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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…