analyze and revise processes, providing a cycle of continuous improvement. Applying artificial intelligence tools can satisfy some of the need for documentation for reimbursement and reduce that burden on clinicians.  

Each organization can find ways to improve the working environment by including clinicians in the change effort. To be successful, organizations must avoid a short-term view as change and its results take time. 

If we expect effective healthcare services in the future, we must take care of our clinicians so they can take care of us. 

Barry Chaiken has more than 25 years of experience in healthcare information technology, public health, epidemiology and quality care. Chaiken is author of the book Navigating the Code: How Revolutionary Technology Transforms the Patient-Physician Journey. He is board certified in general preventive medicine and public health and is a Fellow of the Royal Society of Medicine. Chaiken can be reached at bchaiken@docsnetwork.com.

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