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Sustaining and Embracing Our Physicians and Advanced Practice Clinicians: Conversations We Need to Have

Posted By Jeremy Blanchard, MD, MMM, CPE, FACP, FCCP and FACPE, Wednesday, February 1, 2017
Updated: Wednesday, February 1, 2017

“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.”
- Foreigner

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.

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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)
  6. 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?
  7. 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?

Bibliography:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. Shanafelt T, Balch C, et al. Suicidal Ideation Among American Surgeons. Archives of Surgery 2011; 146(1):54-62.
  8. Shanafelt T, Balch C, et al. Burnout and Medical Errors Among American Surgeons. Annals of Surgery 2010; 251(6):995-1000.
  9. Maslach C, et al. Maslach Burnout Inventory Manual, 1996.
  10. 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.

Tags:  burnout  clinicians  communication  empathy  language  physician  words 

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Making a Difference – Working as a Medical Interpreter

Posted By Jane Blackburn, Friday, September 11, 2015
Updated: Monday, September 14, 2015

The phone rings. The interpreter answers the phone knowing they may be moments away from changing someone’s life.

That’s a thought that goes through the mind of thousands of over-the-phone medical interpreters. These professional interpreters field the urgent calls—from doctors, nurses, paramedics, and even patients themselves—where time and accuracy are often the difference between a spiraling crisis and comforting relief.

In order to comprehend life as a a medical interpreter, we have to begin at the other end of the line, with the limited-English speaking patients. Life for them is trying enough. Add to it the pressure of an imminent baby delivery, a late-night medical emergency, or understanding complex insurance forms, and you begin to see the difficulties they face and the emotions they encounter ranging from exasperation to depression to outright panic. That’s where professional over-the-phone and video interpreters work their wonderful magic.

For instance, interpreter Ayan A. received a call from a terrified, sobbing mother who dialed 9-1-1 because her child was injured and having difficulty breathing. Hearing Ayan’s voice on the line helped to calm the mother so that she could understand and follow the CPR and first aid instructions needed to stabilize her child until the ambulance arrived. Fortunately, by the end of the call, the child had opened his eyes and the bleeding had stopped. Before hanging up, the 9-1-1 operator commented to Ayan that together they had saved a life.

And then there’s Ashi F. He received a call from a nurse who along with a doctor was helping a young woman in labor with her first child. With a calm voice, Ashi helped the medical team through the epidural and delivery of the baby girl. Before the call ended, Ashi heard the sweet cries of the newborn baby as she was placed into her mother’s arms.

A third interpreter, Firas A., was speaking on the phone with a nurse and her cancer patient while they waited for the doctor to arrive with test results. The wait seemed like an eternity, the patient wasn’t optimistic, and Firas began to expect the worst. The doctor finally appeared and declared that the patient was cancer-free. Overwhelmed by his own joy, Firas had to compose himself before interpreting the good news.

And there are countless other stories just like these.

However, these compassionate professionals do much more than interpret words from one language into another. It’s essential that medical interpreters receive specialized training and testing in order to practice their trade. That means they must be intimately familiar with medical terminology and protocols, trained to remain calm during a crisis, and schooled in cultural sensitivity. All of which helps prepare them for any situation that might arise. The use of professional medical interpreters enables accurate diagnosis, reducing unnecessary testing, increasing efficiencies and lowering the cost of patient care.

In addition to the many benefits of interpreting, what most interpreters value about their work is hearing the gratitude expressed by patients. Mario C. summed it up this way, "I have helped with transplants and delivering children, all using my voice. Interpreting makes a difference. I make a difference.”

Read the stories of patient encounters, in the words of professional interpreters, at Real Life Interpreter Stories.

Jane Blackburn joined LanguageLine Solutions in 2001 as a Customer Service Manager. Since 2013, Jane has been the Director of Interpreter Services with responsibility for managing the 8000+ LanguageLine Solutions Interpreter workforce. Jane has a Bachelors degree from California State University.

Tags:  language  medical interpreter  patient  patient experience 

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Language Matters

Posted By Wendy Leebov, Monday, August 25, 2014
Updated: Thursday, August 21, 2014

I’m struck daily by the fact that the words we use strongly influence our goals, strategies and outcomes. In my view, those of us determined to achieve breakthroughs in the patient, family and employee experience need to become more self-conscious about the words we choose, so that these words advance our cause, inspire people and accelerate improvement and transformation.

In the last few years, we’ve made very positive and far-reaching language shifts. Patient experience has replaced patient satisfaction. And employee engagement has replaced employee satisfaction. These language changes reflect and also drive progress.

Still, we are on automatic pilot with words. They pop out of our mouths, pens and keystrokes without much deliberation, and, when that happens, our words reflect our habitual thinking. This is a problem because our habitual thinking often limits our imagination, aspirations, goals and, therefore, our results.

Words That Reinforce Hierarchies and Pecking Orders

Some of our words reinforce the destructive pecking order and hierarchy that have discouraged the teamwork, partnership, collaboration and mutual respect we desperately need throughout healthcare.

  • Compliance vs Adherence: The term patient compliance implies that the doctor knows best, issues orders to the patient and expects the patient to obediently follow their direction. Adherence works so much better because we need to engage and partner with patients, co-develop a plan and, then, we certainly do want to help them adhere to it. We need to develop care plans with patients and families, not for them. Down with compliance! This word disempowers patients. We need engagement and partnership.
  • Super-User: Sure, it’s powerful to identify staff members who excel at certain skills and engage them in helping their colleagues strengthen these same skills. But must we call them "Super-Users”, which, in my view, implies a superiority? Why not "coach?” This is so much more descriptive of how we want to recognize and engage people in helping their peers sharpen their skills.

And how about health partner, care partner and care team instead of caregivers and caretakers?

Words That Narrow Our Scope

Then come the words that reflect a healthcare system of the past, not the present and future. Our language and our strategies have been hospital-focused, not person-focused, and illness-centered, not health-centered. Hospital-centricity encourages relative inattention to homes care, ambulatory care, wellness care, longterm care, health coaching, health education and much more.

How about transition plan, get-well action plan or recovery plan instead of discharge plan? Discharge plan is about what we are doing, not about what the patient is doing.

And the word patient itself is suspect. Is a newborn child a patient? Are her parents attending parenting classes at an outpatient center patients? Does my 96-year-old mother living at home see herself as a patient? When healthcare professionals teach a factory work team to lift in an ergonomic way, are these workers patients? No, and, in fact, they’re trying to avoid BECOMING patients. The term patient works in a healthcare system focused on making sick people well, but it does not work well to describe people who are well and who seek to maintain optimal health and prevent illness. Increasingly, I hope, people will rely on the healthcare system to help them achieve the best possible health, wellness and state of being possible for them throughout their lifetime. We need to focus on person experience, not just the patient experience.

Do we want people to view experiences like these as something a part from the healthcare system? People ARE having a healthcare experience; they are relying on us as members of their healthcare team. I think it’s time we help people see health, wellness and prevention in whatever setting as part and parcel of the healthcare system. Wellness care is what we need. Disease management is what we have. Disease management is for patients. Wellness care is for people.

And while patient and family-centered care is better than patient-centered care, person-centered care is even better.

Words That Impact Behavior in the Moment

Language even affects our behavior and empathy. I no longer talk about "difficult people.” I now think and say difficult-for-me-people or distressed people so I can approach people with loving-kindness, patience and compassion.

Language matters. That’s why my colleagues and I just renamed our company Language of Caring, LLC. We are fanatically committed to helping everyone in healthcare speak the language of caring so patients, coworkers, persons, or whatever you want to call people, feel our caring in every conversation and every interaction 24/7.

Wendy Leebov is a lifelong activist for creating healing experiences for patients, families and the entire healthcare team. She is internationally respected as a thought leader, healthcare executive, culture change strategist, coach and author who has helped hospitals, health systems and medical practices to achieve breakthroughs in the patient and family experience. Wendy is Managing Partner, Language of Caring, LLC.

Tags:  caring  engagement  healthcare  language  patient 

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