Change, Technology, And Physicians: Can The Value-Based Care Transformation Prevent Burnout?

By John Khoury, Pharm.D., Vice President, National Payor/Provider Strategy at Lumeris

Fifty-one percent. More than half. A majority.

That’s how many physicians reported feeling burnout in 2017 according to Medscape’s annual survey. And, it’s a sizeable increase from 40 percent just four years earlier in 2013.

How did burnout become such a sweeping epidemic?

There are plenty of contributing factors. Policy changes, changing workflows, ICD-10, new payment models, general workload – all perfectly acceptable answers.

However, If You Ask Physicians, You’ll Likely Hear A Common Theme: Technology
Clearly, technology advancements bring many benefits. But they also can have unintended consequences, particularly for physicians.

Consider the example of EMRs. These tools digitize the health record and offer a new level of interconnectivity. However, EMRs were originally designed as billing systems – not as a clinical tool. This has often created numerous challenges for the physicians tasked with using them.

And it’s not just EMRs. Healthcare is changing constantly and for nearly every change, a new technology may be required to meet that change. In fact, physician burnout may as well be called change burnout.

For instance, the shift to value-based care is currently transforming the industry. It affects payment, care delivery, and – no surprise – requires an unprecedented amount of technology integration.

Given the stark state of physician burnout, it is easy to worry that the shift toward value-based care has the very real potential to make the problem even worse before it gets better.

But it doesn’t have to. Health systems don’t have to compromise between embracing change and reducing physician burnout. In fact, if done correctly, the shift to value-based care can actually reduce burnout. To achieve this goal, health systems must do the following.

1. Build Every Change Around The Physicians’ Workflow
For decades, the physician’s clinical workflow essentially stayed the same. A nurse took the patient’s vitals, blood pressure and asked a couple questions. Then, the physician conducted an assessment, created a plan and moved on to the next patient. They documented everything in real time on a written chart, often finalizing each case before leaving the room.

Injecting technology into the clinical practice changed everything. It has led to alterations in the workflow and additional documentation requirements – often meaning increased clerical work. It is not uncommon for physicians to take data entry work home with them, or hire additional staff to accomplish what was once completed during the visit. Often, this extra time includes entering redundant data into multiple systems. With a physician’s workday already lasting 10 to 12 hours, this creates a fertile ground for burnout, not to mention the potential for gaps in data entry regarding the visit.

And it's not just the extra hours that cause frustration. Physicians also complain that technology disrupts the time they spend with patients and often inhibits the building of a trusted advisor relationship with their patients. Many feel they already spend too little time with patients, and the time they do spend with their patients, they are often looking at a computer screen instead of the patient sitting across the room from them.

When new initiatives disrupt the physician workflow, they increase frustration and lead to burnout. When possible, health systems should involve physicians in the solution, and integrate new technology and initiatives into workflows that enhance the physician-patient relationship and minimize disruption. And, if that’s not possible, they should focus on gradual shifts. This allows physicians to get comfortable with the change, and minimizes the risk that they’ll reject it.

2. Put Physician Engagement At The Forefront
If you want physicians to adapt to a new initiative or technology, you need to invest as much (if not more) time in increasing physician engagement as in the technology itself. This is mission critical: the technology is only worth it if you can achieve physician adoption and behavior change.

One key to physician engagement is making incremental changes. For instance, the shift to value-based care requires physicians to adopt and use new processes and technologies to make data-driven decisions at both the point of care and when monitoring across populations. It’s also radically shifting how they’re compensated. Clearly, these changes can’t all happen overnight. And, if you lose physician buy-in during the process, the whole effort could collapse.

In this way, physician engagement is like pushing a large boulder up a hill. If you try to roll it all the way to the top at once, you risk it rolling back on you, and losing all your progress. So, you push the boulder up a bit, then put a stop behind it to keep it from rolling back. Once you see it hold, you repeat the process.

This means health systems must stay engaged with physicians throughout any change process. They need to understand and address concerns at each stage, then move forward. Once you lock in one new standard or process well, you can proceed to the next one.

Physician engagement also includes understanding what doctors really care about. Many (if not most) joined the field for altruistic reasons – namely to take care of patients. When possible, health systems should frame change around the clinical and financial goals that optimize patient and population care.

For instance, maybe a new tool or initiative can remove administrative burden – freeing up additional time for each patient. Or, perhaps specific gaps in care are closed in near “real time” during an office visit to drive better patient outcomes. Reignite the desire to help physicians deliver optimal care by making the right thing to do, the easy thing to do – both clinically and financially – and fully aligning incentives across payer, system, provider and patient.

3. Avoid Major Pitfalls
When healthcare systems want to make major changes, from rolling out a new technology to embracing a new initiative, they often fall into a few key traps. Each can exacerbate physician burnout. However, it is possible to avoid these challenges if you know what you’re looking for.

One of the biggest mistakes is making too many changes all at once. Yes, the industry is changing rapidly, but change still takes time. If everything is important, nothing is important. We must remember that physicians are people, not gods or miracle workers – though they are held to high standards, they can’t do everything at once. Like the rock up the hill, change must be gradual to be effective.

This also means avoiding information overload for physicians. If your whole solution is a Swiss army knife, they probably don’t need to learn or use all the tools at once. Start with the most critical or familiar tools first, then slowly expand.

Information overload also extends into the kind of data you give physicians. The healthcare field generates exabytes and exabytes of data each year, but how much of that is actionable? According to a report from the research firm IDC, the volume of healthcare data was 153 exabytes in 2013. At current rates, that figure was estimated to increase to 2,314 exabytes in 2020. To keep physicians engaged, you should ensure they only get the actionable data they care about most – and it MUST be accurate.

And, it’s not just about what data you share, it’s also about when and how you share it. Sharing data after an office visit, or after an adverse event happens isn’t helpful. If you integrate the data into the physician’s workflow, they’re very likely to act on it – around 85 to 90 percent of the time. But if it’s outside that context, action on the data drops to somewhere around 30 percent.

The final pitfall to watch out for is making decisions about processes or technology on knee-jerk reactions or without data. If physicians trust that every new technology or initiative is truly necessary, they’ll be more likely to comply. But when healthcare systems overreact, misinterpret a need or make a bad decision, they leave a trail of failed initiatives in their wake. This leads to a “wait and see” or a “this too shall pass” approach from physicians, decreasing the likelihood of success. It’s critical that each new initiative or technology fully aligns with the organization’s mission.

By being aware of these common issues, health systems can avoid physician burnout and ensure the success of their new initiatives.

Bringing It All Together
The healthcare industry is going to keep changing. And while new methods and technologies can improve both the care delivery and financial model of healthcare, it’s critical that they don’t make the physician burnout crisis worse.

When making changes, health systems must create an environment that is engaging for both physicians and patients across the entire continuum of care. These changes should focus on achieving the triple aim plus one: better health outcomes, lower costs, improved patient care and physician satisfaction.

With changes like value-based care looming, there are real opportunities to make healthcare better than ever before. But to make this a reality, physicians must be on board, engaged and not burnt out.