Clinician Burden Mitigation Goes Beyond EHR Optimization to Culture

Current efforts to mitigate clinician burden, such as EHR optimization, can be enhanced through organizational interventions focused on cultivating positive emotions into daily workflows, according to a study published in The Joint Commission Journal of Quality and Patient Safety.

From November 2018 to May 2020, researchers engaged five health system and physician practice sites in an organizational pilot intervention that focused on cultivating positive emotions to mitigate clinician burden. The intervention included a comprehensive culture assessment, leadership and team development, and redesign of clinical workflow.

The study authors noted that this research differs from other clinician burden intervention studies, as it goes beyond individual skills and coping methods to focus on team culture and interactions, leadership, workflow processes, and use of technology. The study also focused on embedding positive emotion practices into daily workflows, which is not common in most widely adopted improvement methods. 

In general, the intervention focused on building skills for all team members to create more meaningful connections with others to create more positive emotions in each interaction. 

For example, if the survey results illustrated average levels of emotional thriving but low levels of emotional recovery (the ability to bounce back from stress), the researchers suggested a micro-intervention that focused on boosting pride in daily work.

“A team might do this by placing photos of ‘fridge-worthy moments’ in a public space in their clinic and cultivate team-based conversations about these photos,” the study authors explained.

The study found that the pilot intervention was associated with statistically significant reductions in emotional exhaustion.

Overall, emotional exhaustion fell by seven percent for healthcare workers. The study authors saw greater reductions (10 percent) in emotional exhaustion among physicians, NPs, PAs, and nurses. 

Additionally, the researchers observed significant improvements in the rate of respondents who said they would recommend their departments as a place to work.

Trends suggested improvement in emotional recovery and emotional thriving, but these metrics were not statistically significant.

The authors suggested that it may take more than six months (the average time when remeasurement occurred) for these secondary measures to improve since identifying, cultivating, and expanding experience of positive emotions takes longer than structural interventions.

“These findings provide encouraging insights regarding how health care should be approaching burnout,” the authors wrote. “Focusing on weaving positive emotions into facets of daily work, in small and frequent doses, may create substantial improvements in emotional exhaustion. Unfortunately, this approach is often absent in current efforts focused on structural change.”

The authors noted that current clinician burden mitigation efforts such as employee assistance programs, individually focused coping activities, or high-level system change such as EHR optimization could be enhanced if organizations were to simultaneously implement integrated initiatives to focus on cultivating positivity in the workplace.

“Findings from this pilot study suggest that national investments in capacity to support healthcare workers in an approach like the described intervention may provide a helpful addition or alternative to existing efforts,” the study authors said.

They noted that while this approach took considerable investment of time and effort, the study’s results show meaningful change in less than one year, which is a relatively short time.

Additionally, such an investment may help reduce turnover and time away from work in the long run, two major organizational costs.

“These findings are important because burnout remains a significant problem in health care, affecting all members of the workforce, and well-being has not substantially improved in the past decade despite widespread attention and an increasing number of studied interventions,” the study authors said.

“Given the COVID-19 pandemic and its impact on HCWs, we need even more attention on efforts like this intervention, at scale, to make a meaningful impact on HCW well-being,” they concluded.