What’s causing doctor brain drain and how to prevent it

By Alistair Gardiner
Published September 23, 2021

Key Takeaways

We live in a world in which we’re constantly bombarded with information—and the workplace is no exception. According to the authors of a study protocol published in BMC Psychology, our work performance is tied to our ability to process high quantities of information—a task that strains our attention, working memory, and decision-making skills.

As digital technology expands, workplace demands exceed the natural limitations of our cognitive capabilities. Research has found that this type of cognitive strain affects how well we perform tasks. And if your field is medicine, such strain can be harmful, leading to burnout and worse outcomes for your patients.

In medicine, factors like interruptions and performance constraints (for example, unuseful or irrelevant information surfaced at the wrong time or place) predict higher levels of attention failure. Other research has suggested that extraneous cognitive load accounts for a vast majority of individual medical errors.

It’s unlikely that demands on physicians will decrease over time. So what strategies can physicians and health systems use to avoid brain drain, attention split, and burdensome cognitive loads? 

Enter cognitive ergonomics. In this article, we’ll define cognitive ergonomics and explore how it can address the work factors that drain doctors’ brainpower, including “shadow work”—the unseen, unpaid efforts that fill up a physician’s day.

Defining cognitive ergonomics 

Cognitive ergonomics is not an industry-specific concept. In the book Exploring Engineering: An Introduction to Engineering and Design, the 5th edition of which was published in 2021, the term is described as the process by which complex tasks are broken down into small, simple steps, and any needless motions are eliminated—and the precise time each movement requires is measured. 

Cognitive ergonomics is “concerned with mental processes such as perception, memory, reasoning, and motor response, as they affect interactions among humans and other elements of a system,” according to an article published in The Journal of Ergonomics. In short, it means figuring out the best way to make your workflows compatible with your cognitive abilities so you can boost well-being and performance. 

As noted in an article published by the AMA in August of this year, poor cognitive ergonomics is increasingly common in healthcare and has been linked with rising rates of burnout and concerns over patient safety.

Links with patient outcomes

While they have tremendous upside, many of healthcare’s technological advancements were implemented without considering how they might affect clinicians.

For example, the progress made in areas like patient monitoring and EHR connectivity has led to an erasure of typical work hours for some, and a decrease in staffing. According to the AMA article, it’s also led to the creation of “shadow work,” which refers to all the maintenance and operation of this new technology, which often occurs outside of normal working hours.

The result of all of this is twofold: an increase in clinician burnout and a higher risk of subpar patient safety. In fact, one analysis of patient safety found that 87.1% of individual medical errors come down to extraneous cognitive load, while the remaining 12.8% were caused by a lack of knowledge or skill.

A study published in Behaviour & Information Technology provided further evidence to support this position. Researchers examined the decision-making abilities of 20 participants, who were presented with a task that simulates the typical cognitive demands of the analysis of large amounts of data. They found that “accuracy of judgment” decreased as the amount of information increased, and concluded that “limited human cognitive capacity is a true constraint.”

How healthcare organizations can help 

Consider this statement. “A clinician’s brainpower is a limited, highly trained resource. It should be budgeted and optimally used just as you consider budgeting other resources in healthcare delivery.” 

That’s according to Michael R. Privitera, MD, professor of psychiatry at the University of Rochester Medical Center (URMC) and medical director of URMC’s Medical Faculty and Clinician Wellness Program. Privitera and other health care experts tackled the subject of cognitive overload for physicians and what it means for patient safety and physician burnout during an AMA webinar titled, Integrating Organizational Actions Toward Patient Safety and Clinician Wellbeing.  

Factors that lead to cognitive overload and burnout can be addressed at the system level, according to the AMA article. For leadership and staff, “That involves integrating consideration for human factors, such as ergonomics, that affect outcomes in patient safety and the well-being of the physicians and other health care professionals caring for patients.”

One place for organizations to start is by evaluating processes and metrics. If you understand the effects of policies on your physicians’ ability to provide care, you can work to simplify them or remove any unnecessary elements that may slow them down, which will in turn help to reduce shadow work and cognitive load. Implementing standardization across processes and care teams is a good way to approach this, as long as it doesn’t negatively affect patient safety. 

To take this a step further, try consolidating information, so that physicians don’t have to split their attention. And, work to eliminate redundancies, so that clinicians only need to receive information once. Both efforts can increase the amount of attention clinicians can offer to the patient. Putting an onus on how EHR and other systems are designed can help with this—if they’re created in a way that considers user experience and other human factors, they can augment work performance, rather than add to cognitive load. 

Finally, keep in mind that collaboration is vital. The only way to improve cognitive ergonomics is to ensure that all members of clinical staff and leadership are working together to pinpoint wrinkles and opportunities for improvement. Evidence suggests that ironing these out will lead to healthier, happier clinicians, and better outcomes for patients.

For related reading, check out The Surprising Way to Actually Address Physician Burnout on our blog, PhysicianSense.

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