Physician burnout as a consequence of systematic design, not an individual issue

Burnout in health care is an epidemic across the nation, contributing to a lack of empathy for patients, poor care, providers electing to leave the workforce, substance abuse, depression, and even provider suicide. In a recently published case study in the American Physicians Group Case Studies in Excellence, Iora Health made a move to shift the conversation around burnout from an individual phenomenon to a system problem.

Although there is a consensus in the health care community that burnout is a problem plaguing the nation, the response has been tepid, at best. Current conversations put the burden of lessening burnout on overly burdened health care workers. Recommendations such as mindfulness, self-care, and physical health, while crucial to well-being, are stress coping mechanisms. Developing one’s own resilience does nothing to reduce the factors that actually cause burnout — increasing complexity paired with continuous interruptions. In fact, focusing on self-management allows the system to propagate. If we want an engaged health care workforce, able to build empathetic relationships and support us through disease on the road to health, we must first fix the underlying cause — the work of health care.

Primary care today, like all of health care, has massively increased in complexity, and work systems have abjectly failed to keep pace. Exploding paperwork, redundant, poorly designed technology, and operational systems and continuous interruptions all generate friction that erodes our ability to provide care. Iora Health, employing primary care physicians in an advanced model of primary care across the nation, is no stranger to the burdens we place on our care teams. As a physician-founded, physician-led organization committed to restoring humanity to health care, we firmly believe that the way through burnout is the rediscovery of joy. To do this, we need to remove or reduce the friction, the thousands of “papercuts” that accumulate throughout one’s clinical day.

For physicians, like the rest of us, taking work home is toxic to their lives and the care they provide from nine to five. Using a combination of lean and agile principles, we worked across the company to directly change the work of care teams, improve the technology, and even redesign space to better support our care of patients.

Encouragingly, in only six months, we were able to virtually eliminate work taken home by providers while increasing the number of patients under our care by 30 percent. Still, we knew this was only the beginning, and we continually deploy resources to refine our workflow, training, and technology.

By embracing burnout as a consequence of systematic design rather than an individual issue, we have already seen that rapid change is possible when an organization comes together to fix the work and restore joy to care. We challenge the rest of health care to embrace the systematic redesign of daily work, or be left behind. It is necessary for our teams, and ultimately the health of our communities.

Andrew Schutzbank is senior vice-president, development, Iora Health.

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