It’s time to put human relationships back at the center of health care when it comes to how health systems and hospitals approach safety, according to the authors of a recent Mayo Clinic Proceedings commentary.
Doing so would not only improve health system safety and resilience, but also help eliminate some of the sources that are contributing to the high rates of physician burnout.
The approach involves shifting toward a safety mindset and framework that safeguards against human fallibility and empowers physicians to find creative and adaptive solutions that can be tailored to a patient’s individual needs.
This new framework requires reducing the extraneous cognitive load that’s placed on physicians today. This would free them up to focus on providing safe, high-quality and empathetic care.
“Health care has reached a crisis point where action must be taken to protect the resilience of the system and its most critical resources for safety and healing—health care team members,” says the commentary. It was co-written by Christine A. Sinsky, MD, the AMA’s vice president of professional satisfaction, and the lead author is AMA member Heather L. Farley, MD, MHCDS.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Shifting the safety mindset
Under a framework dubbed “Safety II”—from a white paper co-written by Erik Hollnagel, PhD—there would be a systems-based approach that looks at safety as the presence of resilience instead of a system with no errors.
“It is based on the understanding that errors can and will always occur, no matter how well a system is designed,” the authors wrote. They argued that the focus should be on creating systems that can anticipate and avoid error, as well as adapt and recover from errors in a way that supports and leverages the expertise of physicians and other clinicians.
To do that, human behaviors, proficiency and limitations must be incorporated into the design. The integration may include:
- Adopting a mindset that physicians and other health professionals—with their training and creativity—are the essential system safety safeguards whose time and talent need to be protected from “stupid stuff,” which are tasks that create a burden without adding value to the care patients get.
- Investing in standardization of predictable work that reduces extraneous cognitive load and decision fatigue.
- Collaborating with stakeholders to design reasonable safeguards—ones that are gentle nudges—that protect humans from making unnecessary errors.
- Creating a way for physicians and other health professionals to provide feedback to leadership so that decision makers have data to make any adjustments necessary to effectively care for patients.
“Safety will be achieved by systems that are designed to reduce the non-value-added work, to allow more time for relationship building, and to facilitate customization of care to the unique needs of individual patients and their circumstances,” the authors wrote.
How it works in practice
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It’s common for primary care physicians to be copied on every test that other physicians order for their patients. Redundancy leads to information overload in the inbox and can make it unclear as to which physician should follow up with the patient.
The shift to a Safety II mindset recognizes that this type of redundancy can backfire and that a safer approach is to create a policy that says, “you order it, you own it.” It avoids confusion over who is responding and reduces the overloaded inbox.
And reducing that overloaded inbox (PDF) is important because inbox volume adds to the time physicians spend working on the EHR outside of work. Studies have shown that those in the highest quartile of work outside of work experience 11-fold higher odds of burnout than those in the lowest quartile.
“Focusing the goal of improvement efforts,” the authors wrote, “on designing systems that support the strengths of human attention and connection rather than well-intentioned improvement efforts that fail to understand how redundancy overloads health care workers will lead to a safer, more resilient system.”
