Background Studies show that system inefficiency and processes that take away from the joy of medicine contribute to burnout. Using the Hawaii Pacific Health model, a program was established to allow for end user feedback concerning processes that contribute to workload.

Objectives Identify system processes and policies that increase work burden, produce redundancies, affect patient-safety, reduce satisfaction, or could be performed more efficiently by eliciting end user feedback. Provide evaluation of identified processes to then produce meaningful system change reducing workload where possible.

Methods Submissions were received by email or by entry using the Service Now platform from end users. Initial scope was for providers only with expansion to clinical administrators after 6 months. Requests were categorized by project team and variables assigned based on patient safety, provider burnout, similar prior requests, and whether the request could be completed quickly. Evaluation of each request was then directed by the project team with involvement from subject matter experts and other resources when necessary. Upon completion, project assessment remains necessary, resulted in education, removal, or change was completed by the project team. Evaluation of project was performed at 2 years post release.

Results During the initial 2-year project, 563 total requests were received with a closure rate of 97.9%. Closed requests resulted in process change (25.9%), removal (0.6%), deemed necessary (40.7%), education (32.78%), and lack of response (2%). Requests were categorized as relating to the EHR (70.9%), pharmacy (2.3%), documentation (4.9%), compliance, (1.8%), workflows (6%), billing or coding (2%), forms (1.3%) and other (11.3%).

Conclusions Programs to identify and evaluate processes that reduce the joy of healthcare can result in significant opportunities for change (58% of requests in this project) via process change or elimination and education of team members on existing processes that are efficient.