Redesigning Clinical Workflows to Return Joy to Patient Care
Eliminate frustrations to prevent physician burnout
Eliminate frustrations to prevent physician burnout

Does your work to reduce physician burnout include work to eliminate frustrations?

This week I was working with a health system that is committed to reducing physician burnout. I had a number of meetings, including one with the medical group dyad leadership team. This team includes physician leaders and their administrative partners at the manager, director, and chief levels.

To break the ice, I asked each person to share their name, title, and the percentage of physicians reporting up to them that are burned out. They asked if I wanted to know about those are mostly just frustrated as well as those they think are actually burned out. Many said that about half are burned out, while 90-100% are frustrated.

Physicians Want to Eliminate Frustrations

Frustration is a big deal. As a Lean executive coach, many people think I focus on removing waste from workflows. Most doctors aren’t all that interested in removing waste from their workflows. Almost all are passionate about changes that will get rid of the barriers and eliminate frustrations they encounter multiple times a day. When I ask them what frustrates them, and then we eliminate that frustration, they realize this approach works. They are ready to do more.

Burnout happens when we put a highly motivated person into a work environment that is full of barriers and frustrations. Such work environments require the worker to be hyper-vigilant in order to be successful. Most of us can maintain hypervigilance for short periods of time, but doing so consistently over the long term is unsustainable and leads to burnout.

Is frustration the first step on the continuum of burnout?

Burnout is classically defined as having three manifestations:

  • emotional exhaustion,
  • cynicism, and/or
  • loss of self-efficacy.

One can make the case that continuously confronting frustrations will lead to exhaustion, foster cynicism, and add to doubts about self-efficacy.  If we can reduce or eliminate those barriers and frustrations, we can reduce burnout.

How do you eliminate frustrations?

In our work at IBM Watson Health/Simpler Healthcare we use two approaches to eliminate frustrations.

To take on the big frustrations we work on Value Stream Improvement. A team of the doctors, nurses, and their support staff who do the work map out all the steps involved in the process of care, be it an office visit, care in the emergency department, or the process of surgery and recovery. The mapping process identifies many frustrations. The team then plans a series of improvement events to address the big issues.

Teams can take on the smaller frustrations, the “pebbles in your shoes”, in daily huddles. Huddles ideally consist of preparing for the day (ensuring the team has the capacity to meet the demand), track performance toward metric goals, and solve problems that get in the way of having a good day. These are the problems that come up fairly often, aren’t so severe you need to stop everything till you fix them, but repeatedly irritate you. Examples include supplies not being where they should be or the printer running out of paper.  In the huddle a few people can volunteer to take on one of these and report back with a suggested fix for the problem. As more little problems get fixed, everyone’s day goes better.

These approaches to eliminate frustrations address the drivers of burnout. They can:

  • reduce work overload by eliminating work that adds no value
  • regain control for front line clinicians who can choose what to focus on
  • provide the intrinsic reward of participating in changes that make things better
  • build community as teams work together on positive change
  • renew a sense of fairness by addressing real problems, and
  • reduce values conflicts by investing resources in the things that are important to physicians.

What do you do in your practice to eliminate frustrations?

Almost everyone has come up with a few great ideas. I’d love to hear yours.

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