Innovative Models for Team-Based Care: A Solution for Burnout Gaines Richardson, MD, Faculty Monroe Clinic / Mark Thompson, MD, SSM Heath, WI

Transcription

1 Innovative Models for Team-Based Care: A Solution for Burnout Gaines Richardson, MD, Faculty Monroe Clinic / Mark Thompson, MD, SSM Heath, WI Regional CMO Physician Integration

2 Monroe Clinic desires to deliver the:

3 Burnout Physical and/or mental deterioration due to a mismatch between a worker and their work environment Exhaustion Depression Lack of empathy Reduced effectiveness

4 What do the numbers show Physician Burnout Up to 54%, about twice that of the normal population Women working as Physicians up to 51% Men working as Physicians up to 43% Up to 36% would not choose medicine again

5 So you were young and had a dream Let Doctors be Doctors

6 Now you are training and: Let Doctors Be Doctors

7 When we observed: How do we work? Only 27% of our time is in direct patient to physician care 49% of our time is spent at the desk in the EHR 24% was doing other work A study with UW Health found that there are 32 hours of Work after Work per month -- catching up and completing records and outreach

8 Traditional Clinic Design

9 Traditional Clinic Design

10 Traditional Clinic Design

11 What did our Monroe Clinic patients say about team-care during a visit? Doctor and MA Comfortable Neutral Uncomfortable Written Response Online Response Total

12 What did our patients say about our Doctors documenting in EHR during a visit 250 Doctor Documenting Information Comfortable Neutral Uncomfortable Written Response Online Response Total

13 Discussion on Practice Transformation How can we evolve our practice to deliver on the Quadruple Aim? Inform Design of physical space and structure to drive our desired outcomes and address burn-out and team well-being How do we learn and discover? How do we re-charge and regenerate? How are we accessible to our patients and teams? How can we communicate with conversations vs. a computer? How do we have everyone working to the fullest scope? How do we eliminate some of the after-hours work?

14 Source of Input using Monroe Clinic Lean Culture As of January 1, 2017 over 4,000 team member hours had been devoted to the creation of this new space A cumulative effort of over 100 plus members of the Monroe Clinic team in every area of expertise...from physicians to facilities personnel

15 The work from our Front-Line Teams

16 Key takeaways from our Lean Study Process over 3 Weeks Let future-state work flows inform design of our space Move to a 2 MA/RN to provider model of care Pre-Visit Management - leverage the use of the EHR outside of the visit setting 80% of the work should be completed in the record prior to leaving the room

17 Key takeaways from our Lean Study Eliminate waiting by simplifying registration process Move to self-rooming Leverage technology to improve teambased care Design space to promote natural and efficient face-to-face communication Flexible furniture and space Eliminate waste Process over 3 Weeks

18 A mock-up of an Integrated Care Team Space in Monroe Ice Arena

19 The Team in an Integrated Care Team Space

20 The Team Discussing Future Work Flows

21 Quick Check in / Pre-Visit Management Completed Prior to Check in

22 Sub-Waiting for Family Members outside of Integrated Care Areas

23 Patients Self Room

24 Floor Layout: Multi-Specialty

25 Family Medicine Residency Layout

26 Honoring space needs for our work styles Regenerative Getting back to basics. Revitalizes creativity, facilitates sharing, generates new and fresh ideas. Healthcare teams working, but not in a traditional work-space. Open areas, public areas, café, new surroundings and new ideas. Ideation Work style that promotes idea sharing and collaboration among individuals. Brainstorming, educating. This space and work style brings people together. It is a transparent environment with freely flowing information and communication. Huddle areas, training spaces and learning labs that promote continuous learning among peers.

27 Honoring space needs for our work styles Focus About the individual, work accomplished alone. Analysis, research. Deep thinking. Private space and walls and doors are more important. Interaction Space accommodates those who require semi-private but shared environments. Work is more individual in nature and a defined space that spurs conversation among co-workers is desirable.

28 What needs are we addressing Current needs in addition to what will be needed over the next 20 to 40 years Changing Reimbursement models Capitation Risk Sharing Population Health Flexibility to adapt quickly Health Care Delivery Models Tele-health Population Health Group Visits Recruitment and Retention Diverse work-force with different needs and wants

29 What needs are we addressing How the EHR is used How residents and clinical work-force is being trained today Number of clicks and time spent in the computer by Physician and APP work-force Communication that is natural and integrated into the day Time that is spent at home doing work in the EHR Heightening interactions, visibility, team-problem solving and accountability in regards to patient care Strategizing computer use to increase interpersonal engagement

30 Work over the next 1.5 years Trial of work-flow in Primary Care Scribe training of MA Templates Pre-Visit Management Technology and workflow design for Pre-Visit Management Population Health / Outreach Warm Hand-Off for Behavioral Health and Pharmacy

31