How to Sift Through "Pebbles in the Shoe" to Alleviate Frustrations in Your Emergency Department

A “pebble” problem is a small, yet significant, issue in the workflow that causes frustration but is relatively easy to fix in terms of time, money, and process. Addressing these "pebbles" has been shown by the American Medical Association to help reduce physician burnout. By collecting and processing pebbles, healthcare organizations listen to team members and prioritize solutions to promote organizational change. Solving these problems can positively impact a workday and follow the human-centered design principle, allowing emergency physicians to provide feedback on their environment. While burnout solutions vary, this project can be adapted to academic, community, and rural emergency departments. In this session, participants will learn about the “pebbles in the shoe” project, including an in-depth example from an academic emergency department. Specific strategies for success from team leaders and local wellness champions will also be shared. During the interactive portion, participants will plan a “pebbles” project for their departments, considering either the individual or leadership perspective. They will have the opportunity to share plans, address potential roadblocks, and prepare to implement solutions at their institutions.

Learning Objectives:

Upon completion of this session, participants should be able to:
  • Demonstrate the concept of the AMA-defined "pebbles in the shoe” problems that lead to physician burnout.
  • Discuss how a human factors engineering approach to the “pebbles in the shoe” project can improve workflow operations in the emergency department and serve as a systems-based intervention for burnout.
  • Utilize a worksheet to assemble a team to start a "pebbles in the shoe" project to improve workflow operations in their own emergency departments that is set up for success.

Presenters: 

  • Diana Savitzky, MD
  • Yash Chavda, DO, MBA, FPD-AEMUS
  • Suchismita Datta, MD
  • Alexandra Reens, MD, FACEP
Authors

  • Diana Savitzky, MD

    NYU Langone Health

    Diana is a core faculty physician in Pediatric Emergency Medicine, and an assistant clinical professor at NYU Grossman Long Island School of Medicine. She completed her Pediatrics residency at UCLA and Pediatric Emergency Medicine fellowship at Cohen Children’s Hospital at Northwell. In addition, she is the current chair of the ACEP Wellness Section (2024-2025), and has presented regional and nationally on the topic of physician wellness. She co-founded and currently co-chairs the Hospital-Wide Committee for Professional Health and Well-Being at the NYU Grossman Long Island School of Medicine and serves on the Executive Committee to consult with the Dean. Within the Emergency Department she serves as the Director of Wellness for Faculty and GME. She is a wife and mom of 2 young girls, 3 and 5 years old. When Dr. Savitzky isn’t working or solving world peace, she likes to treat travel and taking vacation like a contact sport and loves to chase sunsets.

  • Yash Chavda, DO, MBA, FPD-AEMUS

    NYU Langone Hospital-Long Island

    Dr. Chavda is the Director of Emergency Ultrasound at NYU Langone Hospital - Long Island. He completed his residency and chief residency at St. Barnabas Hospital. He did an academic Fellowship with All NYC EM. Dr. Chavda completed his ultrasound fellowship at North Shore University Hospital. He has presented on various topics at the local, regional, and national level.

  • Suchismita Datta, MD

    NYU Grossman Long Island School of Medicine

    Suchismita [Suchi] Datta, MD is an emergency medicine attending physician at NYU Long Island Hospital. She is core faculty for the residency there, and also serves as the Director for Emergency Medicine Research. Dr Datta in interested in medical education innovations and research, particularly in medical humanities. Her other interests include gender equity and wellness. Dr Datta obtained her medical degree and did her residency training at SUNY Stony Brook.

  • Alexandra Reens, MD, FACEP

    NYU Langone Hospital - Long Island

    Alexandra Reens is an EM/PEM physician who also proudly serves as the director of Pediatric Emergency Medicine at NYU Langone Hospital - Long Island in Mineola, NY. She went to medical school at SUNY Stony Brook and did residency training at North Shore University Hospital in Manhasset and fellowship at Cohen Children's Medical Center in Queens. She is a core faculty member for the Emergency Medicine residency at NYU Grossman Long Island School of Medicine. She serves in both the emergency department-wide and the hospital-wide wellness committees.

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