| Reduce job demands |
Getting Rid of Stupid Stuff [38,68] |
An organization invited clinicians to nominate institutional policies and practices to be deimplemented. Physicians and nurses submitted more than 300 suggestions of wasteful EHR tasks. Ten of the most frequently ignored 12 EHR alerts were removed because they were deemed unnecessary. Upon reevaluation, multiple requirements for documentation and some signatures were also eliminated. |
| Align EHRs to match clinical workflows [69] |
An 11-member informatics team conducted on-site EHR and workflow optimizations for individual clinical units, each for two weeks. The intervention included clinician and staff EHR training, building specialty-specific EHR tools, and redesigning teamwork. Clinician perceptions of quality of care, time spent charting, and satisfaction with their EHR and their work all improved [70]. |
| Reduce inbox volume [71,72,73,74] |
Greater inbox message volume is associated with higher rates of burnout [12,13]. Organizations can turn off messages that are automatic, redundant, or low-information (e.g., notifications that tests were ordered without an indication of the results or that the vitals were obtained). One organization also empowered the care team to review, respond to, and route messages as appropriate, substantially reducing the volume of messages that unnecessarily reached the physician or APP [75]. |
| CMS waiver regarding verbal orders [45] |
During the COVID-19 public health emergency, CMS waived certain requirements related to verbal orders to provide clinicians in hospital settings with additional flexibility. This waiver reduced the burden of computerized order entry for APPs and physicians [43] and empowered nurses and other team members to perform team order entry. |
| Reduce work of prior authorization |
Prior authorization is costly to physician practices when hours spent dealing with health plans are converted to dollars [49]. While working collectively with others to reduce this administrative burden [76], organizational leaders can also develop systems where organization-wide support staff, and not individual physicians and APPs, are responsible for completing the prior authorization process. |
| Eliminate early morning or late afternoon meetings |
A health system surveyed its clinical staff and found that work-life conflicts were a major source of stress, particularly for their clinicians who had young children [77]. Eliminating all mandatory early morning and late afternoon meetings can allow clinicians with children to perform drop-offs or pickups from child care. |
| Improve job resources |
Advanced team-based care with in-room support [17,18,78,79] |
A department of family medicine adopted a model of two MAs per physician, with the MAs providing real-time documentation and team order entry during the office visits. Quality measures improved, productivity increased, overhead costs per visit were unchanged, patient satisfaction improved, staff satisfaction was high at baseline and remained so, and physician burnout was reduced by half, from 56 percent to 28 percent [80]. |
| Improve clinical workflows |
Annual prescription renewal [67] |
By routinely renewing all of a patient’s stable, chronic illness medications for 18 months at the time of the annual visit, an organization reduced requests for prescription renewal by roughly half, saving one hour or more per day of physician, APP, or staff time [81]. |
| Virtual visit options at the bookends of the day |
Health systems can encourage practices that allow clinicians to flexibly schedule patients during the first and last hours of the day, to maintain their productivity while decreasing perceived work-life conflicts and commuting times [82]. Virtual visits at the beginning or end of the day can improve clinician turnover and burnout scores without negatively impacting patient access, relative value units, or total patient visits. |
| Provide support |
Buddy system |
An organization provided a mechanism for peers to sign up as “buddies” to support each other in their work. No formal training was involved. A weekly nudge was sent by email to provide a brief topic of reflection and to encourage check-ins [51]. |
| Collegial dinners |
An institution funded meals every few weeks for small groups of colleagues to informally discuss experiences related to their profession. Food, space, and discussion questions were provided. Participants reported increased sense of meaning in work and reduced burnout after the intervention compared to a cohort of physicians who did not receive the intervention [52]. |
| Peer coaching |
An organization provided a four-day intensive training for invited physicians to become peer coaches, trained to be empathetic listeners who help fellow physicians identify and meet their goals [53,54]. |
| Peer-to-peer support |
An organization identified clinicians with strong communication skills to be invited as peer supporters [53]. These clinicians were trained to support colleagues after an adverse event. The training involves empathetic listening and simply being present for a peer’s pain. |
