The 2014 annual survey at the Massachusetts General Physicians Organization (MGPO) revealed that 41 percent of their 3,200 physicians scored high on the Maslach Burnout Inventory (MBI) and the Utrecht Work Engagement Scale (UWES). Specifically, the survey revealed that a lack of autonomy, loss of connectivity with colleagues and responsibility for non-clinical work were the activities most often correlated with burnout. Around the same time that the survey data were released, new challenges emerged, including the implementation of an electronic health record (EHR) system that many felt compromised the joy they once felt in medicine.
MGPO clinicians realized that urgent action was needed to address the root causes of burnout. This led to the formation of the Physician Burnout Committee, or Frigoletto Committee, to bring the focus back to the relationship between physician and patient and restore meaning and joy to practice. The Committee is named after Dr. Fred Frigoletto, a member of the Massachusetts General Hospital faculty who worked tirelessly to mitigate the impact of administrative burden on clinicians. He passed away shortly after the Committee was formed and it was renamed in his honor.
More than 90 volunteers responded to an organization-wide call to participate in this important initiative. Committee membership consists of 28 physicians representing primary and specialty care, two residents, a third-year medical student and a Board of Trustees member. The Committee drafted the following charter to guide its charge:
“The Frigoletto Physician Burnout Committee has been chartered by the MGPO to identify, evaluate, prioritize, and offer suggestions to the Physicians Organization Executive Committee (POEC) for immediate and longer-term remediation of the factors contributing to physician burnout within the Massachusetts General Physician Organization.”
The Committee is tasked with ideating initiatives on a regular basis that, if selected for implementation, will have both short- and long-term effects that contribute to fulfillment in practice. To accomplish this goal, the Committee members have been meeting for an hour approximately every six weeks since September 2016. Their work is communicated to MGPO via a weekly newsletter, video, social media platforms and leadership meetings, including the Department Chiefs' meeting and MGPO Executive Committee meetings.
Volunteers not selected for the main Committee were active on four sub-committees that addressed specific areas associated with burnout at MGPO:
Information technology (IT) and EHR
The sub-committees were given an eight-week timeline to report their respective initiatives to the Frigoletto Committee. All MGPO members were surveyed about the initiatives and asked to choose their top initiative from each of the four categories. Initiatives with the most votes were presented to MGPO leadership for funding and implementation. The final products of these meetings will try to address the following: delegation of non-clinical work to a non-MD space, personalized EHR training, enhancement of the EHR platform across practices and optimization of resources to practices (for example, optimal use of medical assistants or nurse practitioners). With their tasks complete, the subcommittees have been disbanded and their initiatives are being rolled out by the Frigoletto Committee.
During the process described above, the Committee identified several “quick fixes” that were readily implemented. These included changing note completion in the EHR from three days to three business days, changing the availability of imaging results for patients from one to three days, and establishing a physician EHR support hotline. Other initiatives will soon be rolled out at the system and department levels. Departments are tasked with identifying the most relevant metrics to measure impact of these initiatives on their clinicians.
MGPO believes that any process that looks at burnout should try to be transparent and inclusive and hold leadership accountable. The process should involve changing culture across organizations and making institutional leaders accountable for burnout. Lastly, some of the initiatives may be appropriate to roll out at the institutional level, whereas others are more appropriate at the local, department or divisional level.
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