moving the tracks of the modern healthcare train: a system .../media/files/providence or...
TRANSCRIPT
Todd Caulfield, MDMedical Director, Providence Cardiology West
President, PSVMC Medical StaffChair, Oregon Region Provider Wellness Committee
Moving the Tracks of the Modern Healthcare Train: A System Based Approach to Provider Wellbeing
Modern Healthcare:
And Now:Then:
Work after Work (Pajama Time)
EPIC Provider Efficiency Profiles:
Notes:• Scheduled day = 7 am to 7 pm• More efficient often equates to less patient facing time• Scribe utilization about 70% during this sample
The Darker Side of the Problem
Stat News July 26, 2018Wellness officers? Code Lavender teams? Mindfulness meditation? These aren't the solutions to physician burnout and moral injury.
The moral injury of health care is … being unable to provide high-quality care and healing in the context of health care.
Loss of Stewardship of the Doctor – Patient Relationship
Providence Oregon MinistriesPress Ganey Engagement/Alignment/Burnout
0
10
20
30
40
50
60
70
80
90
100
PSJH PSVMC PPMC PNMC PWFH PMH PHRMH PMMC PSH
Percentile Results
Engagement Alignment Burnout
Press Ganey SurveyPSVMC – Deeper Dive
0
10
20
30
40
50
60
70
Employed Allied Non-DO/MD Male Female
Percentile Results
Engagement Alignment Burnout
Cutting Professional Effort
• Assess physician burnout and satisfaction Mayo Clinic longitudinally 2011 and 2013 (n>2500)
• Independently monitor changes FTE payroll records
• Burnout and satisfaction predicted reduction in FTE over next 24 months– On MV analysis, each 1 point increase burnout OR 1.43 (p<0.001)
– On MV analysis, each 1 point decrease satisfaction OR 1.34 (p=0.03)
• Change burnout and statisfaction 2011 to 2013 predict reduction FTE following 12 months– On MV analysis, each 1 point increase burnout OR 1.28 (p=0.01)
– On MV analysis, each 1 point decrease satisfaction OR 1.67 (p=0.003)
Shanafelt, Mayo Clinic Proceedings, 91:422
Professional & Personal Consequences
JAMA 296:1071, JAMA 304:1173, JAMA 302:1294, Annals IM 136:358, Annals Surg 251:995, JAMA 306:952, Health Psych 12:93, JACS 212:42, Annals IM 149:334, Arch Surg 146:54
Stanford Chief Wellness Officer Course, June 2018
Copyright© 2016 Board of Trustees of the Leland Stanford Jr. University. All rights reserved
Efficiency of PracticeWorkplace systems, processes, and practices that promote safety, quality, effectiveness, positive patient and colleague interactions, and work-life balance.
Culture of WellnessOrganizational work environment, values and behaviors that promote self-care, personal and professional growth, and compassion for ourselves, our colleagues and our patients
Personal ResilienceIndividual skills, behaviors, and attitudes that contribute to
physical, emotional and professional wellbeing.
Framework for Professional Fulfillment
Stanford WellMD Model
• Reflection of Organizational Values• Explicitly stated • Supported from highest levels of
leadership
• Providers valued as humans and professionals • Appreciation• Peer support, compassion• Autonomy
• Community and Collegiality• Intentional
• Leadership Development
Take Home Message #1:
“Never set out to change the culture of your organization. Instead, define the problem, and understand if culture is a headwind or a tailwind.”
- Tait Shanafelt, Stanford CWO Training Course, June 2018
Organizational Culture
• Collection of tacit assumptions
• 3 levels
Tacit Assumptions
Espoused Values
Artifacts
Espoused Values and Artifacts can Contradict
• We Say…• Self care is important
• To err is human
• We have a supportive community
• Physicians are professionals
• Physicians are most important resource
• High quality care is our top priority
• Behavior…• Long hours, work first
• Culture of perfectionism
• Lack of vulnerability with colleagues
• Pre-auths and documentation
• High clerical burden, inefficient care systems
• Current systems drive fatigue, burnout, decreasing QOC
Espoused Values and Artifacts can Contradict
• We Say…• Leadership is important to
organizational success
• We value physician engagement and alignment
• Behavior…• Training and development is reserved
for senior leadership
• Feedback is limited
• Dedicated time is sparse
• Limited access to senior leadership
• Limited contribution by physicians to strategy
Physician Leaders: Maslach Averages
Emotional Exhaustion (EE) Personal Accomplishment Depersonalization
84.89%Moderate to high
66.91%Moderate to high
53.95% moderate to high
N=139
Providence Physician Leadership Retreat, 2018
Take Home Message #2:
“Pay attention to the long game.”
- Tait Shanafelt, Stanford CWO Training Course, June 2018
Take Home Message #3:
“Leaders are our most important lever. We need to support our leaders (our people caring for patients). We need to care for each other for our patients.”
- Steve Swensen, MD Stanford CWO Training Course, June 2018
The Five Leader Index Behaviors
• Include:• Nurture a culture where all are welcome and psychologically safe
• Inform:• Transparently share what you know with the team
• Inquire:• Consistently solicit input and ideas of coworkers
• Develop:• Support professional development and career aspirations of staff
• Recognize:• Express appreciation & gratitude in meaningful way to colleagues
Shanafelt, Swensen. Using the Annual Review to Reduce Burnout and Promote Engagement. Am J. Medical Quality 2017
Providence Oregon Region Provider Wellness(Last 12 months)• Leadership Retreat, with Provider Wellbeing as focus• PWC at PPMC, PSVMC• Oregon Region PWC• Collection of ministry based survey data, system wide, including burnout• Development of peer to peer support systems• Development of CISM programs by spiritual care• Advancement of IT efficiency solutions: Dragon Med One, RFID• Expansion of personal resilience strategies
• Compassion• Gratitude• Mindfulness
What Does Wellness Mean?
Shanafelt Definition:“Well-being goes beyond the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life.”
Lemaire and Wallace Definition:“Well-being reflects the extent o which and individual finds meaning, and is authentically able to express their self in their life and work, which is indicated by an overall satisfaction and balance in one’s life.”
Lebenso Definition:“Wellness can be defined as an active process of making choices in … dimensions of body, mind, and spirit that lead to healthier living.”