Background:Physician burnout is becoming an epidemic, due to the pressures of being productive, an imperfect electronic health record (EHR) system, and limited face-to-face time with patients. Poor usability in EHR-user interface can force users to go through more steps (i.e. more clicks on the computer) in accomplishing a task.Objective:This increased ‘click burden’ is a source of frustration for physicians. In the light of increased click burden and time due to meaningful use requirements, there is a need to improve the physician’s experience by creating innovations in EHR.Method:This case study describes an attempt by physicians at NewYork-Presbyterian Brooklyn Methodist Hospital to enhance the EHR experience with more efficient methods of documentation, chart review, ordering and patient safety.Results:The EHR innovations trialled in this study were: a mobile documentation application; abnormal test results auto-populated into an EHR patient summary; physician alerts to reduce inappropriate test order...

Electronic health record innovations: Helping physicians – One less click at a time

Disruptive behaviors in health care can have a profound effect on staff relationships that can lead to impaired communication, reduced information transfer, and dysfunctional team collaboration that can negatively impact patient care. Recognizing what disruptive behavior is and what it can do is the first step in enabling organizations to develop appropriate programs and effective strategies to reduce its occurrence. Disruptive behaviors occur across all disciplines, but when physicians are involved, by virtue of their role as captain of the ship, it can set off a chain of events that seriously compromises process and flow. By gaining a better understanding of the forces shaping physician attitudes and behaviors, organizations can then provide the necessary assistance and resource support to enhance behavioral adjustments. The ultimate goal is to not only reduce the incidence of disruptive events, but to also improve overall staff relationships, care efficiency, and instill a positive work atmosphere that increases staff morale, physician engagement, and overall satisfaction.

Disruptive and Unprofessional Behaviors

This paper reviews the recent literature in burnout and compassion fatigue focusing on institutional factors influencing burnout where providers work as well as the individual factors affecting providers. In this review, there is an evaluation of the causes and interventions of burnout and compassion fatigue and areas for intervention. The percentage of those suffering from burnout is decreasing for the first time in several years, and there are interventions to help decrease the impact of burnout and compassion fatigue. For an individual provider, mindfulness, cognitive behavioral therapy, and improved communication appear to be productive approaches to help with burnout. Institutional approaches that mitigate the impact of burnout in healthcare include assessing provider needs and returning some autonomy and control over workload to the provider. Burnout and compassion fatigue remain a significant problem in healthcare and impact patient care as well as the well-being of providers. There are approaches that are working to decrease this impact in both the individual provider as well as the institutions in which providers are working. The research in this area from an individual perspective and a business perspective is only beginning.

/pdf/physician-burnout-and-compassion-fatigue-individual-and-miibu5wgdk.pdf

Physician Burnout and Compassion Fatigue: Individual and Institutional Response to an Emerging Crisis

Psychometric validity/reliability of 10-item and 2-item abbreviations of the Connor-Davidson Resilience Scale (CD-RISC-10; CD-RISC-2) was investigated via item response theory and classic approaches.We sampled 5023 adult American participants in a June/July 2020 survey on the COVID-19 pandemic's psychological effects. Our questionnaire incorporated the CD-RISC-10 with other validated measures. CD-RISC-10 items were ranked on item-to-scale correlations, loadings on a one-factor confirmatory factor analysis model, and item slope/threshold parameters plus information curves from a unidimensional graded response model. Concurrent validity of the highest ranked item pair was evaluated vis-à-vis the CD-RISC-10 and CD-RISC-2. Internal consistency, based on average variance extracted (AVE) and multiple reliability coefficients, was also compared. Convergent/divergent validity was tested by correlating anxiety, depression, fear of COVID-19, anxiety sensitivity, coping, and personality measures with both scales and the highest ranked item pair. Binary agreement/classification indexes assessed inter-rater reliability.Items 2 and 9 from CD-RISC-10 ranked the highest. Reliability coefficients were > 0.93, > 0.72, and > 0.82 for the CD-RISC-10, CD-RISC-2, vs summation of items 2 and 9. AVEs were 0.66, 0.67, and 0.77. CD-RISC abbreviations and the summation of items 2 and 9 correlated negatively with anxiety (> - 0.43), depression (> - 0.42), and fear of COVID-19 (> - 0.34); positively with emotional stability (> 0.53) and conscientiousness (> 0.40). Compared to the CD-RISC-2, summative scores of items 2 and 9 more efficiently classified/discriminated high resilience on the CD-RISC-10.We confirmed construct validity/reliability of copyrighted CD-RISC abbreviations. The CD-RISC-10's items 2 and 9 were psychometrically more salient than the CD-RISC-2. 

/pdf/psychometric-validity-and-reliability-of-the-10-and-2-item-55vvv6hg.pdf

Psychometric validity and reliability of the 10- and 2-item Connor–Davidson resilience scales among a national sample of Americans responding to the Covid-19 pandemic: an item response theory analysis

Combining social network analysis (SNA) and data envelopment analysis (DEA) techniques is a recent and relevant trend in the literature. However, although other works have integrated these techniques, none have done so in the way proposed in this study. Seven generic stages were defined to combine these methods and create a new indicator, the Selection Employment Contracts Effectiveness Index, which measures the extent to which the employment contracts selection by a professional is effectively converted into influential social network positioning. Utilising three DEA models (CCR, BCC and RAM with inverted frontier) and choosing a normalization criterion (no normalization, normalization by size, or normalization by size with sensibility factor), this index can be broken down in terms of the quality and quantity of employment contracts selected. These indices were used in a Brazilian healthcare network to demonstrate that: (a) the number of optimal employment contracts of physicians in the network is one; and (b) the Adjusted Selection Employment Contracts Effectiveness Index by quality (ASECEql) correlates negatively with the workload and the number of physician's specialties. This work offers a new means of analysing the nodes in an affiliation network.

Combining social network and data envelopment analysis: A proposal for a Selection Employment Contracts Effectiveness index in healthcare network applications

See also page 432 W e live and work in a time when the nature of clinical practice is changing as never before in the history of American medicine. For clinicians, much of this should be very excitingd innovations in therapeutics, vastly greater capacity for data analytics, and powerful methodologies for process improvement. Unfortunately, however, the experience of current practitioners suggests that many of us are anything but enlivened by these realities. The burdens of contemporary practicedrelentless productivity pressures, imperfect electronic health records (EHRs), cost reduction efforts, and limited faceto-face time with patientsdhave resulted in a near epidemic of “burnout,” the very opposite of creative engagement with the work of patient care. In this issue of Mayo Clinic Proceedings, Shanafelt et al do us the service of studying this phenomenon and its relationship with organizational leadership, testing and confirming the hypothesis that leaders who engage their teams meaningfully create work environments more likely to engender a sense of well-being and less likely to engender burnout. Connecting the study of organizational leadership with the study of physician well-being bridges 2 bodies of work in ways that are meaningful for both scholarship and clinical life. It is hard to overstate the importance of building this bridge between the practice of leadership and the engagement of the clinical team in the act of caregiving. Historically, physicians had high levels of control of their work environments and few external barriers to spending time with their patients. Numerous studies have shown that physicians who have increased autonomy and control of their work environment identify as being both more satisfied and having less employment turnover. Yet today, many aspects

The engaged physician.

Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study.

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.

https://casereports.bmj.com/content/bmjcr/14/3/e240576.full.pdf

A young man presenting with encephalopathy and seizures secondary to SARS-CoV-2.

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The engaged physician.

Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study.

A young man presenting with encephalopathy and seizures secondary to SARS-CoV-2.