The Opportunity for Digital Health to Reduce Burnout and Restore the Joy in Practice for Doctors and Nurses
by Shanna Kirshenblatt 10-04-2017
When you walk in to a busy, high performing emergency department, it looks something like this:
The landline phone is ringing non-stop. The overhead paging system is announcing a team huddle. The fax machine is printing outside hospital records. A resident is paging for a specialty consult for a patient. A nurse is documenting a patient’s vital signs. The nurse manager is updating the staffing schedule to cover a call off. A best practice alert is firing for a potentially septic patient. A patient’s insurance is being verified. The attending physician is running from their overnight shift to a meeting.
All while this is going on, healthcare providers, both clinical and non-clinical, are working relentlessly and tirelessly to deliver efficient, high-quality, patient centered care.
It is therefore no wonder that, faced with these types of environments and competing priorities, doctors are experiencing burnout at a rate of 48% and nurses at 40%, which are rates far above the average American worker. Doctors and nurses are health systems’ most valuable assets and point of differentiation for patient care. When clinicians are experiencing burnout, the quality of care may decline. The “Triple Aim” in medicine – the successful achievement of enhancing the patient experience, improving population health, and reducing cost – is therefore reliant upon the health and well-being of those delivering the care: physicians and nurses.
It is not a one size fits all to restore joy in practice and improve the provider experience. Determining the optimal digital health solution and measuring success or ROI will be role, specialty, and patient population specific. For example, a radiologist may not need to increase their time spent on direct patient care, compared to a cardiologist. Taking a step back to understand the goals, priorities, and overall workflows will identify the underlying processes that need to be aggregated, streamlined, reduced, or eliminated. Digital health solutions will be most impactful once overarching processes are refined.
In this article, we will review:
- Challenges impacting the provider experience and how digital health can help restore the joy in practice for doctors and nurses
- Key success factors and capabilities for digital health solutions to improve the experience for clinicians
Healthbox conducted secondary research and spoke to 15 leaders and providers in the space to identify challenges, potential solutions, and key success factors to improve the provider experience. Although all of the challenges are interdependent, they can be segmented into three categories:
Challenge #1: Inefficient Workflows
The growing number of administrative tasks imposed on physicians and care teams, including documentation and data entry, divert time and focus away from clinical activities. Inadequate staffing levels and challenging work schedules are adding unnecessary stress on healthcare professionals.
Remote scribes, voice recognition and transcription, and natural language processing are examples of digital health solutions to address the inefficient workflows and administrative burden in the clinical setting.
Whether it is staff scheduling or prescription refills, routine and repetitive tasks are ripe for automation, and tools that determine which tasks are critical for a physician to handle and which tasks can be safely delegated to other team members are key elements of an effective solution.
As Dr. Lyle Berkowitz, Physician, CEO of Futurehealth and Associate. Prof. of Clinical Medicine, Feinberg School of Medicine, Northwestern University, has stated, “We don't need pretty interfaces as much as we need automation - from the physician's perspective, the goal should be zero clicks to get things done,” as it relates to usability of digital health solutions.
The goal is to create structured and streamlined documentation and data entry processes that trigger all related work streams (e.g. clinical intervention, orders, billing) simultaneously within the same system.
Challenge #2: Uncoordinated Communication
On average, an estimated $1.7M annually per hospital is wasted on inefficient communication systems in clinical settings. Fragmented communication inside the hospital among care teams and outside the hospital across the continuum of care leads to delays in treatment, incomplete and uncoordinated transitions of care, inappropriate specialty referrals, and limits in the capacity for collaboration.
Communication tools such as secure care team messaging platforms, image sharing, digital rounding, and eConsults are potential digital health solutions that can help drive collaboration across the continuum of care.
Communication solutions should have the ability to categorize and prioritize messages and notifications in a meaningful way, so that the appropriate care team member is receiving the right information to take action. An element of closed loop feedback is key to the success of these solutions.
Furthermore, minimizing the number of communication channels as well as a combination of synchronous and asynchronous communication enables better prioritization of all incoming and outgoing notifications. As Scott Wilkerson, Executive Director of Lurie Children’s Health Partners Clinically Integrated Network stated, “Messages should be categorized and the information placed in discrete buckets to make it is easier for clinicians to prioritize the various channels of communication between specialists, PCPs and specialists, and the entire care team.”
Challenge #3: Information Overload
Medical knowledge is advancing at an exponential rate. Without actionable data, providers may miss important details from excessive alerts, leading clinicians to override best practice alerts and to feel overwhelmed to integrate all the pieces of unstructured data for sound clinical decision making. Dr. Lee Budin, Associate Chief Medical Officer at Lurie Children’s Hospital commented that “Alert fatigue is profound - decision algorithms are not as good as they should be because they are not specific enough to the patient. This can be dangerous when clinicians click through all the alerts because they have become immune to the alerts. The algorithms have the potential to be advanced to have significant impact on delivering high quality, safe, patient-centered care.”
Digital health technologies can sift and filter through large amounts of data to provide meaningful recommendations to inform patient care. Software tools that leverage big data, predictive analytics, AI, and machine learning offer physicians powerful information to support clinical decisions and to customize care plans using precision medicine.
In addition, it is challenging for providers to keep up with the continuous advancement of clinical research and knowledge. Solutions that provide engaging training and educational tools will help and empower providers to stay up-to-date with the most current, innovative clinical information. Examples of digital health solutions include virtual reality, gamification, and social network platforms to share medical knowledge and expertise across the globe.
In order to address the challenges clinicians experience on a daily basis, healthcare organizations can leverage existing and emerging solutions to improve the provider experience thereby increasing the joy in practice for doctors and nurses. The tools should make the work easier for providers to meet their needs and the needs of their patients, by offering actionable data directly at the point of care and enriching the provider-patient experience.
Empowering clinicians to spend time on the responsibilities they feel their patients need in a supporting environment and ensuring the most appropriate caregivers are doing the right work, at the right time, in the right way, drives joy in practice resulting in better patient outcomes and high value care.
 Burnout is defined as the loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Burnout is characterized by depersonalization, emotional exhaustion, and a sense of low personal accomplishment.
 “The IHI Triple Aim.”
 Joy in practice is defined as a high level of work-life satisfaction, low level of burnout, and a feeling that medical practice is fulfilling. Restoring the joy in practice is centered on reviving meaning and purpose into clinicians’ day-to-day work and interactions with patients.