Providers looking to enhance patient experience must also consider physician experience.

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HCD Physcian

Taking a Human-Centered Design Approach to Physician Burnout

These days, health systems face a growing host of challenges, from complying with evolving policy and regulation requirements to purchasing and providing access to novel therapeutics and, of course, negotiating with insurers to ensure appropriate reimbursement for services provided. Yet as the healthcare landscape continues to grow more complex, the physician experience seems to have fallen increasingly by the wayside. Statistics show that the majority of physicians nationally are experiencing burnout [1] but interventions to alleviate this growing problem are generally scarce and ineffective. Meanwhile, employers in other sectors such as tech and financial services have significantly increased rates of employee engagement to great success.
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<h4>At a time when margins in healthcare seem razor-thin, why should health systems invest in their front-line workers? And more importantly, how can they actually succeed in this?</h4>
First, it’s important to understand “physician burnout.” Burnout can be thought of as a combination of emotional exhaustion, depersonalization and a reduced sense of personal accomplishment. Numerous studies have recorded rates as high as 54 percent of physicians meeting criteria for burnout [1]. Furthermore, a recent survey showed 70 percent of physicians were unwilling to recommend healthcare as a profession, and over half plan to retire in the next five years [2].
Burnout in healthcare is especially dangerous because it results in substantially elevated rates of substance use, depression, and suicidal ideation compared to the general population. Further adding to this stress is the fact that there remains severe stigma towards discussing burnout and seeking help for fear of repercussions. Physician licensing boards have been known to use mental illness as justification for revoking medical licenses.
While the moral and ethical imperatives to tackle physician burnout are clear, the concurrent detrimental effect on the wider health systems only adds to the case to address physician wellness. Economic reviews have reported figures ranging from $500K – $1M as the cost of one burned out physician, totaling to $4.3 billion nationally [3]. However, this number only accounts for lost revenue and replacement costs due to turnover. A closer look reveals numerous other effects, including reduced workplace productivity and efficiency. A large academic study found that physicians meeting criteria for burnout were twice as likely to be involved in patient safety incidents and three times more likely to receive low patient satisfaction ratings [4].
Many of the causes of burnout are systems-based. Health systems that have invested in physician wellness through organizational change have seen significant reductions in medical errors and malpractice claims. As researchers from Mayo Clinic put it, “Any health care organization that recognized it has a system issue that threatened quality of care, eroded patient satisfaction, and limited access to care would rapidly mobilize resources to address the problem.” We feel that the problem of physician burnout is no different.
But what can health systems do to tackle the issue? Design thinking can help legacy institutions abandon their traditional top-down approach and flip the model from how do we avoid burned out physicians? to how do we engage our physicians so they are able to deliver high-quality care? The following are ways that human-centered design can allow you to better engage the physicians at your practice.

Since we know that the well-being of physicians affects patient care, shifting from patient-based indicators of quality of care to physician wellness metrics can improve health system quality and performance. Taking it a step further, investigating the needs and pain points of the physicians you employ allows you to enact changes to directly reduce the friction they face when doing the job they were trained to do—take care of patients. In the same way we make a “journey map” to understand the highs and lows of a specific customer journey or interaction with a brand, we can use the same tools to understand how physicians are moving through their healthcare system.

Measure with Intention

Current strategies that have been employed by health systems have included wellness workshops, yoga classes and mindfulness programs. While these individual-directed interventions play a minor role in improving physician well-being, they have paled in comparison to organization-directed approaches. Investing time and resources into interventions which are failing to meet physician needs is a waste and can be avoided through solid design research. Supporting a diverse workforce requires designing for a diverse workforce. Since burnout disproportionately affects women and underrepresented minorities, sampling heterogeneously rather than simply “treating the mean” will yield a more universally successful system. While quantitative methods to measure problems can give part of the picture, when done together, the combination of quantitative and qualitative prototypical of human-centered design is far more powerful.

Trim the Fat

Implementing changes to improve physician engagement across health systems can be logistically cumbersome and financially risky. Taking a human-centered design approach allows you to identify potential opportunities and test corresponding prototypes at a small scale quickly and efficiently, thereby reducing the amount of resources necessary to understand whether they will be successful. Additionally, this process subjects all potential interventions to a “survival of the fittest” challenge in which only the most successful solutions are chosen to then be implemented across the organization.

Lower Investment, Lower Risk

Physician burnout may well be the single greatest threat to patient care, and it is largely going unnoticed or untreated by most health systems. The stakes are high for doing nothing. But the reward is just as high for those willing to invest in change. Healthcare providers that are taking steps to bolster physician engagement see a reduction of overall costs, an improvement in patient outcomes, and overall happier and more successful doctors.
We’ve seen how tactics from organization design and workplace engagement can bolster overall physician experience with clients such as Takeda and DXC. With our deep expertise across industries from financial services to consumer brands, frog is able to bring together design, technology and strategy to find real solutions for improving experiences. Through our frogHealth practice, we’ve made a commitment to improving healthcare for all people (not just patients) and are poised to help healthcare systems conquer the triple aim of improving patient experience, improving the health of populations, and reducing per capita costs of health care by adding one more: ensuring joy in work. Using human-centered design, we have the opportunity to rethink our current health systems in order to grant physicians more agency and autonomy, and ultimately allow them to feel a greater sense of accomplishment.

References:
1.Shanafelt, Tait D., Omar Hasan, Lotte N. Dyrbye, Christine Sinsky, Daniel Satele, Jeff Sloan, and Colin P. West. “Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014.” Mayo Clinic Proceedings 90, no. 12 (December 1, 2015): 1600–1613. https://doi.org/10.1016/j.mayocp.2015.08.023.
2.https://www.thedoctors.com/contentassets/23c0cee958364c6582d4ba95afa47fcc/ 
tdc_the-future-of-healthcare-survey-2018.pdf
3.Shanafelt, Tait, Joel Goh, and Christine Sinsky. “The Business Case for Investing in Physician Well-Being.” JAMA Internal Medicine 177, no. 12 (December 1, 2017): 1826–32. https://doi.org/10.1001/jamainternmed.2017.4340.
4.Panagioti, Maria, Keith Geraghty, Judith Johnson, Anli Zhou, Efharis Panagopoulou, Carolyn Chew-Graham, David Peters, Alexander Hodkinson, Ruth Riley, and Aneez Esmail. “Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-Analysis.” JAMA Internal Medicine 178, no. 10 (October 1, 2018): 1317. https://doi.org/10.1001/jamainternmed.2018.3713.

Nikhil Rajapuram

Nikhil Rajapuram is a visiting Healthcare Specialist at frog and UCSF 4th Year Medical Student. As a Healthcare SME, Nikhil brings a clinical lens to frog’s Healthcare practice. He is currently a research fellow applying HCD to understand burnout in medical students and residents. He will graduate UCSF School of Medicine in 2021 and continue to specialize in Pediatrics with a focus in Cardiology.

Nikhil Rajapuram

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Taking a Human-Centered Design Approach to Physician Burnout

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