December 2022 Faculty Development Tip
December 2022
Maria Egger, PA-C

Fostering Team Problem Solving and Learning as an Antidote to Burnout

Several weeks ago, I was listening to members of our healthcare team trying to determine the cause of a deficiency in routine patient care.  A patient has been found lying on a clean bedpad on top of soiled sheets.  The patient’s caregiver had admitted that she was unable to transfer the patient herself and did not want to leave the patient on soiled bedclothes; working solo she was able to clean the patient and get her onto a dry pad until she could get help with moving the patient out of bed.  This care team member commented that in a previous healthcare setting all routine patient care was performed in teams of two people and wondered if that system should be started in this facility to work more efficiently and provide optimal patient care.  The team leader agreed that this may be a better system, but no movement was made to develop ways to try out the idea.

Key points

  • Short-term, first-order problem solving is not enough to support healthcare team well-being and contributes to burnout.
  • Strategic, second-order problem solving can provide long-term sustainable solutions to systemic problems
  • Second-order problem solving involves participation and learning from the entire team, both leaders and members.

This situation just described illustrates two forms of problem solving.  The team member making up for the lack of assistance to safely transfer the patient demonstrated first-order problem solving.  First-order problem solving occurs when team members compensate for lack of resources or supplies with short-term fixes.  The problem at hand was solved, at least temporarily, but no systemic action was taken to prevent this problem from recurring.  While there may have been some short-term caregiver satisfaction in devising this workaround, repeating problems requiring subpar solutions will lead to mounting frustration, resentment, and burnout.(Tucker & Edmondson, 2003)

The team member suggesting a broader change to teamwork and workflow exhibited second-order problem solving.  This type of problem solving includes communicating to team leaders the problem and suggesting ideas about possible cause and solutions.  Effective second-order problem solving leads to team member inclusiveness, learning, increased job satisfaction and in the healthcare setting better overall patient care. For second-order problem solving to be successful team members must feel psychologically safe and empowered to admit mistakes and suggest solutions.  Team leaders must be approachable and visible to team members and actively encourage members to think about and voice possible solutions to problems.  All disciplines must be willing to “reach across the aisle” and be willing to modify practices or workflow to achieve the desired result.  Leaders must be willing to put in the time to organize and facilitate suggested solutions, involve the team in learning from trial and error, evaluate results and revise solutions.  (Tucker & Edmondson, 2003)

Even prior to the COVID pandemic burnout among healthcare team members was a serious problem.  Statistics published in 2015 cited rates as high as 37% of nurses and 60% of physicians contemplating leaving their profession Poorly designed systems and staffing shortages create a vicious cycle of increasing demands on time and resources contributing to caregiver fatigue in the healthcare workplace (Perlo & Feeley, 2018). Empowering the entire interdisciplinary healthcare team, both leaders and members, to be resourceful and innovative, to arrive at self-directed long-term solutions to systemic problems can preserve a sense of well-being, forward thinking and confidence in delivering optimal patient care.

Perlo, J., & Feeley, D. (2018). Why focusing on professional burnout is not enough. Journal of Healthcare Management, 63(2), 85–89.

Tucker, A. L., & Edmondson, A. C. (2003). California Management Review Why Hospitals Don’t Learn from Failures: Organizational and Psychological Dynamics that Inhibit System Change.

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