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Show Hospitalist Listen-Sort-Empower (LSE) to Identify System Burdens Nathan Wanner, MD, Ryan Murphy, MD, Kim Mahoney, MEd, Heather Balch, MD, Trent Fuller, MD, John Gerstenberger, MD, Thomas Goslinga, MD, Jared Huber, MD, Katherine Lappe, MD, Joshua Marr, MD, Sonja Raaum, MD, Roxanne Weiss, MD, Claire Ciarkowski, MD, Jen Rosio, Kristen Mauck, MBA, Mari Ransco, MA Background Results Intrigued by findings from the 2022 Nursing Figure 1. “LISTEN” Health Taskforce Report,1 the Hospitalist Medical Director partnered with U of U Health’s Experience Design Lab, an interprofessional team of qualitative researchers, technologists, and designers, to How we listened: 3 7 11 FOCUS QUESTIONS HOSPITALIST GROUPS ASKED PARTICIPANTS October/November 2022 (All physicians) Figure 2. “SORT” 1. 2. 3. 4. 5. 6. 7. What works well in your workday? What is most meaningful to you at work? What could make more days work well? What saps meaning from your work? What should we stop doing? What are the challenges in your day-to-day work? Magic wand: If you could change one thing, right now, what would it be? 54 the 72 hospitalist providers within the Division 112 14,706 PAGES OF TRANSCRIPTS of General Internal Medicine at U of U Health. Hospitalist Ryan Murphy with patients (Credit: Deseret News) Methods Adapting the same Listen-Sort-Empower (LSE)2 framework used during the Nursing Health Taskforce, we conducted in-person December 2022 TOTAL RESPONSES 8 WORDS ANALYZED 55.6% Purpose PURPOSE 22.2% Relationships Purpose was identified by hospitalists as the meaning drawn from achieving excellence in patient care, teaching others, and problem solving. Mastery 11.1% Autonomy 11.1% THEMES THEMES REVEALED REVEALED Dates: February 2022 Hospitalist identified “Demotivators” Sort Prioritization Survey Results Dissatisfiers: “Less of this” Purpose System burdens Relationships Difficult patient encounters Mastery Process burdens Autonomy Communication challenges 10.0% 10% 20.0% 20% 30.0% 30% 40. 40% 0% 50.0% 50% 60.0% 60% 32% 32.1% System burdens 21.4% 10.7% 0.0% 0% 10.0% 10% 20.0% 20% 30.0% 30% Recommendation #2: SYSTEM BURDENS 28.6% Difficult patients Communication Recommendation #1: Incorporate top two System Opportunities for Improvement (SOFI) into FY25 departmental goals and objectives. N=33 (46% response rate) Hospitalist team survey to prioritize areas of focus. Process burdens Satisfiers: “More of this” Report-out January 2023 Hospitalist identified “Motivators” Sort Prioritization Survey Results 0.0% 0% Adapted from Swensen, SJ. AMA STEPS FORWARD (2020) What they said: explore upstream drivers of burnout among 56% Questions Asked: Figure 3. “EMPOWER” 40.0% 40% N=33 (46% response rate) Hospitalist team survey to prioritize areas of focus. PRIORITIZE: System burdens are the range of societal, cultural, structural, and organizational factors that contribute to burnout among health care workers. February 2022 Hospitalist Areas of Focus REDUCING ADMINISTRATIVE BURDENS By focusing on addressing system burdens identified by hospitalists, we directly reduce time spent on administrative tasks that can be redirected toward purpose-driven work. Convene key system stakeholders to sponsor and resource identified SOFIs. 55.6% Purpose System burdens 32.1% Recommendation #3: Hospitalists and key system partners develop and implement SOFI improvements throughout the next Fiscal Year (FY25). 0.0% 0% 50.0% 0% 10.0% 10% 20.0% 20% 30.0% 30% 40. 40% 50% 60.0% 60% Report-out January 2023 Drawing from Herzberg’s two-factor theory of motivation,3 we identified two primary factors: Purpose and System Burdens, and eight themes (Figure 1). 33 (46%) of Hospitalist team members responded to the follow-up survey to prioritize findings in order of “what matters most” to them (Figure 2). Based on LISTEN and SORT findings, a comprehensive report with recommendations was developed (Click QR to view report). and virtual semi-structured interviews with 11 members of the Hospitalist team. Between October and November 2022, we captured 3 hours of feedback from in- Conclusions person interviews (2 virtual; 1 in-person). The two primary factors and eight themes outlined in and identify two System Opportunities for Improvement (SOFI) to Each interview followed a standardized this report can be stated in simple terms: Hospitalists focus improvement efforts on in FY25 (7/1/24 – 6/30/25): semi-structured question set adapted from are purpose-driven providers who are currently 1) Obtaining outside hospital records for unplanned admissions, LSE. Over 14,000 words were captured and frustrated and overwhelmed by system-induced and (2) Scheduling post-discharge follow-up appointments. analyzed using qualitative methods. distress and workplace burdens. The Hospitalists 1. Christensen, SS, Nixon, TL, Aguilar, RL, Muhamedagic, Z, Mahoney, K. Using participatory management to empower nurses to identify and prioritize the drivers of their burnout. International Journal of Healthcare Management, 2023. Available online: https://www.tandfonline.com/doi/full/10.1080/20479700.2023.2190251 passion to make the work better. As a result, we were 2. Swensen, SJ, Listen-Sort-Empower: Find and act on local opportunities for improvement to create your ideal practice. AMA STEPS Forward, 2020. Available online: https://edhub.ama-assn.org/steps-forward/module/2767765 able to define what “better” means for hospitalists 3. Syptak, JM, Marsland, DW, Ulmer, D. Job satisfaction: Putting theory into practice. Family Practice Management, 1999. Available online: https://www.aafp.org/pubs/fpm/issues/1999/1000/p26.html engaged in this process with a genuine interest and The identified findings were then prioritized via survey by 33 (46%) team members. DIVISION OF GENERAL INTERNAL MEDICINE |
