INTRODUCTION
Burnout is a consequence of job-related emotional and interpersonal stressors which manifest in the three domains of exhaustion, depersonalization, and inefficiency/low personal accomplishment.1 The negative impact of burnout on delivery of quality care and provider well-being is clear.2 While there is heterogeneity in assessment methods, studies show burnout rates between 20 and 80%.3 Results from our own institution are comparable with national rates, with 45.6% of providers reporting high levels of burnout.4
Administrative tasks perceived as below the level of training of the provider are a driver of burnout, and studies show that organizational interventions to alleviate these burdens can lead to improvements in burnout.5 Obtaining the best possible medication history (BPMH) and updating the electronic health record (EHR) is a vital part of admission, but is time consuming. We piloted a program with pharmacy trainees completing the BPMH and updating the EHR for newly admitted general medicine patients. Our goals were to reduce high levels of burnout and to improve the experience for all clinicians to create a more fulfilling, sustainable work environment. To our knowledge, this is the first burnout reduction program to target this aspect of clinical care.
METHODS
The pilot was implemented on a single service line with an unpredictable census of newly admitted patients. Trained pharmacy students and residents, supervised by clinical pharmacists, verified medication histories with two independent sources, updated the EHR, and documented work in a note. Clinicians could refer to or pharmacy staff could pull patients from the EHR census. The clinician would then complete reconciliation by reviewing the list and ordering medications as appropriate.
We performed pre- and post-pilot surveys to assess impacts. Surveys were voluntary, anonymous, and done before and 6 months after the pilot started. We assessed emotional exhaustion (“I feel emotionally drained working on [service]”) and a validated single-item assessment of burnout (“I feel burnout out working on [service]”) on a 5-point Likert scale: never, a few times a year, a few times a month, a few times a week, and daily.6
Pre-post testing was performed to determine a difference between the distribution of the 5-point Likert responses via the Mann-Whitney U test. Statistical analyses were performed in QI Macros for Microsoft Excel (QI Macros Version 2018; Microsoft Excel–version 1609). This project was undertaken as a QI Initiative at Massachusetts General Hospital and was not reviewed by the Institutional Review Board per their policies.
RESULTS
Fifty-seven providers responded to the pre-pilot survey, and 77 responded to the post-pilot survey (52% and 73% of staff respectively), with 65 responding to the questions relating to burnout. In response to the question “I feel burned out working on [service],” the overall difference when analyzed as a 5-point Likert scale was statistically significant for a shift toward lower frequency answers (p = 0.05). Similar results were seen for the question “I feel emotionally drained from working on [service],” with a shift to lower frequency answers (p = 0.03). A threshold analysis of high- and low-frequency answers demonstrated a large improvement in the proportion of respondents reporting low-frequency burnout (p = 0.014) and exhaustion (p = 0.015). High-frequency answers did not reach statistically significant improvement (Fig. 1, Table 1).
Figure 1.
a Pre- and post-pilot responses to burnout survey question (p = 0.05). Threshold analysis for low-frequency responses in leftmost brackets (p = 0.014). Threshold analysis for high-frequency responses in rightmost brackets (p = 0.13). b Pre- and post-pilot responses to emotional exhaustion survey question (p = 0.03). Threshold analysis for low-frequency responses in leftmost brackets (p = 0.015). Threshold analysis for high-frequency responses in rightmost brackets (p = 0.376)
Table 1.
Survey Responses to burnout and emotional exhaustion questions
| Question | Possible responses | Pre-pilot (n = 57) |
Post-pilot (n = 77) |
p values |
|---|---|---|---|---|
| I feel emotionally drained from working on [service line] | Never | 11 (19.3%) | 16 (24.6%) | 0.03; p = 0.015 for low-frequency responses (never and a few times a year combined) |
| A few times a year | 16 (28.1%) | 29 (44.6) | ||
| A few times a month | 16 (28.1%) | 11 (16.9%) | ||
| A few times a week | 9 (15.8%) | 7 (10.8%) | ||
| Daily | 5 (8.8%) | 2 (3.1%) | ||
| I feel burned out working on [service line] | Never | 5 (8.8%) | 10 (14.9%) | 0.05; p = 0.014 for low-frequency responses (never and a few times a year combined) |
| A few times a year | 20 (35.1%) | 34 (50.7%) | ||
| A few times a month | 21 (36.8% | 14 (20.9%) | ||
| A few times a week | 2 (3.5%) | 4 (6.0% | ||
| Daily | 9 (15.8%) | 5 (7.5%) |
DISCUSSION
This quality improvement initiative demonstrated reductions in burnout and emotional exhaustion by implementation of a pharmacy-driven medication history program on a historically low-satisfaction service line. Overall, the intervention did improve symptoms across all frequencies of symptoms with a statistically significant shift to responses indicating lower levels of burnout after implementation, suggesting that this intervention is effective at promoting clinician well-being.
Our study has several limitations. First, the survey was anonymous, and we cannot match respondents pre- and post-intervention. Second, we did not administer a full burnout assessment, rather utilizing a shorter assessment method to reduce survey burden. Third, we had a small number of providers reporting the highest levels of burnout, limiting our ability to detect differences in this group.
Employing an organizational approach to burnout reduction by having pharmacy complete the best possible medication history led to a statistically significant reduction in burnout and emotional exhaustion on a single service line at our institution. Further work is needed to ensure that these changes are durable within our workplace, and generalizable to other institutions and service lines.
Acknowledgments
The authors would like to acknowledge Francesco Ferrante and Jennifer Giulietti as contributors. The pilot was funded with an internal grant from the Massachusetts General Physicians Organization. No other papers have been published, posted, or submitted from this same project.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
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