Prevent Burnout? Turn From Screen, Talk to Colleagues

May 21, 2013

Researchers searching for joy in the chaotic world of primary care found "pockets of professional satisfaction" in 23 practices that, for all their computerization, have devised human solutions to the problem of burnout, according to new study in the Annals of Family Medicine.

One solution is colocation, which is a fancy term for putting people in the same room. Physicians and medical assistants at North Shore Physicians Group, in suburban Boston, Massachusetts, for example, sit side by side in "flow stations" and talk through patient-care issues instead of sending each other electronic messages.

Similarly, physicians and nurses at the Cambridge (Minnesota) Medical Center try to replace electronic messaging with more "time-efficient verbal messaging" — also known as talking.

"Communication throughout the day is crucial to efficiency," said one physician at the clinic. "We can answer questions on the fly rather than waiting to get back to the computer and pinging messages back and forth."

The study by Christine Sinsky, MD, an internist at Medical Associates Clinic and Health Plans, in Dubuque, Iowa, and colleagues also highlights the value of non-computer behaviors such as regular meetings and huddles to improve work processes and teamwork.

Other innovations that Dr. Sinsky and colleagues encountered in the 23 practices — all but 2 visited in person — involved making electronic health record (EHR) systems and data entry, in particular, less taxing for physicians. In 6 practices, nurses or medical assistants serve as scribes, charting the visit and entering orders while the physician examines and talks with the patient. Likewise, nurses and medical assistants at several practices screen messages in the teeming electronic in-boxes of physicians and filter out normal lab results, prescription renewals, and requests that can be handled by protocol, "passing through to the physician only messages that require physician-level attention."

It Takes a Healthcare Village

Taming health information technology takes a village, and that's one example of the teamwork that makes the 23 practices in the study as joyful as they are.

Dr. Sinsky and colleagues write that many of the practices delegate more clinical responsibilities to medical assistants, licensed practical nurses, and registered nurses. At Clinica Family Health Services, in suburban Denver, Colorado, standing orders allow registered nurses to diagnose and treat simple conditions such as conjunctivitis and uncomplicated urinary tract infections. Likewise, medical assistants administer a 9-item depression screening questionnaire to patients who seem depressed and then contact a behaviorist on the clinical team.

Such collaboration, Dr. Sinsky and colleagues write, exemplifies a shift from a physician-centric model of healthcare to a shared-care model. Besides relieving physicians of clerical work, the shared-care model builds additional capacity in practices that otherwise would be slammed by patient demand. The results are morale-boosting, as reflected in the comments from one physician in a shared-care practice.

"The MAs and nurses are more fully engaged in patient care that they have ever been and they enjoy their work," the physician told the researchers. "I am far more satisfied. I leave work an hour earlier every day and have a very fulfilling relationship with my team.... We're having fun."

No Claims for Medical Nirvanas

Dr. Sinsky and colleagues describe other hassle-reducing tactics in place at the practices they studied.

The Mayo Clinic's Red Cedar branch, in Menomonie, Wisconsin, strives to have a patient's lab tests performed several days before an office visit so the physician and patient can discuss the results and, if need be, set goals to lower blood glucose or blood pressure. Besides improving patient care, such previsit planning spares the physician the time-consuming chore of reporting the test results to the patient after the visit.

The Cambridge Medical Center lessens the busy work of prescription renewals by renewing them for 12 months at a time during an annual visit for comprehensive care. All of a patient's medications for chronic illnesses are synchronized on this schedule to eliminate refill requests throughout the year for "stable prescriptions."

Despite the many success stories, the study authors are not suggesting that they discovered medical nirvanas.

"Even at the best of practices, physicians are still often caught in...the 'frantic bubble' " of clerical chores, confining regulations, unfriendly computer technology, and a time-pressured environment, write Dr. Sinsky and colleagues."Our observations suggest that these 23 innovative sites are pointing the way to a better model. No single practice has solved every problem; each practice still continues to overcome its unique set of constraints."

Nevertheless, at least one physician reported that he is having fun.

The authors have disclosed no relevant financial relationships.

Ann Fam Med. 2013;11:272-278. Full text


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