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To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from January 1, 2007, to October 3, 2018, from multiple databases. Manual searches of grey literature and bibliographies were also performed. Of the 633 identified citations, 50 met inclusion criteria. Four unique categories of organization-directed workplace interventions were identified. Teamwork involved initiatives to incorporate scribes or medical assistants into electronic health record (EHR) processes, expand team responsibilities, and improve communication among physicians. Time studies evaluated the impact of schedule adjustments, duty hour restrictions, and time-banking initiatives. Transitions referred to workflow changes such as process improvement initiatives or policy changes within the organization. Technology related to the implementation or improvement of EHRs. Of the 50 included studies, 35 (70.0%) reported interventions that successfully improved the 3 measures of physician burnout, job satisfaction, and/or stress. The largest benefits resulted from interventions that improved processes, promoted team-based care, and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks. Implementation of EHR interventions to improve clinical workflows worsened burnout, but EHR improvements had positive effects. Time interventions had mixed effects on burnout. The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout. Benefits of process changes can enhance physician resiliency, augment care provided by the team, and optimize the coordination and communication of patient care and health information.
There is increasing awareness that physician burnout is a cause of diminished health and retention of physicians and their care teams, quality of patient care, and viability of health care systems. Many causes of burnout derive from organizational- and system-level factors, including electronic health records (EHRs).
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Most studies evaluating the impact of organization-directed interventions on physician burnout are of poor quality. More randomized controlled trials are needed to adequately test the effect of organization-directed interventions on physician burnout.
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There is evidence from a few high-quality studies that (1) the largest benefits result from interventions that improve workplace processes, promote team-based care, and incorporate the use of scribes or medical assistants to complete EHR documentation and tasks; (2) modifications to intensivists’ schedules for shift work or interrupted schedules significantly reduces burnout; and (3) duty hour requirements and protected sleep have no significant effect on reducing burnout among residents.
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Evidence from poor-quality studies suggests that EHR training and technological improvements of EHR reduce burnout; however, evidence from high-quality studies is needed to identify which technological improvements have the greatest impact.
The prevalence of physician burnout is substantial, with more than half of US physicians reporting at least one symptom of burnout, which is significantly higher than that in the general population.
Burnout is defined as a long-term stress reaction marked by loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization), and a lack of sense of personal accomplishment.
Causes of physician burnout include time pressure, chaotic environments, requirements for electronic health records (EHRs), and responsibilities outside of work.
The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study.
Physician-directed interventions aim to enhance resilience among physicians through activities such as promoting mindfulness or cognitive behavioral techniques to improve an individual’s ability to cope, communicate effectively, and increase competency. However, these supportive physician-directed approaches may be insufficient because they address individual solutions. Burnout more often stems from organizational- or system-level factors,
Some examples of organization-directed interventions include changing schedules, reducing the intensity of workloads, improving teamwork, and increasing physician participation in decision making.
To date, the effectiveness of organization-directed workplace or workflow interventions has not been fully examined. The objective of this review was to assess the evidence on the effect of organization-directed workplace interventions on physician burnout systematically.
Methods
Search Strategy
MEDLINE, Embase, and the Cochrane Library databases were searched on October 3, 2018, for relevant articles published in English from January 1, 2007, to October 3, 2018, that reported on organization-directed interventions for physician burnout related to work, the workplace, or workflow. Search terms included physician, burnout, stress, workflow, time and motion studies, lean, work engagement, psychosocial factors, work behaviors, health outcomes, job performance, job satisfaction, job-person fit, organizational factors, and quadruple aim. Manual searches of grey literature including key conferences and organization websites and bibliographies were also performed. Search details are available in Supplemental Tables 1 through 7 (available online at http://www.mcpiqojournal.org).
Screening Process
One investigator (K.J.T.C. or A.A.) screened all titles and abstracts for eligibility against a priori established inclusion criteria (Supplemental Table 8, available online at http://www.mcpiqojournal.org). Studies marked for inclusion underwent full-text screening by 2 independent reviewers (K.J.T.C. and A.A.), and discrepancies were resolved by adjudication or, if necessary, by a third reviewer. All results at both title/abstract and full-text review stages were tracked in DistillerSR (Evidence Partners).
Data Extraction and Quality Assessment
Included studies were extracted into structured forms by one reviewer (A.A.) and checked for accuracy and completeness by a second (K.J.T.C). Study quality was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence
ACGME = Accreditation Council for Graduate Medical Education; ACP/ASIM = American College of Physicians/American Society of Internal Medicine; her = electronic health record; ESS = Epworth Sleepiness Scale; JSS = Physician Job Satisfaction Scale; ICU = intensive care unit; IT = information technology; MBI = Maslach Burnout Inventory; MEMO = Minimizing Error, Maximizing Outcome; NA = not available; NR = not reported; NYC = New York City; OWL = Office and Work Life measures; PWS = Physician Worklife Study; RCT = randomized controlled trial; STAI = State-Trait Anxiety Inventory; WTR = Working Time Regulations.
Oxford Centre for Evidence-based Medicine Levels of evidence18: 1b = individual RCT (with narrow confidence interval); 2b = individual cohort study (including low-quality RCT; eg, <80% follow-up); 4 = case series (and poor-quality cohort and case control studies).
Teamwork: Employing medical assistants in an innovative model of care with new roles with a focus on career advancement, training, and enhanced compensation for the new medical assistant roles
Physicians Urban academic general internal medicine primary care practice
Teamwork: To evaluate the impact of using full-time clerical support to enter tests ordered by physicians, identify incomplete health maintenance measures, and preload new patient information
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
Physicians 46 Primary care departments in a large ambulatory care delivery system
Teamwork/Transitions: Lean-based workflow redesigns, which included colocating physician and medical assistant dyads, delegating major responsibilities to nonphysician staff, and mandating greater coordination and communication among all care team members
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
Physicians and advanced practice clinicians Academic hospital
Teamwork: 13 Team-based and organizational tactics to improve resilience, including expansion of leadership roles, faculty coaching for new hires, and value-based clinical schedule redesign
Teamwork: Team-based primary care redesign, “Primary Care 2.0”, with the goal of addressing the Quadruple Aim of health care (ie, the Triple Aim plus reducing workforce burnout) with the following components: (1) an expanded “care coordinator” role for medical assistants including scribing, population health management, and between-visit care management, (2) health coaching and motivational interviewing, (3) “lean” quality improvement to support a Learning Health System, (4) telehealth, (5) protected physician time for care coordination, and (6) an onsite extended interdisciplinary care team (ie, mental health, pharmacy, physical therapy)
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Physicians Department of medicine at the Mayo Clinic
Teamwork: 19 Biweekly facilitated physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small group learning
JSS, Empowerment at Work Scale, Medical Outcomes Study Short-Form Health Survey, MBI, Perceived Stress Scale, Jefferson Scale of Physician Empathy
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Teamwork: A defined model of team-based care in which the association between enhanced roles for medical assistants, registered nurses, and behavioral health professionals is defined
Time: Shift work staffing in which there was 24-7 intensivist presence. The same pool of intensivists supplied day shift and night shift coverage. In any given week, a single intensivist was responsible for all 7-day shifts, whereas 2 different intensivists alternated the 7 night shifts
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Residents Pediatric residency programs at hospitals
Time: 2003 ACGME work hour limits for US resident physicians. Residents can work no more than 30 consecutive hours and no more than 80 to 88 h/wk, averaged over 4 wk
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Time: Practice Refresh pilot program that initially reduces and then gradually increases the time physicians spend with patients so that physicians can learn and practice skills in efficiency, teamwork, and self-care
Time: United Kingdom WTR applied fully to junior doctors since 2009, with a limit of 48 h/wk, averaged across a reference period of 26 wk, alongside specified minimum rest periods
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
Time: 2008 Institute of Medicine work duty hour recommendations that limit shifts to 16 or 24 h with a 5-h nap, eliminate averaging of any on-call shifts, increase time off between shifts for night float and overnight call, limit consecutive night float shifts to 4, and provide 1 d off/wk/5 per mo without averaging
Transitions: Data-guided interventions and systematic improvement processes that included (1) leadership valuing physician well-being equal to quality of care and financial stewardship, (2) physicians identifying factors that influenced well-being, followed by plans for improvement with accountability, and (3) measuring the well-being of physicians regularly using validated instruments
Physicians 46 Primary care departments in a large ambulatory care delivery system
Teamwork/Transitions: Lean-based workflow redesigns, which included colocating physician and medical assistant dyads, delegating major responsibilities to nonphysician staff, and mandating greater coordination and communication among all care team members
Neuroradiology fellows and neuroradiologists Academic neuroradiology practice, part of a larger health care system with 6 hospitals and 80 outpatient imaging sites
Transitions: Image interpretive and non–image interpretive reading room workflows
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
Technology: Secondary analysis on data from the MEMO study in which physicians and office managers completed questionnaires about their office practice, including specific EHR features the office used
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
Technology: The impact of a brief, intensive technology deployment and training intervention that was aimed at improving individual clinician’s efficiency in using EHR
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Primary care physicians Practice with more than 10 physicians
Technology: To identify how EHR use affected clinical practice
Likert-type scale questions regarding how EHR affected medical practice
NA
4
a ACGME = Accreditation Council for Graduate Medical Education; ACP/ASIM = American College of Physicians/American Society of Internal Medicine; her = electronic health record; ESS = Epworth Sleepiness Scale; JSS = Physician Job Satisfaction Scale; ICU = intensive care unit; IT = information technology; MBI = Maslach Burnout Inventory; MEMO = Minimizing Error, Maximizing Outcome; NA = not available; NR = not reported; NYC = New York City; OWL = Office and Work Life measures; PWS = Physician Worklife Study; RCT = randomized controlled trial; STAI = State-Trait Anxiety Inventory; WTR = Working Time Regulations.
b Oxford Centre for Evidence-based Medicine Levels of evidence
Literature searches yielded 633 unique citations (Figure 1), of which 140 articles were eligible for full-text screening. Following full-text screening, 50 citations were included in the study,
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The most frequently used measure of burnout (15 studies) was the Maslach Burnout Inventory (MBI), a validated measure considered the criterion standard for identifying burnout.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Effects of 2- vs 4-week attending physician inpatient rotations on unplanned patient revisits, evaluations by trainees, and attending physician burnout: a randomized trial.
Canadian Critical Care Trials Group Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial.
Sixteen studies developed their own surveys to measure outcomes related to physician burnout including job satisfaction, burnout, depersonalization, fatigue, and stress.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
Characteristics of Organization-Directed Interventions
Interventions were categorized into the “4Ts,” a unique categorization created for this study: Teamwork, Time, Transitions, and Technology. Figure 2 provides an overview of the types of interventions and number of studies that fell into each category. Teamwork involved initiatives to incorporate scribes into EHR processes, expand team responsibilities, and improve communication among physicians. Studies about Time evaluated the impact of duty hour limits, schedule changes, and time-banking initiatives. Transitions referred to workflow changes such as process improvement initiatives or policy changes within the organization. Technology related to the implementation or improvement of EHRs.
Figure 2Number of studies by intervention type. EHR = electronic health record.
Thirty-eight of the 50 studies were designed to measure the effect of an organization-directed workplace intervention on physician burnout, job satisfaction, or stress. Eleven of the remaining 12 studies (22.0%) employed a workplace modification not specifically designed to address burnout but included outcomes related to it (the 12th study was a systematic review of several interventions that are included in the 50 studies we assessed). Thirty-five of the 50 workplace interventions (70.0%) successfully decreased physician burnout or stress and/or improved job satisfaction (Figure 3). A large proportion of interventions pertaining to Teamwork and Transitions had a positive impact on burnout, whereas, interventions categorized as Time and Technology had a less consistent overall impact on burnout.
Figure 3Proportion of interventions with a positive impact on burnout, stratified by intervention type and quality of evidence. The x-axis represents the category of intervention and the study quality; the y-axis represents the proportion of articles with a positive impact on reducing physician burnout or related measures. Each bar describes the proportion of studies with a positive impact on physician burnout that fell into the indicated level of quality and type of intervention. Levels of evidence: 1b = individual randomized controlled trial (with narrow confidence interval); 2b = individual cohort study (including low-quality randomized controlled trials; eg, less than 80% follow-up); 4 = case series (and poor-quality cohort and case-control studies).
is shown in Table 1. The majority of the studies (40 [80.0%]) were categorized as level 4 studies, which includes case series, pretest and posttest single-arm, cross-sectional, and poor-quality cohort studies.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Have Accreditation Council for Graduate Medical Education duty hour limits made a difference? a re-examination of resident sleep, mental health, education, and safety seven years later [abstract].
Practice refresh: A 1-month intervention to rebuild physician efficiency and wellness. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 27-28.
Rebooting the joy of practice = clinical/operational leadership + workflow standardization + technology. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 29-30.
The less clicks the better: improving the documentation workflow process for physicians. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 97-98.
High-quality studies were limited to Teamwork, Time, and Transitions interventions (Figure 3).
Teamwork
Twenty of the 50 included studies focused on improving teamwork through team-based care models, use of scribes to enter EHR data, and encouraging communication between physicians.
Use of scribes for documentation assistance in rheumatology and endocrinology clinics: impact on clinic workflow and patient and physician satisfaction.
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
A team-based and organizational framework for fostering resilience and well-being in academic hospital medicine. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, pp 1-2.
The ideal gas lounge: boosting resident happiness with empowerment and common space improvements. Paper presented at: International Conference on Physician Health.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
All of these subcategories of teamwork generally improved burnout, satisfaction, and stress (Table 2). A cross-sectional survey associated greater perceived capabilities of the care team with lower prevalence of exhaustion and cynicism, a higher likelihood to recommend the clinic as a place to work, and greater feasibility of providing primary care.
Clinician perception of team support, burnout and “doability” of primary care. Paper presented at: American Conference on Physician Health; October 12-13, 2017; San Francisco, CA. Abstract book, p 20.
Expanding the duties of medical assistants to add EHR documentation, health coaching, or navigation and/or management of population health and between-visit care improved survey scores of professional fulfillment
Notably, 9 of the 20 studies examined the impact of scribes, and 7 of the 9 studies examining the use of scribes successfully improved clinic workflow efficiencies.
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