As health care workers are burning out, a systems-oriented well-being strategy is essential. While individual-level wellness efforts may be helpful, they don't always address the underlying root causes, including the waste in systems that causes undue burden on associates.
Recent data shows that nearly two-thirds of nurses and physicians are experiencing at least one symptom of burnout, putting them at risk for poor personal and professional outcomes. And this affects not only workforce retention but also quality of care.
“The well-being of our health care workforce is absolutely integral to providing optimal, safe, high-quality health care,” says Maureen Leffler, DO, M.P.H., chief well-being officer at Nemours Children’s Health. “What's important to underscore is that burnout impacts what we care about the most, which is the care that we provide to patients and families. Burnout is associated increased errors, suboptimal communication, poor patient experience, and decreased safety and quality.”
Quoting Christine Sinsky, M.D., vice president of professional satisfaction at the American Medical Association, Leffler says that “burnout manifests in the individual but originates in the system,” describing it as the interactions between colleagues, leaders, patients, families, technology, policies, the physical environment, and the health care organization. All those factors can contribute to well-being or to burnout. “Knowing that burnout is an occupationally induced syndrome—a systems-based problem harming individuals—the logical next step is to direct interventions at the systems level,” she says.
One aspect that overlaps with nearly all those areas is waste—those daily hindrances to work that cause undue burden on staff. “It’s really those small things,” says Audra Bradfield, CLSSBB, PMP, continuous improvement (CI) specialist at Nemours Children’s. “The small things chip away over time, day over day, moment after moment, work around after workaround. I love the Mohammad Ali quote: ‘It isn't the mountains ahead to climb that wear you out; it's the pebble in your shoe.’”
By reducing the work burden, the cognitive load and the workarounds that take a lot of time and energy, health care professionals can do what they do best: get to the bedside and take care of the patients and families.
Given the connection of waste to well-being, it made perfect sense for Leffler’s well-being team and Bradfield’s continuous improvement team—which regularly uses Lean Improvement principles to reduce and eliminate waste—to partner for a solution. “It's a nice counterpart to make sure that we are creating and helping to leverage all the tools that we have from our well-being team and continuous improvement for our associates,” Bradfield says.
Inspired by the American Medical Association’s GROSS campaign, the well-being team put together a program called GROW (Get Rid of Waste) to help teams remove waste from their processes. The CI teams works with the well-being team to expand GROW across the organization, teaching employees to recognize and surface waste and supporting them in doing something about it. Beyond education, this program communicates to employees that they don’t have to accept waste, that they’re empowered to call it out.
The CI team created a guide to identifying waste in their daily work, which includes nine categories:
- Complexity. Complex process flow. Choices that confuse others.
- Correction. Fix anything not done right the first time.
- Inventory. In progress or finished inventory that is idle. Inventory may be materials, ingredients, supplies, or information.
- Processing. Redundant or unnecessary process steps, rechecking and inspection.
- Search time. Time spent looking for information, people, supplies and equipment.
- Space. Storage of unnecessary items, excess inventory, and the general mess that builds up.
- Transportation. Handling or moving something multiple times unnecessarily.
- Underutilized people. Downtime for staff available to work, stifling creativity, not fully using skill sets.
- Wait time. Delays and queues of all types.
In addition, the CI team provides flash cards, coaching in team huddles, and consultations—as much support as a team needs to be empowered, supported, and successful.
The GROW program was put into action at one of Nemours’s primary care clinics that was experiencing long wait times on the phones and in the check-in line. This resulted in upset patients and parents, as well as a backlog in care.
Once that problem surfaced through the well-being team, a continuous improvement specialist connected with the team at the clinic and visited the office for to perform observations and collect data. They discovered waste in two areas: processing and staffing.
The team recommended the use of a Plan, Do, Check, Act (PDCA) cycle to streamline process work and recommended a flexible staffing model to ensure the right amount of people during the right times. The CI specialist coached them on how to check and adjust the new processes for continual improvement. These changes resulted in lower call abandon rates and reduced wait times at check in, which also decreases work burden, redundancy, and stress for the employees.
The success was not only in those improvements but in the cultural shift. “The model is about creating a culture of continuous improvement, of recognizing eliminating waste—a cultural shift that well-being is of importance,” Bradfield says. “These associates felt empowered. It’s great that we have the outcomes, but now we also have associates who know they can come to us again with another issue and not just live with the waste and just see it as part of their job.”