The majority of errors in healthcare are from systems factors that create the latent conditions for error to occur. The majority of occupational stressors causing burnout are also the result of systemic factors. Advances in technology create new levels of stress and expectations on healthcare workers (HCW) with an endless infusion of requirements from multiple authoritative sources that are tracked and monitored. The quality of care and safety of patients is affected by the wellbeing of HCWs who now practice in an environment that has become more complex to navigate, often expending limited neural resource (brainpower) on classifying, organizing, constantly making decisions on how and when they can accomplish what is required(extraneous cognitive load) in addition to direct patient care. New information demonstrates profound biological impact on the brains of those who have burnout in areas that affect the quality and safety of the decisions they make-which affects risk to patients in healthcare. Healthcare administration curriculum currently does not include ways to address these stress-induced problems in healthcare delivery. The science of human factors and ergonomics (HFE) promotes system performance and worker wellbeing. Patient safety is one component of system performance. Since many requirements come without resource to accomplish them, it becomes incumbent upon health system leadership to organize the means for completion of these to minimize the needless loss of brain power diverted away from the delivery of patient care. Human Factor-Based Leadership (HFBL) is an interactive, problem solving seminar series designed for healthcare leaders. The purpose is to provide relevant human factor science to integrate into their leadership and management decisions to make HCWs occupational environment more manageable and sustainable-which makes safer conditions for clinician wellbeing and patient care. After learning the content, a cohort of healthcare leaders believed that adequately addressing HFE in healthcare delivery would significantly reduce clinician burnout and risk of latent errors from upstream leadership decisions. An overview of the content of the seminars is described. Leadership feedback on usability of these seminars is reported. Three HFBL seminars described are Human Factor Relevance in Leadership, Biopsychosocial Approach to Wellness and Burnout, Human Factor Based Leadership: Examples and Applications.
References
[1]
Kohn, L.T., Corrigan, J. and Donaldson, M.S. (2000) To Err Is Human: Building a Safer Health System. Institute of Medicine, National Academy of Sciences, Washington DC.
[2]
Privitera, M.R., Attalah, F., et al. (2018) Physicians’ Electronic Health Record Use at Home, Job Satisfaction, Job Stress and Burnout. Journal of Hospital Administration, 7, 52-58. https://doi.org/10.5430/jha.v7n4p52
[3]
Cohen, S. and Janicki-Deverts, D. (2012) Who’s Stressed? Distributions of Psychological Stress in the United States in Probability Samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42, 1320-1334.
https://doi.org/10.1111/j.1559-1816.2012.00900.x
[4]
Friedman, T. (2016) Thank You for Being Late: An Optimist’s Guide to Thriving in the Age of Accelerations. Farrar, Straus & Giroux, New York.
[5]
Sinsky, C.A. and Privitera, M.R. (2018) Creating a “Manageable Cockpit” for Clinicians: A Shared Responsibility. JAMA Internal Medicine, 178, 741-742.
https://doi.org/10.1001/jamainternmed.2018.0575
[6]
International Ergonomics Association. http://www.iea.cc/
[7]
Maslow, A. and Lowery, R., Eds. (1998) Toward a Psychology of Being. 3rd Edition, John Wiley & Sons, New York.
[8]
Anandarajah, A., Quill, T. and Privitera, M.R. (2018) Adopting the Quadruple Aim: The University of Rochester Medical Center Experience. Moving from Physician Burnout to Physician Resilience. American Journal of Medicine, 131, 979-986.
https://doi.org/10.1016/j.amjmed.2018.04.034
[9]
Shanafelt, T.D., Gorringe, G., et al. (2015) Impact of Organizational Leadership on Physician Burnout and Satisfaction. Mayo Clinic Proceedings, 90, 432-440.
https://doi.org/10.1016/j.mayocp.2015.01.012
[10]
Maslach, C. and Leiter, M.P. (1997) The Truth about Burnout: How Organizations Cause Personal Stress and What to Do about It. Jossey-Bass, San Francisco, CA.
[11]
West, M., Dawson, J., et al. (2011) Employee Engagement and NHS Performance. NHS Staff Management and Health Service Quality. Department of Health, UK Government, London.
[12]
DeVoe, J., Fryer, G.E., Straub, A., McCann, J. and Fairbrother, G. (2007) Congruent Satisfaction. Is There Geographic Correlation between Patient and Physician Satisfaction? Medical Care, 45, 88-94.
https://doi.org/10.1097/01.mlr.0000241048.85215.8b
[13]
McLinton, S.S., Dollard, M.F. and Tuckey, M.R. (2018) New Perspectives on Psychosocial Safety Climate in Healthcare: A Mixed Methods Approach. Safety Science, 109, 236-245. https://doi.org/10.1016/j.ssci.2018.06.005
[14]
Law, R., Dollard, M.F., Tuckey, M.R. and Dormann, C. (2011) Psychosocial Safety Climate as a Lead Indicator of Workplace Bullying and Harassment, Job Resources, Psychological Health and Employee Engagement. Accident Analysis & Prevention, 43, 1782-1793. https://doi.org/10.1016/j.aap.2011.04.010
[15]
Institute for Policy Studies (2018). https://ips-dc.org/
Gooch, K. (2019) Positive Outlook Seen for US Healthcare Stocks This Year. Becker’s Hospital Review.
https://www.beckershospitalreview.com/finance/positive-outlook-seen-for-us-healthcare-stocks-this-year.html
[18]
Lambert, C. (2015) Shadow Work: The Unseen, Unpaid Jobs That Fill Your Day. Counterpoint Press.
Panagioti, M., Geraghty, K., et al. (2018) Association between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction. JAMA Internal Medicine, 178, 1317-1331. https://doi.org/10.1001/jamainternmed.2018.3713
[21]
Anagnostopoulos, F., Liolios, E., et al. (2012) Physician Burnout and Patient Satisfaction with Consultation in Primary Health Care Settings: Evidence of Relationships from a One-with-Many Design. Journal of Clinical Psychology in Medical Settings, 19, 401-410. https://doi.org/10.1007/s10880-011-9278-8
[22]
Toker, S., Melamed, S., Berliner, S., Zeltser, D. and Shapira, I. (2012) Burnout and Risk of Coronary Heart Disease: A Prospective Study of 8838 Employees. Psychosomatic Medicine, 74, 840-847. https://doi.org/10.1097/PSY.0b013e31826c3174
[23]
Ahola, K., Hakanen, J., Perhoniemi, R. and Mutanen, P. (2014) Relationship between Burnout and Depressive Symptoms: A Study Using the Person-Centered Approach. Burnout Research, 1, 29-37. https://doi.org/10.1016/j.burn.2014.03.003
[24]
Garrett, S.K. and Kashawneh, M.T. (2011) Human Factors and Ergonomics in Healthcare Delivery: A Special Issue on Health Information Technology and Medication Administration Safety. International Journal of Industrial Ergonomics, 41, 333-335. https://doi.org/10.1016/j.ergon.2011.05.003
[25]
Arndt, B.G., Beasley, J.W., et al. (2017) Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. The Annals of Family Medicine, 15, 419-426.
https://doi.org/10.1370/afm.2121
[26]
Amin, R.P. and Johansen, M.E. (2017) Tethered to the EHR: A Physician Workload Assessment. Annals of Family Medicine, 15, iii. https://doi.org/10.1370/afm.2147
[27]
Sinsky, C., Colligan, L., et al. (2016) Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine, 165, 753-760. https://doi.org/10.7326/M16-0961
[28]
Dawson, D. and Reid, K. (1997) Fatigue, Alcohol and Performance Impairment. Nature, 388, 235. https://doi.org/10.1038/40775
[29]
Dyrbye, L.N., Sotile, W., et al. (2014) A Survey of U.S. Physicians and Their Partners Regarding the Impact of Work-Home Conflict. Journal of General Internal Medicine, 29, 155-161. https://doi.org/10.1007/s11606-013-2581-3
[30]
Henrikson, K., Dayton, E., et al. (2008) Chapter 5. Understanding Adverse Events: A Human Factors Framework. In: Hughes, R.G., Ed., Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Agency for Healthcare Research and Quality (US), Rockville, MD.
[31]
Frieden, T. (2010) A Framework for Public Health Action. The Health Impact Pyramid. American Journal of Public Health, 100, 590-595.
https://doi.org/10.2105/AJPH.2009.185652
[32]
Lowe, C.M. (2006) Accidents Waiting to Happen: The Contribution of Latent Conditions to Patient Safety. BMJ Quality & Safety, 15, i72-i75.
https://doi.org/10.1136/qshc.2006.016071
[33]
Croskerry, P., Abbass, A. and Wu, A.W. (2010) Emotional Influences in Patient Safety. Journal of Patient Safety, 6, 199-205.
https://doi.org/10.1097/PTS.0b013e3181f6c01a
[34]
Arnsten, A.F.T. (1998) The Biology of Being Frazzled. Neuroscience, 280, 1711-1712.
https://doi.org/10.1126/science.280.5370.1711
[35]
Glavin, R.J. (2011) Human Performance Limitations (Communication, Stress, Prospective Memory and Fatigue). Best Practice & Research: Clinical Anaesthesiology, 25, 193-206. https://doi.org/10.1016/j.bpa.2011.01.004
[36]
Engel, G. (1980) The Clinical Application of the Biopsychosocial Model. American Journal of Psychiatry, 137, 535-544. https://doi.org/10.1176/ajp.137.5.535
[37]
Heatherton, T.F. and Wagner, D.D. (2011) Cognitive Neuroscience of Self-Regulation Failure. Trends in Cognitive Sciences, 15, 132-139.
https://doi.org/10.1016/j.tics.2010.12.005
[38]
Pickering, B.W., Herasevich, V., Ahmed, A. and Gajic, O. (2010) Novel Representation of Clinical Information in the ICU. Applied Clinical Informatics, 1, 116-131.
https://doi.org/10.4338/ACI-2009-12-CR-0027
[39]
Michel, A. (2016) Burnout and the Brain. Association for Psychological Science.
http://www.psychologicalscience.org/index.php/publications/observer/2016/february-16/burnout-and-the-brain.html
[40]
Savic, I. (2015) Structural Changes of the Brain in Relation to Occupational Stress. Cerebral Cortex, 25, 1554-1564. https://doi.org/10.1093/cercor/bht348
[41]
Golkar, A., et al. (2014) The Influence of Work Related Chronic Stress on the Regulation of Emotion and Functional Connectivity in the Brain. PLoS ONE, 9, e104550.
https://doi.org/10.1371/journal.pone.0104550
[42]
NIOSH (2008) Exposure to Stress: Occupational Hazards in Hospitals. Centers for Disease Control and Prevention, Publication No. 2008-136, 1-13.
https://www.cdc.gov/niosh/docs/2008-136/
[43]
Alkadhi, K. (2013) Brain Physiology and Pathophysiology in Mental Stress. ISRN Physiology, 2013, Article ID: 806104.
https://www.hindawi.com/journals/isrn/2013/806104/
https://doi.org/10.1155/2013/806104
[44]
Ridout, K.K., Ridout, S.J., Guille, C., Mata, D.A., Akil, H. and Sen, S. (2019) Physician Training Stress and Accelerated Cellular Aging. Biological Psychiatry, in press.
https://doi.org/10.1016/j.biopsych.2019.04.030
[45]
Wurm, W., Vogel, K., et al. (2016) Depression-Burnout Overlap in Physicians. PLoS ONE, 11, e0149913. https://doi.org/10.1371/journal.pone.0149913
[46]
Risken, A., Erez, A., et al. (2015) The Impact of Rudeness on Medical Team Performance: A Randomized Trial. Pediatrics, 136, 487-495.
https://doi.org/10.1542/peds.2015-1385
[47]
Hadley, A., Adair, K., Rehder, K. and Sexton, J. (2018) Disruptive Behaviors in Healthcare Setting and Their Effect on Safety Culture. Critical Care Medicine, 47, 40. https://doi.org/10.1097/01.ccm.0000550871.12369.6c
[48]
Ariely, D., Gneezy, U., Lowenstein, G., et al. (2005) Large Stakes and Big Mistakes. Federal Reserve Bank of Boston Working Paper No. 05-11.
[49]
Dan Pink (2010) The Surprising Truth about What Motivates Us.
https://www.youtube.com/watch?v=u6XAPnuFjJc
[50]
Privitera, M.R. (2018) Is Burnout a Form of Depression? It’s Not That Simple. Medscape Psychiatry, Requested Commentary.
https://www.medscape.com/viewarticle/896537
[51]
Stahl, S.M. (2000) Essential Psychopharmacology: Neuroscientific Basis and Practical Applications. 2nd Edition, Cambridge University Press, Cambridge, UK, 152.
[52]
Kaplan, H.I. and Sadock, B.J. (1998) Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry. 8th Edition, Chapter 3, Lippincott Williams & Wilkins, Baltimore.
[53]
Nemeroff, C. (1998) The Neurobiology of Depression. Scientific American, 278, 42-49. https://doi.org/10.1038/scientificamerican0698-42
[54]
Frazer, A. (2000) Norepinephrine Involvement in Antidepressant Action. Journal of Clinical Psychiatry, 61, 25-30.
[55]
Martin, R. (2007) How Successful Leaders Think. Harvard Business Review, 85, 60-67.
[56]
Dimoka, A. and Banker, R.V., et al. (2012) On the Use of Neurophysiological Tool in IS Research: Developing a Research Agenda for NeuroIS. MIS Quarterly, 36, 679-702.
[57]
Privitera, M.R. (2018) Addressing Human Factors in Burnout and the Delivery of Healthcare: Quality & Safety Imperative of the Quadruple Aim. Health, 10, 629-644.
https://doi.org/10.4236/health.2018.105049
[58]
Privitera, M.R., Plessow, F. and Rosenstein, A.H. (2015) Burnout as a Safety Issue: How Physician Cognitive Workload Impacts Care. National Patient Safety Foundation e-News.
https://www.npsf.org/blogpost/1158873/224974/Burnout-as-a-Safety-Issue--How-Physician-Cognitive-Workload-Impacts-Care?tag=burnout
[59]
Sweller, J. (1988) Cognitive load During Problem Solving: Effects on Learning. Cognitive Science, 12, 257-285. https://doi.org/10.1207/s15516709cog1202_4
[60]
Berwick, D.M., Nolan, T.W. and Whittington, J. (2008) The Triple Aim: Care, Health and Cost. Health Affairs (Millwood), 27, 759-769.
https://doi.org/10.1377/hlthaff.27.3.759
[61]
Fleming, C. (2010) Berwick Brings “The Triple Aim” to CMS. Health Affairs Blog.
https://www.healthaffairs.org/do/10.1377/hblog20100914.006950/full/
[62]
Spinelli, W.M. (2013) The Phantom Limb of the Triple Aim. Mayo Clinic Proceedings, 88, 1356-1357. https://doi.org/10.1016/j.mayocp.2013.08.017
[63]
Bodenheimer, T. and Sinsky, C.A. (2014) From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine, 12, 573-576. https://doi.org/10.1370/afm.1713
[64]
Sikka, R., Morath, J.M. and Leape, L. (2015) The Quadruple Aim: Care, Health, Cost and Meaning in Work. BMJ Quality & Safety, 24, 608-610.
https://doi.org/10.1136/bmjqs-2015-004160
[65]
Weisz, J.R., McCabe, M.A. and Dennig, M.D. (1994) Primary and Secondary Control among Children Undergoing Medical Procedures: Adjustment as a Function of Coping Style. Journal of Consulting and Clinical Psychology, 62, 324-332.
https://doi.org/10.1037/0022-006X.62.2.324
[66]
Jones, J.W., Barge, B.N., et al. (1998) Stress and Medical Malpractice: Organizational Risk Assessment and Intervention. Journal of Applied Psychology, 73, 727-735.
https://doi.org/10.1037/0021-9010.73.4.727
[67]
Fahrenkopf, A.M., Sectish, T.C., et al. (2008) Rates of Medication Errors among Depressed and Burnt out Residents: Prospective Cohort Study. BMJ, 336, 488-491.
https://doi.org/10.1136/bmj.39469.763218.BE
[68]
West, C.P., Huschka, M.M., et al. (2006) Association of Perceived Medical Errors with Resident Distress and Empathy. JAMA, 296, 1071-1078.
https://doi.org/10.1001/jama.296.9.1071
[69]
Linzer, M., Poplau, S., et al. (2015) A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. Journal of General Internal Medicine, 30, 1105-1111. https://doi.org/10.1007/s11606-015-3235-4
[70]
Simpson, K.R. and Knox, G.E. (2003) Recognizing and Understanding Adverse Perinatal Outcomes and Preventing Common Accidents. AWHONN Lifelines, 7, 224-235. https://doi.org/10.1177/1091592303255715
[71]
Nolan, T.W. (2000) Education and Debate: System Changes to Improve Patient Safety. BMJ, 320, 771-773. https://doi.org/10.1136/bmj.320.7237.771
Simon, H.A. (1956) Rational Choice and the Structure of the Environment. Psychological Review, 63, 129-138. https://doi.org/10.1037/h0042769
[74]
Berwick, D.M., Loehrer, S. and Gunther-Murphy, C. (2017) Breaking the Rules for Better Care. JAMA, 317, 2161-2162. https://doi.org/10.1001/jama.2017.4703
[75]
Merlino, J. (2015) The Responsibility Matrix: A Strategy for Stronger Physician/Administrator Partnerships. Becker’s Hospital Review.
https://www.beckershospitalreview.com/hospital-physician-relationships/the-responsibility-matrix-a-strategy-for-stronger-physician-administrator-partnerships.html
