In the two years since the COVID-19 pandemic began, staffing problems at every healthcare organization in the U. S. continue to increase. Lauren Manzione, a project analyst at KLAS Research, authored a Clinician Turnover and the EHR Experience report.
Organizations face high turnover, increasing costs, and stress on existing employees to train new employees, resulting in overstretched clinicians, excess expenditures, and reduced services/care for patients.
Almost 60,000 clinicians have responded thus far to the KLAS survey asking about their likelihood of leaving their facility in the upcoming two years. The KLAS survey gleans insight into who is most likely to depart and what actions organizations could take to retain current clinicians. Those surveyed included physicians, advanced practice providers (APPs), nurses, and other healthcare professionals.
The survey categorized 12 significant reasons prompting clinicians to consider leaving.
- Clinicians who feel completely burned out – 60%
- Clinicians who disagree that their employer has done a great job implementing, training, and supporting their EHR system – 35%
- Clinicians who are highly dissatisfied overall with their EHR system – 34%
- Clinicians who strongly disagree that they have learned their EHR system well – 34%
- Clinicians who strongly disagree that patient records (both data and results) are easy to access and understand – 33%
- Clinicians who strongly disagree that the EHR vendor developed an excellent system – 32%
- Clinicians who strongly disagree that current EHR instruction/training is helpful and educational – 32%
- Clinicians who strongly disagree that their training included the use of the EHR for specialty-specific workflows – 31%
- Nurses who lose 5 or more hours weekly from unproductive charting requirements – 30%
- Clinicians who strongly disagree that their original EHR training was adequate – 28%
- Clinicians and nurses who have served in their respective fields for over 25 years – 24%
- Clinicians who spend over 25 hours weekly outside normal working hours finalizing charting – 24%
The KLAS survey confirmed that burnout is the primary reason clinicians and nurses want to leave their employers. Higher levels of burnout were associated with an increased risk of attrition. Fully 60% of clinicians experiencing the highest levels of burnout indicated that they were likely to leave. Dissatisfaction, frustration, and inefficiencies with their organization’s EHR system were frequent sources of burnout.
Frustrations at work were another critical area for clinicians — chaotic working conditions were cited by 47% of respondents as a contributing factor for wanting to leave their organization. Another source of discontent was the time spent on bureaucratic tasks — 46% of respondents cited their frustration over too much wasted time.
Just over one-third of respondents cited a lack of shared values with their organization, having no personal control over their workload, and lack of teamwork.
About one-quarter of those who responded to the KLAS survey cited EHR or other IT tools impacting their efficiency or ability to deliver quality care, after-hours workload, or lack of autonomy in their job.
Only 15% of respondents cited COVID-related work distress as a potential reason to leave their employer.
Take-aways from the KLAS Survey
Dissatisfaction with EHR — from training and ease of use to easier access to patients’ records — resulted in lower confidence in IT leadership. Senior management mitigation in this critical area might include two-way communication between EHR users and IT leadership — and insuring that the IT department demonstrates expertise, consistent support, and good contacts with users.
Notably, users satisfied with their EHR are much less likely to leave their organization than dissatisfied EHR users. Organizations should concentrate on the areas of their EHR that need the most enhancement — specifically reliable performance (uptime) and quick response to downtime/availability issues.
Adjusting/personalizing every clinician’s workflow to avoid after-hours charting can help charting efficiency. Sutter Health redesigned its workflow, meaningfully reducing nurses’ charting burden; their nurses experienced a 44.7% increase in their Net EHR Experience Score. Tailoring EHR training to specific workflows is another strategy that is likely to decrease attrition.
High turnover rates are costly in terms of direct financial costs and increasing additional burnout among remaining clinicians.