Modifying Your Environment to Reduce Stress

Gabriel A. Sara, MD

Disclosures

January 01, 2017

Practical Tactics to Deal With Your Environment

There are ways to change the environment around you without coming into conflict with your colleagues. One way is training to say "no" to all the little commitments that are required of you. These can pile up and cause burnout.

For example, a step as simple as asking people not to include you on day-to-day emails when you are away on vacation might decrease the mountain of emails you have to deal with when you return.

Even when no one objects, setting limits on work is hard for many doctors to do, according to radiologist Peter S. Moskowitz, MD, a life coach and director of the Center for Professional and Personal Renewal.[1]

Physicians are "not asked to do unimportant or worthless things," Dr Moskowitz notes. "But if they continue to say yes, eventually they will not have time for anything. To be effective in work-life balance, you have to set priorities."

Learning to Say 'No'

Physicians need to learn to say no, says Elizabeth Brooks, PhD, a researcher at the University of Colorado.[2] "Many physicians have difficulty turning down requests from work and the community," Dr Brooks notes. "Sometimes saying no is the best medical care for both the patient and the doctor."

Being proactive means taking responsibility for your life. "When we stop believing that we're just victims of our situation and see that we are really perpetrators, then we will see change," writes family physician Ahnna Lake, MD, a physician coach and president of International Health Consulting in Stowe, Vermont.[1]

Dr Lake counsels physicians to keep track of key indicators of their own well-being, such as close relationships, general health, energy level, and satisfaction with work and daily life. If you see a decline, she says, look at your behaviors and make adjustments.

But it's easier said than done. Physicians usually identify strongly with their work and career, and as a result, other activities or demands may fall by the wayside.

Time Management Tactics

To carve out time for personal activities, some physician coaches tell their clients to follow the principles of time management, in which they can find ways to finish tasks faster.

"Create a plan with a task list or calendar of activities," advises surgeon Patrick A. Hudson, MD, a physician coach who conducts workshops on overcoming burnout.[3]

One element of time management, Dr Hudson adds, is determining which activities are priorities and cutting out some of the other activities. No matter how alluring or tempting they may be, at some point there are only a certain number of hours in a day or week, and you can't do everything. You may need to adopt a longer-range view, Dr Hudson maintains, and put off some activities or goals until a future time.

You may need to adopt a longer-range view and put off some activities or goals until a future time.

But some experts contend that time management is an illusory Band-Aid. For example, Dike Drummond, MD, a physician coach and author of Stop Physician Burnout: What to Do When Working Harder Isn't Working, has a somewhat different view. "Time management is a myth," he argues.[4] "You and I get 24 hours in each day—168 of them in a week. No more and no less." Instead of trying to manage your time, Dr Drummond advises managing "your priorities and intentions." Write down your goals and pick just one of them to do this week, he says, and "once you nail that one you can move on to the next."

Dealing With Systems Issues

Many physicians are not satisfied with attitudinal changes, or even carving more time for themselves or mindfulness. They argue that the main cause of burnout has to do with systems issues, such as practice inefficiencies, poorly functioning EHR systems, and demands for greater productivity.

Indeed, Christine Sinsky, MD, vice president for professional satisfaction at the American Medical Association, estimates that 80% of burnout has to do with institutional issues and only 20% involves individual factors.

Some changes in the environment, such as reducing productivity quotas, might be beyond the reach of physicians working in a large organization. But many other changes involve fairly simple alterations of your immediate work environment.

Learn to Delegate

Dr Sinsky advises physicians to reject "the hero model," where they personally provide most of the care to their patients.

"Burnout often results when we know we're spending the wrong time on things we shouldn't, such as clerical work," she said in an address to the Michigan State Medical Society. "This is work other people can do."[5]

Burnout often results when we know we're spending the wrong time on things we shouldn't.

Dr Sinsky was the lead author of a 2013 study that gathered tips from successful practices on how to avoid physician burnout by becoming more efficient.[5] These included assigning more responsibilities to nonphysicians and using huddles or team meetings to resolve a variety of problems, such as not having a patient's lab results at the time of a patient visit.

Tweaking the practice workflow would ensure that test results are obtained and entered into the patient record well ahead of a patient visit, Dr Sinsky and colleagues wrote.[6] This would enable the doctor to discuss the results with the patient and engage the patient in shared decision-making at the time of the visit. Shared decision-making improves patient adherence.

Learn to Systemize

In Dr Sinsky's small Iowa practice, where she still works part-time, "we systematized anything we could, so that the right things happen by default," she says.[5]

"Medical care involves a great deal of recurrent tasks, such as registration, rooming patients, ordering studies, making referrals, and refilling prescriptions," she explains. "Adopting a systems approach to practice redesign can improve efficiency and reduce waste."

It can also reduce burnout by enabling doctors to focus on doctoring—that is, practicing at top of license—rather than having to cope with inefficient ways of doing things.

By streamlining tasks, a practice can reduce workplace chaos, which is a driver of burnout. "When the environment doesn't feel disorganized or chaotic, physicians and staff can focus on patients," Dr Sinsky observes.[5]

Changing Your Practice Workflow

Large healthcare organizations have been slow to change workflows to reduce burnout. In a 2016 survey of healthcare CEOs by Modern Healthcare, fewer than 36% said their organizations had programs to address physician burnout; another 36% said that such programs were "under development"; and nearly 28% had no plans for burnout prevention in the clinical staff.[6]

How do you change workflow practices? One way is to introduce team meetings in which staff members are able to collectively brainstorm ways to improve inefficient processes. Another step is to hire a practice management consultant. An outside expert can analyze practice operations with a fresh set of eyes and offer recommendations for improvements.

It's also worthwhile to attend—or have your practice manager attend—at least one medical or practice management-related conference that addresses practice management issues. It's an opportunity for practice owners or managers to rub elbows with colleagues around the country. Attendees can share common problems and offer solutions that other practices have already successfully addressed.

Introducing a suggestion box in the practice, or otherwise making it easy for clinical and administrative staffers to offer constructive criticism without fear of stepping on someone's toes, can pay off handsomely. It gives the people closest to a problem permission to offer thoughtful solutions that directly affect their work.

Introducing a suggestion box in the practice...can pay off handsomely.

The Role of Large Organizations

Large healthcare organizations that tie physician compensation to productivity, impose inflexible work schedules, and have multiple layers of management, so that the people charged with fixing a problem are far removed from the problem, can contribute to physician burnout.

Some enlightened organizations have been changing their policies to reduce physician burnout, on the basis that doctors who are not stressed out, exhausted, and miserable perform better than those who are.

On the other hand, other factors that contribute to burnout, such as the need to see more patients and increasing productivity goals on an annual basis, are business necessities that organizations may not be willing to change.

Still, it is worthwhile bringing up the question at a medical staff meeting, or to the head of your department. Hospitals need to be aware that their physicians are suffering, and that ultimately this can affect the hospital's performance and standing. Hospitals rarely move quickly, but it's wise to at least let them know that a problem exists.

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