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Curbside Consult with Dr. Jayne 3/19/18

March 19, 2018 Dr. Jayne 3 Comments

Many of the physicians and other health professionals I work with during consulting engagements are suffering from burnout. As I work with troubled organizations, I am finding an increasing number of non-caregivers experiencing symptoms of burnout as well. I’ve recently partnered with an executive coach to work on strategies that we can use to better assist these organizations. It used to be that teams became stressed during times of change or times of institutional uncertainty, but we’re seeing teams that are now under stress all the time. Budgets have been cut, positions have been eliminated, and remaining workers are expected to absorb the work of others regardless of their capacity for additional tasks.

Healthcare informatics work is becoming more high stakes as systems are more deeply intertwined in care delivery. It’s not just about keeping systems in a state of high availability anymore. Now, healthcare IT teams are expected to monitor clinical quality calculations, enable reporting that has significant financial ramifications, and monitor updates and patches to ensure there are no changes to critical business processes or reporting processes. At one hospital where I have worked, there is no budget for clinical informatics, so the IT team is handling everything from system maintenance to ensuring physician adoption, with little support from medical leadership. The analysts are stressed all the time, caught between a mandate to ensure clinicians use the system properly and not having any authority to actually get the physicians to come to training. The turnover rate in the IT department is high, and leaders don’t seem to understand why people don’t want to stay.

The executive coach I’ve partnered with works with organizations to try to build resilience. The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, or stress – such as family and relationship problems, serious health problems, or workplace and financial stressors. It means ‘bouncing back’ from difficult experiences.” The people we’re working with are adaptable – they’ve watched the evolution of healthcare IT systems and some of them have worked on everything from basic billing systems to complex enterprise applications. They’ve watched the growth of technology at the bedside, and have seen the need for more transparency in the IT organization as the number of departments using technology has grown. They’ve coped their way through the rise of E&M coding, Meaningful Use, MACRA, MIPS, and ACOs.

Even with those changes under their belts, we see people struggling with the day-to-day stressors that impact their work. People are double booked for meetings and more than once I’ve been confronted by a conference call participant who appears to be inattentive who responds by saying he’s on multiple calls. (I still don’t understand how that works, but people do it, so it’s definitely a thing.) Workers are reluctant to take much-needed time off because they don’t have adequate coverage or feel that they’ll be buried when they come back. Others don’t want to burden their coworkers with the extra work that might shift their way if someone takes off. I see IT analysts that are continually frustrated by buggy software and delayed release schedules, who feel it acutely when they can’t deliver solutions to their customers. They’re caught between the vendor and the end user and may feel powerless to remedy the situation.

We’re working with groups in this situation by helping individuals analyze their individual work styles and better understand their own strengths. We help them identify situations they find challenging and develop strategies to work through them. Unfortunately, learning new strategies and figuring out how to incorporate them in the workplace takes time, and already-stressed teams struggle with finding the time to do this type of contemplation and reflective work. It’s often the management level that is feeling the most stress, because they have little control over budgets and priorities but are expected to deliver results regardless. When working with managers, one of the first steps we take is to help them complete a 360-degree evaluation, where they understand how they are seen by supervisors, peers, and direct reports. In one organization, we struggled with even getting the team to find time to respond to the surveys required to complete the evaluations.

There’s a concept that’s referred to in clinical circles called Moral Distress. It’s defined as the state of knowing there is a “right” thing to do but there are institutional constraints present that make it impossible to pursue the correct course of action. We typically talk about this when discussing nursing shortages and clinical staffing issues, when clinicians have to make difficult choices on how they deploy scarce resources. It’s thought that being unable to care for patients properly creates a particular kind of stress that increases the risk of caregivers quitting. A study of nurses performed in 2014 found that 20 percent of nurses surveyed intended to leave their current position due to moral distress.

Although it’s not quite as severe as moral distress at the point of care, we’re starting to see similar levels of stress in the teams that support front-line caregivers. Those support teams feel it acutely when clinical staffers can’t complete tasks or don’t have the technology they need to care for patients. I watched one IT analyst tear up as he tried to help a nurse figure out a documentation issue, when he understood that problems in the EHR were directly responsible for errors in care that negatively impacted a patient. He had reported the issue to his manager previously and they had been working with the vendor to try resolve it, yet he was told to move on to other priorities. He feels personally responsible even though there wasn’t anything he could have done, other than not follow the instructions that his leadership had given him. This isn’t the first time he’s been in a situation where patients were impacted by system issues, and he’s actively pursuing a job outside of healthcare.

As leaders, we need to figure out how to make sure our teams have the resources they need to do their jobs properly and ensure that the ultimate customer, the patient, is taken care of. We’re often between the proverbial rock and a hard place figuring out budgets and staffing while we prioritize projects. Maybe we need to be more forceful at saying no to implementing an on-demand meal ordering platform when our laboratory and radiology orders platforms aren’t at peak performance. Maybe we need fewer 70-inch TVs in patient rooms and more functional desktops and mobile workstations so documentation can occur quickly at the point of care. Maybe we need to stop adding bells and whistles to our systems when we haven’t fully implemented the basics. These are issues that the C-suite deal with regularly as our hospitals try to keep up with the Joneses across town.

I’d be interested to hear from any healthcare IT leaders who are taking a back-to-basics approach and trying to refocus energies on reducing stress while helping workers be more resilient. Have you found the recipe for the secret sauce? Leave a comment or email me.

Email Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. Excellent article — I 100% agree. Thank you for consistently articulating the realities of the healthcare informatics environment

  2. You can’t simply pile on more work and expect employees to not be stressed. How about not reducing FTEs until you implement more cost effective and efficient processes that save time – then the employees won’t be asked to do more with less. Or helping employees prioritize what they can stop doing in order to take on more responsibilities. Otherwise, there is no way you can ask people to do more and take on more responsibility and not stress them out. The Europeans take 6 weeks of vacation, and I know many people who don’t take 2 weeks of vacation because they don’t think they can afford to be out of the office. I don’t understand why executives don’t understand this. On the other hand, many young professionals do understand this, and won’t stick around when asked to do more than a full time job. Which leaves even more work for the baby boomers who just stress out.


  3. I’m glad I know have a description for what I have experienced in two jobs now, “Moral Distress”. I am not a clinician, but was working in a clinician-facing operation with real-time handling of patient records, and later designing and implementing a clinician-facing EHR (not the entire thing, but lots of it.) I stayed at each job probably two years past my “sell by” date because I knew that I was one of a very small number of people who cared that vulnerable people were on the other end of this transaction, and that if I left, that would be one less voice (in one case, the only voice) screaming about things like patient safety. I’d say with some seriousness that I’ve probably shaved a year off my life expectancy from the stress; I was absolutely experiencing physical symptoms in the moment (two bouts of TMJ that lasted a month each).

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