Understanding the root causes of physician burnout & the extent to which digital technologies contribute.


Given the highly regulated nature of healthcare, we knew we couldn’t rely solely on user interviews and contextual studies.

While we were fortunate enough to be able to speak to various physicians (and on two occasions, even in the context of their practice), we found a wealth of knowledge through conducting extensive literature reviews, engaging with subject matter experts, and even attending a conference in New Orleans focused on Human Factors and Ergonomics in Healthcare.


Our focus during early stages of research centered around how physicians themselves described burnout, how often they felt burnt out, what they felt contributed to burnout, and the extent to which digital tools either helped or hindered their workflow.

Methods

Literature Review

We read over 60 academic papers related to EMR software, physician burnout, and human factors considerations surrounding physicians' workflow. Special attention was paid to issues of cognitive processing, visual-sensory research, information foraging, and capacity of working memory.

Guerrilla Interviews

Before conducting any scheduled, formal interviews, we wanted to get a rough understanding of physician’s perspectives regarding burnout. We conducted 8 ‘guerilla’ interviews with physicians leaving shifts outside of the University of Pittsburgh Medical Center (UPMC).

Subject Matter Expert
(SME) Interviews

We spoke with 18 subject matter experts, ranging from current designers at health-tech companies to human factors engineers responsible for the development of medical devices.

Contextual Inquiries

We conducted 2 contextual inquiries with local, Pittsburgh-based physicians to see first-hand the day-to-day tasks and responsibilities of primary care physicians.

Physician Interviews

We conducted 11 hour-long, semi-structured interviews with physicians working across the United States.

HFES Symposium on Healthcare

We attended the annual Human Factors and Ergonomics Society's (HFES) Symposium focused specifically on healthcare technology, where we had the opportunity to engage in numerous workshops, sit in on presentation sessions, and network with professionals in the healthcare space.

Affinity Mapping
Our group collected a lot of information - transcripts from interviews, pertinent research studies found in literature reviews, highlights from conferences, and more.

Setting aside ample time for our team to review and organize the information collected through affinity mapping was critical for illuminating key insights. Issues regarding data entry became immediately clear, fitting into a broader category of administrative tasks which seemed to command a significant portion of physicians’ time.
Journey Mapping
While the patient-physician interaction is heavily influenced by what brings the patient in for a visit, most physicians we spoke to did indicate a typical work style that they loosely followed, regardless of what patient had been roomed. While some physicians preferred to see vitals first, others found summaries of recent visits more helpful. Gathehr puts the content of that ‘first glance’ view in the hands of physicians. Gathehr will adapt to the nuances of your workflow, and allow you to modify what you see first at any time.
Core Insight
The amount of continuous cognitive load that physicians experience on a daily basis is the primary cause of burnout.
Pressures inherent to the medical profession, an increasing patient to physician ratio, and the incompatibility of current software to support the physician workflow necessitate the repeated use of key mental resources (task-switching, directing attention, memory recall, etc.) which add to cognitive load.

Contributors to Cognitive Load:

Directing Attention

Decision-Making

Sorting Info

Task-Switching

Maintaining Goals

Working Memory

Emotion Regulation

Interruptions

* A presentation by design researcher Kate MacNamee at the 2022 HFES Symposium was instrumental to our understanding of contributors to cognitive load.

Key Insights
Our various key insights can be roughly broken down into three categories: Information Processing, Workflow Friction, and Psychological Stress.
Insights related to information processing centered around how physicians searched for, viewed, and processed clinically-relevant data. The largely fragmented process of locating pertinent bits of information created friction within their workflow and did not support a typical diagnostic process. Chronic psychological stress seemed to surround the primary care experience in particular, as they often served as the first touchpoint to other specialists/care centers.

01

Timing of data entry is a tradeoff for physicians
The abundance of manual data entry forces physicians to weigh tradeoffs in their time; they can either rely on recall, charting after work hours and during breaks, or task switch and undermine patient interaction by charting during the patient exam.

Task-Switching

Recall

02

Finding missing patient information takes multiple steps
A lack of interoperability causes physicians to miss critical information about patient history. This requires added effort to search in a remote system for this information or rely on patients to share.

Task-Switching

Interruptions

03

Making diagnoses requires sifting through data
Poor information architecture requires physicians to sift through multiple layers of patient data to find relevant information needed to identify trends, make accurate diagnoses, and finalize charting. 

Attention

Sorting Info

04

Inundation of alerts leads to fatigue
The lack of information hierarchy in EMR inbox and constant stream of alerts—tasks, results, messages—puts added mental load on physicians to keep track of tasks, direct attention to high priority alerts, and focus amid distractions.  

Attention

Interruptions

Task-Switching

05

Basic Tasks Require Multiple Clicks
Clunky EMR navigation requires ample amounts of searching to input basic information in the patient chart. This requires multiple clicks and extends the time it takes to navigate between pages of patient history and building progress notes.

Attention

Memory Recall

06

Mental models of ICD codes are mismatched
A disconnect exists between how physicians define certain diagnoses and what ICD-10 codes actually mean, leading to time-consuming, confusing code selection processes. A poor understanding of where ICD codes fall in HCC blocks complicates reimbursements.

Memory Recall

Interruptions

07

EMR systems cause redundancy in the physician workflow
EMR system lags and crashes, a lack of system personalization, and a need to input the same data multiple times leads to redundancy in the physician workflow, slowing physicians down. This uncertainty and repetition in the workflow causes anxiety and frustration.

Attention

Memory Recall

08

Physicians employ customizations to speed up their workflow
Over their careers, physicians maneuver usability issues in EMR systems, customizing these systems and creating workarounds; physicians leverage Google Docs of common phrases to reference and adapted screen orientations to decrease scrolling and speed up their workflow.

Maintaining Goals

09

The primary care role requires wearing multiple hats
Due to the preventative nature of their work, primary care physicians are concerned with the holistic health of their patients. When lacking immediate access to other specialties, primary care physicians often wear multiple hats and take on additional administrative responsibilities.

Attention

Task-Switching

10

Burnout is due to career stage
Burnout differed among physicians based on career stage rather than generation. Early-career physicians take on more patients due to low tenure, take over patients from retiring physicians who trust them less, lack knowledge from experience, and have their authority questioned.

Attention

Emotion Regulation

Problem Definition
Given our learnings from four months of generative research, we were able to define the problem we were trying to solve more clearly:
How might we reduce the amount of cognitive load that physicians face while interacting with digital systems during a patient encounter?