Posted By Jeremy Blanchard, MD, MMM, CPE, FACP, FCCP and FACPE,
Wednesday, February 1, 2017
Updated: Wednesday, February 1, 2017
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“I was on the inside looking outside. The millions of faces, but still I’m alone… I hope we’ll be here when they’re through with us.”
When I hear Foreigner sing “Long, Long Way from Home,” I am reminded of conversations I have had with my colleagues, physicians and advanced practice clinicians (APCs). The world of medicine is so dynamic and different from when I started medical school in 1987. Many of these changes are good and have great intent, but many of the ramifications threaten core value attributes of our different generations of healthcare providers: autonomy, sacred relationships with patients, complex problem solving and the joy of practicing medicine. In these conversations the providers relate not having a voice, feeling like healthcare is changing without their input, and not for the better. They feel alone and not valued.
Being a caregiver seldom, if ever, starts from the perspective of practicing medicine as a business opportunity. It starts from a place of the desire to do good. As we enter medical school bright eyed, empathic and energized, what happens to us? Or at least how is our showing of empathy and building relationships threatened or compromised?
This blog is my call for action. A call for us, leaders in healthcare and patient experience, to develop a strategy to address the following question. How can we help our physicians and APCs, seasoned and new, from multiple different generations, feel valued and recapture or sustain their joy of practice? It is paramount, because the provider being empathetic, engaged and joyful is pivotal to our family and friends’ quality of care and how they feel when receiving that care (1, 2).
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
- Maya Angelou
The reality of our present American healthcare model in regard to providers is reflected in these powerful statistics.
- 54% of doctors show signs of burnout and only 40% of doctors are satisfied with their work life balance.(3)
- For every 1 hour physicians provide direct patient care, nearly 2 additional hours are spent in activities associated with the Electronic Health Record.(4)
- In one study 52% of medical students suffered from burnout; of those burned out, 35% admitted to unprofessional conduct related to patient care.(5)
- 14% of Internal Medicine Residents rate life “as bad as it can be” or “somewhat bad.”(6)
- 38% of Internal Medicine Residents had personal debts greater than $100,000 dollars (2008 monies).(6)
- 6.3% of participating surgeons had suicidal ideations in the past 12 months.(7)
Physician burnout is real and threatening our whole healthcare system - the quality, safety and compassion of the delivery of healthcare.(8) Burnout is not just among older physicians or surgeons; it is across the whole spectrum of healthcare. In Maslach’s Burnout Inventory Manual, he states, “Burnout is a syndrome of emotional exhaustion, loss of meaning in work, feelings of ineffectiveness and a tendency to view people as objects rather than as human beings.”(9)
When considering this subject there is a complementary way of looking at it that I find valuable. In each of the above statistical bullet points there are multiple challenges accumulating to depersonalize and overwhelm the provider. But what if we were to focus on how we support these courageous and valuable members of the healthcare team? Instead of focusing on burnout, reposition ourselves and focus on developing resilience, investing in our providers to help them find their joy, recapture their personal and cultural value. The following are conversation topics I believe we need to discuss now to answer this call to action. Here are statements to serve as an agenda for generative conversations and next steps to action.
- Interventions for burnout need to be as multi-factorial as the causes. The etiologies of burnout for my generation of providers, compared to the millennial provider, may have the same or different root causes. Recognizing the differences in generations allows for more impactful and valuable interventions.
- Costs in healthcare live in silos with their relationships unrecognized or declared. A key to making this a prioritized conversation is identifying the price tag to this epidemic. The cost shifts this conversation from the doctor’s and APC’s problem to the CFO’s and CEO’s problem.
- We need senior leadership in health care to recognize and quantify the hidden opportunities of investing in our providers. Data shows doctors who have sustained empathy and joy provide safer care and a better patient experience. In population health models this translates to increased revenue.
- It is proposed with future physician shortages, APCs will have a greater impact on care delivery, healthcare revenue and patient experience; that “future” is now. We need to create systems that recognize the APC as a unique member of the healthcare team.
- With the changes taking place in healthcare we need to assure the new paradigm of excellent care outcomes (the quadruple aim) - enhancing patient experience, improving population health, reducing costs and improving the work life balance of those who provide care.(10)
- A happy physician or APC costs the institution much less in legal fees, mistakes, nurse turnover, etc. How do we help our medical culture apply the resources to address major causes of burnout and to support the development of resiliency programs?
- Essential to a successful navigation of our healthcare future is identifying communication as an advanced healthcare competency. It deserves the same attention as the mastery of procedural skills, knowledge base and work flow.
The time is now and the “who” is us. If we do not begin to have these conversations and change the perspective of healthcare, our “default” future is one of: not enough healthcare providers, increased healthcare costs and a loss of the “sacred” relationship between the noble men and women who care for patients. This conversation is focused on physicians, but applies to all who touch a patient’s life. Won’t you join me?
- Lucian Leape Institute. Through the Eyes of the Workforce: Creating Joy, Meaning and Safer Health Care. Lucian Leape Institute of the National Patient Safety Foundation 2013.
- Beach M, Sugarman J, et al. Do Patients Treated with Dignity Report Higher Satisfaction, Adherence, and Receipt of Preventive Care? Annals of Family Medicine 2005; 3:331-8.
- Shanafelt T, Hasan O, et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clinic Proceedings 2015; 90(12):1600-1613.
- Sinsky C, et al. Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties. Annals of Internal Medicine 2016; 165(11):753-760.
- Dyrbye L, Massie F, et al. Relationship Between Burnout and Professional Conduct and Attitudes Among US Medical Students. Journal of the American Medical Association 2010; 304(11):1173-1180.
- West C, et al. Quality of Life, Burnout, Educational Debt, and Medical Knowledge Among Internal Medicine Residents. Journal of American Medical Association 2011; 306(9):952-960.
- Shanafelt T, Balch C, et al. Suicidal Ideation Among American Surgeons. Archives of Surgery 2011; 146(1):54-62.
- Shanafelt T, Balch C, et al. Burnout and Medical Errors Among American Surgeons. Annals of Surgery 2010; 251(6):995-1000.
- Maslach C, et al. Maslach Burnout Inventory Manual, 1996.
- Bodenheimer T and Sinsky C, From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine 2014; 12(6):573-576.
Jeremy R. Blanchard, MD, MMM, CPE, is a Chief Medical Officer at Language of Caring. Grounded in healthcare realities and aspiring to partner with others committed to healthcare transformation, Dr. Blanchard is an expert in ensuring physician development, commitment and wholehearted engagement. A dynamic speaker, skilled facilitator and coach, he provides tailored programs for medical staff, coaches individual physicians, and partners with physician leaders to assess needs and implement physician engagement strategies.
Posted By Paul Westbrook,
Friday, June 12, 2015
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In the first article of this series entitled, "A Thin Line, The Nature of Care,” we discussed the inherent challenges discovered in our three-year patient experience transformation at Inova Health System. Our commitment to addressing those challenges, by focusing on hospitality principles was addressed. In the third and final section, we will present, "The Return on Hospitality,” indicating the objective and measurable success we’re achieving. Today, in this second installment, "Of Heads, Hearts and Hands,” the call of moving from the head – to our hearts and hands, from plans and strategies to actions and tactics is examined. As we get started, enjoy this quote:
"A person's most useful asset is not a head full of knowledge, but a heart full of love… and a hand willing to help.” – Anonymous
As we commenced our journey of patient experience transformation at Inova Health System, our first objective was to re-examine strategies and tactics, of uniting heads, hearts and hands in fulfilling the Inova Promise. The initial SWOT analysis revealed sobering realities and opportunities for growth. Through the valuable introspection of the newly formed Patient Experience Transformation Team, it was determined that the most effective channels for change would be to re-inspire five core work streams. This system-wide evolution across core work systems continues today at Inova as we embrace and fulfill our promise:
"We seek every opportunity to meet the unique needs of each person we are privileged to serve – every time, every touch.” – Inova Promise
The Five Core Work Streams
- Culture.The heart of the matter of service excellence in healthcare is creating a culture that endures across all care areas and locations. With a passionate commitment to our promise, we embody a culture of making emotional connections. Where service is individualized. Where every action is built on intentionality and purpose – in an atmosphere of mutual respect.
- Communication.Information is power. Through open communication about mission and vision, staff members are empowered, have a sense of pride and see their roles as critical in the delivery of care. Leaders convey inclusion and respect by sharing insights through multiple channels such as recognition meetings, huddles, executive rounding, newsletters, blogs and other media. Consistent and cohesive communication is foundational to building a culture of shared values.
- HR Processes.To be the best, we strive to attract and retain the best. Through a combination of behavioral interviewing and setting the expectation early, we commit to attracting, selecting, orienting, on-boarding, rewarding/recognizing and nurturing the best people we can find, keeping a constant focus on the balance between talent and cultural fit.
- Leadership Development. Healthcare leadership requires clinical excellence coupled with interpersonal and administrative acumen. We foster well-rounded excellence in medical competence and leadership that invites and inspires and that is engaging, efficient and effective.
- Service Excellence. Our day-to-day engagements include developing champions and driving service essentials like rounding, white board completion and shift-to-shift handoffs. Moreover, we consider one another as internal customers and endeavor to pleasantly surprise each other and our patients with the unexpected anticipation of needs and desires.
The patient experience at Inova Health System embodies a three-stage effort of 1.) Approach 2.) Deployment and 3.) Results. As I’ve discussed the deployment of action through these five core work streams, the next blog post of this three-part series will present the results – results that illustrate a system’s integration of "heads full of knowledge,” and "hearts full of love and hands willing to help.” I will share results that show the impact of a system-wide transformation of service to those "we are privileged to serve – every time, every touch.”
*This is the second piece of a special three-part guest blog series focusing on various components of patient experience excellence, including patient and family care, culture and leadership and employee engagement. Read Part 1 and Part 3 here.
Paul is the Vice President of Patient Experience at Inova Health System. Prior to joining Inova, Paul began his service delivery consulting company, Westbrook Consulting, LLC, with the mission of transferring his 35 years of hospitality service in branding, strategic deployment, and operations to other service industries, to give back to his community and make a meaningful difference in peoples’ lives. Paul is also part of The Beryl Institute's Patient Experience Executive Board.
Posted By Diane W. Shannon,
Monday, February 10, 2014
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As a primary care physician, I saw firsthand that the patient experience was not always optimal. Patients were often frustrated by miscommunication or by inefficiencies in the system. And they weren’t always given the respect and focused attention they deserved.
As for me, I burned out trying to provide compassionate care in the system as it was in the 1990s. I chose to leave after just three years of practice. In my second career, as a freelance health care writer, I have come to understand some of the large-scale factors that undermine an ideal care experience, such as a less-than-ideal organizational culture and traditional hierarchies that hinder open communication.
I’ve also come to appreciate that the quality of the patient experience is hugely dependent on the condition of the interface with the care provider. An optimal patient experience requires that both patient and care provider are able to show up at their best—the patient is informed, activated, and engaged and the care provider is empathetic, communicative, and respectful. For the provider half of that dyad to be fully present for that connection, he or she must be well.
And yet almost half of physicians have one or more symptoms of burnout. Burnout is a tragedy for providers who walk away from their chosen profession, for those who remain yet work at diminished potential, and most of all for patients. How can I show up to listen, to be present, to offer the best of myself as a clinician when I’m stressed to my limits as a human being? This isn’t the kind of professional life clinicians want and it’s not conducive to the kind of experience patients deserve.
What’s the solution? Providers can take steps to care for themselves, like meditation and practicing mindfulness. But no degree of self-care will completely inoculate providers from burnout in a system that fails to recognize the humanity of both patients and caregivers. Fortunately, researchers have identified specific factors in the practice environment that predispose to burnout, such as time pressure, lack of control regarding work, and insufficient resources.
Payment reform offers a unique opportunity to address these factors. As doctors and hospitals are increasingly paid to provide better care rather than doing more procedures and ordering more tests, there will be a greater incentive to invest in systemic changes to support better outcomes.
Done right, these changes can reduce burnout. For example, hospital executives can negotiate with payers to pay for important services, such as e-visits, that put extra strain on providers because these items are rarely covered under the fee-for-service payment structure. Leaders of physician group practices can hire additional clinicians to reduce to each provider’s patient panel to a reasonable size. They can support part-time positions and job sharing, allowing care providers with young children or elderly parents to scale back when needed. These steps will require an upfront investment, but will reap large dividends for both providers and patients.
To improve the patient experience, we must respect the humanity of those providing care. As a primary care physician said to me recently, "If we want caregivers to give, we must first care for the caregivers.” Common sense? Yes, yet a relatively unchartered area that offers a valuable opportunity to accelerate improvement and ensure that every patient receives the kind of care that we all want: care that is high-quality, safe, and compassionate.
Diane W. Shannon, MD, MPH is a freelance writer who focuses on improvement in health care. She lives in Massachusetts.
Posted By Diana B. Denholm, Ph.D.,
Monday, December 2, 2013
Updated: Wednesday, November 27, 2013
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Reading Dr. Wolf’s Patient Experience blogs, we learn the importance of involvement in order to achieve excellence, that patients are partners and that we are the patient experience. Whether we’re actually the patient, or part of family or professional care teams, we all make up the patient experience. While instituting change may be arduous, if we see a problem, I believe it’s our responsibility to try to do something about it. We need to get involved and propel that move toward excellence – even if life has thrown lemons at us – or maybe because it has.
In 1999 my husband, John, received a heart transplant at a major teaching hospital. While in intensive care, he was intubated and was put in hand restraints so he couldn’t pull out the tube. Although it was still within his reach, his nurse call button was broken. Although the walls around him were glass, his charts were taped to the window blocking all view of his face. Then something went wrong - and he started choking. He was in distress, frightened and in danger - and he couldn’t get anybody’s attention to help him. Here in one of the finest teaching hospitals in the world, my husband had no way to signal for assistance. It was horrible for him.
I’ll never forget how panicked he was when I came into his room and discovered this inexcusable circumstance. I’ll never forget how appalled and angry I was that this had happened to my Darling John! What a horrific patient experience!
Once out of danger, he was given a piece of paper with the alphabet on it and told to point to letters to spell out what he wanted to say. This ridiculous method was infuriating. Yet, any time you or your loved ones are hospitalized, you face the possibility of encountering similar frustrating, frightening and dangerous circumstances because patient communication methods are often sorely inadequate. This shouldn’t happen to you, nor to those you love and care about.
Rather than citing the hospital for negligence, I did something more constructive and more important. I invented a patient concierge system to help every hospitalized person, you and your loved ones, have a better and safer patient experience.
Of course you want to have your loved ones close when you are ill, and loved ones want to be close to you. Yet visits aren’t always allowed. My secretary had a heart attack and was hospitalized for several months. Because she had a trach tube, written notes were her only form of communication. She was in a long-term relationship, but her gentleman friend was not allowed to visit because he wasn’t a relative – thus creating a greatly diminished patient experience for her. Picture your cell phone and computer in 1999 and you’ll quickly remember how difficult it was to communicate with anyone – even if you could get cell service. So, technology didn’t even provide a serviceable option. As a board certified medical psychotherapist, I know these loving interactions are crucial to a compassionate experience and to creating the most beneficial healing environment.
Instead of focusing just on the needs of the professional care team, which was the norm for hospitals for many years, the focus desperately needed to be shifted to patient-family centered care practices providing direct access links to care staff, support services, food services, and family and visitors. Though it’s taken many years since this 1999 incident, we’ve seen the tide begin to turn making the patient experience and patient satisfaction so fundamental that reimbursements are now linked to them. Patient partnering and involvement are what turned that tide toward an excellent patient experience.
Diana B. Denholm, Ph.D., an internationally recognized caregiving expert, is the inventor of myPAL™ – Patient Access Links and the author of The Caregiving Wife’s Handbook (www.caregivingwife.com) which is endorsed by the AARP, National Council on Aging and Mental Health America. She currently writes for Psychology Today, Stroke Network, PBS and a variety of print publications. She may be reached at email@example.com.
patient centered care