Understanding and Addressing Community Health Center Burden, Resiliency, and Burnout - Systems Engineering Analyses and Approaches - Abstract An estimated 31% of physicians and 54% of nurses experience professional burnout, at a cost of ~$4.6 billion annually, in part due to significant time burden, poor system resiliency, and process inefficiencies. Declared a national emergency by the U.S. Surgeon General’s Office – a staggering 76% of healthcare professionals re- ported exhaustion, burnout, and excessive work burden during the COVID-19 pandemic – burnout significantly affects care quality, medical error, occupational injury, workforce attrition, depression, and suicide contempla- tion. Work burden, personnel burnout, staff shortages, and strained resources are complex issues, deeply in- tertwined, and especially prevalent in practices serving disadvantaged populations, yet remain both signifi- cantly understudied, as a system, and increasingly common. The encouraging broad adoption of asynchronous care (patient portals, EHR email, text messaging) fortunately can significantly improve care and patient experi- ence, but also contribute significantly to time stresses, work-after-work, and burnout, further exacerbated by (and contributing to) staff shortages, inefficient processes, and non-resilient systems. It is not surprising that a National Academy of Medicine report (Taking Action Against Provider Burnout: A Sys- tems Approach) thus recommended greater use of systems engineering to optimize technology use workflows, reduce endemic inefficiencies, develop resilient processes, and apply complex adaptive systems ideas. This project directly responds to 4 of the 8 NAM report recommendations, uniquely incorporating systems science and systems engineering approaches to better understand and address the relative impacts of these issues by: (Aim 1) Understanding the nature, extent, issues, and exemplars of system resiliency, efficiency, and optimized workflows in asynchronous care processes; (Aim 2) Investigating relationships between work burden, system resiliency, inefficiency, and burnout and their impact on care quality and safety; and (Aim 3) Estimating the rel- ative impacts and generalizability to other settings of various types of interventions effective interventions. Notably, (1) analytic process simulation and system dynamics models will be integrated with other methods to help understand these issues, identify insights, estimate effect and relationship sizes, and evaluate potential interventions, and (2) system resiliency analysis and design methods will be applied to develop more robust adaptive processes – both hallmarks of systems engineering. This research will be conducted by a multidisci- plinary team of engineering, qualitative, and health service researchers working with 4 varied community health centers (in complexity, rurality, ethnicity) and validated through statewide CHC and primary care organizations for generalizability, since burnout affects some demographics more than others. Results will be evaluated through a combination of process, resiliency, burnout, and safety measures, with expected impacts including more efficient and resilient processes, reduced burden and burnout, and better care that, if scaled to 20% of primary care across the US, could benefit 209,000 practices serving 133 million patients.
