November 9, 2023 Building “Early Warning Indicators” for healthcare burnout

An introduction to a practical approach

What it is and why it’s valuable

An “Early Warning Indicator” dashboard shows burnout risk for each department. It is an approach designed to help executives determine where to focus their time and support. One health system uses such a dashboard to inform where a single, centralized “Lean Swat” team focuses their efforts. 

In a paper written and published in late 2023, Simmy King, DNP, MS, MBA, RN-BC, NE-BC, CHSE, FAAN, Chief Nursing Informatics and Education Officer at Children’s National Hospital in Washington DC, and her colleagues shared a pragmatic approach to building such a dashboard. The paper, “Using Real-Time Data to Mitigate Nurse Burnout,” proposes a pragmatic approach using already-available data and was published in AONL’s journal Nurse Leader. The development of the approach was done in partnership with Laudio.

The paper discusses how, while burnout is not a new challenge, today, “unprecedented turnover due to workloads, stress, and burnout and the growing demand for nurses make it necessary for nurse leaders to be equipped with real-time data to affect real-time change.”  

What it looks like

The proposed Early Warning of Burnout dashboard gives executives metrics in three areas:

1. • What percentage of team members float to other departments in 10% or more of their shifts?  
   • What percent of team members are precepting in 20% or more of their shifts, thus balancing the work of both teaching and performing their own clinical duties?  

1. • What percent of team members are in charge in 50% or more of their shifts?

Role Overload  

• • • What percent of team members are clocking in early or clocking out late 50% or more of their shifts?

The cutoff values given (e.g., precepting in 20% or more of shifts) here are examples that are intended to indicate a legitimate workload when applied on top of a full clinical schedule.

What it means for executives

By looking at these indicators for each department every month, specific departments with consistently high values can be prioritized by executive leaders. 

Departments that are trending towards higher metrics can also be investigated, with proactive interventions deployed before the situation is exacerbated.

When burnout indicator values are consistently high, it often indicates departments where the challenges are beyond the manager's scope. Directors, VPs, and executives can offer support by assisting departments that require additional resources or support.

What it means for managers

The underlying data behind these metrics can also be provided to individual managers. One manager discusses how such an approach allows her to intervene locally as well: 

“In our department, we highly value the data and recommendations. We use it to recognize staff for various achievements, such as picking up extra shifts, floating to other units, and acting as preceptors. Additionally, we address staff who consistently scan out late by setting up meetings to understand their reasons... 

Our ability to access data, identify at-risk nurses, and monitor their progress allowed us to intervene effectively… Thank-you emails from our staff and in-person conversations validate the impact of this approach.”

Footnote

• King, Simmy, et al. “Using Real-Time Data to Mitigate Nurse Burnout,” 2023. Published in Nurse Leader. Available at: https://www.nurseleader.com/article/S1541-4612(23)00206-9/pdf