Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

Abstract

To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from multiple databases. Manual searches of grey literature and bibliographies were also performed. Of the 633 identified citations, 50 met inclusion criteria. Four unique categories of organization-directed workplace interventions were identified. Teamwork involved initiatives to incorporate scribes or medical assistants into electronic health record (EHR) processes, expand team responsibilities, and improve communication among physicians. Time studies evaluated the impact of schedule adjustments, duty hour restrictions, and time-banking initiatives. Transitions referred to workflow changes such as process improvement initiatives or policy changes within the organization. Technology related to the implementation or improvement of EHRs. Of the 50 included studies, 35 (70.0%) reported interventions that successfully improved the 3 measures of physician burnout, job satisfaction, and/or stress. The largest benefits resulted from interventions that improved processes, promoted teambased care, and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks. Implementation of EHR interventions to improve clinical workflows worsened burnout, but EHR improvements had positive effects. Time interventions had mixed effects on burnout. The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout. Benefits of process changes can enhance physician resiliency, augment care provided by the team, and optimize the coordination and communication of patient care and health information.

Improving your experience with electronic health records

“…3 Consider using physician-extender staff and other personnel, such as scribes, to complete documentation into the EHR. 3,8 This may help reduce burnout, create more time for clinical care, and improve faceto-face patient interactions. 8 Employing scribes can allow doctors to be better able to directly attend to their patients while complying with record-keeping needs.…”

“…3,8 This may help reduce burnout, create more time for clinical care, and improve faceto-face patient interactions. 8 Employing scribes can allow doctors to be better able to directly attend to their patients while complying with record-keeping needs. Although scribes make charting easier, they are an additional expense, and must be trained.…”

“…Here I suggest practical steps clinicians can take to improve their experience with their EHR system. [4][5][6][7][8] Steps to take during patient visits Because entering information into the EHR can be distracting, be prepared to multitask during each clinical encounter. [1][2][3][4][5][6][7] Be ready to address pertinent inquiries and issues your patient raises, and provide instructions on therapies and interventions.…”

Human Factors/Ergonomics (HFE) in Leadership and Management: Organizational Interventions to Reduce Stress in Healthcare Delivery

“…In reviews and meta-analysis of interventions to reduce burnout in physicians, organizational interventions had larger effects than individually directed interventions [13] [14] [15]. Healthy clinician administrator relationships can create the culture for clinicians to acknowledge and reduce stress [16].…”

“…In complex healthcare systems, it is difficult to achieve a high quality controlled study unless variables are simplified and measurable [13] [14] [15]. It may take many years to research a wide variety of interventions in such complex systems.…”