Beating Burnout: How Doctors Can Regain Control

Leigh Page

Disclosures

October 12, 2016

In This Article

Make Your Work Schedule More Flexible

In this new era of "value-based" care, doctors are urged to set their sights on the "triple aim"—enhancing the patient experience, improving population health, and reducing costs. To these aims, Dr Sinsky adds a fourth: preserving professional well-being, to make sure doctors aren't sidelined by burnout.

One way to preserve your own well-being is to alter your schedule so that you can take care of your personal life. For example, many young doctors have to drop off their kids at day care and still make sure they get to work on time, which can cause a lot of stress.

Overlaps between personal and professional responsibilities can be resolved through flexible scheduling, according to Mark Linzer, MD, a Minnesota internist who has worked extensively on practice re-engineering as director of the Office of Professional Worklife at Hennepin County Medical Center in Minneapolis and who wrote several modules for STEPS Forward.

"You can change the schedule at the beginning or the end of the day," he says. "If some doctors have to come in a little later, you can stagger the schedules for their MAs so that they come in every half-hour. The earliest one would have to leave earlier. Dr Linzer adds, "Of course, you can't shorten the schedule at both ends."

How difficult is it for physicians to change staff schedules? Even in a large organization like the Minneapolis medical center, "this usually can be done without having to get permission," according to Sara Poplau, assistant director of the Office of Professional Worklife.

Scheduling can be used to give hassled doctors an open slot to catch up. This so-called desktop slot can markedly lower their stress, Dr Linzer says, but in most cases, it's only needed temporarily, so there isn't much of an extra cost. "Once these clinicians recovered, they didn't need the extra slot anymore," he says. "What really helped was that they saw we were listening."

Strong Staff Relationships Improve Workflow and Help Burnout

Having strong relationships among staff can improve workflow, but this is often overlooked, Dr Sinsky says. Sometimes "the role of relationship-building and communication gets shortchanged," she says.

A practice can make all sorts of changes to improve workflow, but if they don't have a "team culture," implementation can be spotty, according to the STEPS Forward module[5] on team culture. The culture of a practice can cancel out the improvements you try to make.

You can diagnose the current state of your team culture by using surveys. Discuss survey results with staff and come up with strategies. To ensure a strong team culture, the module suggests asking staff to sign a "staff compact," a written document that contains their suggestions on how team members should treat each other.

STEPS Forward places a great deal of emphasis on team interactions as a way to make sure that care processes will be carried out successfully. For example, staff members who work a lot with each other should engage in a "team huddle" once or twice a day. Each huddle lasts from 5 to 15 minutes. Members discuss potential problems in the schedule, such as patient needs or "changes in staffing and logistics," to avoid surprises, according to the team huddle module.[6]

A formal team meeting is a key ingredient of the STEPS Forward action plan. Many organizations already hold regular meetings, but "they can be tedious and are poorly attended," says Dr Linzer.

"If meetings are not meaningful, people don't show up," he says. "People need to talk about important topics, which usually have to do with patients. Administrative 'housekeeping' can be handled by email."

The point of the meetings, Dr Sinsky adds, should be to re-energize your providers and help them reconnect with the joy of practicing medicine. "When people share their personal lives, they start to like each other more," she says.

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