Redesigning Clinical Workflows to Return Joy to Patient Care
Resilience or Redesign: What Are You Doing About Burnout?
Resilience or Redesign: What Are You Doing About Burnout?

A question for healthcare executives – are you addressing physician burnout by investing in resilience or redesign?

Same question for physicians – are you addressing burnout for you and your colleagues by investing in resilience or redesign?

While most work on physician burnout still focuses on resilience, there is an increasing, and much needed, focus on redesign to address burnout.

Resilience or Redesign – Not really an either/or question

The reality is we have to invest in both.

Healthcare executives must invest in resilience to help the growing majority of physicians who are truly suffering the consequences of burnout – exhaustion, cynicism, and lack of self-efficacy.  The secondary impacts, including depression, substance abuse, family dysfunction, and suicide, are hurting individual physicians and the profession as a whole.  We must support resilience training to help physicians deal with the toxic workplaces they cope with every day.

Physicians also must invest in resilience. If we are burning out, resilience supports our road to recovery. Even in the best of circumstances, our profession carries inherent risks for burnout.

  • We are, by nature and training, perfectionistic paranoid overachievers. We had to be in order to get into med school and get through residency.
  • We deal with life, death, and deeply personal aspects of our patients’ lives. While value this opportunity, it can take its psychological toll on anyone, no matter how naturally resilient we may be.

And yet, if we are investing in resilience without investing in clinical workflow redesign we are missing the point.

Resilience or Redesign – How are you allocating your investment to maximize ROI?

Let me start by explaining my approach to Return on Investment (ROI).  Executives focus on maximizing ROI. It’s part of the job description, and usually we are focused strictly on the financial return. Investments in reducing burnout provide other returns as well.

Many physicians consider maximizing ROI an anathema. We’ve seen programs that maximize productivity and decrease quality in the name of “maximizing ROI” and want no part of activities that prioritize ROI.

Reducing physician burnout improves physicians’ personal and professional lives. This is a key return on the investment in reducing burnout.  With this comes improved physician engagement and improved performance on quality, safety, access, and patient satisfaction. These metrics are important in every healthcare system where I consult. The great thing is, these improvements lead to improved financial performance as well.

Resilience or Redesign – What’s the right ratio to invest between the two?

Redesign is hard work for everyone involved. It’s much easier to invest in resilience training. And resilience training can quickly reduce the suffering of burned out physicians. So most organizations start by investing more in resilience. That’s OK, as long as the investments do not stop there, and the ratio of investment in clinical workflow redesign quickly ramps up to exceed the investment in resilience.

I recommend a 3:1 ratio of investment in clinical workflow redesign over investment in resilience. Dysfunctional clinical workflows are the root cause of burnout. If we are not serious about fixing this dysfunction, we are ultimately wasting our money on resilience training.

This investment in reducing burnout is not just made with dollars. We must, executives and physicians alike, invest our personal time and effort. The financial investment in workflow redesign simply supports the real work of redesign. Those who do the work, physicians engaged directly in patient care, know what’s wrong and have great ideas to fix the problems. If we redesign without the physicians, we don’t

Many physicians feel they can’t commit significant amounts of time to redesign work. They need support:

  • Part of the organization’s financial investment should go to protecting the compensation of physicians engaged in redesign work. We should not ask physicians to do this work “pro bono” unless executives are willing to do the same.
  • Physicians also worry that time away from practice will put additional burden on their partners. When all physicians participate, we all share in the burden.
  • As clinical workflows improve, physicians realize personal benefits as returns on the investment of their time, including better work-life balance, better ability to focus on their patient, and, potentially, better incomes.

At Simpler Healthcare, our clients average a 3:1 financial ROI.

Redesign works

As CEO of the Sutter Gould Medical Foundation, I invested $1.3M in our redesign effort over five years. We received the highest overall rating from Consumer Reports among 170 medical groups in California two years in a row. Our physician satisfaction improved from the 45th to 87th percentile in the AMGA provider satisfaction survey. We started with a $9M loss and ended up outperforming our budget year over year.

The theme for our redesign effort was “Returning Joy to Patient Care”. We made small investments in resilience relative to major investments in redesign. We knew that if we supported our doctors by providing a stable reliable practice environment that enhanced their ability to focus on their patient while in the office, and regain personal time to focus on themselves and their families when not in the office, we would have a greater and longer-lasting impact.

What are you doing in your organization?

What’s your ratio between resilience or redesign?

I welcome you to share your experience with others in the comments below.



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