BARRIER REMOVAL: A paradigm shift to clinical wellness

If we, as medical professionals, can just make the time to grab a 10-minute session of mindfulness, then burnout levels will subsequently start to drop, right? Or maybe, in our non-clinical time, we can proactively reach out to your Employee Assistance Program (EAP) and connect with a therapist…that should help. Well, at least we can check out the 3-hour burnout lecture that the organization has scheduled for us on Friday @ 5:30 pm, right? I mean, it’s just on Zoom, and we can probably get away with wearing pajamas (at least bottoms).

Seriously though, if we look at all of these common burnout-mitigation strategies being adopted and promoted by many healthcare organizations, there just seems some dissonance to me, and I’m sure I’m not the only one who sees and feels this. While all of these strategies can be effective and are backed by good intentions, a commonality between them is that they need to be in addition to our clinical time, not taking the place of, or being integrated into. There is additional mental bandwidth, time, and energy required to take the steps to decrease burnout. But, this doesn’t make much sense, given that exhaustion is one of the hallmark symptoms of burnout, and the energy necessary to pursue any of these strategies is, by definition, in short supply. We can’t allocate or reallocate a valuable resource, such as time, if we don’t have it to give. We also are talking about finite resources here, so at some point, the tank is empty and we literally might not have the resources needed to take on one of these tone-deaf strategies.

Why are we asking exhausted medical professionals to add anything to our plates, even if the intentions are beneficent? It seems counterintuitive, and a case of “Good intentions, poor execution” to me. I propose a paradigm shift in which we start to take a hard look at the barriers to wellness, such as Electronic Medical Record (EMR) inefficiencies, and begin to reduce or remove these barriers in order to reallocate our precious time and energy towards a better work-life balance. 

A metaphor I like to help explain my thinking is riding in a hot air balloon: If you want to get off of the ground, you’re going to have to release some of the sandbags first. The weight of the sandbags is directly opposing any lift created by the heated air: until you cut the weight (barrier to lift), the balloon is unlikely to fly, no matter how much energy you put into it. 

So, I hope that organizations can start to think more about, and integrate, strategies to remove the barriers to the wellness of their employees. As I see it, these simple steps can be followed: 

  1. Identify the barriers.
  2. Create strategies to help minimize or eliminate these barriers to wellness.
  3. Integrate in and execute on these strategies.
  4. Reallocate the added time and energy on sustainable wellness practices.
  5. Repeat steps 1-4, over and over.

In a well-received presentation to the Wellness Council of my organization, I recently presented this paradigm shift and the steps listed above. Here’s one specific example of what we came up with:

BARRIER IDENTIFICATION: EMR (Epic in my organization)
A) Collect pre-intervention data via surveys and Epic efficiency/proficiency informatics.  
B) Train more staff (including me) to be Specialty Champions.
A) Lunch ‘N Learn sessions.
B) EMR-based CME sessions, with time carved out to take part.
C) Invite employees to one-on-one sessions with Specialty Champions.
D) Proactively solicit employees to see who might want assistance.
E) Collect post-intervention data.
A) Recruit new Specialty Champions as trainers.
B) Increase visibility and promotion of wellness options to staff with more resources (time, energy, etc.) available to them.

Although this is just one example, my belief is that improving the EMR experience for users, including all medical professionals that use one, is the best place to start. It’s easy to track progress, saves time and energy and results can be seen immediately and have exponential benefits. One resource that I found did just what I described above, and here were their findings:
1) >70% of their clinicians have reduced burnout
2) RVUs increased
3) 50% decrease in days spent working late
4) Average daily savings of 25 minutes per provider (84 hours per year!)

With this one intervention, by improving the EMR barriers, this organization was able to reduce burnout and ALSO free up 84 hours per year for each provider! I don’t know about you, but I’m thinking “Sign me up!” I imagine that many medical professionals, with these time savings, would be more willing to integrate some daily mindfulness techniques, connect with a therapist or take part in that Burnout town hall meeting. Even if they don’t, that is still 25 extra minutes per day that they might be able to reallocate towards exercise, spending time with their loved ones, healthy food preparation, taking a walk, or whatever restorative activity that suits them. 

I feel that many people, including myself, will say “I just need to make the time for mindfulness” or “I’m not making the time for my family.” Although unintentional, the verbiage of “MAKING” time is setting us up for failure. We can’t create time, as it is finite, with many constraints on it (easy there, Mr. Philosophy major…not trying to debate what “time” is here). We can “FIND” the time to do something, as it is already there, and we need to discover how to access it for what we need most. We, as well as the organizations we work for, should focus on removing barriers and “find” the time for wellness practices, as opposed to being asked to “make” it outside of our clinical practices. Thinking about it through this lens, via barrier removal as the prerequisite to wellness practices, will more likely allow us to “find” the resources we need for an optimal work-life balance, professional satisfaction, and joy. 

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) There are no conflicts of interest to report. 3) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

KEYWORDS: #burnout #medicine #physicianassistant #nursepractitioner #doctor #barriers #wellness