Administrative burdens in Burnout

Armin Moradi

2021-10-26

Hi there!

Automation in Burnout

Hello everyone, I'm Armin PGY3. I have written a shorter title here, but the full title of this talk is "Digital transformation and automation of administrative burdens in physician-leader burnout rates". That's a mouthful of words to say we want to explore the relationship between burnout and manual performance of administrative tasks. In this context, digital transformation means moving from paper to digital media, and automation meaning, well, removing as much manual intervention as possible. As a sidebar, this is not about changing any of the processes we have, but more about making the same processes easier and more streamlined.

The question I'm essentially trying to answer is how can we reduce burnout rates by automating as much of the manual mostly-thoughtless processes as we can.

But that's the end goal. Before we get there, let's talk about what burnout is, so we know what to target. We'll also talk about the motivation behind this project, not in that particular order.

Obligatory `whoami`

PGY3 Psychiatry
Software developer

In a previous life, I was a professional backend software developer mainly working on some of ontario traffic systems. If you've ever encountered one of those big metal boxes beside traffic lights, part of what I'd written is on those…in ontario, not here. Most of what I'd worked on also runs the the central coordinator systems that manages those boxes in a region. Also worked on traffic simulation. Have been a member of the Fedora Project team, and have over the years contributed code to various other projects. But all that's irrelevant. What is relevant however, is how I've been involved with software in both hobby and professional capacities. And this is where certain themes have become evident, and that's where I got the inspiration for this project.

Why that long of an introduction? My point here is to introduce a piece of another world that exists out there and bring a little bit of it into my world, the medical world. And, interestingly, I could not have chosen two so very different worlds to mix.

World of Software

Manual processes are dead.
Long live automation.

A bit tongue in cheek, I admit.

The point here is that the manual processes in the software world are deemed inefficient by principle. They are not considered a luxury but a necessity. Any manual process that doesn't involve decision making which only a human could do is almost immediately replaced by code. What's more, even having those manual processes in the workplace is frowned upon.

I couldn't come up with an analogous attitude in medicine, but the closest thing would be how we feel about evidence-based medicine. Doing something which has no evidence behind it makes us uncomfortable, as if something's wrong, as if something needs to change, so we look and change what needs to change. A similar attitude exists in the software world for manual processes. Again, not quite analogous. If you have to type it in, something's wrong. If you have to look at it, something's wrong. Theses processes make people uncomfortable. In fact, there are entire teams dedicated to automating the mundane tasks called the DevOps (Developer Operations) team.

Just as an example, there is something called continuous integration in software, where the software that written gets automatically tested through and through for issues. a level above that, we have software that helps you write software, and we have other programs that write programs that then write programs, expanding a single word that you type into a whole thousand line file, which then gets automatically parsed and processed.

Why is any of this relevant?

Type type type

Automation

Is it worth it?

Burnout

Definition
Factors
What can we do!?

Definition

WHO¹
ICD-11²
C. Maslach³

First let's start with health! WHO defines health as "state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity". Therefore, burnout makes us unhealthy, and it's been studies since at least the 1970s⁴.

One of the prominent names in burnout research is Christina Maslach, professor of psychology in UC Berkley. Her research in 1976⁵ lead to the definition that burnout is a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment. Her work also yielded Maslach Burnout Inventory (MBI)⁶. Others have come up with other definitions, but they all converge on the concept of mental exhaustion from work⁷.

According to International Classification of Diseases (ICD) revision 11 (ICD-11):

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

feelings of energy depletion or exhaustion;
increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and
reduced professional efficacy.

Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life.

That's a quote from WHO's website.

Systemic factors - Demands

Excessive Workload, Unmanageable Work Schedules, and Inadequate Staffing
Administrative Burden*
Workflow*, Interruptions, and Distractions
Inadequate Technology Usability*
Time Pressure and Encroachment on Personal Time
Moral Distress
Degraded Patient–Provider Relationships

Factors⁸

Long work hours and workload ⁹^,¹⁰ have, time and time again, been strongly associated with burnout. In terms of long work hours, total work hours have been highly associated with emotional exhaustion in a meta-analysis of 71 studies. In fact, for every 1 extra hour above 51.8 hours per week, there is a 2% increase in risk of burnout.¹¹^,¹²

Just a sidenote, 'work' itself can be thought of as either what is performed, or, as the effects of the work on the worker ¹³. Which leads to my next point:

Interestingly, one study demonstrated that "perception of the work as stressful" was also strongly associated with increased emotional exhaustion in orthopedic surgeons. That's not to say "it's all in our heads", but there is that perception component to burnout that at least exists and is worth considering.

What is even more interesting, is that the most prominent current complaint by clinicians about their workplaces is the excessive amount of time they must spend on administrative tasks. A complaint that is, and please bare with me, essentially non-existent in the software world.

So, administrative burden, workflow, and technology usability are at least 3 low hanging fruit that we can target as potential improvements. Technology usability less so because there are systems we use already and changing those would be a humongous undertaking. There are terrible systems, stuff of nightmare in fact, but alas, not much can be done about it. Blame the marketing departments of said software systems.

On a sidenote, there is an unfortunate outcome where EMRs have become more of a burden than paper records were ¹⁴ mostly because they are no longer about patient care but about process and collection of data. There is a nice analysis of this in the references, but I won't go into that here.

There are, of course, other factors that contribute to burnout, and here's an abbreviated list. There are also individual factors.

Systemic factors - Resources

Meaning and Purpose in Work
Organizational Culture
Alignment of Values and Expectations
Job Control, Flexibility, and Autonomy
Rewards
Professional Relationships and Social Support
Work–Life Integration

Individual factors

Personality and Temperament
Coping Strategies
Resilience
Personal Relationships and Support Systems

Why

World dominati… cough …burnout!

How

Start with the easy parts first

Future

World domination!

QA

Thank you

amoradi.org/public/burnout.html