How to Reduce Anxiety and Burnout at Primary Care Practices

Change such as the adoption of new information technology can wreak havoc among primary care practice staff members.

Improving change management can reduce anxiety and burnout among staff at primary care practices, a recent research article says.

Burnout is taking a significant toll in the healthcare sector. It is estimated that a doctor commits suicide every day. Research indicates that nearly half of physicians nationwide are experiencing burnout symptoms. A study published in October 2018 found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction.

The recent research article, which was published in Journal of the American Board of Family Medicine, found that change is a driver of anxiety and burnout at primary care practices.

"Primary care physicians, advanced practice clinicians, and staff experience a tremendous number of workplace changes brought about by the adoption and use of EHRs and other information technology, transformation to new care delivery models such as a patient-centered medical home or accountable care organization, transfer of practice ownership, and/or compliance to numerous regulatory and payer requirements," the article says.

The research examined data collected from more than 1,200 physicians, advanced practice clinicians, clinical support staff, and administrative staff at primary care practices. The study features several key data points.

• Primary care physicians reported the highest level of burnout, at 31.6%.
   
• A significant level of burnout was reported in all other staff categories: 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff.
   
• Healthcare professionals with higher levels of anxiety and frustration were twice as likely to report burnout than counterparts with lower levels of anxiety and frustration.
   
• Physicians with higher levels of anxiety and withdrawal were more than three times as likely to report burnout than physicians with lower levels of anxiety and withdrawal.

"Although we found that physicians experience higher burnout than other healthcare professionals, high anxiety levels were reported across health professional groups, indicating a need for programs and services that focus on all employees," the research article says.

Addressing anxiety and burnout

Methods to improve the work environment during change include increased support from leadership, targeted education and training, effective communication, and individual coaching, the research article says.

During periods of change, organizations should avoid leadership dictating mandates for primary care practices, one of the research article's co-authors told HealthLeaders.

"What we have encouraged is that policy makers and leadership in these organizations do a better job of involving the folks who are on the ground in terms of making sure they understand what is coming and are involved in the process. When change happens to you without a lot of direct involvement, the anxiety levels tend to increase significantly," said Victoria Grady, DSc, MS, an assistant professor at George Mason University School of Business in Fairfax, Virginia.

For example, if a primary care practice is owned by a health system that wants to install a new electronic medical record at the practice, health system leaders should not solely push the change, she said. "The practice and its staff should be involved in how a new EMR is chosen. They should be involved in looking at different EMR systems and how the new EMR system is going to be rolled out."

As part of the change management process, leadership should seek out clinicians and other primary care practice staff members to play an active role in initiatives, she said.

"At small- to medium-sized primary care practices, it is not difficult to identify an individual within the organization who has influence over others. It could be a physician or a staff member who has influence over folks in the organization—someone who can be on the ground explaining why change is happening, how change is going to happen, and the nuances involved."

To improve the work environment during change, leadership should be proactive and collaborative, Grady said. "It is more important than ever for leadership to be proactive in terms of defining how the influencers within the organization can be a part of the decision-making process, instead of just mandating decisions. There needs to be a collaborative, team-based approach."

Another factor in improving the work environment during change is focusing on how individual staff members will be impacted, she said.

"Leadership needs to understand the individuals who are going to be affected by change. Organizations are collections of individuals. When implementing change, you need to take the time to understand individuals within the organization and how the impact of change is going to affect day-to-day work tasks. You need to understand the behavioral change implications."

A targeted training and education program is an essential ingredient in change management at primary care practices, Grady said. "You need training and education. A lot of organizations are not integrating a detailed and proactive training program upfront before change. It is more reactionary."

Citing the new EMR adoption example, she said training and education must be provided before and during the initiative's implementation. "Leadership needs to make time to allow all of the staff impacted by change to have a meaningful education and training experience as part of the overall change strategy."