Denver Health CMO Focused on Physician Burnout

Connie Savor Price says physician burnout leads to medical errors and compromises the quality of care.

Addressing physician burnout is fundamental to promoting patient safety and care quality, says Connie Savor Price, MD, MBA, CMO at Denver Health.

Physician burnout was widespread before the coronavirus pandemic and spiked during the public health emergency. A study found that from September 2019 to January 2022, overall emotional exhaustion among healthcare workers increased from 31.8% of staff members to 40.4%.

Physician burnout has a significant negative impact on patient care, says Savor Price, who is a member of the HealthLeaders CMO Exchange.

"If a physician comes to work and feels tired or burned out, which is a feeling of disengagement sometimes to the level of despair, that can lead to medical errors," she says. "We know from data that physicians who are experiencing high rates of burnout are more likely to make diagnostic mistakes, treatment mistakes, and medication mistakes. If burnout gets to the point of depression, which is something that physicians who are burned out may experience, that leads to reduced attention to detail, cognitive impairments, and lapses in clinical judgment."

Denver Health has been working intentionally to reduce physician burnout for the past eight years. There is no silver bullet to address the problem, Savor Price says.

"There is not a singular solution to the problem, but we know we must work on it regardless of the challenges," she says. "We must try different things and make continued efforts to move the needle because provider burnout has a big impact on patient safety and quality."

To address physician burnout, healthcare organizations need to know their medical staff and know what factors are contributing most to burnout, Savor Price says.

"At an institution like Denver Health, a major driver of burnout is moral dilemmas," she says. "We have many patients who come into our emergency departments who are uninsured or under-insured. We can't always offer the full spectrum of services to those patients because they do not have the right type of resource to be able to afford services. As a physician, that situation is incredibly distressing."

So, one of the physician burnout initiatives at Denver Health has been to offer patients services for insurance enrollment. "We are doing everything we can to support the patients, which is important for our medical staff," Savor Price says.

Connie Savor Price, MD, MBA, is chief medical officer of Denver Health. Photo courtesy of Denver Health.

Physician burnout initiatives

In addition to helping uninsured and under-insured patients, Denver Health has launched many other physician burnout initiatives.

A primary effort has been to address excessive workload and administrative burdens such as documenting clinical care in the electronic medical record, Savor Price says.

"One of our most successful clinician burnout initiatives that was launched about three years ago has been at-the-elbow support in using the electronic medical record, which is Epic," she says. "We have had Epic 'super users' who are very knowledgeable in how to use the EMR to make themselves more efficient work with other clinicians. These super users have been working with their peers to show them how to efficiently document clinical care."

This at-the-elbow support effort has been conducted in the outpatient setting and the inpatient setting. Denver Health data shows that the initiative has reduced physicians' documentation time after their shifts have ended as well as overall documentation time.

Another primary physician burnout effort has been to promote a collegial environment with organizational support around opportunities for professional development, peer networking events, support groups, and medical staff events, Savor Price says. "We want to make Denver Health a collegial and pleasant place for our clinicians. For many clinicians, it is important to be happy at work and to have friends at work. We know from data that clinicians who have some friendships at work tend to be happier and stay in their jobs."

To select and develop physician burnout initiatives, Denver Health has used the health system's Medical Staff Executive Committee and a subcommittee of that group called the Provider Engagement and Wellness Committee to challenge the frontline medical staff to come up with initiatives.

"One of the proposals that came out of this effort was to create a Women in Medicine Mentoring Group," Savor Price says. "We know that mentorship programs can reduce burnout. A group of 25 female physicians met quarterly to talk about shared challenges, especially challenges that were unique to women. For example, they talked about balancing their careers and outside life. This mentorship program is something we are going to continue to support going forward because of the impact it has had on the first cohort of women, and we plan to expand the program to a new cohort in the coming year."

Other physician burnout initiatives that have come out of the Provider Engagement and Wellness Committee include lunch-and-learn sessions, yoga classes, and task-shifting.

"The task-shifting initiative has included focusing on paperwork tasks that are burdensome and annoying for physicians, who feel their most valued skills are related to clinical work such as diagnostics and treatment," Savor Price says. "In one of our clinics, we hired medical assistants to take on the burden of answering MyChart messages and tackling paperwork that the physicians could offload. This task-shifting has not only improved productivity. It is smart from a business perspective because it promotes physicians functioning at the top of their licenses."

Another physician burnout initiative that has come from the feedback of frontline clinicians is a plan to step up efforts to provide public recognition, Savor Price says.

"I am working with our communications department to profile some of our doctors," she says. "There are inspiring stories that come from patients and the peers of clinicians. I want to highlight clinicians who do community service. We will highlight these clinicians internally and externally. We can celebrate them on social media and other venues to help them know that we are proud of the work they do. Whether it is a single provider or a group of providers, we want to take advantage of telling their stories."

Measuring initiative impact

It is important to measure the impact of physician burnout initiatives, Savor Price says.

For several years, Denver Health has been using the Mini Z survey, which is an annual survey used to measure burnout. The health system plans to poll physicians and other staff members on a quarterly basis with two of the Mini Z survey questions, Savor Price says. "The first question is, 'Overall, I am satisfied with my current job.' Respondents answer the question on a five-point scale, which goes from strongly disagree, disagree, neutral, agree, and strongly agree. The second question is, 'I feel a great deal of stress because of my job.' The second question calls for the same five-point scale."

Savor Price acknowledges that Denver Health "has a long way to go" in addressing physician burnout.

"We have been largely stagnant on the annual Mini Z survey; and during the coronavirus pandemic, we slid backward," she says. "In the last survey, we made great progress, especially in addressing workload and stress. In terms of the national average for physician burnout, we were at the national average before the pandemic, slid to above average during the pandemic, and returned to average after the pandemic. Meeting the national average is not our goal—we need to do better."

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