Loss of Control

It is important to understand the emotional and spiritual impact of a career in healthcare.  We must understand our personal response to the stressors we encounter and how to care for ourselves so that we can care for others.  But this is only part of the problem.

Research is clear that one of the most significant factors in workplace stress, and therefore burnout, is the loss of control over the clinical environment and the increased demands of extra clinical responsibilities. Hospitals are now run by business executives with very little direct control by physicians and nurses. Clinicians are constantly monitored for efficiency, billing, core measure compliance, and patient satisfaction. This is only a small portion of what we do in healthcare. Clinicians and patients would likely report these are less valuable indicators of quality care.  Accuracy of diagnosis, quality of treatment, medical outcomes, and caring patient interactions would probably be of most value to the actual provider and recipient of care.  You get what you measure.  If you focus on measuring efficiency, productivity, and compliance with EHR completion, that is what you will get.  But sitting at a desk clicking boxes does not translate to excellent bedside patient care. In fact, it very likely deters clinicians from providing excellent care.

EHRs were intended to empower the clinician to be more efficient and accurate but have only led to additional workload. For instance, when a patient is triaged in our department, the nurse has no fewer than 10 safety screening questions to ask including smoking risk, safety in the home, fall risk, HTN risk, and suicide risk.  Few if any of these screening question have any useful follow up mechanism available to the clinician if the patient should screen positive, especially in the acute care setting.  For instance, if the patient answers positively to recent fall in the home, there is no referral to an OT/PT, or fall clinic. It is simply a question providing new information (problem) and no clear pathway to actually help the patient. We can gather infinite information on our patients but we haven't done a very good job of actually helping them. Information is easy to gather but problems haven't gotten any easier to solve. 

Before we can make a significant improvement in the burnout rates of healthcare providers, we have to evaluate these workplace stressors in a systematic manner.  How can we trim the ancillary tasks that caregivers are required to perform in addition to patient care?  Who is monitoring workplace satisfaction for staff?  Who is evaluating whether or not these processes are contributing to or detracting from clinician efficiency and job satisfaction and even patient outcomes? 

We have focused a great deal of attention on the responsibility of caregivers to care for themselves, to attend to their own emotional and spiritual wellness in the workplace.  It is now time to turn attention to the workplace itself.  The burden of the system is contributing to burnout.  How are we going to evaluate and improve this?

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