High Engagement. and Low Burnout: Solutions for Your Workplace

Transcription

1 Session Code C7 These presenters have nothing to disclose High Engagement and Low Burnout: Solutions for Your Workplace Stephen Swensen, MD, MMM, FACR Pierre Barker, MBChB, MD Paul DeChant, MD, MBA Diane Shannon, MD, MPH December 6, :30pm

2 What Stops Engagement and Drives Burnout? 2 System Leaders often have an organizational quality mission but don t know how to connect with care providers and lead the change required to improve performance Care providers are often disengaged from the organizational mission and focused primarily on the task or patient in front of them Overburdened Underappreciated Lack of control Patients, families and communities find themselves in health systems that are not designed around their needs The patient is not part of the improvement design

3 How to Create a Joyful, Engaged Workforce Outcome: Patient experience Organizational performance Staff burnout 4. Use improvement science to test approaches to improving joy in your organization 3. Commit to making Joy in Work a shared responsibility at all levels 2. Identify unique impediments to Joy in Work in the local context 1. Ask staff what matters to you?

4 High Engagement and Low Burnout: Solutions for Your Workplace 4 Dianne Shannon Paul De Chant Stephen Swensen

5

6

7 The Components of Burnout Emotional Exhaustion Depersonalization Inefficacy

8 The Burnout-Engagement Spectrum Burnout Work Engagement Exhaustion Energy Depersonalization Involvement Inefficacy Efficacy Maslach C. In Eur J Work Organ Psy ; Cameron KS

9 Physicians in Crisis Only 1 in 10 physicians would recommend medicine as a career More than half of physicians surveyed reported at least one burnout feature 30% of primary care physicians age 35 to 39 plan to leave practice within 5 years The Doctor s Company Market Research. 2012; Shanafelt T. Mayo Clin Proc. 2015; Gray BH. J Prim Care Community Health

10 Increasing Gap to General Population

11 Work Life Balance Gap Even Greater In 2014, 41% of US physicians were satisfied with their Work Life Balance Down from 49% in 2011 Compared to 63% of average US workers Physician WLB worsened significantly between while WLB for the average US worker improved

12 The Consequences of Burnout Costs Patient care Human toll

13 The Drivers of Burnout External Drivers Workplace Physician

14 The fact that almost 1 in 2 US physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals. Shanafelt T. Arch Intern Med

15 Workplace Drivers Workload Chaotic work environment Time Pressure Control Reward Community Fairness Values Maslach C. J Applied Psychol. 2008; Linzer, M. J Gen Intern Med

16 What to Do About Burnout? Start or strengthen a physician wellness program Necessary and valuable services Every healthcare organization should have an active program - Christine Sinsky, MD - Ted Hamilton, MD - Rebecca Smith-Coggins, MD Coaches everyone please write these down Wayne Sotile, PhD Dike Drummond, MD Starla Fitch, MD Michelle Mudge-Riley, DO

17 Mindfulness and other individual solutions are a great resource, but if you only give physicians these solutions, it s like saying, If you only knew how to swim better, this toxic ocean wouldn t be a problem. Karen Weiner, MD, MMM, Chief Medical Officer, Oregon Health

18 According to Shanafelt There is an urgent need for systematic application of evidence-based interventions addressing the drivers of burnout among physicians. These interventions must address contributing factors in the practice environment rather than focusing exclusively on helping physicians care for themselves and training them to be more resilient.

19 Why should we care about the contributing factors? Google External Drivers Workplace Payers Physician

20 I m Mad as Hell and I m Not Going to Take This Anymore!

21 2015 VITAL WorkLife Physician Stress & Burnout Survey Results: Over 2000 Physicians Report Stress and Burnout Increasing relative to Survey in 2011: 66% say more stress and burnout than 4 years ago 46% report severe stress & burnout Only 18% feel their organizations offer help VITAL WorkLife & Cejka Search

22 Preventing Physician Burnout with Lean Done Right Lean Done Right : Continuously fixing broken patient care processes, via the elimination of caregiver frustrations, led by the caregivers, in their clinical sites, under the caring guidance of a mentor. Lean = Preventive Medicine for Burnout

23 The Two Key Principles of Lean Respect for People Seeing systems, not people, as the problem Management by coaching, not disciplining Going to where work is done (gemba) to see and learn Continuous Improvement Huddles PDSA Value Stream Improvements Without Respect for People You Can Get Improvement, but It Won t Be Continuous

24 Focusing on What s Most Important

25 Lean Management System: The Inverted Org Chart Flow of Information Mission and vision Core values True North One leadership system Leaders as teachers Structured coaching Dyads CEO / COO VPs Directors Managers Supervisors Staff Flow of Information Huddles Clinic standard work Leader standard work Metrics Identify barriers / problems Improvement ideas Escalate problems if needed

26 True North Metrics: Are we succeeding? Where should we focus our attention? Quality and safety Delivery / service Patient satisfaction Cost / productivity Growth Human development Staff & physician engagement Joy in Patient Care

27 Daily Management Huddles Everyone participates, staff lead Preparing for the day Review unit-based performance metrics Problem solving in real time Coached by leadership

28 Remove Waste Reduce Frustration: Eight Frustrations in Healthcare 1 Overproduction 5 Overprocessing Repeating tests because results are not available Repeatedly filling out/signing forms, CPOE v. verbal orders 2 Transportation 6 Motion (unnecessary) Moving patients from room to room in an office or unit 3 Defects 7 Inventory Rx errors, wound infections, inaccurate notes, broken equipment Waiting Is a full waiting room a good thing? Going in and out of a room to get supplies or equipment Secret stashes of supplies because you might run out of what you need 4 8 Unused human potential Physicians entering data into the EHR

29 Deserving Special Recognition: The EHR 2 hours administrative work for every hour of direct patient care Distracted Doctoring in Exam Room 53% of time on direct clinical face time 37% on EHR and desk work Like texting while driving Work after work Average 1-2 hours of EHR time at home Pajama time Saturday night date with EHR Decreased Interaction with Colleagues in the Hospital and Office Annal Int Med 6 SEPTEMBER 2016 Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties Christine Sinsky, MD; Lacey Colligan, MD; Ling Li, PhD; Mirela Prgomet, PhD; Sam Reynolds, MBA; Lindsey Goeders, MBA; Johanna Westbrook, PhD; Michael Tutty, PhD; George Blike, MD Beasley, John, MD I-PrACTISE.

30 A3 Thinking Solving Problems Like a Clinician: The 9 Box A3 1 Define the problem, specifically Chief complaint 2 Describe the current state H&P, Initial testing 3 Describe the goal state Homeostasis, baseline health 4 Identify and analyze the gaps between current and goal states to understand root cause DDx 5 Solutions approach Consider treatment options 6 Experiments to fix underlying root cause Trials of treatment options 7 Develop new Standard Work Treatment plan 8 Monitor outcomes Follow up 9 Insights Learnings to apply to the next patient

31 Standard Work The currently best known way to do a task Not static, requires ongoing continuous improvement by the people performing the work PDSA Plan, Do, Study, Adjust (Act) Not cookbook medicine Facilitates autonomy and the art of medicine

32 A Lean management system and culture = An organization that can quickly adapt in an environment of volatility and uncertainty It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. Charles Darwin Truven Health Analytics Inc. All Rights Reserved

33 Typical Improvements

34 Call Center: Average Speed of Answer and Grade of Service

35 Laboratory Value Stream Value Stream Metrics Initial Target Aug 2014 Quality Service Finance Specimen quality (# of samples needing redraw per month Press Ganey scores / wait time % patients waiting <10 minutes Urgent care turn-around time (order time to results/minutes) min 20 min Finance Test volume 17,597 10% 19,356 19,686 People % of problems fixed by staff 30% 60% 85%

36 Imaging Modalities Backlog Reduction NVL Sacramento Backlog Trend Backlog (days) CT MRI ULS 5 0 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12

37 Cumulative Savings $8,000, $7,000, $6,000, Total hard savings and add'l revenue $5,000, Total soft savings $4,000, Total hard and soft savings with add'l revenue $3,000, $2,000, $1,000, $

38 Recognition: Sutter Gould Medical Foundation was rated Highest in Overall Care by Consumer Reports among 170 California medical groups two years in a row February 2014 & 2015

39 Provider Satisfaction AMGA Provider Satisfaction Survey Percentile

40 Focusing Only on the Triple Aim => Burnout

41 Returning Joy to Patient Care: Pursuing the Quadruple Aim The Triple Aim + Frustration-Free Patient Care

42 Critical Components for Ensuring a Joyful, Engaged Workforce Interlocking responsibilities at all levels Real Time Measurement Physical & Psychological Safety Wellness & Resilience Daily Improvement Happy Healthy Productive People Meaning & Purpose Autonomy & Control Camaraderie & Teamwork Recognition & Rewards Participative Management

43 Next Steps: Take Action Physicians Learn about burnout, knowledge is power Survey the medical staff Take care of yourself, seek help if you think you may need it Take care of each other Physician Wellness Program Talk to colleagues if concerned Improve working relationships with administration Participate in Opportunities Participate in Lean activities to fix your frustrations VSAs, RIEs, Huddles Friday Morning Report Outs Value Stream Steering Teams Team Care Options Leaders Learn about burnout, knowledge is key Educate your BOD Survey the medical staff with MBI and AWS Take care of yourself and each other, you can t help the physicians if you are overwhelmed Improve relations with physicians Physician Wellness Program Formal and informal meetings Maximize value of Lean No Meeting Zone Go to where the work is done Shadow physicians VSAs, RIEs, Huddles Friday Morning Report Outs Value Stream Steering Teams

44 Questions??? Contact info: Paul DeChant, MD, MBA Blog: Contact Info: Diane Shannon, MD, MPH Blog: