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Jul 19, 2019

Professional burnout in healthcare – is technology the cause and the solution?

Estimated reading time: 9-11 minutes

    

Loss of enthusiasm. Low self-esteem. Feelings of cynicism and a diminishing sense of achievement. 

 

These are just some of the symptoms of professional burnout which, unless appropriately recognized and addressed, can contribute towards ill health, retirement, failed relationships, dependency on alcohol and abuse of other substances. And, in the worst cases, self-harm and suicidal thoughts. 

The healthcare industry is finally beginning to recognize and confront the systematic burnout that’s inflicting untold damage on the profession. In fact, Dr. Edward Ellison, executive medical director and chairman at the Southern California Permanente Medical Group recently shared his view that studies estimate a doctor is lost to suicide every day in the USA[1]. 

 

Alongside the dire personal consequences, we should also recognize that systematic levels of burnout are impacting industry job satisfaction and productivity on a daily basis, and also the appetite for young people to choose a career in medicine. Inevitably, the quality of care and overall patient safety is also being severely impacted.

 

As a doctor and as a former hospital CEO, it’s my heartfelt view that burnout is one of the most significant challenges faced by the healthcare industry and society at large. 

 

In the healthcare context, if you wish to better understand the highs, lows, stresses and strains of a career in medicine, I strongly encourage you to read Adam Kay’s UK bestseller, “This is going to Hurt”. As a first-hand account of life as an NHS junior doctor, the book paints a picture of the pressures, demands and daily heroism asked of healthcare professionals with tremendous humor but also painful honesty. 

 

Taking the analysis deeper, a recent survey in an Annals of Family Medicine report[2] suggests that medics working in emergency care, neurology and general practice are especially vulnerable. 68% of US family doctors and 73% of general internists would not choose the same path if they could start afresh. 

 

It’s clear that decisive efforts must be made to overcome this blight on the industry. Better staff outreach, coaching and peer-to-peer support in a comprehensive mental health strategy is one approach warranting a separate discussion. 

 

But with rising rates of chronic disease, an aging population and a shortage of specialist skills, daily workloads and system pressures are still continuing to increase. Therefore, the industry must also focus on measures to become more productive and reduce the administrative burdens being placed on healthcare professionals.

 

For health technology companies like Philips, we have had to recognize that whilst digital technologies and data-led medicine can break new ground and, in some cases, even be a savior. But too often these tools are also adding to the daily burden and complexities being asked of care teams. Poor integration of technology can often result in doctors working more hours but spending less time with patients.

Electronic health records (EHRs) are a major culprit, and both anecdotal and empirical evidence reveals many flaws in the way they operate, and the way clinicians use them. 

 

Analysis of morning ward rounds in New England reported in PLOS ONE[3] shows that different care teams use different recording methods, and that many professionals use workarounds (presumably to save time). EHRs are not regularly used for information sharing and, worse still, frequently get in the way of communication between the different care teams. Even more fundamentally, system design and hospital-room set-up often do not facilitate efficient workflow or an environment conducive to quality care.

 

However, maybe it’s not all doom and gloom. Contrasting to this US study, the 2019 Philips Future Health Index gives a global perspective. It reports that 64% of healthcare professionals surveyed say that EHRs have actually had a positive impact on their working environment and overall levels productivity. 

So where does this leave us? Of course no one wants to go back to the days of paper reporting and archives. Perhaps these contrasting studies reflect that, in mature markets especially, the industry may have lost its way somewhat when it comes to technology integration and interoperability. However, advancements in EHRs and the adoption of digital healthcare is still adding significant global value. 

 

Thinking about professional burnout and how we can integrate technology more seamlessly, at Philips, it’s my role to strongly advocate for the needs of care teams and their patients. We want to focus our innovation on solutions, interfaces and ways of working that reduce complexity and improve productivity across both clinical and operational tasks. Health technologies must contribute to overall higher standards of care together with gains in efficiency.  
 

Here are a few examples of the ways in which we are working on this kind of staff-centered innovation:

 

1. Embedded decision support. The early adopters of data and eHealth applications often make the complaint that medical staff, “are drowning in data, but starving for wisdom”. Philips’ approach for health informatics and data innovation is rooted in the integration of data from multiple sources with critical analysis and visualization functionality that supports real-time decision-making. First-time right diagnosis and triage is a major benefactor of this kind of innovation, but decision-support solutions are also enhancing decision-making in acute settings, like the ICU and general ward. Here predictive analytics can help reduce serious events by supporting care teams who are making near-constant judgements on behalf of their patients.

2. Usability & design. User experience (UX) is a growing area of research and activity at Philips, and we are working on the standardization of interfaces, configuration tools and intuitive software experiences. This reduces fatigue for care teams when moving from console to console and enables the display of multiple inputs in an integrated and coherent dashboard to inform the next step along the care pathway. Consistency in elements like UX, design and data visualization can boost productivity and enhance the quality of care through better communication and collaboration between specialist teams.

3. Operational productivity. Rethinking processes and workflows is a critical part of technology integration and change management, bringing a team based approach to help alleviate the daily pressures in care delivery. LEAN practices and continuous improvement are a necessity for all health systems in this day and age. But new innovation also plays it part. For example, significant gains can be made by examining how hospitals utilize existing assets and measure performance in real-time. To illustrate this, efficient patient scheduling and equipment maintenance are “low hanging fruit” when it comes to improving performance outcomes in the radiology department. By unifying data across different modalities, systems and processes, you can implement a dashboard approach to continuously optimize variables like equipment uptime and usage capacity, also providing the basis for deeper patient referral analysis and interdisciplinary knowledge sharing. 

4. Clinical care coordination – Continuing with the need to take a holistic view of processes and outcomes, clinical command centers and care coordination is another innovation area at the cutting edge of health data aggregation and analysis trend. Centralizing multiple decision support systems enables the smart allocation of resources according to real-time supply and demand for services inside (and increasingly outside) the hospital. Akin to Air Traffic Control, at Philips, we have built up expertise to feed command centers with health informatics to improve staff productivity and patient transitions from pre-admissions, acute care and into post-discharge care. With the right continuous improvement practices, clinical command centers are setting a new standard in care delivery. Check out this blog by my colleague Jeroen Tas if you want to go deeper on this topic.

 

Of course, sitting behind each of these examples, we must continue to champion common platforms, interoperability and data standardization. It’s vital for the plug and play technology approach that we strive for at Philips and is the basis for increasingly sophisticated artificial intelligence applications to enhance skills, reduce workloads and boost staff productivity.

 

To conclude, I am passionate that the healthcare industry must confront and overcome the physician burnout problems causing so much harm to a profession I love. In my experience, a strong sense of duty and purpose is an attribute that I have found in all my medical colleagues throughout my working life. Doctors, nurses and care managers tend to be people who never give up. But current workloads and system pressures have reached an unsustainable level. Together with proper mental health, coaching and support programs, digital technology clearly has a major role to play to boost productivity and health outcomes. I am proud that Philips has identified healthcare staff satisfaction and well-being as one of its core innovation objectives. We owe it to them to get it right!

[1] https://permanente.org/edward-ellison-md-addresses-physician-burnout-at-cnbc-event/

[2] Thomas Bodenheimer, Christine Sinsky, Annals of Family Medicine Vol 12 No. 6, “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider”, November/December 2014, pp- 573-576

[3] Shiri Assis-Hassid, Barbara J. Grosz, Eyal Zimlichman, Ronen Rozenblum, David W. Bates, PLOS ONE, “Assessing EHR use during hospital morning rounds: A multi-faceted study”, February 25 2019

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Author

Jan Kimpen

Jan Kimpen

Chief Medical Officer, Royal Philips

Before joining Philips in 2016, Jan Kimpen, Professor of Pediatrics, was CEO of the University Medical Center in Utrecht. He leads the global clinical team of Philips, focusing on advocacy, customer partnerships, clinical research and medical consulting, and is responsible for the annual publication of the Philips Future Health Index.

 

He is a strategic advisor for commercial and clinical strategy, market reimbursement, R&D roadmaps and partnerships and M&A, and provides thought leadership on relevant clinical and medical topics. Jan participates in the WEF Global Future Council on Healthcare, the American Heart Association alliance and the Board of Sanara Ventures in Israel. Jan is president of COCIR, the European trade union for imaging, healthcare informatics and radiotherapy.

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