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Oncology Team Well-Being

Mini-Z Survey Results

Results from Mini Z Burnout Survey

To gauge the level of burnout in the multidisciplinary cancer care team, ACCC recently surveyed its membership using the clinically validated Mini Z survey developed by the American Medical Association. While only a small number of respondents (14.9%) report dissatisfaction with their current job, burnout and stress levels are significant.
Download Survey Infographic

Cancer Buzz Podcast

Other ACCC Resources

ACCC Institute for the Future of Oncology

The sixth annual ACCC Institute held in Washington, D.C., on June 27, 2018, convened more than 30 experts in cancer care, wellness, and resiliency to share insights on what is fueling burnout among members of the cancer care team and what needs to happen on both on both a micro and macro level to support and improve team well-being. The day-long forum discussion focused on ACCC President Tom Gallo’s 2018-2019 presidential theme: Reflect, Renew, Reignite: Creating a Resilient Oncology Team in Your Community.
Read the Executive Summary


Breaking Down Silos: Revenue Cycle Tiers Increase Efficiency and Reduce Waste
By Pamela R. Proman, MBA, RTT; William D. James, MHA; and Nancy H. Johnson, MSM

After a review of key performance indicators, including charge lag, month-end close, patient registration, and insurance identification and verification, this cancer program leveraged its EHR and billing data to identify actionable areas for improvement. Four primary impacts of silo mentality were identified: resource waste, incorrect denials, reduced cash flow, and increased risk for financial toxicity. Performance improvements were prioritized using a matrix to grade urgency and importance.
Read Article


Culture, Resiliency, & Work: Deep Dive Workshop Recap

April 08, 2019
Employee surrounded by paperwork

Although nearly three-fourths of respondents to a 2019 ACCC survey of its membership reported "overall satisfaction" with their current position, nearly 59 percent said they either "agree" or "strongly agree" with the statement: “I feel a great deal of stress because of my job.” Fifty-six percent ranked the atmosphere in their primary work area as a “4” or “5” on a scale of 1 to 5, in which 1 is “calm” and 5 is “hectic, chaotic.” Perhaps most concerning, 41 percent described their workplace as “unreasonably busy,” and 33 percent said they are “definitely burning out.”

With these responses in mind, Linda D. Bosserman, MD, Assistant Clinical Professor at City of Hope in Duarte, California, and Kathleen LaRaia, MS, Executive Director of Oncology Services at Munson Healthcare in Traverse City, Michigan, offered some strategies to oncology leaders for addressing workplace burnout. During a workshop at the recent ACCC 45th Annual Meeting & Cancer Center Business Summit, Dr. Bosserman and Ms. LaRaia described some of the reasons behind the rise in burnout among members of the cancer care team and shared a some tactics to help restore workplace resilience.

Staff burnout can take a significant toll on patient care and clinician well-being. In her March 22 presentation, Dr. Bosserman described a recent American Medical Association report that found that with each percentage point increase in physician burnout, the likelihood that physicians will report a medical error increases 3 percent to 10 percent. On a personal level, physician burnout correlates with higher rates of work dissatisfaction, divorce, depression, alcohol and drug abuse, and even suicide.

Dr. Bosserman and LaRaia say the main drivers of burnout in today’s cancer care environment stem from five key causes:

  • Excessively high workloads caused by high volumes of data entry, documentation, and patient visits
  • Workplace inefficiencies caused by poor processes, heavy patient volume, and delays in obtaining authorization for patient therapies
  • Loss of meaning in work resulting from more time spent on data entry and less time spent with patients and colleagues
  • Social isolation in the workplace due to siloed eletronic healthcare record (EHR) entry and paperwork
  • Pressure to prioritize corporate values over personal values

To address the trends in healthcare delivery that are dragging down employee morale, Dr. Bosserman said City of Hope gave its staff members surveys that asked them to identify their specific stressors and suggest ways to ameliorate them. In a 2018 survey, 73 percent of 92 respondents reported symptoms of burnout. Respondents said that significantly contributing to their burnout was the amount of time they spent documenting their work in their EHR. Seventy-four percent said their proficiency in using their EHR was marginal to poor, and 47 percent said they spend moderately high to excessive amounts of time entering data into their EHR while they are at home. Accordingly, the top two strategies survey respondents identified to reduce their stress levels were improving workplace efficiencies within their teams and reducing the clerical burden of EHRs.

City of Hope responded to these staff concerns by addressing inefficient workflows and processes and providing additional EHR training. Although these remedies adopted a multi-pronged approach to decrease and streamline workloads, City of Hope found that even small changes could make a big difference. A faster, seven-second log-in to the EHR system saved an estimated 9,100 provider hours per year. A transition to team-based care and a medical scribe pilot program are currently underway at City of Hope to further address the inefficiencies staff members identified in the survey.

After presenting, Dr. Bosserman and LaRaia invited workshop participants to identify what their organizations should stop doing, start doing, do less of, and do more of to address workplace stress and burnout. Among the responses were:

  • Stop: gossiping, implementing fixes before a problem is understood, scheduling meetings without a clear agenda
  • Start: giving permission for self-care, attending professional gatherings, working as a team, measuring burnout regularly, learning to use the EHR more efficiently
  • Do less: scheduling meetings, answering email at night, spending excessive time on the EHR, working on weekends
  • Do more: mentoring younger staff and clinicians, building relationships across departments, socializing with staff, developing team-based processes and data-entry.
The drivers of burnout in healthcare are multi-faceted. While there is no simple fix, as City of Hope learned by asking, listening, and taking action, even small changes can turn down the heat.

If your cancer program or practice has an innovative program that addresses wellness and resiliency in the workplace, we want to hear from you. Email to share your story.

From Oncology Issues

  •  Can You Hear Me Now?
    Kimberly Smith, MPHA
    After integrating voice recognition software with its EMR, Mount Sinai Health System reduced physician workload, improved patient care, and streamlined clinic workflow. Physicians and staff shared that this process improvement initiative also improved their well-being, freeing clinicians up to spend more time doing what they want to do—caring for patients.
  •  Caring for the Caregiver
    April Alexander, MSW, LCSW, OSW-C, et al.
    A holistic Self-Care and Resiliency Program for Oncology Professionals has helped to decrease oncology staff burnout rates. Key components include Patient Remembrance Ceremonies, staff support groups, educational opportunities, and social events.
  •  Breaking Down Silos
    Pamela R. Proman, MBA, RTT, et al.
    Using its EHR and billing data to examine key metrics—including charge lag, patient registration, and insurance verification—the Nancy N. and J. C. Lewis Cancer & Research Pavilion at St. Joseph’s/Candler identified four key effects of the “silo mentality” on its cancer program. Focusing on efficiency and urgency, the program broke down its silos, reducing waste and incorrect denials, improving cash flow, and alleviating patient—and program—financial toxicity.
  •  Utilizing Scribes to Improve Patient-Centered Care and Efficiency and Reduce Burnout
    By Amy Hindman
    More oncology programs across the country are hiring scribes in their practices to improve patient-centered care, reduce physician burnout, and create administrative efficiencies.
  •  Caring for the Caregiver
    By ACCC Editorial Staff
    Dr. Farley directs Christiana Care Health System’s strategy to promote the professional fulfillment and personal well-being of its caregivers—and, subsequently, its patients.
  •  Burnout Prevention & Education
    By Monique Dawkins, EDD, MPA, et al.
    Being aware of how burnout manifests itself can help supervisors and staff identify the condition early.
  • Small in Stature, Large in Impact
    By ACCC Editorial Staff
    Caring for patients with cancer is inherently stressful, but many cancer team members say that their difficulties go beyond the expected emotional strain. Robin Hearne, RN, MS, director of Cancer Services and Chronic Disease Care at The Outer Banks Hospital, elaborates on the burdens of bureaucracy and shares the programs she’s developed to provide staff with necessary tools for patient and self-care.
  • Removing the Blame from Burnout
    ACCC Editorial Staff
    Burnout among U.S. healthcare clinicians is a national concern, and cancer care is no exception. To gauge the level of burnout in the cancer care team, ACCC surveyed its membership and created a hub for team well-being resources.
  • One Best Practice: Streamlining Workflow, Unifying Staff, and Reducing Redundancy
    Elizabeth Koelker, MHA, FACHE
    When Kettering Health Network reorganized its operations by service lines, oncology had major problems—internal competition, communication deficits, inefficiencies, and a lack of infrastructure. Learn how Kettering united its oncology staff under “one best practice,” streamlined operations, increased patient volume, and decreased internal competition.
  • Turning Off Turnover
    Tom Gallo, MS, MDA
    Though stemming burnout at the source is vital work, it is also important to recognize and alleviate symptoms as they appear. One such symptom is decreased workforce retention.

Burnout is on the rise as oncology becomes increasingly complex with new treatment options, growing financial toxicity, an aging patient population, and an increasingly burdensome healthcare system. It has received much media attention, with some calling it an epidemic.

Thomas A. Gallo, MS, MDA, ACCC President, selected his 2018–2019 president’s theme: Reflect, Renew, Reignite: Creating a Resilient Oncology Team in Your Community, in order to shed light on the pain points that frustrate physicians, nurses, social workers, administrators, pharmacists, and all of the other professionals who collaborate to provide the highest level of patient care.

The ACCC 35th National Oncology Conference, October 17 – 19, in Phoenix, AZ, featured stories and strategies for fostering resilience and a healthcare culture that mitigates burnout among all members of the cancer care team. Three featured speakers inspired while providing practical strategies to help increase engagement, transform your work culture, and embrace experimentation. 

6 essential standards for a healthy work environment

ACCC is committed to identifying shared strategies and solutions to help combat the burnout and frustration that many of its members experience. This Building a Resilient Oncology Team: Issues and Solutions infographic details key findings on clinician burnout and a bevy of solutions to help you mitigate stress and bring the joy back to your workplace. 
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