Culture, Resiliency, & Work: Deep Dive Workshop Recap

Although nearly three-fourths of respondents to a 2019 ACCC survey of its membership reported "overall satisfaction" with their current position, nearly 59 percent said they either "agree" or "strongly agree" with the statement: “I feel a great deal of stress because of my job.” Fifty-six percent ranked the atmosphere in their primary work area as a “4” or “5” on a scale of 1 to 5, in which 1 is “calm” and 5 is “hectic, chaotic.” Perhaps most concerning, 41 percent described their workplace as “unreasonably busy,” and 33 percent said they are “definitely burning out.”

With these responses in mind, Linda D. Bosserman, MD, Assistant Clinical Professor at City of Hope in Duarte, California, and Kathleen LaRaia, MS, Executive Director of Oncology Services at Munson Healthcare in Traverse City, Michigan, offered some strategies to oncology leaders for addressing workplace burnout. During a workshop at the recent ACCC 45^th Annual Meeting & Cancer Center Business Summit, Dr. Bosserman and Ms. LaRaia described some of the reasons behind the rise in burnout among members of the cancer care team and shared a some tactics to help restore workplace resilience.

Staff burnout can take a significant toll on patient care and clinician well-being. In her March 22 presentation, Dr. Bosserman described a recent American Medical Association report that found that with each percentage point increase in physician burnout, the likelihood that physicians will report a medical error increases 3 percent to 10 percent. On a personal level, physician burnout correlates with higher rates of work dissatisfaction, divorce, depression, alcohol and drug abuse, and even suicide.

Dr. Bosserman and LaRaia say the main drivers of burnout in today’s cancer care environment stem from five key causes:

• Excessively high workloads caused by high volumes of data entry, documentation, and patient visits
• Workplace inefficiencies caused by poor processes, heavy patient volume, and delays in obtaining authorization for patient therapies
• Loss of meaning in work resulting from more time spent on data entry and less time spent with patients and colleagues
• Social isolation in the workplace due to siloed eletronic healthcare record (EHR) entry and paperwork
• Pressure to prioritize corporate values over personal values

To address the trends in healthcare delivery that are dragging down employee morale, Dr. Bosserman said City of Hope gave its staff members surveys that asked them to identify their specific stressors and suggest ways to ameliorate them. In a 2018 survey, 73 percent of 92 respondents reported symptoms of burnout. Respondents said that significantly contributing to their burnout was the amount of time they spent documenting their work in their EHR. Seventy-four percent said their proficiency in using their EHR was marginal to poor, and 47 percent said they spend moderately high to excessive amounts of time entering data into their EHR while they are at home. Accordingly, the top two strategies survey respondents identified to reduce their stress levels were improving workplace efficiencies within their teams and reducing the clerical burden of EHRs.

City of Hope responded to these staff concerns by addressing inefficient workflows and processes and providing additional EHR training. Although these remedies adopted a multi-pronged approach to decrease and streamline workloads, City of Hope found that even small changes could make a big difference. A faster, seven-second log-in to the EHR system saved an estimated 9,100 provider hours per year. A transition to team-based care and a medical scribe pilot program are currently underway at City of Hope to further address the inefficiencies staff members identified in the survey.

After presenting, Dr. Bosserman and LaRaia invited workshop participants to identify what their organizations should stop doing, start doing, do less of, and do more of to address workplace stress and burnout. Among the responses were:

• Stop: gossiping, implementing fixes before a problem is understood, scheduling meetings without a clear agenda
• Start: giving permission for self-care, attending professional gatherings, working as a team, measuring burnout regularly, learning to use the EHR more efficiently
• Do less: scheduling meetings, answering email at night, spending excessive time on the EHR, working on weekends
• Do more: mentoring younger staff and clinicians, building relationships across departments, socializing with staff, developing team-based processes and data-entry.

The drivers of burnout in healthcare are multi-faceted. While there is no simple fix, as City of Hope learned by asking, listening, and taking action, even small changes can turn down the heat.
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If your cancer program or practice has an innovative program that addresses wellness and resiliency in the workplace, we want to hear from you. Email mmarino@accc-cancer.org to share your story.