Practical solutions to combat burnout in ambulatory clinics

Clinical team members often face the challenging reality of balancing full schedules with the commitment to exceptional patient care. Front-line staff work tirelessly to keep pace with rapidly evolving industry standards, demonstrating remarkable adaptability and dedication, without sacrificing any tenets of their vocation. Despite these demands, there is no shortage of devotion, professionalism and resilience when it comes to patient care. 

There is always work to be done in ambulatory clinics, and the expectation is that all tasks — ranging from phone calls and patient portal messages to vaccinations and procedures — need to be completed within a finite period. This requirement can create a stressful work setting for team members who often feel overlooked and eventually burned out. What can we do to address the shortages with viable help?

Challenges in staffing models

There is no simple answer to the challenge of inadequate staffing levels, especially if the clinic staffing model does not align with productivity goals. 

In a variable staffing model, clinics adjust staffing levels according to demand or volume. For example, if a practice sees fewer patients on Fridays compared to Mondays, staff should be reduced to account for the volume difference. Rush University Medical Group’s staffing-to-demand (S2D) model applies a data-driven approach by measuring standard work tasks to calculate full-time equivalent needs based on forecasted patient volume and time to complete each task.¹ To optimize this model, regularly reevaluate it within your practice by assessing patient outcomes and staff feedback. 

For clinics associated with large hospitals or organizations, we often see an enterprise approach where staffing levels are typically higher to support multiple locations and offer flexibility through contingency float pools.² Larger enterprises with substantial geographic distances between locations often require more extensive float pools. Despite an optimized staffing model, however, many employees may still perceive the workload as overwhelming, with insufficient time or personnel to meet demands. Fortunately, there are practical solutions to help shift these perceptions and improve workforce morale. 

Benefits of cross-training

Cross training is essential for successful medical practices, offering both operational flexibility for clinics and professional growth opportunities for staff. By ensuring tasks are completed in a timely manner without assigning them to specific individuals, cross-training sometimes allows team members to step outside their comfort zones and to learn new skills. Whether training a receptionist to room patients or having a medical assistant (MA) manage incoming patient calls, this approach enables staff to support multiple areas within the practice, providing a much-needed break in a demanding work environment. 

For established practices, however, gaining team buy-in can be a barrier. Staff may initially view cross-training as more work. Engaging them in open discussions about the barriers they face daily can reveal the best approaches to alleviate bottlenecks. Team members are often candid about what isn’t working well, so actively listening to their concerns is essential to successful implementation. 

Simple solutions, such as assigning dual roles to staff members, can greatly enhance flexibility. For example, medical office assistants (MOA) often handle both clinical and clerical tasks, allowing them to assist on the floor or manage patient calls in the front office. With proper training, there is no lapse in duties during times of PTO or unexpected callouts for others. However, unless clarified during interviewing, clerical staff may hesitate to assume clinical duties of any kind. It is important here to emphasize teamwork and career growth as motivators. By developing a practical understanding of all clinic functions, team members not only boost productivity but also upskill themselves for career growth in an evergreen industry. 

Centralization of tasks

The concept of centralization in duties has become a necessary evolution in shifting away from the idea that certain people must complete certain tasks. While certain roles, such as registered nurses (RNs) and medical assistants, have duties defined by their licenses, effective strategies can ensure timely patient care without relying solely on designated staff members. 

For example, consider a busy orthopedic clinic with seven providers facing challenges in managing post-op calls for surgical patients due to high demand or staff availability. Patients should receive a check-in call within 24 hours of their procedures to ensure they are doing well. Typically, this call is made by the surgeon’s nurse, who is familiar with the patient and procedure. However, if the nurse is out on vacation for a week, this essential duty may fall through the cracks. In response, the clinic manager spoke with his staff and providers to find a solution. They implemented a post-op call log for each clinic day, listing all patients who underwent procedures. If a particular nurse was out or needed assistance, the manager would assign another clinical team member to complete the calls. 

This centralized approach not only ensured consistent follow-up for patients but also secured team buy-in by highlighting the collective benefits. Nurses could leave with peace of mind, knowing their patients were in good hands while they were out of office. Centralization can streamline other functions, as well, including prescription requests, incoming calls, patient check-in/out and more, creating a more resilient and collaborative workflow. 

Value-based care approach

Amid the shift toward value-based care and focus on improving patient outcomes, many healthcare workers feel they lack the time needed to provide optimal care. From physicians who end up charting after hours to RNs struggling to keep up with their patient calls, collaboration has proven to be one of the most effective approaches. 

Adopting a care team approach expands the personnel involved in patient care. For example, in a primary care clinic with one physician, one advanced practice provider (APP) and three MOAs, the physician and APP coordinate as seamless team-based workflow for every patient encounter. While a patient waits in the exam room to be seen by the physician, the APP meets with them to discuss their current symptoms and chart relevant information needed for the physician. This approach not only creates multiple touchpoints for patients but also fosters a more engaged, collaborative environment for the entire practice. 

Practices that adopt a coordinated approach to care often see improvements in care coordination, care management and staff morale and engagement. Patients feel more supported, knowing they have a dedicated team of healthcare professionals supporting their health objectives. Shifting to a value-based care model frequently leads to increased efficiency and responsiveness from staff, as well as greater accountability from patients.³

Conclusion

In addressing burnout, practical solutions don’t require reinventing the wheel. Approaches like cross-training increase productivity and foster greater staff buy-in, while task centralization improves turnaround times, reduces individual burdens and strengthens team unity. Lastly, a shift to value-based care, which prioritizes patient outcomes over volume, encourages more accountability and enhances patient satisfaction, all while boosting staff engagement and helping to alleviate burnout among clinic staff. 

Notes:

1. Hill M, Driscoll S, Turley S. “Staffing to demand: How a medical group illuminated staffing needs.” MGMA Connection. July 2021. 
2. Korth J. “Variable Staffing Models at Work.” MGMA. Aug. 1, 2015. Available from: https://www.mgma.com/articles/variable-staffing-models-at-work.
3. MGMA and Humana. “Value-Based Care in the Primary Care Environment.” Oct. 13, 2019. Available from: https://www.mgma.com/vbc-report.