Background: Burnout is the syndrome of emotional exhaustion, depersonalization and reduced personal efficacy that occurs in individuals working in the human services field. Recent data suggests that 50% of physicians are experiencing at least one symptom of burnout. Factors that contribute to physician burnout include lack of efficiency and lack of input.There is growing concern among healthcare leaders that the increasing prevalence of physician burnout represents a threat to patient quality and safety. As a result, some healthcare systems are shifting emphasis from the Triple Aim – population health, reduced costs and patient satisfaction – to the Quadruple Aim, which incorporates healthcare provider wellness. Evidence suggests that organizational-level approaches are more effective than individually-focused interventions in reducing burnout.
LEAN is a process-focused, customer-centered methodology that improves efficiency and quality. Within a LEAN system, improvements are made based on the input of everyone involved in the process. Since lack of efficiency, effectiveness and input are contributing factors to provider burnout, creating a system that addresses inefficiencies while adding greater flexibility and autonomy may reduce burnout.

Purpose: In 2013, Penn State Health built a new stand-alone children’s hospital and experienced bed demands that exceeded bed availability. This resulted in decreased divisional and organizational efficiency, high stress, and elevated physician burnout in our division as identified by a stress measurement tool from Mindtools®.

Description: Using group input, we piloted and fully implemented a new service model in 2012-2015. We redesigned our service line using LEAN principles, such as “staff to demand” and “standardize work”. To “staff to demand”, we hired three additional FTE. This allowed creation of two rounding teams (from one) and reduced our patient-to-attending ratio from 15:1 to 8:1. Workflow was re-sequenced and standardized, which enabled teams to see discharges at the start of rounds. We also provided in-house evening and overnight resident supervision. Our model permitted flexibility in physicians’ schedules, deemphasized reliance on RVUs and heightened purpose and efficiency in work as determinants of providers’ value-adding capacity.
This staffing model improved both service line and hospital efficiency. As hypothesized, our intervention simultaneously reduced faculty stress. Our group’s mean stress score decreased from twenty-three (pre-intervention) to fifteen over the first two years, and has remained steady for a period of three years. Our divisional work life balance measurement 2 years after the intervention was 85%, well above the reported average of 41%. We have maintained a low physician turnover rate at 3.5% over the last 3 years.

Conclusions: Adopting LEAN principles may allow hospitalist services to eliminate the workplace factors that contribute to physician stress without compromising efficiency and quality of care.