In Part 1 of this series we reviewed the root causes of the alarming increase in physician burnout. Part 2 focuses on the important role physician leaders can and must play in helping to not only stem but also reverse the pervasive tide of dissatisfaction and burnout among doctors affiliated with health systems, hospitals and large physician services companies.
Research has shown that physician leaders have a major impact on burnout in those who report to them. In the April 2015 issue of Mayo Clinic Proceedings, researchers Tait D. Shanafelt, M.D. and colleagues shared the results of their study evaluating the impact of organizational leadership on the professional satisfaction and burnout of individual physicians working for a large health care organization. The study found that the leadership qualities of physician supervisors significantly affected the well-being and satisfaction of individual physicians working their organizations. Higher supervisor scores in each of the 12 leadership dimensions and composite leadership score correlated strongly with lower burnout and higher satisfaction scores of individual physicians.
Engaging physicians is more important than ever before, as health systems and their physicians both work to deliver excellent healthcare to the patients they serve. Physician leaders need to support doctors by mitigating the factors causing burnout as much as possible. Improving physician satisfaction can impact not only the doctors they supervise, but also the quality of care that patients receive and the sustainability of the health system in which they practice.
Strategies for Combating Burnout
The first step is to make physician satisfaction and wellness a priority in your organization. Stanford Healthcare’s Stanford Committee for Professional Satisfaction and Support (SCPSS), created in 2010, has developed a wide range of successful programs to promote physician wellness. Peer support for faculty and residents, litigation support, a medicine & literature group, mindfulness training and faculty flexibility are among its most often-used programs. One of its most innovative initiatives is a time-banking program that lets Emergency Medicine doctors “bank” the time they spend on often underappreciated work, such as mentoring, serving on committees, covering colleagues’ shifts on short notice or deploying in emergencies. The time is “banked” in the form of credits that can be exchanged for work- or home-related products and services, such as gourmet meal deliveries, housecleaning services, baby-sitting, elder care, life coaching, movie tickets, grant writing help, handyman services, dry cleaning pickup, speech training and Web support – all provided courtesy of Stanford. Greg Gilbert, M.D., a clinical associate professor in Emergency Medicine at Stanford Hospital who has used his time-banking credits for meal delivery, housecleaning, life coaching and help with grant proposals, told Stanford, "The program makes you feel valued. It gives me more bandwidth at work and more time to hang out with my kids."
According to an August 2015 article in The Washington Post, the two-year time bank pilot delivered big increases in job satisfaction, work-life balance and collegiality, as well as a greater number of research grant applications and a higher approval rate among participants than among nonparticipating Stanford faculty. According to the article, “Volunteering to cover shifts on short notice nearly doubled, to 83 percent, and people reported feeling more collegiality. Fewer postponed or avoided taking care of their health or put off vacation. The proportion of faculty who had time to discuss science with their colleagues jumped from 9 to 55 percent. And the share of female faculty members who felt Stanford supported their career development rose from 29 to 57 percent.” When the pilot ended and departments who wanted to maintain the program would have to take over the financial and administrative responsibility for it, Stanford’s former Chief of Emergency Medicine Paul Auerbach, M.D. quickly agreed. “In my mind, this program is brilliant,” he said, “and maintaining it was an easy decision.” He called the program “extremely cost-effective,” explaining that the credits cost far less than 1 percent of his department’s budget.
Other ways that physician leaders can support doctors by streamlining their workflow and listening to their concerns. For example, Sheridan’s ED Physician Portal gives Emergency Department doctors access to tools and resources such as Sheridan’s Emergency Medicine Leadership and Support Service teams, including Sheridan’s Kaizen, Operations and Clinical Quality teams. Sheridan’s Clinical and Operations leadership teams provide guidance and support to our Clinical Chiefs and clinicians. And an online suggestion box allows Emergency Department physicians to air their concerns, suggest improvements and know their voices are being heard, because Sheridan’s Emergency Medicine Leadership reads and considers every suggestion.
Make Decisions Using the Quadruple Aim Framework
Gerald A. Maccioli, M.D., Sheridan’s Chief Quality Officer, believes that that the administrative burden created in the pursuit of the Triple Aim – improving population health, enhancing patient experience and reducing costs, coupled with multiple regulatory reporting requirements, are imperiling, rather than facilitating, the achievement of those goals.
There is ample evidence of a correlation between high levels of physician satisfaction and high-functioning practices, and also between physician burnout and lower patient satisfaction, worse outcomes and potentially higher costs. That’s why he’s a vocal proponent of the Quadruple Aim, i.e., expanding the Triple Aim to include a focus on improving physicians’ work life and satisfaction.
Dr. Maccioli recommends a few ways in which physician leaders can better support their doctors to help reduce the stressors causing burnout, based on some of the strategies that have proven successful at Sheridan:
- Make quality reporting requirements impactful and lower barriers to participation.
- Provide doctors with meaningful feedback on their performance: where they excel as well as where they can improve.
- Design tools for inputting data with three goals in mind: Ease of use, impactful data and facilitating workflow.
- Maintain active clinical quality committees.
- Help busy doctors practice the best medicine by keeping them up-to-date on best practices for their specialties.
- Consider streamlining the revenue system so that physicians can spend more of their time with patients and focus on delivering quality care.
Learn more about why Dr. Maccioli urges physician leaders to frame every decision with the Quadruple Aim in mind.