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April 9: Today on TownHall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care talks with Liz Griffith, Director of EHR Education at uPerform. In their conversation they delve into the intertwined issues of burnout and turnover in the healthcare sector, a phenomenon Liz Griffith dubs as "burnover." Liz, with her extensive background in healthcare technology and EHR satisfaction research, sheds light on how the pandemic has drastically altered the landscape of training within healthcare systems. But how exactly do EHR systems contribute to this burnover? And more importantly, what innovative solutions can mitigate these challenges? How can healthcare systems better align their priorities with the needs of frontline workers to combat burnover effectively?

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Today on Town Hall

if you have those small irritations on a daily basis.

might not seem like a big thing to someone sitting in the office over here, but to that nurse on the floor. Those small irritating pebbles in the shoe are the things that lead to nurse burnout that are like, this is so frustrating, but I have to enter, this data here. And then I enter the exact same data here.

And I enter the exact same data here.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health.

Where we are dedicated to transforming healthcare, one connection at a time. Our town hall show is designed to bring insights from practitioners and leaders. on the front lines of healthcare. Today's episode is sponsored by ARMIS, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Alright, let's jump right into today's episode.

Hey everybody, I'm Jake Lancaster. I'm an Internal Medicine Physician and the Chief Medical Information Officer for Baptist Memorial Healthcare, and today I'm very excited to have Liz Griffith on from UPerform to talk about a topic of hers that she's passionate about called Burnover. Liz, welcome to the program.

Thanks so much, Dr. Lancaster. Super happy to be here.

So can you just tell the audience briefly about your background and what you do?

Absolutely. I kind of, I like to joke that I kind of fell into healthcare technology and it worked for a couple different vendors over the years, but really feel like I got started class research working in the ARCH collaborative.

So working really closely to understand the EHR satisfaction. And then that led into understanding the role that EHRs play in burnout and turnover. And then jumped over here and joined up with uPerform in early 2022. And that actually spurred from all of that research, trying to understand EHR satisfaction.

And one of the biggest takeaways from the arts collaborative research is actually around training. Whether that be the lack of training, or really impactful training, and as everyone knows, COVID changed the world, and I was working directly with health systems to measure and understand their satisfaction at the time, and they would come to me and say, What can we do?

We don't have classroom training anymore. We can't even put people in the same room. We're really struggling. Some organizations just didn't provide training at all. They had to just be like, well, what are we going to do? And others tried to really embrace how do we move to more of a virtual training environment.

It was at that time that I got introduced to uPerform, and I kind of remember having a moment where I was like, where have you been? People need this. This is super important. And that was when I kind of decided, hey, this is something that I feel really passionate about. And I want to help bring to more healthcare providers and to more systems and kind of evangelize this work that we do.

So that's kind of how I got started in all of this and my background and it's the topic I really love to talk about.

Yeah, no, it's really fascinating how things have changed, especially with the pandemic in regards to how we do training. I'm sure everybody in the country has really flipped the script about how they do it.

But you mentioned a couple of things early on burnout and turnover. And you, I don't know if you coined the term or where you found it, but this is the first time I'm hearing of burnover. So tell me what that is.

You could say I coined it. I. Fell all over it. We were actually back at Class Research doing a deep dive into some of the arch collaborative data and how you perform works with our clients.

And we were talking about burnout and turnover, except I kept saying burn over and everyone would kind of laugh and chuckle in it. And it really was something I fell into. And then our VP of healthcare strategy, Bobby Czar, he said, I actually think he's like, well, we're laughing about this.

It's actually a really important topic because They're so intertwined. You can't really extricate burnout out of turnover, yet you can't necessarily identify exactly the role it plays. They're really interconnected in a kind of messy way. And so the more that we start talking about them as one thing versus two independent and separate things, I think maybe the better we'll start to understand them.

Yeah, so let's dive into it a little bit more. you mentioned a framework for how you evaluate burnout and what to do about it. Take us through that framework.

Yeah, great question. So one of the ways I really like to think about it, and I try to look at a lot of other experts, Stanford in particular.

They have a three part professional fulfillment framework that they use, and the three parts are personal resilience. So that's where, especially as it relates to healthcare, we talk about like, well, you know, physicians can do things to improve how they feel, or nurses can work on, a better work life balance, or having more emotional intelligence.

That's kind of that personal resiliency. Then there's efficiency of practice, which we're going to really dive into because I think that's the piece where it gets really important, and a culture of wellness, a culture of wellness for any organization is going to be really important. And I think that this is also part of the role that HIT can play is creating a culture of wellness.

via technology. Sometimes I think that when we think of a culture of wellness, we think what kind of wellness programs do we have? Do we offer enough meditation rooms or yoga classes or wellness programs that people can participate in? But I think that a culture of wellness goes deeper. I think it's looking at our governance structures.

It's looking at how we support our clinicians when it comes to technology. It's how we support them from, even when it comes to staffing or the safety of our nurses and our physicians. I think there's a lot that goes into that. We really kind of hone in on that efficiency of practice.

And as a CMIO, I'm sure you've seen this, where when clinicians feel really frustrated in their workflows and frustrated in the technology that they have to use, it really is disempowering. And you start to even see, you know, not to get too psychological, but you start to see some of that learned helplessness, where it's like why should I even attend that training?

It's never worked before. It's not going to like, it's always just been a waste of my time. And that really does start to lead to those feelings of, it doesn't matter what I do, it's not going to get better.


so I, I think that this is the area where particularly, IT leadership has an opportunity to dive in and say, how do we remove as many obstacles as possible?

How do we make it as easy and effective as possible to learn and adopt the technologies that we all know are there? To help improve patient care, right? We all know that the true purpose of the EHR, while we joke that it's maybe a glorified billing machine, it truly was meant to deliver better patient care.

And so how do we help both create workflows, create support structures and training structures that help align our clinicians, our physicians, and our nurses, and our APPs, so that they are getting the most out of that technology and using it to deliver the best patient care.

Yeah, I think that's really well said, and taking it back to those three pillars that you mentioned resiliency is something we also, we often talk about with burnout, but most physicians are very resilient.

You have to be in order to get through medical school and residency and get through all of this. So that it's kind of baked into the job. So asking a physician to be more resilient after that is is a, it's a tough ask. And then the wellbeing side, I agree, work life balance, all of that is extremely important, but the way I typically see it put on is, here's a wellbeing module for you to go watch in your spare time when you should maybe be spending time with your family, or, we're going to offer it on Saturday.

And we did this once. We had a. Well being seminar on Saturday for our physicians to come in, and I got, personally, I got the hate mail from physicians about this is my only day off, and you're asking me to come and do more work. So it's, it is tough where, as you said, the meat of what we can probably do is that piece in the middle, make them more efficient for what they do at work.

So let's dive into that a little bit more. There's a really great graph that I shared with you before this that we, I talked about before, where on the x axis, there is, how efficient am I at doing my job out of my skills as a clinician with the tools I have. So, as it goes from zero to infinity, that moves up.

On the x axis. On the y axis is how challenging is my job, or how many tasks am I being asked to do on a daily basis? And so, as you move up and down the chart, if you have on the far right and down at the bottom quadrant somebody who's incredibly efficient and has very little tasks to do they get bored.

And on the opposite side of that, where they have Very little experience with how to use their tools, but yet the tasks are tremendous. That top left quadrant, that's where the burnout zone is. And really we want people in the middle, that's kind of where the flow would be. So, take us through your thoughts on how health systems can get people with that right mix.

Oh my gosh, I love that. And you did share this graph with me and I absolutely love it. And in the work that I did in the ARCH Collaborative, Sadly, most of what I saw were those people with an insurmountable amount of tasks and feeling extremely inefficient sitting in that burn, in that scary burnout zone, where you start to see people moving into the middle or in the organizations.

And again, this is going to go back to that combining a culture of wellness with efficiency of practice, the organizations who definitely make it a priority to bring training to their clinicians. There's kind of two schools of thought. And I would meet with leaders who would say things like, Well, we just can't get our clinicians to attend training.

And that's almost kind of, it's kind of defeatist. Well, why should we offer it? No one's going to attend. Then you had the leadership groups that would say things like, how do we get our training to our clinicians? How what can we do? What are the things that we can remove to make it easier?

I really remember working with a nursing leadership group at formerly known as Spectrum Health. I think they're now Poor Well Health. And we did a big case study together, and they talked about removing the pebbles from the shoes of their nurses in an effort to reduce burnout. And it was their whole focus was if you have those small irritations on a daily basis.

They might not seem like a big thing to someone sitting in the office over here, but to that nurse on the floor. Those small irritating pebbles in the shoe are the things that lead to nurse burnout that are like, this is so frustrating, but I have to enter, this data here. And then I enter the exact same data here.

And I enter the exact same data here. Simple changes that the IT team can make to workflows that can improve the efficiency for our clinicians are the kind of changes in an organization that's truly supporting a culture of wellness, because a culture of wellness is a culture of efficiency. It's a culture that says, how do we deliver training at the right time, but for the right person?

Because, you know, I'm going to go back to our VP of Strategy, Bobby Zarr. He always says, Physicians don't hate training. They hate training that wastes their time. So if you can get the right training to a physician and they use it and they're like, oh my gosh, like I was able to set up this personalization or I set up this, filter or this template that allowed me to save so much time instead of having to enter this over and over, I now click this button over here and it automatically populates these things.

Wow, that saved me 15 minutes. a day or five minutes per patient that I see. Those are the kind of things that then they share, right? Because then they go knock on Dr. So and so's door and they're like, Oh my gosh, have you used this? Did you know about this? The flip side of that is an organization who says, Hey, you got to go log into this SharePoint site over here.

Go, there's lots of training available, but you need to go find it. So like you mentioned, on Saturday, when you're not working, make sure you go attend this extra training. And it's expensive, and we know that, health systems are counting on every penny, and margins are extremely tight.

But if you're expecting all of your clinicians to take their own time, unpaid and unaccounted for, to learn these technologies that they absolutely have to use and need to be efficient in, and that, quite frankly, have the impact to harm, The truth is that technology has the impact to harm patients if we don't use it correctly.

And so it's not just an investment in efficiency, it tells your clinicians that you're as invested in their patient care as they are. And that's where you start to see like significant trust being built, where you start to see a lot of Unifying, we see, especially in the burnout data, where clinicians will say things like, I just don't feel in alignment with my leadership.

Well, you're going to see that where you feel clinicians and leaders are divided on where the priorities are. Are the priorities that helping me deliver the best patient care possible? Or are the priorities making sure that the board members are the happiest? And I know that's a balance, right?

Like, I'm not trying to make anyone a bad guy here. Both of those things have to exist, but they need to exist in a way that we start to feel unified with the people delivering that frontline care.

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 No, I think that's really well said, and, it shows up in my own data. We do the class survey as well, and the number one thing that usually comes across is we need to improve our training.

And I feel the frustration of those organizations because I share that is how do you get the physicians to come to training? They're asking for training. It's, I see it in the comments, but I make available trainers. I make available myself. I say, I will come meet with you and, every month I send out, our updates and I include that message at the bottom.

If you need help here are our trainers, or if they're not available, Reach out to me, and I will be glad to come sit with you. And I never receive any responses. Nobody ever asks. But yet, every month, every year, on the survey, they're begging for it. So, what does uPerform do that kind of allows, I guess, fixes the problem of meeting the physicians where they want to be met with the training they want?

I love this question. And I love that you brought this up because there's a lot of frustration on your shoulders as this leader. You're literally like, I'll come, I'll help you. Like, I will personally come help you. There's some really interesting data coming out of class research right now around, they're looking now at virtual self directed learning, which is where you perform falls, right?

We fall in that category. There's an interesting I don't know if I want to call it a phenomenon or a trend in the data. A positive experience with self directed virtual learning has the capacity to reduce self reported burnout by up to 50%. On the flip side of that, there's also data that shows that a negative experience with one on one training like you're talking about is actually has almost as much impact for harm.

And I'll explain this. And here's my hypothesis. And I don't have data to support this. So this is my opinion here. As individuals, especially physicians, right? We're talking about some of the most educated they're all experts in their fields. They're very educated people.

To even have to say, I need help with this thing is a very vulnerable thing to do. So to say to a fellow physician, Hey, I need help is almost saying like, I don't got this from someone who always has it. And when you empower your clinicians, To receive training directly in the flow of work so that while they're working in that phone, they're like, gosh, I don't remember how to do this and they can very easily access a drop down or a pop up menu right inside of the EHR without having to log in somewhere else.

And that training is not only specific to that workflow. But it's specific to their login. Now they don't have to go in and sift through and be like, Oh my gosh, I don't know which of these 300 tip sheets I need. It's just delivered right there. I also didn't have to tell anyone that I don't remember how to do this thing that someone already showed me how to do.

That's, it really is, there's so much like human psychology behind this. Yeah, I never thought of it

that way.

Yeah it's kind of tough. And as someone who struggles with technology and I have to be told several times how to do things, I can tell you it starts to get embarrassing when you're like, I'm kind of smart in so many ways, but I'm really bad when it comes to remembering how to do something that I don't do all the time.

And I think that's the area of EHR education where we really shine. When you have your workflows that you do all the time, you can get really efficient at those. But let's say, when the patient's record is no longer.

Necessary, and you have to, there's a term for it where you have to get, you kind of have to, like, archive that patient record. It's not something that physicians do very often. And so it's a workflow that they just don't use maybe more than three to four times a year. And so it's one of those workflows where it's like, Oh my gosh, I cannot remember how to do this


I just don't do it frequently enough.

Those are the places where self directed e learning just shines bright because I can very quickly pull up in that workflow, my tip sheet or my video that shows me step by step how to walk through that. I didn't have to reach out and say, Oh my gosh, I don't remember how to do this. And I was able to just move on with my day.

Those are the kind of, so when I talk about removing stumbling blocks or removing the pebbles, like the more that you can empower, and that's my favorite word when it comes to you perform, we are empowering learning for physicians and nurses. That's really what it's about.

No, that's a really good example.

And Ella, you're saying I'm a smart person. I should know how to do this. I'd do that. I'm very good. At our EHR, but if I have to go into a different application that I use not very frequently, because I'm very tech savvy with EHR, I just assume that if I can't figure out how to use this other application, then it's just a bad design.

And they did something wrong. It's not me because I know how to do everything. So I think it's a really good insight that you just mentioned. And certainly, yeah, there's those rare occurrences that maybe it's A duplicate patient record that you need to merge or something like that. And you don't know how to ask for help.

Having something at the on hand right at the moment would be very helpful. So you didn't have to reach out to somebody else.

Exactly. Exactly. And I think that, again, back to empowering. I really think that goes back to like the chart you're talking about. When I feel empowered, even though I might be inefficient right now, my efficiency jumps up as soon as I feel like I have access to what I need.

And I don't have to, especially like, I don't have to go log in somewhere else. I don't have to go to a different site. I don't even have to leave my EHR. I can get the access that I need right there in that workflow. And it was designed specifically for me in my role. So instead of being like, wait, these screenshots that they're sharing in this, that's not what my screen looks like, because this was designed for someone else's workflow.

And so I think that it's those types of the kind of specificity that you can get with self directed e learning. With you perform is incredible. Like I really believe that's where the magic happens is when I feel like the training is tailored to me.

Yeah, I think that's a good point.

And, probably the average physician needs different things than something. So I'm often asked to, provide tip sheets or, a tip of the month to our physicians and on how to use the HR more efficiently. And I tend to gravitate to the things that are Maybe fancy, would help you.

But when I go meet with them one on one, they just want to know the basics a lot of the time. And I'm just a lot of the time shocked about how easy it is for me to improve their day by showing them something that I thought was common knowledge. And so I, I think the benefit of having a platform like this where they can get that self directed help on their own time without having to reach out to another position colleague would be probably impactful.

Absolutely. Absolutely. We're really excited about it. And it's been exciting to, get to work with a lot of the same clients that I worked with at class, but over here on the uPerform side and watching how this has impacted, their physician satisfaction or their nurse satisfaction has been really exciting.

Well, Liz thank you so much for meeting with us today. Thank you to the audience for listening. A lot of great work going on out there. Thanks again.

Thank you.

Thanks for listening to this week's Town Hall. A big thanks to our hosts and content creators. We really couldn't do it without them. We hope that you're going to share this podcast with a peer or a friend. It's a great chance to discuss and even establish a mentoring relationship along the way.

One way you can support the show is to subscribe and leave us a rating. That would be really appreciated. And a big thanks to our partners, Armis, First Health Advisory, Meditech, Optimum Health IT, and uPerform. Check them out at thisweekhealth. com slash partners. Thanks for listening. That's all for now..

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