Most healthcare leaders acknowledge clinician burnout has reached a tipping point, according to a recent survey by the Experience Innovation Network, part of Vocera. But many are unsure of how to address it or justify the cost of improvement.
Those attempting to transform their organizations’ cultures face the ultimate dilemma: how to make changes without exacerbating burnout. Fifty-seven percent of respondents cited change fatigue as the leading contributor to burnout. Yet, clinical workflow improvement is necessary to reduce burnout and support well-being.
The need for sustainable change
More than 2/3 of respondents believe designing new workflows and care models holds the greatest promise to improve well-being. They recognize the need to pair fundamental change in care delivery with training in individual and team resilience skills, including mindfulness, cognitive behavioral techniques, and personal coping strategies.
Additionally, more than 50 percent see the need to lessen the administrative burden on team members, either by shifting responsibilities or streamlining the tools and processes required to complete them, for example, by hiring scribes or redesigning electronic health record (EHR) interfaces.
However, when asked to rate their organizations’ performance in designing new workflows and building resilience skills, more than half of respondents said they were doing this poorly or not at all. Given that leaders indicated these areas had the greatest potential to impact well-being, there is a clear need for organizations to adopt new approaches in these domains.
How care model redesign can transform well-Being
When Bon Secours Medical Group hired Robert Fortini, PNP, Vice President and Chief Clinical Officer, to build a nurse navigator program, leaders were focused on creating infrastructure to better support patients across the care continuum. But the initiative turned out to be transformative for physicians, nurses and staff as well.
The concept is built on embedding either in-person or virtual nurse navigators into primary care practices. When a patient belonging to the medical home is discharged from a hospital, the nurse navigator receives a notification and risk stratification via the shared EHR platform. The nurse then reaches out to the patient and builds a customized care plan that helps the patient regain health and avoid future hospitalization.
The model’s success rests on more than just adding staff. The team also has a cross-system model for continuous improvement. When care team members uncover new ideas to improve the care delivery model, these are funneled to and operationalized by three multidisciplinary Smart Teams, which, in turn, fuel staff training. “Some of our most creative and impactful ideas have come from our Smart Teams,” Fortini said. “We’re empowering everyone to practice to the top of their licenses, which has led to a great deal of professional satisfaction, a more balanced workload, and improvements in patient outcomes.”
Designing workflow with well-being as an aim
Over the past decade, a cascade of best practices has fallen on the shoulders of nurses. Data entry requirements, evidence-based imperatives, and other critical nursing responsibilities have left them with a mountain of tasks and insufficient time to get them all done.
Leaders at Novant Health recognized this situation as one likely to cause nurse burnout and high turnover. They undertook a design process using experience mapping, observations of interactions, and interviews with patients, families, and team members to understand the nurse and patient experience. The team combined these insights into a blueprint for an “ideal” day that meets both clinical best practice requirements, and supports nurses in caring for themselves, other clinicians, and their patients.
The blueprinting process had three phases. Nursing leaders held “We Heard You” forums to listen to and understand what mattered most to nurses. From there, Novant Health conducted full-day discussion and design sessions that included executives, managers, bedside nurses, and patient experience experts. Collectively, they designed a set of nurse- and patient-focused imperatives that were tested and improved, and now are being rolled out across all 11 medical-surgical units.
“When we entered into this, we wanted to embrace nurses and focus on the human relationship,” said Cindy Jarrett-Pulliam, RN, MSN, NEC, FACHE, Vice President of Nursing and Greater Winston Salem Market Chief Nursing Officer. “We listened when nurses told us what mattered for their own self-care: getting to the bathroom, getting food, and getting a break.”
Staffing models for care excellence and peace of mind
The bone marrow transplant (BMT) units at Hackensack Meridian Health are high performers, with high patient satisfaction scores, engaged staff, and high quality outcomes. Nurses from the BMT units were sometimes reassigned to provide coverage to other patient care areas where they were less comfortable, and concern grew about leaving BMT patients without the required nursing resources for this high-acuity patient population.
“The acuity on this unit requires that we stay with our patients,” said Anne Corbett, MS, BSN, RN, Nurse Manager. “Our patients are with us anywhere from 14 to 21 days, and sometimes they go home, come back, and are with us for three months. They have specific needs ranging from receiving complex medications to family members requiring psychosocial support and education from nurses.”
As part of a year-long project to enhance resilience, well-being, and joy, nurses took the initiative to address the staffing concerns by implementing an acuity-based staffing tool. Nurses score each patient on 10 different dimensions of care, and the charge nurse uses the scores to assign staff for the next shift. “Now we have data to show the staffing numbers we need to continue delivering high quality care and to prevent burnout among our nurses,” Corbett said. “You know the nurses are engaged with the tool. They aren’t just checking boxes and calculating numbers. They are customizing every element, and have ownership of it.”
Four imperatives to a successful resilience, well-being, and joy strategy
The examples above underscore the importance of four key imperatives required for a successful and sustainable strategy to reduce burnout and support well-being:
- Build an intentional, human-centered culture.
- Approach burnout and well-being comprehensively.
- Cultivate a team mindset.
- Integrate burnout and well-being strategies with all other organizational activities.
Healthcare today is a team-based endeavor, relying on nurses, physicians, support staff, families, volunteers, and patients to provide high-quality, safe, compassionate care. Just as care delivery hinges on team engagement, improving well-being requires an approach that builds connection, communication, and coordination across traditional silos.
