All 26 key actionable interventions suggested by GIM and ED physicians to reduce burnout, listed in correspondence to the emerging themes
| Theme | Suggested intervention |
| Interruptions and noise | 1. “We need to alert the public to how they’re supposed to behave in an emergency department or where they’re accepting patient care in the hospital. Because that kind of behavior is not even acceptable, like at a family doctor’s office or at the dermatologists.” (ED) |
| Heavy workload and scheduling | 2. “A communication app, where individuals would sign-in to their role in the hospital every given day” (GIM) 3. “Having a hospitalist to help with the load” (GIM) 4. “A way to redirect phone calls so that they’re batched or prioritized.” (GIM) 5. “Flexibility in scheduling… having locums to take unwanted call shifts/weekends” (GIM) 6. “Post-call days or wellness days” (GIM) 7. “Rather than us calling five different (people) there should be a service that takes like a hospitalist service - it’s expensive, but it’s an easy, low-lying fruit that is contributing to our burnout, for sure.” (ED) |
| Interdepartmental conflict | 8. “Develop sort of interdisciplinary or cross cultural, cross disciplinary teams of physicians that work together so that we can actually work with them instead of always working against them(…)like an internist, a GP, a nurse practitioner sort of all working together, instead of just being entirely internal medicine and keeping everybody at bay.” (GIM) 9. “Cultural change within surgical services(…)more buy in from higher ups in terms of surgical services, like accepting the actual surgical issues(…)it would be nice for the surgical services to take ownership of their patient.” (GIM) 10. “Defining boundaries of our specialty (ie, admission criteria)” (GIM) 11. “Developing personal connections with colleagues, particularly those in the emergency department and amongst other specialties can help to reduce stress and improve patient care.” (GIM) 12. “Having an unbiased clinician to resolve challenging dispositions disputes of patients in the ER.” (GIM) 13. “Culture change to accept that that when someone’s on call there should be expected to receive phone calls at two in the morning or three in the morning, just like just like we do when we’re awake there.” (ED) |
| Bureaucracy and inefficiencies | 14. “More computers would be nice, but also coming up with a system where there’s some leeway for order entry or verbal orders.” (GIM) 15. “Reducing the amount of administration with order entry with Cerner.” (GIM) |
| Non-physician roles | 16. “Hire extra staff on the wards so that that could reduce our administrative burden. And so that we can focus on the practice of medicine (ie, social worker, housecleaners, porters)” (GIM and ED) 17. “Have a chronic clinical associate or like nurse practitioner on each team.” (GIM) 18. “Workforce planning and hiring enough people for the future.” (GIM) 19. “Have people ED to help (patients) fill out the paperwork for housing, get them better clothes, get them better food.” (ED) 20. “A social/behavioural ICU” (ED) |
| Patient experience in the waiting room | 21. “Having a quiet workspace, nice aesthetic workspace, places to meet, places to talk with patients and families, less cluttered hallways, all of these things contribute to the fatigue of the day.” (GIM) 22. “Waiting room better staffed, maybe with someone who’s looking after these patients, watching out for, you know, signs of people escalating, people becoming more violent.” (ED) |
| Financial structures and remuneration | 23. “Recently on CTU, we moved off of the set amount (during COVID) and back to fee for service. And I’ve never seen the teams look happier when we’re on a set amount of money… you had more time to teach, more time to look after patients. And we were in the thick of COVID, with no vaccinations. And I’ve never seen my faculty and teams actually look more satisfied… So, I think we still need to find some funding model that is equitable for the time spent, not the clinical load, but the time spent. And that would then allow us to spend more time with our residents with our patients and spread the load.” (GIM) 24. “Improving remuneration to attract fellows to live/work in Vancouver.” (GIM) |
| Violence against physicians | 25. “Physical barriers to actually protect (physicians).” (ED) 26. “Offsite opiate overdose (and) sobering units” (ED) |
ED, emergency department; GIM, general internal medicine.