DeChant Paul F, Acs Annabel, Rhee Kyu B, Boulanger Talia S, Snowdon Jane L, Tutty Michael A, Sinsky Christine A, Thomas Craig Kelly J
IBM Watson Health, Cambridge, MA.
American Medical Association, Chicago, IL.
Mayo Clin Proc Innov Qual Outcomes. 2019 Sep 26;3(4):384-408. doi: 10.1016/j.mayocpiqo.2019.07.006. eCollection 2019 Dec.
To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from January 1, 2007, to October 3, 2018, from multiple databases. Manual searches of grey literature and bibliographies were also performed. Of the 633 identified citations, 50 met inclusion criteria. Four unique categories of organization-directed workplace interventions were identified. involved initiatives to incorporate scribes or medical assistants into electronic health record (EHR) processes, expand team responsibilities, and improve communication among physicians. studies evaluated the impact of schedule adjustments, duty hour restrictions, and time-banking initiatives. referred to workflow changes such as process improvement initiatives or policy changes within the organization. related to the implementation or improvement of EHRs. Of the 50 included studies, 35 (70.0%) reported interventions that successfully improved the 3 measures of physician burnout, job satisfaction, and/or stress. The largest benefits resulted from interventions that improved processes, promoted team-based care, and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks. Implementation of EHR interventions to improve clinical workflows worsened burnout, but EHR improvements had positive effects. Time interventions had mixed effects on burnout. The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout. Benefits of process changes can enhance physician resiliency, augment care provided by the team, and optimize the coordination and communication of patient care and health information.
为评估组织导向的工作场所干预措施对医生职业倦怠的影响，包括在所有环境中的压力或工作满意度，我们对2007年1月1日至2018年10月3日期间从多个数据库发表的文献进行了系统综述。还对手稿文献和参考文献进行了人工检索。在633条已识别的引文中，有50条符合纳入标准。确定了四类独特的组织导向的工作场所干预措施。其中包括将抄写员或医疗助理纳入电子健康记录（EHR）流程、扩大团队职责以及改善医生之间沟通的举措。一些研究评估了排班调整、值班时间限制和时间银行计划的影响。还有一些涉及工作流程的改变，如组织内的流程改进计划或政策变化。另外一些与电子健康记录的实施或改进有关。在纳入的50项研究中，35项（70.0%）报告了成功改善医生职业倦怠、工作满意度和/或压力这三项指标的干预措施。最大的益处来自于改善流程、促进团队协作护理以及使用抄写员/医疗助理来完成电子健康记录文档和任务的干预措施。实施电子健康记录干预措施以改善临床工作流程会加重职业倦怠，但电子健康记录的改进有积极影响。时间干预对职业倦怠的影响不一。我们的研究结果表明，组织导向的工作场所干预措施，如改善流程、优化电子健康记录、通过使用抄写员减轻文书工作负担以及实施团队协作护理，可以减轻医生的职业倦怠。流程改变的益处可以增强医生的适应能力，增加团队提供的护理，并优化患者护理和健康信息的协调与沟通。
