‘Choosing Wisely’ effort aims to reduce burnout for clinicians

Many in the health care workforce at U-M Health are experiencing high levels of burnout, which threatens workforce stability and ability to execute the clinical mission.

One way that U-M Health is tackling this issue involves implementing a “Choosing Wisely” effort, intended to identify, design, and rigorously and rapidly evaluate specific projects focused on improving the value of clinical care. The goal is to allow clinicians to provide the clinical care they are trained to do and eliminate or scale back unnecessary administrative work, thereby improving both professional and patient satisfaction. 

For example, Hawaii Pacific Health eliminated an unnecessary requirement for hourly rounding documentation and saved approximately 1,700 nursing hours per month across 4 hospitals.

The first step in this effort involves gathering feedback from clinicians – anyone who delivers direct patient care within medicine, nursing, pharmacy, mental health and other similar disciplines. 

A workgroup, co-led by Eve Kerr, M.D., M.P.H. (Department of Internal Medicine) and Christopher Friese, Ph.D., R.N. (School of Nursing), is asking for suggestions on clinical administrative work that U-M Health should stop or scale back via the feedback survey linked here. 

The team is also seeking clinicians who have at least a 50% appointment focused on clinical care delivery to join its workgroup. The workgroup will examine responses on low-value administrative practices that contribute to clinician burnout to launch a pilot effort to eliminate or scale back one aspect of low-value clinical administrative work and address other identified areas over time. In addition to providing nominations for areas of focus, please indicate your interest in workgroup involvement on the survey. 

To identify low-value administrative practices performed by clinicians that should be eliminated or scaled back, respondents are asked to consider items that: (1) Create unnecessary burdens for the clinician workforce; (2) Do not have sufficient evidence base to improve clinical quality, access, equity, or other organizational outcomes (e.g., financial performance); (3) Do not address outcomes patients care about; and/or (4) Are duplicative or a waste of time. These may include unnecessary, redundant or unwieldy practices that could be stopped without harming patient care such as:

• Time-consuming MiChart (Epic) features.
• Documentation processes and signature requirements.
• Mandatory compliance and risk-management trainings.
• Medication renewal and reconciliation management.
• Prior authorization processes.
• Coding requirements and processes.
• Referral, care coordination and scheduling barriers.
• Administrative work directed to clinicians when other team members could perform this work.

For more information about “Choosing Wisely” and workgroup involvement, or questions about the survey, please contact Sarah Gargan (sgargan@med.umich.edu).