LOUDER THAN WORDS: Frustrations with the glacial pace of bureaucracy

For those of us who work within a health care organization, as opposed to a private practice, we are thrust into a bureaucratic structure when we accept our positions. Within this structure, there are many advantages built in, including opportunities to join task forces and committees to address organizational problems. Although with good intentions on these groups, and some great work being done (eg COVID preparations and adaptations), I find myself awfully frustrated with the lack of urgency and glacial pace of change that seems to accompany many of these bureaucratic committees.

My main example that leads me to write this is our Epic Specialty Champion group, whose primary task has been to improve the end-user experience on the EMR (Epic for us). After doing some research and finding that the EMR experience consistently ranks in the top 3 causes cited for burnout, it seems like a very tangible place to start decreasing the work burdens for our clinicians and beyond. Given that I am naturally inclined to favor proficiency and efficiency in my work, I found myself gravitating towards the top percentile in the Epic metrics for these measures, and felt that I could potentially help my fellow clinicians by speeding up their documentation and decreasing their clerical tasks. So, I created a presentation and gave that to our Wellness Council, where it was well-received and passed along, and joined the Epic Specialty Champion group in the hopes of being “part of the solution” for burnout within our organization. This is where my energy and passion for this project was put through the bureaucratic wood-chipper and doesn’t feel or look the same on the other side.

Well, fast forward at least 3 months, and I have not yet spent a single minute actually working with other clinicians on improving their Epic usage. NOT A SINGLE MINUTE. We, as the Epic Specialty group, did some necessary trainings and had some other meetings, but no actual tangible efforts to speak of. My question is: “Where is the sense of urgency?” Burnout is in pandemic proportions right now, and yet we continue to kick the can of actions down the road with postponed and cancelled meetings, along with additional trainings. And when these meetings get cancelled, they are typically delayed for an entire month at a time, which means that another month will go by without any new action to decrease burnout via EMR optimization. 

Granted, we did experience a cyberattack and lost our EMR for 4 weeks, and it is still being rolled back out in phases. But, if this pandemic has taught us anything, it’s that we should not become complacent, as there will be other hurdles and new fires to put out. It just feels we could’ve been rolling out small actions to address burnout, including EMR optimization strategies, prior to this latest emergency. But, here we are, delayed by months, and I don’t believe that burnout levels are just working themselves out in the interim. Of course we all like to think we could be doing it better ourselves, but why couldn’t we have been engaging the EMR users via surveys or focus groups, or even taking a grassroots approach and meeting with individuals in-person or virtually. Given how much technology we have, there are just about zero barriers to make incremental changes, so I just don’t see any excuses being valid on the delayed rollout of the Epic optimization strategies. If we had been given the green light to do so, individual members of this Epic subgroup could’ve been methodically collecting data, inviting clinicians and other medical staff to schedule training sessions, or even holding virtual training sessions for multiple individuals.

And from the perspective of an employee, I just don’t want to hear any excuses coming from my employer as to why tangible actions aren’t getting done…I want to hear and feel that my organization not only cares about my concerns, but is actively working to address them, with a sense of urgency, especially when it comes to systemic problems in pandemic proportions, like burnout. Yes, I appreciate the acknowledgment and validation, and understand many organizations don’t even give that, but SHOW ME SOME ACTION and convince me that you really are acting as a version of a Wellness Fiduciary that you should be. 

Overall, I enjoy working for my organization and love my job, don’t get me wrong. I feel compensated well and generally supported, and feel my work-life balance is very good. But, this is because I have the time and energy to make this the case, and not every other medical staff member is as fortunate. I feel that the organization should feel obligation, with a sense of urgency, to continually move the ball forward on employee wellness initiatives, especially those where the data is present and supportive of small investments having exponential and lasting benefits. The onus should not be on just the individual, but the organization should also take some ownership over the well-being of their employees, done with incremental actions with a sense of some urgency. 

I’ll end with a great Chinese proverb I read the other day, which sums up the best time for action:  “The best time to plant a tree was 20 years ago. The second best time is now.”

DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) There are no conflicts of interest to report. 3) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.

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