#MEQAPI – Tweetchat March 30th 2017 3ET: Quality Improvement vs Clinician Burnout

Next tweetchat: Thursday March 30th, 2017 3:00-4:00 PM ET

Topic:  Quality Improvement vs Clinician Burnout

Just a reminder, MEQAPI stands for Monitoring & Evaluation, Quality Assurance, and Process Improvement.

This week the #MEQAPI topics are based on the Physicians’s Weekly articles on clinician burnout. (Thanks to @DermHAG, Dr. Howard Green for the suggestion).

Clinician burnout has climbed over time, and yet we act surprised that it is happening, when we can see burnout even in medical training. Burnout is robbing clinicians of satisfaction in their work, and has serious implications in terms of access to care, care quality, and clinician and patient safety. Amongst other things, burnout Erodes the Sense of Calling, it is widespread and prevalent among Pediatric Residents and across all specialties, and negatively affects Quality and Safety.

Could better collaboration help reduce burnout?

We will take a QI approach, and discuss clinician burnout using each of the typical arms of the basic Quality Improvement Ishikawa diagram to guide and support discussion. An Ishikawa diagram for clinician burnout may look something like this:

MEQAPI Burnout 2

Participants will bring their own experiences, perspectives, and expectations to the discussion, but the topics might break down something along these lines:

  • Methods
    • Policies: either unit, office, organization, or national policies that might increase frustration and burnout risks.
    • Workflow: how things are done that might increase risks of errors, or antagonize the patient, or create gaps in handoff, etc.
    • Insurance Models: Clinicians face billing and criteria issues and typically deal with several insurance providers, each with their own criteria, payment models, and processes. This may result in copious paperwork, slow payment, low payment, and the denial of payment even when there are compelling medical reasons.
  • Machines (equipment, EHR)
    • Medical or office equipment that might increase risk of malpractice claims, old, broken, poorly installed, etc.
    • Software systems (especially EHR?), that might lead to duplicate work, frustration, cause medical errors like wrong pt, wrong site, wrong meds, and create hours of extra work per day.
  • People
    • Staffing: insufficient or unqualified staff
    • Training: insufficient base training, incorrect training, insufficient CME, etc.
    • Attitudes: staff attitudes e.g. paternalism, rudeness, and workplace bullying.
  • Materials
    • Patients: as the “raw material” of the medical process, patients are both the joy and the anguish of medical practice. Patients may come with a range of attitudes, health problems, life situations, and ability to comply with treatment that are challenging and stressful.
    • Supplies: medical or office, inferior fax paper, lack of coffee(!)
    • Data? – sent to wrong recipient, not shared with pt or specialist, etc.
  • Measurement
    • KPIs: operational metrics that focus on the wrong things, or are poor measures, and that drive wrong behavior
    • Targets: improper or unachievable performance targets
    • Incentives: improper, biased, or discriminatory rewards, conflicting or perverse
  • Environment
    • Noise: distracting noises, sound levels too high, etc.
    • Space: cramped, uncomfortable, slippery surfaces, etc.
    • Time: Too little time per patient, too little time in a day, too many demands
    • Location: things not where they should be, too much movement of staff, pt, or equipment needed, etc.

The aim of this chat is look at each of these dimensions of causation, and discuss what we have seen before that has been a risk or developed into burnout, or that we anticipate is likely to become an issue or end up with clinician burnout.


  1. What Methods (policies, workflow, etc) have you seen or anticipate may increase risk or have led to burnout
  2. What Machines (med/office equipment, EHR/SW) have you seen or anticipate may increase risk or have led to burnout
  3. What People issues (staffing, training, bullying) have you seen or anticipate may increase risk or have led to burnout
  4. What Materials (forms, supplies, data?) have you seen or anticipate may increase risk or have led to burnout
  5. What Measurements (KPIs, targets, incentives) have you seen or anticipate may increase risk or have led to burnout
  6. What Environment issues (noise, space, time) have you seen or anticipate may increase risk or have led to burnout


The six domains of care quality (STEEEP) mapped out by the Agency for Healthcare Research and Quality (AHRQ) are foundational to healthcare improvement. All care, and by inference quality measures, should be focused on being Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

The MEQAPI tweetchat aims to give voice to a broad range of stakeholders in healthcare improvement, and it embraces everyone from administrators to zoologists, and includes physicians, nurses, researchers, bed czars, cleaners, and yes, patients and care-givers.


meqapi stats march 30 2017