Monday, February 27, 2023

Ten Ways to Help Reduce Frustration and Burnout

Hi fellow CMIOs, CNIOs, and other Clinical Informatics and HealthIT friends,

With all of the recent discussions about 'burnout' (moral injury) among clinicians and other struggles with healthcare technology, I thought I'd take a moment to share some lessons about what you can do to help reduce frustration and burnout, based on my own experiences and lessons I've learned (sometimes the hard way!) over the last sixteen years I've worked in Applied Clinical Informatics. 

10. Worry about the details.

Most providers are acutely aware of the effect of the problem, but not the cause. So when you are looking at workflow problems, try hard to resist the temptation to get overwhelmed with the details - they are very important. You can sometimes tell when people get overwhelmed, because they sometimes say things at meetings like : 
  • "You can't boil the ocean!"
  • "We can't get too into the weeds here."
  • "Let's just look for some quick wins / low-hanging fruit!"
  • "Don't fall victim to analysis paralysis!"
  • "Perfection is the enemy of good!"
  • "We don't have time to plan!"
Unfortunately, anything that prevents important details from being reviewed and discussed can lead to workflow problems, so it helps to set expectations early and accept that details are important - and so you should always look for ways to discuss them easily, openly, and honestly.

9. Have organized, well-developed project intake and project management processes. 

Healthcare is complicated. The need for change could come from any one of a number of different directions

... so you will need to plan for how to manage all of these stakeholders above. Developing an organized project intake, prioritization, and management process for all of your stakeholders to participate in will help them to see the big picture, better negotiate conflicts when they arise, and provide transparency to end-users.

8. Have an organized, well-developed change management process. 

People like predictable outcomes. While it might take some time and resources to do :
  • formal evaluations of change/project requests, along with...
  • the necessary policy/regulatory searches
  • identification of best practices (e.g. through literature search, site visits, and interviews), 
  • current-state/future-state ('gap') analysis
  • design of organized blueprints, and ...
  • proper identification of stakeholders and deliverables, 
... but it always pays off in smooth workflows, smooth implementations, predictable outcomes, and happy users/patients. So the answer is not to skip these necessary analysis and planning steps - The answer is to have a clear, consistent, well-developed, and well-supported change management process that - not unlike a factory assembly line - lets you accomplish all of these important steps in a smooth, well-oiled process throughout the intake, analysis, design, build, approval, trainingimplementation, and support phases of your projects.

7. Have standardized definitions and templates for common tools (both inside and outside the EMR).

Creating an organizational glossary (with policy-grade definitions!) and developing standardized templates for common tools will decrease training and development times, increase standardization and functionality, increase predictable outcomes, and improve user satisfaction. A common source of workflow inconsistency happens when development teams focus on developing only the tools inside the EMR (on the right below), while letting someone else worry about the tools outside of your EMR (on the left below) : 

You can help avoid those unnecessary workflow inconsistencies by using both the red and grey lists above (as a checklist!) when identifying the deliverables necessary for your requested clinical workflow implementations/updates. 

6. Worry about document control and standardized document management. 

At first, it might seem like a trivial detail. Most people don't give it much thought, but having a single, centralized catalog (source-of-truth) for all of your important operational documents (policies, procedures, guidelines, protocols, forms, etc.) can help create a great deal of clarity, understanding, and collaboration. As the saying goes, "Control your documents, before they control you." - Without good document control and management, it's easy for project implementations to be delayed and/or result in unexpected outcomes

5. For those who write Federal/State regulations - You can help save time and frustration by fully understanding the subject matter, working from clear policy-grade definitions, and writing clearly and succinctly.

Some of the administrative complexities of modern healthcare can result from Federal / State agencies sometimes writing vague regulations, using vague definitions, sometimes with a vague understanding of the clinical workflows and subject matter. So if you write regulations, you can help organizations to save time and reduce administrative costs by using standardized, federal policy-grade definitions and writing regulations that are clear, short, and succinct. You could even help organizations to succeed by writing more than just regulations - Consider other tools necessary for success, such as sample workflows, best practices, educational curriculum, and sample policies : 

Finally, always have a plan for expiring/retiring or updating your regulations - Regulations with no planned expiration date may not get the necessary attention and updates they deserve.

4. Always have clearly written operational policies and procedures. 

Your operational policies are the standards of your organization, and your associated procedures describe how you will achieve those standards. Not only do good policies and procedures create clarity, harmony, and understanding - but they can be used to educate staff, answer questions, and even help plan/design workflows. While some believe the mantra 'don't paint yourself into a corner' , always remember - Good policies help to create clarity, improve understandingimprove accountability, encourage teamwork, and reduce risk of harm or unexpected outcomes.

3. Have an Applied Clinical Informatics team. 

When budgeting for technology, details are important. Total Cost of Ownership (TCO) and Return-on-Investment (ROI) are crucial to make smart business decisions. Applied Clinical Informatics professionals specialize in the analysis, planning, budgeting, design, development, implementation, and monitoring/support of technology implementations. So it's very helpful - if not essential - to have a multidisciplinary team of them available to help you with your most common clinical and business needs : 

... through not just your purchasing decisions, but also for your clinical workflow analysis/designs (#BlueprintsBeforeBuild), complex tickets/projects, special event planning, compliance, maintenance, and other strategic clinical and business needs.

2. Build clear, complete, and consistent order sets.

Physicians spend a lot of time ordering. Order sets connect all of the orders they need for all of their common clinical scenarios. Having inconsistent, incomplete, or unclear order sets only creates frustration, clicks, and unnecessary pages for your physicians. So to help reduce clicks, reduce frustration, and reduce unnecessary pages - you can help ensure your order sets are always clear, complete, and consistent by : 
  • Making sure you have a standardized order set template for developing your ordering tools (in a consistent manner).
  • Making sure you have the terminology necessary to clearly distinguish your order sets from your other common clinical tools like protocols, guidelines, templates, and clinical pathways.
  • Making sure your organizational order set development, approval, implementation, monitoring/support, and update processes are clear, well-defined, and well-supported.
  • Making sure you have organized naming conventions for all of your order set types.

1. Empower your clinical leaders. 

Supporting your Physician, Advanced Practice Providers (APPs), Nursing, and Pharmacy leaders might take time, planning, and resources - but expanding their skill set with helpful information about governance, committee chairing, policy writing, operations, finance, and/or project and change management will : 
  • give your clinical leaders more satisfaction, understanding, and control of their workflows, while also ...
  • empowering them them to play a more active role in problem solving, project development, and project implementation.
Remember - With the necessary Clinical Informatics support, support for/from your clinical leaders, and change and project infrastructure - you too can help create the clarity, harmony, efficiency, and predictable outcomes needed to help fully see the return on your technology investments

I hope this blog post helps spur some discussions with your own teams on how to help reduce frustration, reduce burnout, improve planning, improve analysis/design, improve usability, improve participation, and perhaps most importantly - improve patient satisfaction and patient care

Remember : This blog is for educational and discussion purposes only - Your mileage may vary! Have any other helpful suggestions for reducing frustration and burnout? Please feel free to leave them in the feedback section below!