Provider Burnout, an Ignored Scaffold to achieve Quadruple Aim

As Dr. Mel a Community Health Professor at University of Nevada mentions ‘Policies drive our Behaviors’ a system in any country is an outcome of its policies. Change policies are increasingly becoming part of our everyday life. Healthcare delivery is little behind its schedule, but its catching-up fast. A system wide triple aim of healthcare’s, is to achieve: Quality, Access and Cost. Mostly its the provider’s responsibility to balance these three when delivering care. A provider can be, a primary care physician, pharmacist, care giver, nurse, insurance agents, administrative staff, managers, and executives. Dr. Reka Danko Chief Medical Officer at Hope Clinic, Reno adds another piece to this objective, ‘provider burnout’ making it Quadruple aim.

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Over the years medical practice has become progressively stressful. Burnout occurs when passionate, committed individual become disillusioned with the job that derived them identity and meaning; and the things that inspired passion and enthusiasm are stripped away and unpleasant crowd kicks in the mind. Provider exhaustion was an ignored subject for all these years. A 2015 landmark study involving 7000 doctors and other workers led by Mayo Clinic, mentions it as, ‘a tendency to view people as objects rather than as human beings’.

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Physician burnout often begins in medical residency, amid increasing debts of hundreds of thousands of dollars, starting on the first day of practice. A provider is reimbursed by the number of encounters, at the same time he is responsible to maintain the delicate balance between quality care and cost.

As Policies drives behaviors. If a fatigued provider over stretches to increase its encounters and throughput, he is cutting each patient’s time and not delivering quality and compassionate care.

An unattended burnout may show symptoms such as, depersonalization, emotional exhaustion, reduced sense of personal accomplishment. Maslach Burnout Inventory, a three-dimensional tool developed by social psychologists Christina Maslach and Susan Jackson, is used to assess this syndrome through exhaustion, cynicism and inefficiency.

This uneasy relationship between people and work, is unrelated to individual weakness or evil workplaces. The era of electronic medical record (EMR) was intended to streamline everything from bookkeeping, research to patient care, by capturing real information, analyze it, exploit the results to cut costs, improve service. However, this added more pressure on the physicians, who found themselves subjected to more closer scrutiny for quality metrics.

The healthcare workforce burnout epidemic is a national crisis. In United States on average 400 physicians commit suicides every year. The underlying cause and solution is much deeper and complex. Reversing burnout, requires paradigm policy shift not only on a person, but also on the organization to bring back the sync in the care.  In 2015 Accreditation council for Medical Education (ACME) convened to investigate cause of physician burnout and provide training solutions for its prevention. American Meditation Institute is also taking an initiative to generate awareness and transform stress into strength.

Ayurveda, says before you plan for any treatment, make sure you have competent Quadruple elements put together. They are Physician, Medicine, Patient and Caregiver. If any of them are missing or tired, efforts to accomplish a successful treatment will be futile.

Writing on Provider Burnout, is in continuation of my reflection to contribute to Vibrant Healthy Communities. Share your thoughts on this most common problem of Burnout in today’s technological world!

Author: VandanaSandhir

Developing Vibrant Communities

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