Confront Burnout In Healthcare With Design Thinking (Part I)
This is our first article in a two part series addressing burnout in the healthcare field and how design thinking can help.
“Torturing people is hard.”
Healthcare providers take a pledge to “first, do no harm;” however, hospitals administer life-extending procedures that may not align with the patients’ wishes and challenge individual provider’s values.
The Berkeley Innovation Group (big) is partnering with Common Practice to apply design thinking to the triad of exhaustion, depersonalization, and reduced personal accomplishment, known as “moral distress” or “burnout” felt by healthcare providers. Using big’s design thinking process as our roadmap, we conducted interviews and grouped our Observations into three clusters of contributors to moral distress: memories of past cases, conflict with personal values, and coping with daily duties.
“I remember it like it was yesterday.”
In rural America, local clinics address small injuries, while significant cases get transported to regional medical centers via helicopter. Michelle was part of a crew assigned to ferry a critically-wounded 9-year old gunshot victim. Upon arrival at the clinic, Michelle found the child had passed. As with most small towns, everyone knows everyone, and the attending doctor asked the helicopter team to speak with the child’s family. Struck by both the tragic death of a child and being the bearer of bad news to the family, Michelle was emotionally drained and looked forward to the flight home.
Now in her fifties, when Michelle asked how the team addressed their emotions around the tragedy, she said, “I am not proud of this, but we went to the local bar, and by one o’clock in the afternoon, we were calling cabs because we couldn’t drive.” Our Insight is: while hospital leadership focuses on the tangible metrics of facility utilization, also, they should monitor the mental health of their caregivers because events in the past impact their efficiency today.
“I don’t know why they drink.”
Every intensive care unit (ICU) has a group of “regulars,” people with drug and alcohol addictions. While the staff dutifully works to stabilize the patients, in private, providers ask themselves “why am I helping this person if they keep coming back?” Another nurse immediately followed with, “treating drug addicts is hard when they keep making bad choices.”
This cycle drove one nurse to describe the evolution of her philosophy from the number of patients served to the quality of care those patients receive. At first, I balked at this comment; however, probing with “tell me more,” she replied, “I never want to torture my family.” By asking probing question, I discovered a profoundly compassionate caregiver and uncovered the Insight: caregivers want to treat patients like family.
“I haven’t peed all day.”
Caregivers are spread thin with a variety of cases with wildly divergent goals such as lowering pain meds before removing a ventilator tube, a patient having a successful bowel movement, or a patient responding to a loved one’s voice after a stroke. Behind each of these tasks are families juggling emotions of anger, fear, and hope. In the hectic environment of the ICU, one nurse took great pride in her ability as a self-described “chameleon.” However, does that attitude deliver the authenticity that patients deserve?
Additionally, how do nurses find time to mentor new caregivers, share best practices among peers, and find time for lunch? Pressed with “can you tell me about a time when,” a Millennial-aged nurse talked about an informal Facebook group where current and former staff members “acknowledge(d) the day,” without sharing patient details. Contrasting this Observation with our Insight from Michelle’s story is evidence to leadership that “one-size does not fit all,” when it comes to “morale distress.”
“If all you have is a hammer, everything looks like a nail.”
The Insights generated from these interviews are the qualitative evidence that augments studies producing quantitative data with human stories. Without these stories, the data lacks the necessary context to solve an unseen, but present issue among healthcare workers. In a few weeks, we will share a second blog post sharing our Ideation and Experimentation work.