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Primary Care Workforce Burnout Goes Beyond EHR Use to Leadership Style

While EHR use has often been attributed to workforce burnout, organizational leadership and culture plays a large role in workforce satisfaction.

A new Health Affairs study found that burnout was not associated with EHR satisfaction or the number of patients seen per clinician. Instead, researchers found that facilitative leadership centered on building relationships, enhancing communication, ensuring psychological safety, and promoting teamwork, is linked with low rates of workforce burnout.

Facilitative leadership strays from traditional hierarchal structures, allowing for practices to foster emerging leadership skills among all practice members, the study authors explained.

The findings are based on a survey of 715 small-to-medium primary care practices.

“Survey respondents who felt a greater sense of support and job control could balance known stressors – including high volume of patients – and showed lower rates of overall burnout,” Samuel T. Edwards, MD, MPH, assistant professor of medicine at the OHSU School of Medicine and the study’s lead author, said in a press release.  

While the survey collected responses from small-to-medium sized primary care facilities, the study authors argued that primary care practices of all sizes could help mitigate clinical stress through facilitative leadership.

“Larger practices and health systems can promote leadership and agency by delegating decision making to the lowest possible level of their organizations, and practices of all configurations could benefit from interprofessional leadership development,” the authors wrote.

Personal interventions such as counseling or time away from work can help an individual who is experiencing burnout, Edwards elaborated. However, to impact the overall wellbeing of an entire practice or care team, leaders should consider an organization-wide approach that leverages facilitative leadership.

“Creating supportive environments and offering more local control to help balance employee and patient needs could allow greater opportunity to provide the best care to everyone,” Edwards, who also serves as a staff physician at the Veterans Affairs Portland Health Care System, suggested.

Most “zero-burnout” practices also leveraged quality improvement strategies more frequently than facilities that experience higher rates of workforce burnout.

“Burnout improvement efforts should consider focusing on whole practices and the systems in which they are nested,” the authors asserted.

What’s more, the study revealed several structural characteristics that impact clinician burnout rates. Solo practices had the lowest rates of burnout. Additionally, clinician-owned practices and practices that did not participate in external transformation initiatives like, like accountable care organizations, had lower burnout statuses. This suggests that agency may be related to organizational and professional wellbeing.

“Smaller practice arrangements with fewer employees may have better communication, stronger in-practice relationships, and increased agency, which together could contribute to less burnout,” the study authors noted.

“Although there has been a trend toward consolidation, smaller independent practices remain a critical component of primary care in the US, with small practice models such as direct primary care emerging,” the report authors wrote.

To support small clinician-owned practices in an era characterized by industry consolidation, the authors called for the funding of primary care practice extension networks, which provide external technical support to practices.

While this study did not find EHR usability as a major challenge for primary care practices, this may reflect the practices’ adaptation to EHR use.

According to a recent study, many primary care practices experience EHR usability barriers.

April Savoy, PhD, human factors engineer, Regenstrief Institute research scientist, and lead author of that second study, noted that it can be easier for consumers to find a pair of shoes in a desired size, color, and style online than it is for PCPs to order a specialty consultation or medication refill. Sorting through multiple systems and tabs to access clinical information may lead to greater clinician burden.

"Current EHRs are overloading primary care physicians with information in disparate files and folders rather than presenting comprehensive, actionable data in a context that gives meaning,” Savoy explained.

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