Fighting the good fight: How providers and vendors can stop clinician burden

The appointment date has been circled on his calendar for weeks. He spends nearly an hour with his eyes on the door of the waiting room until, finally, his physician emerges. She bears the promise of relieving his unrelenting pain but, after spending most of her day working for her computer instead of the other way around, she doesn't ask her usual questions. He is shy, and she doesn't pick up on his non-verbal cues. She is a talented clinician, but today her talents are no match for the burdens many clinicians often feel, and because of it, her patient will suffer.

                                                     This article is sponsored by Allscripts

Clinician burden is one of the most pressing issues facing hospitals and health systems, and during a Nov. 14 executive roundtable at the Becker's Hospital Review 7th Annual CEO + CFO Roundtable in Chicago, Geoff Caplea, MD, and Ross Teague, PhD, of Allscripts encouraged the executives in attendance to have a candid conversation about the problem.

Dr. Caplea, medical director at Allscripts, and Dr. Teague, the company's director of user experience, gathered hospital executives from across the country to better understand the root causes of clinician burden, which is related to many system factors and affects patient care, physician engagement, physician well-being and hospital operations.

The issue of clinician burnout has been around for decades, but has become especially pronounced in recent years as regulatory burden, payer requirements, accreditation concerns, practice environment and payment pressures have compounded the problem. Rather than engage in a simple transactional relationship with providers, Allscripts leaders are looking to forge partnerships with organizations that can help alleviate clinician burden.

"We are definitely looking at all ways in which we can address the issue and how we can extend support for all the associated factors that contribute to clinician burden," said Dr. Caplea. "We want to hear from you in this conversation: What are the challenges, what's working well, what's not, and how can we be a better partner?"

In a survey of attendees, patient safety was the No. 1 concern related to clinician burden. As the chief nursing officer of one Midwestern hospital succinctly put it: "It is difficult to care for others when you aren't able to care for yourself."

When diagnosing a patient, physicians not only rely on their vast clinical knowledge but also on an understanding of human behavior informed by years of experience. However, when they are burdened by a number of systematic factors, this dimension of care can become overshadowed.

"Clinician burden also makes you not pay as close attention to detail as you might have in the past, where you don't see subtle things any longer," said the chief quality and transformation officer of a hospital in the Pacific Northwest. "Whether it's the tone of a patient's voice, or a physical finding that they may demonstrate. You're just not as attentive to detail as you might otherwise be."

Some executives said small steps such as scribe services have helped reduce some administrative burden for clinicians, leaving them more energy to dedicate to the patient. One hospital employs navigators to answer questions about patient history before the patient ever sees the physician, a small adjustment that has helped alleviate burden.

Attendees emphasized that while clinician burden is the culmination of numerous factors, it is important for providers to cultivate close relationships with their vendors in order to tailor EHRs to their organization's unique needs. Allscripts has taken this client-centered approach when working to ease clinician burden at its partner organizations. Collaboration between clinicians, hospital leaders and vendors can lead to innovative solutions.

"One thing that has to happen is…actually finding a vendor willing to look at how you work. To look at your workflows, to do the things that a good informatics department does in terms of examining how an individual system functions, and actually partnering with them to design cloud-based solutions," said the chief quality and transformation officer from the Pacific Northwest. "That is not the kind of relationship where a system is held hostage by the vendor every time there's an upgrade and hospitals have no control over the cost."

Faced with a problem as systematic as clinician burden, many individual physicians and nurses feel it is futile to try and change anything on their own. However, while it would be difficult to individually create a wave of change that alters the entire healthcare industry, it is possible for organizations to implement top-down changes that can help ease the burden on their clinicians. For that to happen, leadership objectives must be completely aligned with the needs of front-line clinicians.

"I think that it starts with leadership. I think the only effective leadership in healthcare nowadays, is the concept of service leadership," said the CMO of a large Midwestern hospital. "That's service to both the customer and service to your staff."

With effective leadership in place, organizations can take steps to help reduce clinician burden. However, clinician burden is caused by a myriad of systemic pressures, and these steps cannot be incremental; they must instead keep an eye toward transformation and partnership.

"You know, you have to partner with people and give them the he tools they need to do their work," said the CEO of a Midwestern specialty hospital. "Right now, many people are trying to plant a garden and they need a backhoe, but they are using a little gardener shovel."

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