Redesigning Clinical Workflows to Return Joy to Patient Care
Preventing Physician Burnout – Q & A
Preventing Physician Burnout – Q & A

“As an RN, this presentation is on target with the level of frustration we deal with as well…great delivery.” This was one of the comments I received following a presentation on Preventing Physician Burnout at IBM’s office in Cambridge, MA.  This nurse is right, burnout is not unique to physicians, and in fact affects all health care workers.

This past week I had the honor of presenting a talk on Preventing Physician Burnout and Returning Joy to Patient Care through Lean Done Right with my co-author, Dr. Diane Shannon.  It is a part of the HOPE team series of lectures on Watson Health to help IBMers learn about health care from industry insiders.

We had a great audience, both in the auditorium at IBM’s Binney Street office, as well as on the webinar, where about 450 people signed on to view the presentation remotely.  I’ll be posting some outtakes from the presentation on my website soon.

The key points of our presentation included the fact that physician burnout is a serious and growing problem that affects over half of physicians, it has impacts on patients, health systems, and physicians alike, and efforts to address burnout need to include wellness program, but can’t stop there.  We need to fix the root cause – broken workflow processes in our hospitals and clinics.

I’d like to take this opportunity to address other questions on Preventing Physician Burnout that we were not able to answer as we ran out of time during Q&A.

  • How is Watson Health helping clients address this issue?
    • Watson Health does a number of things that make a difference.  Our care management modules provide physicians with a summary of a patient’s gaps in care at the time of the appointment, reducing redundant work for the physician and team. Watson for Oncology reduces the time needed for clinical trial matching by 73%.  There are Watson Health teams developing APIs to reduce the documentation burden that distracts physicians from directly connecting with their patients.
  • Have the waste management practices from IT, such as prioritizing, delegating, and focusing on limited activities, been considered as part of the solution?
    • Beyond IT solutions, the Simpler component of the WH team coaches hospital and clinic leaders and staff on Lean management and redesign, with a focus on removing the barriers and frustrations to patient care that are key drivers for burnout. Our work aligns with the IT practices described.
  • I would like to see Watson Scribe for the doctor.
    • We’re working on it and will keep you posted.
  • I wonder if time to train new physicians is an issue. Are there simpler decisions that could be made by people with less/shorter training?
    • We support the development of care teams, led by a physician, and including nurse practitioners, physician assistants, RNs, medical assistants, and health coaches. This team approach is key to relieving burnout while expanding the number of patients the team can care for.
  • How/why did these external factors causing burnout come about?
    • In the presentation I talk about the changes that have happened to patient care in the last 10 years that are causing the increase in burnout.  They include expansion of the EHR, multiple regulatory changes, an aging and culturally diverse patient population, patients consulting Google before consulting their doctor, the opiod epidemic, patient satisfaction surveys, and reduced reimbursements. Individually, each change makes sense. Collectively, they have created a huge burden on physicians.
  • “Call it “Creeping Complacency” — the lack of outrage over all the frustrating annoyances of the job”
    • This comment came in response to my concern that the collective burden is so large that physicians and leaders should be outraged at the situation. However, the “annoyances” have appeared gradually over 10 years, not all at once. So physicians have absorbed each as it arises, making it hard to see the global impact.
  • I wonder if physician’s have been diagnosing burnout in other professions in the past.
    • We have a diagnosis for burnout, but it is technically a “contributing factor” diagnosis, not the primary problem.  It may be used at times, but burnout has not been a commonly used diagnosis.  It is not listed in the DSM-5, the compendium of behavioral health diagnoses.  There are more calls from physician and nursing groups to do so.
  • How does US physician burnout % compare to physician burnout % developing countries from South America, MEA & Asia? How can we apply these to Latin America?
    • Burnout is everywhere.  There is variation in burnout rates that vary by country, and within a country.  In some ways, like the saying on politics, “All burnout is local.”  It depends on the quality of leadership and the management philosophy of the institution.  An approach based in “Respect for People” and focused on removing barriers and frustrations for care givers is key to preventing physician burnout.
  • In your experience, what’s the most effective way to address BO with responsible parties in settings where the theme is “taboo”?
    • This is an important issue.  There are many reasons people don’t want to acknowledge burnout, from a feeling that if one complains it is a sign of weakness, to a concern that if we acknowledge burnout and restrict work hours in response, our systems will not have enough workers to meet the patient demand.
    • A great way to remove the stigma of burnout is to have leaders and members of the board of directors spend a day immersed in the hospital, shadowing physicians and nurses as they do their work.  There is no better way for a leader to understand the problem than to see the challenges first hand.  This frequently changes the conversation and enables everyone to get engaged and collaborate to take burnout seriously.

These questions on preventing physician burnout may have raised some other questions for you.  Feel free to share your thoughts in the comments section below.  I’ll look forward to them.

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