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Why burnout impedes the transition to high-impact healthcare

“They’re making us apathetic. I got into medicine because I really wanted to make a difference in people’s lives. But after going through hell, I just don’t care anymore.”

This raw observation by a new physician in the popular blog Humans of New York (HONY) echoes the findings of a recent discussion paper in the National Academies of Medicine. Warning of an “underrecognized threat to high quality care,” researchers observed that as the U.S. healthcare workforce works to improve care while payment, delivery approaches, electronic health records, patient portals and metrics, more clinicians are suffering from burnout.

About 44 percent of physicians and 70 percent of nurses report high levels of emotional exhaustion; high percentages also report cynicism and a low sense of personal accomplishment from work.

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Burnout stands in the way of the goal to transition to a promising new model of high-impact healthcare, an approach replacing the transactional model of the past with a model that leverages the synergies of sophisticated medical care, big data, technology, population health management and consumerism. To achieve this optimal state of care delivery, managers must do a better job addressing the stressors inherent in the health system and caring for our own workforces.

A healthy workplace enhances patient safety, facilitates better quality of care, reduces costs, and drives a system of care that leverages efficiencies by multiple stakeholders. In addition, a healthy workforce contributes to organizational health and well-being. Conversely, a burned out workforce can lead to more medical errors, increased costs, and decreased patient satisfaction and can result in the destruction of care organizations.

From a healthcare practitioner’s perspective, high-demand, high-pressure value-based care can contribute to the feeling of depersonalization in care delivery. Clinicians may feel like they work in a factory, where they are less valued for their provision of medical care than qualifying for an incentive payment. According to a 2018 survey, 86 percent of physicians reported that factors such as data reporting for quality metrics “diminished my joy in practicing medicine," a contributing factor to depression and burnout.

Organizations can start by revisiting workflows so that pressure on physicians, nurses and other care providers is minimized and clinicians can again realize that joy. Every administrative task that can be done by someone else should be done by someone else. At the same time, organizations must ensure that every member of the team is supported and valued for her or his role, and that the organization is committed to individual success as an integral value of a shared vision.

The collaborative approach toward a shared vision should be infused in all workforce strategies. Consider HONY’s burned out physician. Imagine a future in which administrators took the time to ask: “How can we best support you as our organization changes? What steps will help you and your colleagues through the process?”

Technology plays a role but is only as good as the humans that use it. Research shows that among physicians, health information technology-related stress is common (as identified by about 70 percent among clinicians) and predictive of burnout.

To change this dynamic, conversations and decisions on care and coding, electronic recordkeeping, and health information technology should not happen in a silo. Leadership of care organizations, providers, health IT professionals and support staff should all be involved in the discussion of roles and responsibilities. When healthcare practitioners are relieved of some of those responsibilities, the potential of burnout is diminished, and support staff is more likely to feel valued when clinicians acknowledge the contributions of the entire team and all parties commit to strategies for mutual successes.

This collaboration is not limited to electronic health records (EHRs). Increasingly, robotic technology, artificial intelligence that produces predictive modeling to identify and treat conditions, and other technologies will advance high-impact care, but only if the entire workforce has been primed and trained with the soft skills to harness technology and use it.

Donald Berwick, MD, who served as administrator of the Centers for Medicare and Medicaid Services and chief executive of the Institute for Healthcare Improvement, once said “As joy in the workforce erodes, quality goes down.” We must strive for an improved culture that better supports and lifts the humans that further patient care.

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