'Nothing is ever taken away': 26 clinical leaders on the largest contributors to burnout

Burnout is not unique to healthcare. In fact, it officially earned recognition as a medical syndrome in May 2019 when the World Health Organization assigned it an ICD-11 code. Symptoms include emotional exhaustion, loss of meaning in work and feelings of ineffectiveness. 

While many industries and professionals have their own confrontations with burnout, the condition is especially troubling in the high-stakes field of healthcare. The risks and costs of burnout present themselves in many ways. 

Direct expenses tied to physician burnout cost the U.S. more than $4 billion annually, according to a study published in Annals of Internal Medicine. For healthcare organizations, burnout is linked to $7,600 in costs per employed physician per year. Of greater weight is the cost to patient safety and wellbeing: Researchers at Stanford University School of Medicine have found physician burnout is at least equally responsible for medical errors as unsafe workplace conditions.

In May, Allscripts Ross Teague, PhD, director of user experience and Christopher Caggiano, M.D., solution director, led a discussion during an executive roundtable at the Becker's Hospital Review 2nd Health IT + Clinical Leadership + Pharmacy 2019 in Chicago, where 26 hospital and health system executives discussed the largest drivers of burnout, the link between health IT and clinician wellbeing, and what organizations have done to support their clinicians and alleviate burnout. 

During the executive roundtable, Allscripts leveraged mobile polling to pose questions to executive participants and gain their insights in real time. Here are a few of the points raised during the roundtable, with summarized responses and excerpts of conversations that followed: 

1. Roundtable respondents said rules and regulations and clinicians' healthcare responsibilities are the largest drivers of physician burnout in their organizations.

Clinicians made note of the numerous regulatory boxes they have to check to care for patients, and how the complexity of these requirements intensifies as more are added at the federal, state, local and organizational levels. In one year alone, nearly 24,000 pages of federal regulations were published for hospitals and post-acute care providers, according to the American Hospital Association. 

Such vast output of rules means hospital staff must not only work to provide high-quality, high-value care to patients, but do so in a way that complies with existing regulatory requirements as they learn to understand and implement new or revised regulations.

"The rules are changing every day," said the vice president of nursing operations for a 606-bed health system in the Northeast. "The CMS appeals are different today than the ones we got yesterday. You capture it, then next month you have a different kind of appeal and what we did before is not good anymore. How do you keep up with that?" 

"Things get added on and nothing is ever taken away," said the CMO of a 247-bed hospital in the Northeast. "'It's just one more click.' Sure, it's just one data point, but it's one data point on another data point on another data point. Who is the one putting it in?"

"It doesn't matter if the regulation is from the hospital or government – it's still something I, the clinician, have to do," said the chief clinical officer of a 45-bed hospital in the Southwest.

Several roundtable participants said they would see EHRs and health IT as more effective solutions if they reduced the burden and complexity of regulatory compliance. "All of the regulations we're talking [about] are now something you have to enter into the medical record to be compliant," said the CNO of a 77-bed hospital in the Midwest. "The amount you have to document is getting larger and larger so you can't even see the patient."

Although the term burnout is often preceded by "physician," roundtable participants pointed out the high stakes for all members of the care team. "If we don't care for all of these people, the system is going to collapse," said the chief clinical officer of the 45-bed hospital in the Southwest.

Out of several medical roles, respondents indicated greatest concern about nurses burning out. 

"Many of the things described for physicians are the exact same stressors and burdens nurses experience – documentation, rules, regulations, patient experiences, trying to fill in gaps for providers," said the CNO of a 77-bed hospital in the Midwest. "But if patients are not happy with the outcome, especially in the emergency department, we are the last people to discharge them. The unhappiness then lands on our shoulders or ears, and after a while you get tired. I see younger nurses stay for 5 to 8 years, and then they're done. They're burned out and there are other choices for a profession."

2. When health IT products do not support the end user's high-level goals, the technology can cause stress, interruptions and added burden that contribute to burnout. 

Roundtable respondents shared their high-level goals that health IT must support: 

  • Care for the patient
  • Spend time with patients
  • Optimal care and outcomes for patients
  • Provide safe, quality care
  • Have a life
  • Get paid for work
  • Have patients go healthier than they came
  • Clear, concise communication to the treatment team
  • High-quality care within established, successful workflows that leaves time with my family

One roundtable participant noted her desire for more voice-enabled solutions, which can promote physicians' face-time with patients over screentime with computers. "Part of the moral distress clinicians feel from the documentation burden is the fact that they've missed care," said the CNO of the 77-bed hospital in the Midwest.

One associate chief nursing executive at a 186-bed hospital in the Northeast said clinicians who experience burnout are emotionally exhausted and almost lose their sense of empathy for patients. This is where the patient-clinician relationship can break down, especially if IT tools exacerbate versus alleviate clinicians' stress. 

"It's like they're going through the motions," she said. "That impacts the patient, because the patient understands when you care and are in their corner and are trying to make things better for them versus a check-the-box effort. They are less likely to stay connected with their care team unless they are very self-motivated or they had a really positive interaction with their clinicians." 

3. Several roundtable respondents indicated that clinician burnout is one of their organizations’ top three concerns. 

With a physician shortage quickly approaching and greater demands for chronic healthcare, health systems, hospitals and medical groups must act now to reduce burnout among their ranks and retain their clinical talent.

Although the importance and impact of clinician burnout is well established, some respondents noted that their hospitals are doing nothing to address burnout. Others shared a medley of solutions their organizations have deployed, some more robust than others:

  • Floundering
  • PTO
  • Paying enormous salaries
  • Education
  • More job fairs
  • Scribes
  • Focus on streamlining the EHR

Several participants said their organizations have taken the first step of responding to burnout by issuing surveys to gauge the problem at their organizations and to properly measure improvement. "We came out with the data and that there is only one direction for us to go — we need to be better," said the CMIO of a 407-bed hospital in the Pacific Northwest. "We don't just look at burnout, but also satisfaction with the EMR." 

Some solutions discussed are applicable within the walls of a hospital or health system, while others address the macro environment that fuels exhaustion among America's care teams. Most respondents see value in the latter, macro-level approach, with only 7 percent of executive respondents indicating that their organizational culture has a major effect on burnout.

The associate CNO of a 245-bed hospital in the West said his organization is investing in advocacy to reduce regulations for medical documentation and other clerical work. "Those of us steering the ship are tired and frustrated, too," he said. "We preach activism at our organization – write your legislators. I am doing that on behalf of my organization."

For participants who are familiar with organization-specific interventions, they discussed efforts focused on clinicians' own health and wellbeing, along with a cultural shift that leaves people feeling more connected with one another. "There are different models our facility focuses on, like self-care and working with coworkers as a team," said the CNO of a 50-bed hospital in the South. "We are changing the culture to one that is more like a family, with the expectation that leadership will recognize staff and get input and feedback to drive change." 

Key points in summary:

  • Burnout symptoms include emotional exhaustion, loss of meaning in work and feelings of ineffectiveness. The condition is linked to greater administrative spend in healthcare and greater risks of medical errors. 
  • Several roundtable respondents indicated that clinician burnout is one of their organizations top three concerns.
  • Clinicians said regulatory requirements for medical documentation and other clerical work are the largest stressors and thereby contributors toward clinician burnout.
  • Clinical leaders said health IT must support their relationship with patients, first and foremost, to alleviate versus exacerbate the stress that can culminate to burnout. 
  • Few organizations have deployed sophisticated, meaningful and strategic responses to help their care teams combat burnout, with several participants noting the lack of a robust game plan in their organization. 


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