Case Study of How Alleviating "Pebbles in the Shoe" Improves Operations in the Emergency Department

Area of Science:

• Medical Quality Improvement
• Physician Well-being
• Human-Centered Design

Background:

• Physician burnout is a significant concern, exacerbated by minor workplace frustrations termed "pebbles."
• Addressing these workflow issues can enhance clinician well-being and practice efficiency.
• A human-centered design approach was employed to tackle these challenges in an academic emergency department.

Purpose of the Study:

• To enhance clinician well-being in an emergency department (ED) by systematically identifying and resolving workflow "pebbles."
• To implement a human-centered design process engaging clinicians in problem-solving.
• To assess the impact of resolving these issues on clinician well-being.

Main Methods:

• A task force of emergency physicians and leadership was formed to address clinician-submitted "pebbles."
• Clinicians anonymously submitted "pebbles" via surveys and QR codes.
• A bimonthly task force meeting, monthly progress reports, and an anonymous post-project survey were utilized.

Main Results:

• Over seven months, 284 "pebbles" were submitted, with 75% (214) resolved.
• The majority of issues were equipment/supply (40%) and nursing/clinical (30%), with 53% deemed easy to fix.
• Among respondents, 80% rated the project as very to extremely effective in improving well-being.

Conclusions:

• Resolving small, feasible issues identified by clinicians positively impacts well-being and practice efficiency.
• The project demonstrated a low-cost, replicable method for enhancing clinician work environments.
• While equipment and supply issues were most common and easiest to fix, human interaction issues presented greater challenges.