By Dr. Bridget Duffy, Chief Medical Officer, Vocera Communications
Healthcare organizations have spent a fortune on new health IT solutions with the goal of improving outcomes. But as new revenue management, population health and analytics applications are layered on top of each other, the result has often been a mountain of administrative burden that leaves doctors and nurses burned out and patients feeling ignored. Despite the near-ubiquitous presence of “patient-centered” language in healthcare quality discourse, the full realization of human-centeredness remains elusive in many care settings. This must change. Technology providers need to work with, and for, clinicians to help them restore resilience, well-being and joy to the practice of medicine.
A 2011 JAMA report found that career dissatisfaction is more common among medical doctors than it is for those in other careers, with 45 percent of physicians reporting at least one symptom of burnout. A report by the Experience Innovation Network reveals that the number has continued to climb, with 54 percent of physicians reporting they have experienced at least one symptom of burnout.
EHRs have become a double edged sword — essential for continuity of care and electronic document exchange, but often, a burdensome and physical barrier between doctor and patient. Doctors must repeatedly sort through numerous clicks and break focus with the patient to enter data, effectively limiting moments of interaction that improve the physician-patient bond. In an effort to quantify the impact of EHRs, a 2016 published study that directly observed 57 physicians for a total of 430 hours revealed that 49 percent of a physician’s day is spent doing clerical tasks, while only 33 percent was spent interacting with patients.
By Dr. Bridget Duffy, Chief Medical Officer, Vocera Communications
Healthcare organizations have spent a fortune on new health IT solutions with the goal of improving outcomes. But as new revenue management, population health and analytics applications are layered on top of each other, the result has often been a mountain of administrative burden that leaves doctors and nurses burned out and patients feeling ignored. Despite the near-ubiquitous presence of “patient-centered” language in healthcare quality discourse, the full realization of human-centeredness remains elusive in many care settings. This must change. Technology providers need to work with, and for, clinicians to help them restore resilience, well-being and joy to the practice of medicine.
A 2011 JAMA report found that career dissatisfaction is more common among medical doctors than it is for those in other careers, with 45 percent of physicians reporting at least one symptom of burnout. A report by the Experience Innovation Network reveals that the number has continued to climb, with 54 percent of physicians reporting they have experienced at least one symptom of burnout.
EHRs have become a double edged sword — essential for continuity of care and electronic document exchange, but often, a burdensome and physical barrier between doctor and patient. Doctors must repeatedly sort through numerous clicks and break focus with the patient to enter data, effectively limiting moments of interaction that improve the physician-patient bond. In an effort to quantify the impact of EHRs, a 2016 published study that directly observed 57 physicians for a total of 430 hours revealed that 49 percent of a physician’s day is spent doing clerical tasks, while only 33 percent was spent interacting with patients.
Some doctors refuse to shortchange their patients, taking their laptops home at night or on vacation to complete the seemingly endless clerical demands of medicine today. This is shortchanging the clinician’s family and loved ones, and contributing to their burnout. Many systems have come up with creative and cost effective ways to eliminate the data entry work for clinicians. In Dr. Alan Glaseroff’s and Dr. Ann Lindsay’s model at Stanford Coordinated Care, they have paired two medical assistants to every physician as trusted partners to them and the patient. Not only has this model demonstrated the cost effectiveness, but it also has restored joy to the clinicians as they were no longer typing notes at the end of the day. Our doctors and nurses are stressed out, and the problem needs to be tackled head-on, adopting models like this if we really care about improving outcomes in this nation.
We are at the cross roads of technology and humanity. The key to improving quality, efficiency, and experience is to co-design technology and process innovations with patients, families and care teams. The voice of these stakeholders is critical to identifying solutions that optimize the patient encounter, build trust and compliance, optimize operational efficiency and remove the administrative burdens for clinicians.
That’s why the Experience Innovation Network (EIN), an international group of Chief Experience Officers (CXOs) and other health system executives focused on patient and care team experience, is dedicated to helping providers meet what we call the “Quadruple Aim,” using human centered design principles to identify technologies that optimize the patient-physician encounter, which will help restore joy back to the practice of medicine. The Quadruple Aim builds on IHI’s Triple Aim — improving patient experience, improving population health, and decreasing the cost of care — by adding a fourth measure focused on achieving joy, well-being and resilience among care teams, including physicians.
This paradigm shift won’t be easy. A challenge of this magnitude requires bold and courageous leadership at the highest level. To this end, the U.S. should appoint a Chief Experience Officer (CXO) — on par with the Surgeon General — to oversee efforts to re-center the person as the primary focus of healthcare. This will include:
- Restoring empathy, efficiency, and quality to healthcare;
- Promoting human-centered design principles with patients as partners;
- Deploying technologies that build trust and ease the burden of being a clinician;
- Embedding patients as “Experience Co-Design Fellows” in all hospitals and clinics nationwide (replacing the underutilized patient and family advisory councils that often simply rubberstamp design plans);
- Mandating training on improving organizational culture and communication practices to ensure seamless care transitions as well as competence and compassion at every patient encounter; and
- Creating “Metrics for Humanity” that assess resiliency, joy, and well-being of care teams, and are applied to technologies that improve the outcome and experience of both staff and patients.
With sufficient legislative and programmatic infrastructure, these activities would help us transform our fragmented healthcare system beyond the “Triple Aim” of improving patient experience and health while reducing per capita healthcare costs. We can and should pursue the “Quadruple Aim” that includes restoring joy back to the practice of medicine, using a truly interdisciplinary approach that addresses the inherent trauma of the system and liberates people from bureaucracy. Key to that approach is a thoughtful examination of how the right types of process improvement and technology — leveraged in the right ways — can counter burnout rates while also improving the healthcare experience for both care teams and patients.
