Identifying Measures to Fight Physician Burnout at the Enterprise Level

Geeta Nayyar, M.D., MBA: Rasu, you’ve got a big role, you’ve got a big title, right? This is something that you, your organization and your doctors are dealing with. From a strategic view and from an innovation view, how much is the measurement of physician burnout important to your bottom line? How much is that tool and that measurement really important to you?

Rasu Shrestha, M.D., MBA: I think, in so many different ways, that’s what matters the most. Because we’re all concerned in health systems with providing not just care, but optimal care. We want what is in the well-being of the patients that we’re serving. And if we’re not able to measure and really address the specifics of the burnout of those healers who are providing that care, then we’re not doing anyone service.

What’s really interesting, on top of what Janae just said, is that I actually believe that it starts at the top. So, yes, we need to take care of the physicians and the clinicians who are out there on the floors and providing that care. But this is a cultural and a moral imperative. It starts at the top. It’s important for us to: A) recognize that this thing is happening; B) measure it as you rightly said; and C) specifically have programs in place to address this. Not just to check a box to say that we have programs that are measuring and addressing the issues of clinician burnout, but to really specifically have programs that are actually proactively going after this in meaningful ways.

Geeta Nayyar, M.D., MBA: Heather, what are your thoughts on this? Have you seen a particular customer, a particular provider organization, really move the needle on this with some of the tools that your organization deals with?

Heather Staples Lavoie: Yes. We’ve been advocating for quite some time. Starting in 2015, we launched the Physician Misery Index to assess the degree of physician satisfaction, or the degree of physician misery, that was being experienced out in the field. And, on a scale of 1 to 5, it was nearing 4. It was about 3.7 at the time. And, actually, we redid the survey in 2018 and it was even higher. It was almost exactly 4 points out of a 5-point scale. So it’s actually gotten worse over the past three years, even though we’re obviously in healthcare technology and we thought that things might potentially be improving.

We’ve encouraged our customers, but we have made the survey freely available as well to anyone who wants to use it. It’s just a nine-question survey, and we’ve used it with customers — before they implement our software, but certainly during implementation and then periodically thereafter — to monitor this on an ongoing basis, just like you might evaluate for employee satisfaction and levels of engagement across the board. But this is specifically to home in on physicians, given the challenges that we know are being experienced, to see how things are faring and to course-correct.

We’ve had customers who then have been using that as a monitoring tool, to be able to course-correct and to have a dialogue with physicians. It’s really to be able to check in with physicians about what’s going on and how we can make things better — what are some of the challenges — and to have open discourse. Because that’s what it’s going to take in terms of coming to some strong solutions. And it varies by organization. Certainly, there are common root causes, but it does vary by organization in terms of what some of the expectations are and what the culture is that’s been set by that organization.

Geeta Nayyar, M.D., MBA: So much of what we talk about for our patients is prevention, right? It’s about value, it’s about prevention. What’s the No. 1 measure for prevention in this? Like Janae said, once someone is already burned out, we’ve pretty much lost them depending on where they are from a mental health perspective. Each of you, what’s the number one thing you think from a preventive standpoint that is just critical?

Rasu Shrestha, M.D., MBA: What’s interesting is, when you look at the issue of burnout across the board, I think there are scales upon which you’re able to look at the human elements of what it means to make sure that this caregiver continues to not just survive but thrive. Because it’s very different. And we’re human beings, and we have these expectations that we talk about to get the job done because we’re not allowed to complain. We just go in there. You’ve got your medical degree, you’re slapped with a white coat and you’ve got your stethoscope around your neck. Just go there and do your job, don’t complain. But it’s not just about surviving, it really is about thriving.

I think when you look at the scales, there’s the resiliency aspect that you need to measure and you need to look at. How resilient are these human beings, these healers, in the tasks that they have in front of them? The engagement aspect; how engaged are they? Are they actually engaged and motivated in the things that they’re doing? And then there’s, at the other end, the empowerment aspect. Are they empowered to actually do the things that they’re supposed to do? So there are multiple things that we can look at, but I think it’s really important to unearth this one by one and make sure that you go after this in a very calculated way.

Geeta Nayyar, M.D., MBA: I love that. Instead of a Physician Misery Index, maybe a Physician Strive Index. That sounds great.

Janae Sharp: One of the things that I think is important is that we have all these measures, but there might not be an ideal measure. Physicians love studies. This is something that I’ve realized working with them: They love data, they love studies.

Geeta Nayyar, M.D., MBA: That’s why they’re burned out.

Rasu Shrestha, M.D., MBA: They’re really competitive, too.

Janae Sharp: They want to publish it. They want to be the best at this. Change, especially in mental health, doesn’t correlate to how many studies you’ve taken. So the stories are important. The measuring tool is a tool to help people heal. And I think that’s part of the underlying bigger problem. You’ve taken people who are super hard working, used to succeeding, and love tools, and suddenly you give them a tool — maybe that’s the electronic health record, maybe that’s our health system — but these tools don’t actually lead to healing. So we have to say these measures all fail in creating a healing environment because tools aren’t the things that heal us.

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