Imagine you're a CEO of a specialty shoe manufacturer. Suddenly, for an unknown reason, a rapidly escalating number of your workers develop work-related injuries: carpal tunnel syndrome, back strains, limb fractures, rotator cuff tears. Healthcare costs escalate due to physician visits, imaging, surgery, and physical therapy. Disability payouts soar. Production grinds to a halt, with fewer healthy workers available to handle the orders. Long-term clients turn elsewhere when your company fails to meet order deadlines.
Given that your top revenue generators are compromised, wouldn't your primary objective be finding the underlying causes of the injuries and taking active steps to prevent them?
As burnout researcher, Christina Maslach, PhD, professor emeritus in the Department of Psychology, University of California Berkeley, said in an interview for our book:
One of the biggest challenges is that people tend to think of burnout in terms of individual factors and individual responsibility. They tend to blame the individual. Despite research that shows the importance of the environment, background, and situation, people still think, “too bad that person can't handle it.” A harder message to hear, or a more overwhelming one, is that the problem is more than the individual.
Professional burnout is not reflective of individual weakness or susceptibility, and burnout among physicians is not simply a matter of “whiny doctors” complaining about changes in the practice environment. Burnout manifests in the individual but is caused by systemic stress in the workplace.
Seeing the Big Picture
The systems problems that create the toxic clinical workplace are driven in large part by new and overwhelming external factors—the increasing focus on cost containment; federal mandates regarding electronic health record utilization; payments that are partially tied to metrics of quality and patient experience; the explosion of medical information, which threatens to outpace physicians' ability to read and process it; and the increased prevalence of chronic conditions. These external factors, which are not directly controlled by either administrators or physicians, have tremendously changed the daily work experience of clinicians at the front lines of care. In many cases, they have also driven a wedge between administrators and physicians.
As stated by Dr. Maslach, too often administrators (and physicians themselves) see burnout as an individual problem and attempt to address it with individually focused solutions alone, such as by offering wellness classes, personal coaches, and mindfulness training. While these strategies are useful for building resilience to stress, they do nothing to fix the source of the stress—the toxic workplace.
What physicians need is an improved work environment—one with fewer daily frustrations, fewer instances of requiring “workarounds” to get the job done, fewer barriers to spending time on direct patient care—in short, a workplace with fewer “pokes,” as one physician interviewed for our book described the inefficiencies.
Physicians—and other clinicians, healthcare professionals, and paraprofessionals—also need to be treated with respect. Disrespect erodes organizational culture and deflates morale. When queried about the factors that foster engagement with their organizations, physicians' No. 1 response is “respect for my competency and skills,” according to a 2013 survey.a
What does respect for physicians entail? One example comes from Vancouver Clinic, where physicians' input is actively pursued as part of strategic decision making. The organization uses the nominal group technique to understand the work experience, needs, and values of the physicians and to solicit their ideas for solutions. As Sharon A. Crowell, MD, an internist and the clinic's board chair, said in an interview for the book, “The process was so successful that we use it for every big decision now.”
Physician burnout is not a problem with a quick fix nor one that either physicians or administrators can solve on their own. Physicians and administrators must work collaboratively to mitigate the effects of the external factors that are driving the record-high prevalence of burnout among physicians.
Although many organizations are beginning to tackle the problem, the endeavor is in its infancy, and evidence is lacking regarding the effectiveness of specific interventions in addressing the current systems problems. One overarching conceptual solution—and a good place to start—is team-based care with co-location of team members.
Team care surrounds a physician with support staff who can perform most of the administrative tasks that frustrate physicians. Patients benefit because the physician can focus on the unique needs of the patient, rather than on administrative minutiae. Physicians and their families benefit from the reduction in busywork that adds hours of work to a doctor's day and to his or her after-hours time.b
Burnout among physicians and other clinicians is a growing, urgent problem that threatens the viability and performance of healthcare organizations. Clinician burnout reflects systems problems that require systems solutions rather than simply wellness programs. Administrators must work collaboratively with physicians—within a culture of respect—to address the true drivers of burnout and avert the negative consequences for their organizations and the patients they serve.
Paul DeChant, MD, MBA, practiced family medicine for 25 years and has 30 years of healthcare management experience. He now serves as an executive coach and senior advisor with Simpler Healthcare.
Diane W. Shannon, MD, MPH, left clinical practice because of burnout. She is a freelance healthcare writer based in Boston who focuses on healthcare improvement, patient safety, and prevention of physician burnout.
a. VITAL WorkLife, “VITAL WorkLife and Cejka Search Physician Engagement Survey,” 2013.
b. Sinsky, C., Colligan, L., Li, L., et al., “Allocation of Physician Time in Ambulatory Practice: a Time and Motion Study in 4 Specialties,” Annals of Internal Medicine, Dec. 6, 2016.
Friday, March 17, 2017
Registration: Click here to register. There is no charge for participation.
Recommendation: Test your connection 10-15 minutes before the webinar to ensure you have the latest version of Adobe Connect.
Paul DeChant, MD, MBA with Simpler, an IBM Watson Health company will discuss physician burnout, including its manifestations, causes, and impacts. He and co-presenter, Diane Shannon, MD, MPH will describe the crucial role of hospital leaders and what they can do to reduce the drivers of burnout and return joy to patient care in their institutions.
About the Presenters
Paul DeChant, MD, MBA is a professional consultant, executive coach, and experienced physician executive. He is an expert on physician burnout and can identify, treat, and prevent burnout in staff and organizations.
Diane Shannon, MD, MPH is a freelance writer, physician advocate, and change agent. She's also an internist who left medical practice due to burnout. Diane writes on topics such as the patient experience, communication, patient safety, communication, electronic health records, and teamwork. Diane first wrote publicly about her experience with burnout in 2013 in a post for WBUR, the Boston National Public Radio affiliate. The many physicians who share their personal stories of burnout are the motivation for this book and for her work. You can find Diane on the web at mdwriter.com and on Twitter @dianewshannon.
Three years ago, Caldwell Memorial Hospital partnered with Simpler Consulting to replace the hospital's transactional approach to supply chain with a strategic methodology for inventory management.
Laura Easton, CEO of the Lenoir, N.C.-based community hospital, credits this partnership as the beginning of her education in supply chain management.
With the help of Simpler, Caldwell Memorial leadership identified six areas of focus. They started in what Ms. Easton calls "low hanging fruit" — the inventory system.
"Having the right products go to the clinician at the right time is crucial for a successful supply chain," says James Spann, global practice leader for supply chain and logistics at Simpler. "Having pipeline visibility of your product — even as far back as the vendor — and knowing what you have on the shelf can not only lower costs, but help prevent delays when taking care of patients."
Caldwell Memorial struggled with effectively moving products from the loading dock to the nursing station or point of use, according to Mr. Spann. Products and supplies were distributed all over the facility with little visibility. Physician preference items involved substantial variation and inefficiency, representing an additional opportunity for Caldwell Memorial to standardize and consolidate products.
To assess its inventory, the hospital tapped Simpler's LEAN methodology services and conducted a 6S events analysis in every area of the hospital. Through a series of rapid improvement projects, front-line staff members helped organize supplies stored in each of the hospital's clinical settings.
"Engaging front-line staff in initiatives to drive improvement will help garner the involvement of the staff — and their awareness and participation in those solutions — to allow for more sustained and beneficial results," says Ms. Easton. "You have to help them understand that supplies on a shelf are equivalent to dollar bills on the shelf if they're not used."
Mr. Spann cites staff involvement and lack of supply chain knowledge as two often overlooked challenges for many hospitals. "Making sure you have a team who is capable and knowledgeable is crucial to the success of your supply chain," he says.
In terms of ordering and replenishing, Caldwell Memorial implemented a 2-Bin system through the hospital, which Ms. Easton says is a transparent, easy method for front-line staff to manage inventory. The system change helped reduce "pick and replenish" levels and switch ordering and replenishing responsibilities back to the materials management department, rather than front-line staff. Clinicians no longer spend three or four hours a week on inventory management and instead spend that regained time on patient care, according to Ms. Easton.
By standardizing inventory and lowering minimum stock levels, Caldwell Memorial saw a 2 percent reduction in supply cost over the first year. Ms. Easton is planning to multiply this figure over several years for multi-million-dollar cost savings.
"Those changes are just the beginning of the work we need to do to transform supply chain," she says. "We still have significant challenges going forward."
The next step is ensuring products ordered by Caldwell Memorial bring the greatest value possible to their patients, according to Ms. Easton. In 2017, the hospital will establish a value analysis system for products, along with pharmacy and therapeutics.
"Looking into the future, the supply chain is going to be very strategic as we shift into a value-based world, and value adds to the total outcome of patient care," says Ms. Easton.
A successful lean organization by definition is a learning organization, but how to best share knowledge can prove confusing. Several lean leaders, including Simpler's EVP Jon Armstrong, share their tips.
The success of any supply chain begins before any one request or procedure is even put into place. Problems arise in the supply chain when there are weaknesses in forecasting and planning, as well as incomplete or inaccurate information gathered along the way that lead to higher costs, delayed timing and unsatisfied customers down the line. To avoid these setbacks, conducting a comprehensive analysis of operations can help establish a strategic roadmap, and investigate inefficiencies or issues ahead of time...
What's driving the challenges of recruiting top health care leadership talent these days? There are many factors, not the least of which is the sheer courage and force of will it takes to be a change agent in our chaotic field. While the pace of change in health care is accelerating more rapidly than ever before, there are some age-old truths about the risks of leadership that we ignore at our peril...
Healthcare organizations suffering from high costs and inefficiencies find relief by improving supply chain and distribution processes. The prognosis? Improved patient care and lower healthcare costs.