Over the next six weeks I will be posting about each of the six primary drivers of burnout, starting today with the first of the six – Work Overload. Work Overload is the first thing people think of as a root cause of burnout. When there is too much to do, people become overwhelmed and exhausted. Of course, Emotional Exhaustion is one of the three manifestations of burnout, with depersonalization and a sense of inefficacy as the other two.
Work overload has gotten worse due to EHRs that require a greater amount of time and effort to complete tasks that were quick and easy in the paper world. It’s common for physicians to spend 2 or more hours at home each night finishing up progress notes and in basket demands from the day. This has been described in the medical literature as “pajama time.”
It is so common that EHR vendors have developed reports documenting the mismatch of when physicians are working compared to their scheduled hours. I personally have fallen asleep on the keyboard on more than one occasion in an effort to “do today’s work today” even if it really meant “doing today’s work tonight.”
Physician-related Factors in Work Overload
For physicians, Work Overload is complicated by two other work-related factors – a chaotic work environment and time pressure. Both present unique challenges.For many people work is fairly predictable. They know what time they will be going to work, what is likely to happen during the day, and when they will be going home. For many physicians this is not the case. We often know when we will start our day, although in many specialties is is not uncommon to be called in early. Most of us cannot predict how our day will go or what time we will be leaving. There is just too much uncertainty regarding patient needs and unexpected demands.
Time pressure is a constant challenge for most specialties. We impose some of this on ourselves, trying to keep up with patient demand or hit productivity targets imposed by ourselves or our organizations’ leadership. As such, even if we are able to complete our work by the end of the day, many of us go through our days in a state of chronic hypervigilance, watching the clock to ensure we are not getting too far behind, and feeling increasingly stressed as the waiting room fills up with patients who have waited too long.
How to Deal with Work Overload
Lean helps us to address workload in three ways:
- Reducing the work effort needed in order to accomplish the same results is a strength of Lean. We can redesign workflows to remove the waste, barriers, and frustrations that make it hard to get through our day. Once we do so, we don’t have to work as hard.
- We can get some control over the chaos by developing standard work for ourselves and our teams, ensuring that patients are consistently prepped for us. We can use 5S to ensure that supplies and equipment are ready when and where we need them.
- We can also reduce time pressure by redesigning schedules and work flow processes with a focus on “takt time”, matching the pace of work to the demand for services. As we do this we focus on matching capacity to the demand. This may require adjusting staffing accordingly once we have achieved improvements in waste reduction, standard work, and schedule adjustments.
The Impact of Work Overload on Lack of Control
Being overloaded with too much work leads directly into the second driver of burnout – Lack of Control. That will be the topic of next Sunday’s posting. In the meanwhile, check back on Wednesday for a vignette from a Northeast Georgia Physicians Group primary care clinic in Cleveland, Georgia, where the physicians and staff have successfully implemented a Lean transformation and significantly reduced their work loads.
What do you think? Is Work Overload an issue for you? What have you found that makes a difference? Click on “Comments” above to share your thoughts.