When healthcare historians look back to figure out how we navigated these turbulent times, they will talk about the declaration published on March 28, 2017. Signed by eleven of the most significant healthcare leaders in the United States, it represents a significant shift regarding physician and nurse burnout. The following leaders issued the call to action:
- John Noseworthy, President, and CEO of Mayo Clinic.
- James Madara, CEO of the American Medical Association
- Delos Cosgrove, President, and CEO of the Cleveland Clinic.
- Mitchell Edgeworth, CEO of Vanderbilt University Hospitals and Clinics.
- Ed Ellison, Executive Medical Director and Chairman of the Board for the Southern California Permanente Medical Group.
- Sarah Krevans, CEO Sutter Health
- Paul Rothman, Dean/CEO, Johns Hopkins Health System and the School of Medicine
- Kevin Sowers, President of Duke University Hospital
- Steven Strongwater, CEO of Atrius Health
- David Torchiana, President, and CEO of Partners HealthCare
- Dean Harrison, President, and CEO of Northwestern Memorial HealthCare
A bit of historical context is helpful. In 2008, Berwick and colleagues wrote their widely cited article in HealthAffairs entitled, “The Triple Aim: Care, Health, And Cost.”1 They called on the healthcare world to commit to:
- enhancing patient experience
- improving population health
- reducing costs
It was a great and noble effort, but the additional resources need to accomplish it were nonexistent. Physicians and nurses were just supposed to “toughen up” and do more.
Six years later, two physicians, Thomas Bodenheimer, MD and Christine Sinsky, MD published their response: “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider”2. I agree with their statement:
“Society expects more and more of physicians and practices, particularly in primary care. Patients want their health to be better, to be seen in a timely fashion with empathy, and to enjoy a continuous relationship with a high-quality clinician whom they choose. A patient-centered practice has been described as, “They give me exactly the help I need and want exactly when I need and want it.” Yet for primary care, society has not provided the resources to meet these lofty benchmarks.”2
It is no wonder that we are seeing increasing numbers of physician and nurses struggling with disengagement and burnout. The consequences are threatening the entire healthcare system. Up to 60% of practicing physicians report symptoms of burnout.3 Time pressures are the biggest reported cause of physician burnout followed by the electronic medical record (EMR). A recent time and motion study showed that, for every hour physicians spend with a patient, they spend two hours with the EMR!4 Burnout impacts the quality of care, increases the risk of medical errors, damages the patient experience, and the impairs the ability to make the changes needed to deliver cost-effective care. It also contributes to physician and staff turnover during a time when access is already critical in many areas. Unfortunately, the initial attempts to remedy the situation have focused exclusively on increasing the resilience of doctors and nurses. While that can be helpful, if that is the only strategy, it is like giving swimming lessons to the people on the Titanic. It is not enough.
I’m encouraged by the new declaration forged by these eleven top national healthcare leaders. They held a special meeting specifically to address the issue of burnout at the recent American Medical Association national conference.
The eleven leaders committed to the following principles (emphesis mine)5:
- Regularly measure the well-being of our physician workforce at our institutions using one of several standardized, benchmarked instruments.
- Where possible, include measures of physician well-being in our institutional performance dashboards along with financial and other performance metrics.
- Evaluate and track the institutional costs of physician turnover, early retirement, and reductions in clinical effort.
- Emphasize the importance of leadership skill development for physicians and managers leading physicians throughout our organization.
- Understand and address more fully the clerical burden and inappropriate allocation of work to physicians that is contributing to professional burnout.
- Support collaborative, team-based models of care where physician expertise is maximally utilized for patient benefit, with tasks that do not require the unique training of a physician delegated to other skilled team members.
- Encourage government/regulators to address the increasing regulatory burden that is driving inefficiency, redundancy, and waste in health care and to proactively monitor and address new unnecessary and/or redundant regulations.
- Encourage and support the AMA and other national organizations to work with regulators and technology vendors to align technology and policy with advanced models of team-based care and to reduce the burden of the EHR on all users.
- Encourage and support the AMA and other national organizations in developing further initiatives to make progress in this area by compiling and sharing best practices from institutions that have successfully begun to address burnout, profiling case studies of effective well-being programs, efficient and satisfying changes in task distribution, and outlining a set of principles for achieving the well-being of health professionals.
- Continue to educate our fellow CEOs as well as other stakeholders in the health care ecosystem about the importance of reducing burnout and improving the well-being of physicians as well as other health care professionals.
- Support and use organizational research at our centers to determine the most effective policies and interventions to improve professional well-being among our physicians and other health care professionals.
In my work with physicians and nurses around the nation, I have witnessed a hunger to address these issues and begin to heal our ailing healthcare system. There is plenty of work to be done. My hope is that healthcare systems around the country will rally to the call. I’m eager to be a part of this transformation.
Please join the discussion. I welcome your comments.
- Health Aff May 2008 vol. 27 no. 3 759-769↩︎
- Ann Fam MedNovember/December 2014 vol. 12 no. 6 573-576 ↩︎
- Krasner, M. S., Epstein, R. M., Beckman, H., Suchman, A. L., Chapman, B., Mooney, C. J., & Quill, T. E. (2009). Association of an Educational Program in Mindful Communication With Burnout, Empathy, and Attitudes Among Primary Care Physicians. Jama, 302(12), 1284–1293. ↩︎
- Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., et al. (2016). Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 SpecialtiesAllocation of Physician Time in Ambulatory Practice. Annals of Internal Medicine, 165(11), 753–760. http://doi.org/10.7326/M16-0961 ↩︎
- http://healthaffairs.org/blog/2017/03/28/physician-burnout-is-a-public-health-crisis-a-message-to-our-fellow-health-care-ceos/ ↩︎