Michael Privitera, M.S., M.D. is Professor of Psychiatry at University of Rochester Medical Center (URMC), a consultation/liaison psychiatrist and director of the clinician wellness program. It was my great pleasure to interview him recently, as I’ve followed his work on Human Factors Engineering for many years. He will be presenting at the upcoming Healthcare Burnout Symposium in San Francisco.
As described on the patient safety network website, Human Factors engineering focuses on how systems work in actual practice, with real—and fallible—human beings at the controls, and attempts to design systems that optimize safety and minimize the risk of error in complex environments.
In a clinician’s world, one in which the workload and expectations have become truly impossible, human factors engineers help everyone, from senior leaders to those directly caring for patients on the front lines.
An Impossible Job
A number of factors have led to the exacerbation of clinician burnout:
The demands of the job have become so numerous, complex, and conflicting that it is literally impossible for clinicians to succeed at doing the job expected of them.
The only people who feel the totality of the demands are the clinicians bearing the burden.
Senior leaders, being overwhelmed with administrative demands, are disconnected from, and unaware of, the real challenges clinicians encounter in patient care. Additionally, few senior leaders have received the training in human factors that helps a leader see the potential for worker breakdown.
Clinicians don’t do a good job of taking care of themselves. Drawn to healthcare because of the virtuous nature of the work, many find it hard to say “no” to daily demands, hard to take the time to take care of themselves.
Primary Prevention of Burnout using Human Factors/Ergonomics
Dr. Privitera describes this approach for primary prevention of burnout by means of Human Factors/Ergonomics (HFE) basic knowledge in the hands of leaders. As such, it also gives opportunity to fix existing stressors by its application. Getting HFE concepts into the vernacular and knowledge base of healthcare leaders has great potential to help improve the work environment for clinicians – which is the same environment as the healing/safety environment for patients.
He and I have discussed how HFE science may explain how Lean Process works. In HFE application, the “waste” can be equated to extraneous (unnecessary) cognitive load that can be removed by better design to get to the essential meaningful core process. The result being less mental burden, which in turn lowers the occupational stress. Applied throughout healthcare delivery processes, the benefits can accumulate. HFE science also affords an excellent format for administration and clinicians to work together to improve healthcare delivery experience for clinicians and patients.
These concepts of Human Factors Engineering are not new, having been discussed in academic circles for 50 years and championed by William Pasmore of Columbia University with his promotion of Sociotechnical Systems (STS) perspective in designing effective organizations. Pasmore demonstrated that over time technical capabilities have changed with increasing speed, yet the capability of an organization to adapt to this change by changing its organizational design is lagging and essentially unchanged. This is more of a challenge in healthcare which is notoriously slow to change for a variety of reasons.
Burnout as a Bio-Psycho-Social Phenomenon
The impacts of burnout on clinicians is significant. Burnout is a bio-psycho-social phenomenon, in which the brain’s biology changes in response to non-controllable stress. With chronic burnout, the brain is less able to cope with stresses, further exacerbating the condition.
Recognizing this, a group of leaders who focus on clinician burnout have formed a national Collaborative for Human Factors, Cognitive Load and Wellbeing in Healthcare, based upon human factors engineering. One key goal is to focus upon healthcare senior leaders, helping them understand the impacts and take action to reduce human factors driving burnout in the workplace, essentially pursuing preventive medicine for burnout.
Editorial comment: In my experience with using Lean as a management system and culture, when Lean is done right with a focus on both principles of Lean – Respect for People and Continuous Improvement – there is no more effective management approach to creating a sustainable culture that both empowers and aligns everyone in the organization, reducing the drivers of burnout while ensuring enterprise-wide success. Dr. Privitera will go into greater depth on all of these concepts in his presentation on January 24th at the Healthcare Burnout Symposium in San Francisco. I’m looking forward to learning more myself!
If you’d like to learn more about the symposium, use this link, or reach out to me directly at paul@pauldechantmd.com