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Monday Feb 19, 2018

Burnout Part 2: Adopting a Systems Approach to Prevention

It is nearly impossible to read an online medical journal, follow a physician Twitter feed or read any physician-directed blog and not see something about physician burnout.  

[Physician in lab coat with stethoscope holding blackboard with Burnout printed on it]

I previously wrote about tools and techniques for individual resilience and burnout prevention from a personal perspective after a series of stressful events in my life. However, it's resoundingly clear that many of the root causes of burnout are not centered on the individual, but are system-related. The rallying cry, "Don't fix me, fix the system," was heard loud and clear when the AAFP launched its Physician Health First initiative at last year's Family Medicine Experience.

The AAFP is working on many issues related to the shortcomings of electronic health records, which is one of the commonly identified root causes of burnout, but for this post I want to focus on how we can approach burnout and resilience from the perspectives of the small practice, the multispecialty group and the hospital medical staff -- again from my own experiences in these settings.

Burnout is pervasive, affecting all medical specialties. More than 50 percent of family physicians have described themselves as burned out in multiple surveys.(www.medscape.com)

At the small practice level, burnout leads to reduced physician practice enjoyment, engagement, efficiency, income, and patient satisfaction, as well as to increased staff turnover, partner stress and recruitment difficulty.

At the multispecialty group level, add to this list strained relationships between specialties, inadequate hand-offs, poor patient outcomes, increased malpractice risk, adverse impact to the group's reputation, and difficulty recruiting physicians and negotiating payer contracts. Researchers at Stanford University found that physician burnout costs their system nearly $7.75 million per year(wire.ama-assn.org) in lost productivity, turnover, recruitment and replacement costs.

At the hospital medical staff level, burnout also brings the stress of managing relationships in a dysfunctional group and the reluctance of community physicians to engage the staff, among other problems. Not infrequently, it also leads to contentious medical staff and hospital board problems that result in credentialing, privileging and disciplinary actions, as well as lawsuits.

Burnout also can be a major risk for physician suicide.

How do we adopt a systems approach to preventing burnout? Here are some suggestions:

Practice Group

  • Form a Balint Group.(www.Americanbalintsociety.org) This takes training and facilitation to get started, but it can become a self-sustaining and effective means of maintaining a cohesive group that explores physician-patient relationships and medical practice culture.
  • Huddle at the beginning of each day(wire.ama-assn.org) to acknowledge each staff member, briefly review the schedule for possible choke points or flexible spots, and celebrate the previous day's successes.
  • Use staff experience surveys to make your practice friendlier to the team that supports you. If everyone has more joy, it spreads.
  • Build wellness time into everyone's schedule. For example, set aside 20 minutes for a group walk three days a week or five minutes at the beginning of the day for three expressions of gratitude, or invite a patient to the huddle once a week to tell the staff how your practice helped them in a special way.
  • Learn how to use behavioral interviewing techniques to evaluate potential new hires -- not just physicians, but everyone. Fit is important. In a practice, we are a family that gets to choose its members.
  • If the group decides its own compensation package, build in a wellness component.

Multispecialty Group

  • Adopt the suggestions for practice groups.
  • Form a leadership council with representatives from each practice in the group, and compensate them for the work.
  • Ensure that leadership implements activities that address all-staff communication, team-building, care collaboration and quality improvement activities, and follows up immediately on concerns.
  • Design compensation packages that prevent overscheduling, excessive call and sleep deprivation, and that compensate for citizenship activities.
  • Hold regular social activities that involve families.
  • Prioritize care for the families and staff of the group's physicians.
  • Establish a wellness committee that provides educational resources, confidential referrals and confidential monitoring for clinicians in treatment programs.

Hospital Medical Staff

  • Ensure that, as is typical in this practice setting, a wellness committee provides education on resources and monitors physicians in substance treatment programs.
  • Create mentoring programs for new physicians that include social events with significant others.
  • Develop Just Culture(www.ahrq.gov) approaches to communication and patient safety to improve quality and safety of care.

In all of these settings, there is opportunity to take lessons from the resources available to us as AAFP members and make a positive impact on the health of our colleagues and our teams.

There also is no substitute for regularly working on your own individual wellness and resilience plan. This might include regular exercise, mindfulness and meditation, structured expressions of gratitude, walking barefoot in the grass, performing music, praying(www.contemplativeoutreach.org) or a number of other techniques that have worked for others. We each need to find our own effective path. Don't leave it to chance!

Start by completing your personalized assessment via the Physician Health First portal, then consider attending the first Family Physician Health and Well-Being Conference, which will be April 18-21 in Naples, Fla.

Hope to see you there.

Carl Olden, M.D., is a member of the AAFP Board of Directors.

Posted at 02:35PM Feb 19, 2018 by Carl Olden, M.D.

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