A version of this article was published in the May 2022 edition of Healthcare News.

Physician burnout is a major threat and turnover by doctors in primary care is estimated to add $1 billion in additional costs to a system already burdened with waste.

Task burden—the inbound knowledge work that causes constant shifting of cognition and attention from patient to inbox task throughout a clinic day—is often the cause of burnout. The more tasks a provider takes on during the workday, the greater their risk of burnout.

Fortunately, evidence-based health care tools rooted in lean methodologies can help reduce physician burnout. A Mayo Clinic systematic review demonstrated lean-like process improvements towards team-based care can help reduce clerical tasks and documentation burden, decrease burnout, and improve job satisfaction.

Risks of Burnout

Burnout can have serious consequences. With surging patient loads during peak hours, providers start to rush and can demonstrate poor process flow as the hours progress. They increasingly defer complex decisions, experience decision fatigue, and lurch into low-value care decisions and practice patterns.

Falling behind can lead to risks including:

• Antibiotics increasingly prescribed for viral infections, which are useless and can cause increased resistance to bacterial infections
• Opiate prescriptions for painful conditions increase
• Statins for high-risk vascular disease patients decrease
• Mammograms and colon cancer screens decrease

Research estimates 25% of health care is wasteful and defective, costing $1.3 trillion annually with a range approaching $1 trillion in waste and upwards of $300 billion in opportunity savings through waste reduction interventions.

How Can Health Care Providers Reduce Burnout and Task Burden?

Interventions to reduce task burden involve improving flow, which boosts quality and lessens burnout. Engineering care into a better flow preserves precious time for making high-value health care decisions. In 2021, the Joint Commission on Quality and Patient Safety demonstrated that for every 10% decrease in provider task load, the odds of experiencing burnout fell 33%.

Workflow process improvement projects and clinical quality improvement projects are also proven to reduce provider burnout scores. Providers naturally care more about clinical quality than clinical finances as such efforts align with their professional ethos and intrinsic motivations, improving the meaning in their work and their sense of efficacy. Loss of meaning and efficacy are core attributes of burnout.

Combined efforts that restructure care, reduce duty hours, and offer mindfulness programs can address this drop in morale. However, process improvements that restructure care and save time are more powerful than mindfulness offerings, which are helpful palliatives. Getting care into good flow saves time so that duty hours can be reduced without harming access to care.

How Can Health Care Providers Improve Process Flow and Work Burdens?

Lean principles can be especially effective in reducing task burden; therefore improving care quality and mitigating risk of burnout.

Lean interventions often start with the principles of 5S—sort, set-in-order, shine, standardize, and sustain, expanded as follows:

• Remove what isn’t needed by separating necessary supplies and processes from the unnecessary.
• Identify and organize the remaining necessary supplies, equipment, and processes.
• Conduct regular so-called cleaning of the physical environment and tuning of processes to keep the work area organized and safe.
• Create a standardized schedule for regular process shining and maintenance by following the sort, set-in-order, and shine methods.
• Make 5S a part of your organization’s mission by following the first four methods.

By organizing the real and virtual—for example, the InBasket—workplace, staff can declutter materials and processes, and reduce time wasted in searching, waiting, and over-documenting.

Beyond 5S, the standard suite of lean principles also form the centerpiece of team-based care.

Strategy Deployment

Everyone, from the executives to frontline teams, is clearly organized around the must-do, can’t fail initiatives, which are visible and present, and tracked in all meetings daily.

Standard Work

Each team member should have standard work that sets up other team members with standard handoffs and protocols that speed the flow of information.

Flow

Improving flow can help reduce the cognitive burden and incessant choice-making that fuels burnout.

Rather than batching a cache of activities at the end of the day, everyone in the practice should take on bits of work throughout the day.

By moving from batched work into flow, providers make best use of their skills—and their team’s skills. They have more energy and focus for what they’re trained to do, which offers greater fulfillment, engagement, and joy in work, infusing energy and commitment back into daily work.

External Setup

Standardize the setup process for patient visits so staff can more efficiently receive information around patient histories, documents, review of systems, care gaps, standing orders, and procedures.

This effort includes teaming up on clerical processes to standardize and manage them by protocols, so providers just add a signature or bits of clinical information. This team-based management of clerical tasks can hopefully lead to automation of clerical tasks as the future unfolds.

With external setup, transitions and handoffs can become smoother and fewer errors are introduced.

Leveling, Team-Based Care

Promote skill-task alignment, which matches the right person and certification to the right task.

Electronic Health Record (EHR) improvements reduce burnout additionally and can be accomplished using 5S methods and lean principles that take documentation from batch to flow. In an evolved and redesigned team, task load can decrease, documentation is shared and leveled across the team, as are results reporting and inbox messages.

In lean redesigns, people at the point of care decide what task burdens to reduce by elimination and spreading tasks across the team. This counters the EHR’s architecture, which concentrates tasks on the provider. Lean harnesses the experience and creativity of the people who do the work to align tasks to each team member’s skills and reduce time and task burdens.

Social network theories and studies in provider groups suggest that friendship and patient-sharing ties drive clinical quality improvements, adoption of EHRs, and evidence-based care better than hierarchical exhortations and mandates. Developing the guiding coalitions that harness social networks and management structures can help ingrain quality improvement into daily work.

We’re Here to Help

To learn more about lean principles and how to reduce physician burnout, contact your Moss Adams professional.

You can also visit our Health Care Practice for additional resources.