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Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

机译:组织定向工作场所干预对医生倦怠的影响:系统审查

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摘要

To assess the impact of organization-directed workplace interventions on physician burnout, including stress or job satisfaction in all settings, we conducted a systematic review of the literature published from January 1, 2007, to October 3, 2018, from multiple databases. Manual searches of grey literature and bibliographies were also performed. Of the 633 identified citations, 50 met inclusion criteria. Four unique categories of organization-directed workplace interventions were identified. Teamwork involved initiatives to incorporate scribes or medical assistants into electronic health record (EHR) processes, expand team responsibilities, and improve communication among physicians. Time studies evaluated the impact of schedule adjustments, duty hour restrictions, and time-banking initiatives. Transitions referred to workflow changes such as process improvement initiatives or policy changes within the organization. Technology related to the implementation or improvement of EHRs. Of the 50 included studies, 35 (70.0%) reported interventions that successfully improved the 3 measures of physician burnout, job satisfaction, and/or stress. The largest benefits resulted from interventions that improved processes, promoted team-based care, and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks. Implementation of EHR interventions to improve clinical workflows worsened burnout, but EHR improvements had positive effects. Time interventions had mixed effects on burnout. The results of our study suggest that organization-directed workplace interventions that improve processes, optimize EHRs, reduce clerical burden by the use of scribes, and implement team-based care can lessen physician burnout. Benefits of process changes can enhance physician resiliency, augment care provided by the team, and optimize the coordination and communication of patient care and health information.
机译:为了评估组织导向的工作场所干预对医生倦怠的影响,包括所有环境中的压力或工作满意度,我们对从2007年1月1日至2018年10月3日,从多个数据库进行了系统审查。还进行了手工搜索灰色文学和书目。在633个确定的引文中,50个符合纳入标准。确定了四种独特的组织定向工作场所干预措施。团队合作涉及将抄写员或医疗助理纳入电子健康记录(EHR)流程的举措,扩大团队职责,以及改善医生之间的沟通。时间研究评估了计划调整,占空比限制和时间银行举措的影响。转换转入工作流程变化,例如组织内的过程改进计划或政策变更。与ehrs的实施或改进有关的技术。在50个包括的研究中,35名(70.0%)报告的干预措施成功改善了3种医生倦怠,工作满意度和/或压力的3个衡量标准。最大的益处由改进流程,促进基于团队的护理的干预措施,并纳入了抄写员/医疗助理来完成EHR文件和任务。实施EHR干预以改善临床工作流出的倦怠恶化,但EHR改善具有积极的影响。时间干预对倦怠有混合影响。我们的研究结果表明,通过使用抄写率来改进流程,优化EHR的组织定向的工作场所干预,并实施基于团队的护理可以减少医生倦怠。过程变化的好处可以增强医生弹性,由团队提供的增强护理,并优化患者护理和健康信息的协调和沟通。

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