AI Scribes: One part of the solution
It's no secret that the EHR, no matter the vendor, is the bane of most clinicians' existence and a major factor in fueling work overload, one of the 6 drivers of burnout identified by Maslach and Leiter.
[The other 5 drivers are lack of control or autonomy, insufficient reward and/or recognition, loss of community, unfairness, and/or values conflict between the organization and individual(s).]
Both the leading EHR vendors as well as literally dozens of tech start-ups have been developing solutions to streamline historically clunky EHR workflows and lessen the need for data entry and retrieval by clinicians. The advent and use of ambient AI-powered virtual scribes is being touted by many as THE CURE for what ails beleaguered clinicians.
Don't believe the hype. . . While no one is questioning whether the leading ambient AI virtual scribes provide a benefit, the scribes are not the silver bullet that will stanch the burnout epidemic among clinicians.
The latest evidence for the modest vs. transformative benefit comes from "Ambient Artificial Intelligence Scribes: Learnings after 1 Year and over 2.5 Million Uses" by Aaron A. Tierney, PhD et al in the March 31 issue of NEJM Catalyst. The authors tracked the deployment of two different AI scribes across 7,000 physicians in California's Permanente Medical Group from October 2023 through December 2024. The researchers found that "compared with nonusers, AI scribe users observed statistically significant reductions in minutes of pajama time (1.03, P=0.02), time outside 7 a.m. to 7 p.m. (1.83, P<0.001), time in notes per appointment (0.40, P<0.001), and time in orders per appointment (0.07, P=0.01; Figure 5A). On the other hand, AI scribe users also observed a small increase in time in the in-basket per appointment (−0.10, P=0.008; Figure 5B)."
Senior executives and clinical leaders should certainly proceed with acquiring ambient AI scribes for their clinicians while recognizing that the AI scribes alone will not solve the exhaustion devolving upon clinicians. But more importantly, the other 5 drivers of burnout do not lend themselves to "cures" relying on technology-based solutions. Rather, the remaining 5 drivers require changes in leadership practices and priorities and in organizational culture.
Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus for curing clinician burnout and staffing challenges runs through the C-suite. Here are examples of leadership-driven changes to the workplace that my colleague Paul DeChant, MD, and I often recommend:
> Regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
> Consistently apply one or more of the improvement sciences (Lean, Six Sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
> Expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff, where observing and deep listening are emphasized, in lieu of typical rounding.
> Create and require leader standard work (LSW).
> Develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
> Judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
> Support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
> Get rid of superfluous or outdated policies, procedures, redundant approvals, and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by mistrust or even adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation Clinicians feel toward the C-Suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.
