One step at a time

The care sector is under unprecedented strain from the Covid-19 pandemic, with many working on the frontline under huge stress. Nina Miranda outlines a five-step plan to address healthcare worker burnout.

Health systems need more innovative operating models that are sensitive to the needs of its patients and its healthcare providers to prevent worker burnout.

COVID-19 is bringing a long-simmering wellbeing crisis in healthcare to a boiling point. Physicians and nurses, many pulled from their specialties to provide emergency care, are scrambling to treat the ever-growing number of patients, logging gruelling hours while confronting extraordinary numbers of deaths, including colleagues. In COVID-19 hotspots, overwhelmed hospitals have faced shortages of personal protective equipment and the need to build makeshift wards in cafeterias, lobbies, and even public parks.

Unsurprisingly, many front and second-line healthcare workers reported symptoms of post-traumatic stress (49%), depression (24%), anxiety (19%) and insomnia (8%) in March 2020, according to The Journal of American Medical Association Network Open. This is undeniably a crisis for a group of professionals of whom 44% were already reporting feeling burned out in 2019.

One positive that has emerged, however, is the renewed focus on health worker wellbeing. Just as doctors and nurses take care of others, we’re all now realising the need to help clinicians prioritise their mental health and wellbeing.

Five steps to addressing burnout

Long before COVID-19, researchers had linked clinician burnout to poor healthcare outcomes, including worse patient safety. Now, the need to address the challenge is even more pressing. And it’s clear traditional wellness programming won’t be enough – snippets of content and digital nudges for self-care are all well and good in a business as usual environment, but in today’s world, healthcare workers need more innovative interventions to support their mental health and wellbeing.

Like a five-stage nursing approach, the problem of burnout needs a structured process across assessment, diagnosis, planning, implementation, and evaluation.

1. Assessment

The first stage of addressing burnout is understanding the current state of workplace health through a data-driven approach. Traditionally, organisations have assessed workplace health using the rate of employee absenteeism as a guide. But absenteeism is a surface metric, and it can be expensive to continuously monitor the underlying causes with tools like the Maslach Burnout Inventory.

Here’s where today’s technology can help. Healthcare organisations have vast amounts of data to hand about their workforce, from performance indicators in clinician workflows to COVID-19 contact tracing. By consolidating this information in a central digital database, and integrating tools to continuously and automatically collect the data, artificial intelligence programs could identify meaningful trends that predict burnout, thereby allowing leaders to take early action and quickly assess the effects on workforce performance and ultimately patient safety.

2. Diagnosis

The second stage in addressing burnout issues is diagnosing root causes – once you’ve established there is a problem, it’s vital to test your assumptions about the cause. Fortunately, health systems are already studying precisely what their doctors and nurses do each day to figure out how to reduce burnout from an operational standpoint. For example, at this year’s HIMSS & Health 2.0 European Digital Conference, panels discussed the burden of electronic health records (EHRs), the number of system alerts to which to respond, and the lack of meaningful dashboard analytics to describe the state of patient care at aggregate levels.

Identifying these issues through root cause analysis, such as on-the-job time studies or virtual focus groups, allows leaders to see which activities are taking up workers’ time and find ways to better manage them.

3. Planning

The third stage in addressing burnout issues is to plan for operational changes. It isn’t enough to assess, diagnose and offer blanket solutions. It’s critical to personalise holistic change plans for physicians and clinicians, as that will reduce disruption to existing workflows that cross specialties. For example, dissecting the workflows of frontline staff to find tasks that don’t require their level of expertise, cause inefficiencies, or distract from their primary roles as healers allows change and digital experts to see how emerging technologies can streamline these tasks.

When we developed ingenious skills for Amazon Echo devices to help adults who require social care maintain their independence, understanding carers’ daily tasks was key. They highlighted the challenges involved in specific tasks, like shopping, for vulnerable adults, letting us tailor the Echo’s functionality to these challenges. The trial has changed people’s lives for the better, with 72 per cent of those needing care believing the voice-activated assistant would improve their daily routine. At the same time, carers had more time to focus on the more challenging aspects of adult social care.

4. Implementation

Whether healthcare leaders decide to carve out a new operating model that prioritises wellbeing interventions or go further to address systemic issues, such as the number of patients seen in a single shift, they need a thoughtful implementation plan – a plan designed with physician and clinician leaders in mind, who themselves must deal with burnout and personal stress. After all, if leaders can’t manage their own mental health and wellbeing, the problem will trickle down.

Consider the implementation of telehealth technologies during the COVID-19 pandemic. Implementing new platforms and technologies to manage caseloads made it possible to improve access to care despite stay-at-home orders. But this also resulted in a mix of stressors, such as click fatigue, additional EHR documentation and new workflow demands, that exacerbated burnout issues. Implementation plans for new technologies should always focus on employee needs – it should be about supporting workers to do things better, rather than just implementing new technology for the sake of it.

5. Evaluation

The answers to addressing burnout issues for physicians, clinicians and staff are different for each health system. The change required to implement interventions can be multifaceted and deeply complex. Often, multiple root causes add to the complexity of those issues. Regardless, all burnout issues require some level of organisational transformation, be it policies, processes, or operating models. Having a method to evaluate how well health workers make those changes is critical to building an iterative process for continuous improvement.

For accurate results, leaders must customise success metrics to the health system and their organisational strategies. Crucially, leaders must define these success metrics early to ensure there’s a concrete way to track progress through implementation and beyond. Only when change teams are working towards robust targets can they assess the impact they’re making and pivot to improve results.

Opportunities in a post-COVID-19 world

In the aftermath of COVID-19, health systems are ripe for change. As they re-invigorate their pursuit of the triple aim to meet better outcomes and better patient experience at lower cost, they must also prioritise the need to ease some of the burdens on frontline workers. Health systems need more innovative operating models that are sensitive not only to the needs of its patients, but also to its healthcare providers.