Transcript Resource - The Center for Care Innovations

Bringing Joy Back to Practice
The Case for Care Delivery Transformation
Physicians are Suffering…
“I can’t tell you how defeated I
feel…The feeling of being
punished for delivering good care
is nerve-racking.”
“I hate being a
doctor…I can’t wait
to get out.”
“I am no longer a physician but
the data manager, data entry
clerk and steno girl… I became
a doctor to take care of
patients. I have become the
typist.”
“The joy of
practicing
medicine is
gone.”
Current State: Physician & Staff Burn Out
•
More than half of general internists & family physicians have symptoms of burnout
•
Frustration in not being able to provide the highest quality of care
•
Not enough time or opportunity to build meaningful relationships with patients
•
Dissatisfaction fueled by performing many functions that do not require their professional training.
– Paperwork and administrative hassles
• 87% of physicians named the leading cause of work-related stress and burnout as paperwork and administration, with 63%
indicating that stress is increasing.1
• 43% of physicians surveyed in 2014 reported spending over 30% of their day on administrative tasks.
– Patient time diminished by EHR time
• In the exam room with patients, primary care physicians spend from 25% to 50% of the time attending to the computer.
• In a 2011 survey, over three-quarters of physicians reported that the EHR increases the time it takes to plan, review, order,
and document care.2
Current State: Physician & Staff Burn Out
Practitioners are suffering…
• Loss of enthusiasm
• Feelings of Cynicism
• Low sense of personal accomplishment
Resulting in:
o Early retirement
o Alcohol use
o Suicidal ideation
Staff are suffering…
• Physician and Staff burnout feed one another
• Other care team professionals are impacted by physician dissatisfaction,
as well as their own stressors of patient care.
o Receptionists often feel caught between provider and patient demands, or that
the complexity of their work is unappreciated by the physicians.
o “Front line receptionists have a stressful job, with 68% experiencing verbal
abuse from patients.” 3
o 60% of employees working for health care employers reported job burnout and
34% planned to look for a different job. Complaints included heavy patient
loads, small staffs, and high stress levels.4
Patients are suffering…
• Worse access
• Diminished patient satisfaction
• Lower quality of care & patient safety
o “Dissatisfied physicians are more likely to
prescribe inappropriate medications which can
result in expensive complications.” 5
o “Burnout also leads to lower levels of empathy,
which is associated with worsened clinical
outcomes for patients with diabetes.” 6
o “Patient safety is threatened by nurse
dissatisfaction; many nurses report that their
workload causes them to miss important
changes in their patients’ condition.” 7
• Reduced adherence to treatment plans
resulting in negatively affected clinical
outcomes 8
Impact of Increased Joy in Practice (WIIFM)
team satisfaction /
engagement
patient outcomes and
adherence to Tx plan
Working at top of license
Sharing in more patient
care; engaging in more
meaningful & impactful
ways
staff turnover
working relationships
and communication with
clinicians
professional
development / mentorship
from clinicians (“just in
time teaching”)
Patient
physician satisfaction
scores
patient outcomes and
adherence to Tx plan
Relationships that foster
healing
time on administrative
and non-clinical work
Working at top of license
continuity of care for
patients
turnover in the practice
Staff
Value-Based Payments /
increased revenue
patient volume
patient outcomes
patient experience
Retention of clinicians &
staff
•
errors and
expensive complications
Provider
Leadership
“Joy in practice includes a high level of physician work life satisfaction, a low level of
burnout, and a feeling that medical practice is fulfilling.”
access
outcomes
relationship &
communication with care
team
“What matters most” to
patients is known and
addressed
Provider / Care Team
continuity (Patients get to
see their own care team)
Potential improved
affordability (right number
of visits, etc.)
Getting the right care at
the right time, in the right
place, by the right person
What drives “joy in practice?”
Environment
of mutual
respect
Teamwork
Joy and
meaning
in work
Key questions to consider when assessing environment:
• Am I treated with dignity and respect by everyone?
• Do I have what I need so I can make a contribution that gives meaning to
my life?
• Am I recognized and thanked for what I do?
How to bring “joy” back into the practice?
Innovative Solutions
Problem
Innovation
Unplanned visits with overfull agendas
•
•
Pre-visit planning
Pre-appointment laboratory tests
Inadequate support to meet the patient demand
for care
•
Sharing the care*
•
•
•
•
Expanded nurse or medical assistant rooming protocol
Standing orders
Extended responsibility for health coaching, care coordination, and integrated
behavioral health to non-physician members of the team
Team responsibility for panel management
Too much time spent documenting and complying
with administrative and regulatory requirements
•
•
•
Scribing
Assistant order entry
Standardized prescription renewal
Computerized technology that pushes more work
to the physician
•
•
In-box management
Verbal messaging
Teams that function poorly and complicate rather
than simplify the work
•
Improving team communication through…
•
•
•
•
Co-location
Huddles
Regular team meetings
Improving team functioning
•
•
Systems planning
Work flow mapping
*These roles require 2- or 3-to-1 clinical support per physician.
How to bring “joy” back into the practice?
What does a joyful practice look like?
Effective, high-reliability organizations create safe and supportive work environments
Continuous Learning
Improvement
• Create a learning and improvement system
• Support industry-wide research to design and conduct studies that will
explore issues and conditions in health care that are harming our
workforce and our patients
• Develop and embody shared core values of:
• mutual respect and civility;
• transparency and truth telling;
• safety of all workers and patients;
• alignment & accountability from the boardroom through the front lines.
• Adopt the aim to eliminate harm to the workforce & patients
• Commit to creating a high-reliability organization (HRO) and demonstrate
the discipline to achieve highly reliable performance by
• creating a learning and improvement system,
• adopting evidence-based management skills for reliability.
Teamwork
Transparency
• Recognize and celebrate the work and accomplishments of the
workforce, regularly and with high visibility.
• Establish data capture, database, and performance metrics for
accountability and improvement
Meet your practices where they are!
Don’t aim for the top of the pyramid if you are starting at the bottom…