I had a front row seat to nurse burnout.
I was lucky. After my near-fatal ski accident, I received excellent care during my 7-week stay that spanned three of the highest ranked hospitals in the country. But I could not shake the dissonance between the care I received and the engagement and satisfaction of the people delivering it. My caregivers were helping me, and I was truly grateful. From my perspective they were doing the most important job in the world. But as I got to know my team, I understood that they did not feel the same way about their jobs that I felt about them. They were burning out.
Why were they burning out? For a bunch of reasons: Overwork. The invasion of technologies like the EHR. Higher acuity patients with less time. Lack of appreciation. Inability to see a future career path. Crazy schedules. These reasons and many, many more.
The consequences of burnout add negative fuel to a healthcare system that already struggles with quality and cost. Burnout causes mental distress, disengagement, loss of focus, and at its worst end-state, leaving a job or a career (known in the industry as “turnover”). All of these downstream effects of burnout are impediments to the teamwork, communication, and training that are key to achieving end results.
Given that healthcare is now the largest sector in our economy, there are innumerable healthcare workers that are at risk. Burnout is not just about nurses, it is pervasive across the healthcare workforce, also including doctors, lab techs, therapists, cafeteria workers, housekeepers, and many more roles. Given that we all eventually need healthcare, we will all be impacted by healthcare workforce burnout.
I was motivated. After my recovery, I assembled a team of the smartest people I know, and we set out to identify whether we could determine the causes of burnout and then, given these causes, devise a solution to reduce it. Why were the caregivers — who were engaging in what should or could be the most fulfilling work, human caregiving — burning out with increasing frequency and intensity? Who was most at risk? Was there a way to predict and take action early enough to make a difference?
We studied this issue for over a year talking to more than 150 healthcare staff in over 100 institutions across both the US and UK. We initially focused on nurses but soon expanded our inquiry to all healthcare staff. We partnered to create a first of its kind dataset looking at healthcare staff activities and behavior, and scrutinized it for signals, patterns, and insights. We talked to published academics and subject matter experts. We kept asking questions and testing hypotheses. We did our best to leave no stone unturned.
Then, a breakthrough: we started to hone in on the role of the frontline staff manager. Frontline staff managers exist in the health system across almost all domains from nursing (over 50% of frontline managers are nurse managers) to the laboratory to housekeeping. Multiple avenues of investigation signaled to us that the staff’s manager played a crucial role in the burnout equation. The signals were nuanced: we heard that managers were in control of many of the levers to prevent burnout, but only infrequently directly caused it. We dug deeper.
We learned that managers of healthcare staff have large spans of control, averaging 50:1 (but up to as many as 200:1). There is high variation between managers, since most have been promoted into that role with little training, and there are few ways to share best practices between managers. In our data, which was a large cross-institution data set, we found a correlation between a manager’s span of control, and the rate of turnover and engagement of that manager’s team, when comparing like areas (such as Emergency Departments). In general, the more frontline workers that a manager was managing, the higher the turnover of their staff. Perhaps this is intuitive – as the manager was spread thinner, and pulled away from staff relationships due to administrative work, the less tight the connections can exist between a worker and their manager, or their job, we hypothesized. But the most impactful leverage on the problem (the manager) was, for cost and scarcity reasons, actually getting spread thinner with ever larger spans of control.
This led us toward a solution. What if we could make a large team feel like a small team? What if we used “gentle AI” to automate and make easy much of the administrative work of managing, so that the interpersonal connections could shine? Could we then accelerate and amplify these interpersonal connections by making them easier? Would this make a difference in burnout? In engagement? In retention? In care? Our own front-line team, 15 engineers, two designers and two data scientists accepted the challenge, with humility but gusto.
We built a system that would work within managers’ existing workflows, to make these workflows better, faster, and more effective. We were guided by a panel of ten frontline managers that could support us on a day-to-day basis. These managers came from a wide array of institutions and care settings so that we could focus initially on the common pain points. Together, we identified almost one-hundred administrative management workflows to automate, and we did that. In addition to administrative streamlining, we scoured the literature for best practices to prevent burnout. Through published academic experts, we identified a framework that any manager could apply to better manage their staff. We automated as much of the work around applying this framework as we could. After a few months of very hard work, we had built a system that could both automate administrative duties and turbo-charge interpersonal actions for the manager, making them more efficient and effective, while infusing best practices we had uncovered through our research.
We had created a Staff Relationship Management platform, and we have been building on it ever since, releasing improvements and refinements in sprints, every two weeks. Nothing like it exists (at least that we have found!). We named the platform Laudio, after the Latin word laudare which means “to praise”. Praise is one of the key levers of interpersonal relationships that the platform seeks to optimize. We began deploying this platform a few months ago at an academic medical center (AMC) who wanted to be an innovation leader in the area of engagement, leadership, labor expense, and turnover. And guess what? It works.
At our AMC partner, our platform saved managers hundreds of hours of time while supporting thousands of new interactions with their staff, aided by Laudio’s smart recommendation engine which tee’d up opportunities with the staff that needed it most. The turnover trends of the teams using our platform were 4% lower than the teams not using the platform, which is worth millions of dollars a year in savings for the health system. But the best part was hearing from the managers talking about the positive difference the platform was making for them and for their staff. “It saved me over ten hours last week”, said one manager. “My staff think I am very smart”, said another. “It helps me do what I was already doing, but to do it more consistently”, said a third.
We are now introducing this solution to the broader health system market. This includes ambulatory settings, post-acute, and senior communities. The market is huge and the initial response is strong. Our initial pilots are showing ROI potential as much as 40:1, based on the retention impacts, alone. We hope to see additional impacts in quality and safety as we continue to measure our progress.
We know we are onto something important, and we hope we will be able to make a difference in burnout. How big a difference? Time will tell, but our team is super excited. We thrive on the instant feedback we get from showing this new type of platform to health system leaders. A movement is clearly growing and we are grateful to be part of it. We would love to show it to you, and if you are interested, you can keep up with our progress at www.laudio.com.
Russ Richmond, MD
Founder and CEO, Laudio