Aspiring to the Quadruple Aim - Internal Medicine · •US Physicians experience more burnout than...
Transcript of Aspiring to the Quadruple Aim - Internal Medicine · •US Physicians experience more burnout than...
ConflictsofInterest/Disclosures
• IreceiveastipendfromtheACPasChairoftheBoardofRegents
• IamChairingtheACP’sWellnessTaskForce
• Idon’talwaysgetitright
WhyPayAttentionToClinicianExperience?• USPhysiciansexperiencemoreburnoutthanotherworkingadults
• 46%ofrespondentsinlargesurveyusingMaslach BurnoutInventory(ArchInt Med,2012)
• Highestratesinfront-linespecialties:GeneralInternalMedicine,FamilyMedicineandEmergencyMedicine
• Physicianburnouthasbeendescribedas“endemic”and“inevitable”
• Physiciansuiciderates2-3xthatofgeneralpopulation• Preventionof“downstream”consequencesofburnout
PredictorsofBurnout
Remediable—andreliable—predictorsfromMiniZsurvey:
•Highstress•Chaoticworkenvironment• Lackofcontrol•Non-alignmentofvalues
ACPBOGResolution6-F16AdvocatingforFormalInfrastructuretoSupport
ExpansionandSustainabilityofWellnessInitiatives
• RESOLVED,thattheBoardofRegentscreatesandsupportsaformalinfrastructure,suchasaCenterforPhysicianWellness,thatwillallowforexpansionandsustainabilityofitscurrentandfuturewellnessinitiativesforphysiciansandphysicians-in-training;andbeitfurther
• RESOLVED,thattheACPBoardofRegentsbecomes aleadingvoice inaddressingareassuchasburnoutprevention,physicianwellness,andprofessionalsatisfactionandcollaborate withlike-mindedorganizationsandentities intheseareas.
ACP’sEffortstoReduceBurnout• PatientsBeforePaperworkinitiativebegun- Spring2015• ACP/HennepinCountry/AMAcollaborationonEliminatingBurnoutStepsForwardpracticetransformationmodule– Summer2015
• WellnessChampionstraining– Fall2015• PromotingprofessionalsatisfactionaddedasanACPstrategicpriority– Winter2016• ACP– AMAcollaborationonpracticetransformation– February2016• ACPjoinedNAMActionCollaborativeonClinicianWell-being– January2017• ACPWellnessTaskForceformed– February2017• SecondWellnessChampionstraining– Spring2017• PuttingPatientsFirstbyreducingAdministrativeBurdenspaperreleased– March2017• ACPparticipatedinAMAMulti-stakeholderscollaborative– April2017
TheWellnessChampionsInitiative• TraintheTrainerconcept• FacilitatedbyMarkLinzer,MD,FACP• Initialcohort(October,2015)
• 20participants• ACPCouncilofEarlyCareerPhysicianmembers• ACPGovernors-Elect• ACPGovernors• ACPRegents• Geographicallyanddemographicallydiverse
• 2-dayprogram• Secondcohort(March2017)• ContractwithMarkLinzertoexpandanddevelopinfrastructurefordeployment
TheWellnessChampionsInitiativeObjectives
• ACPleaderstoserveasresources fortheCollegeanditsChapters• Createadataregistrybyestablishingbaselinesandtrackingchangesovertime
• FormalorganizationalrecognitionofscopeandseverityofInternalMedicinephysicianburnout
• Developacurriculumand/ortoolkit forChapters• Encourage healthylifestylesamongmembersandhealthyworkenvironmentsthatpromotelongevity,engagementandqualityofcare
•Work toputpatientsbeforepaperwork
AAIM/CHARM• DickWardrop• CarrieHorwitch• SueHingle
AMAStudy• PamHiebert
InternationalConferenceonPhysicianHealth
• SueHingle
AMASpeakersBureau• EileenBarrett• CarrieHorwitch• DaisySmith• SujaMatthews
NationalAcademyofMedicineCollaborative
• DaisySmith• SueHingle
Presentations
ACPChapterMeetings26andcounting
Local/regionalMeetings79andcounting
NationalMeetings/OrganizationsACP,AAIM,SHM,AssociationofCliniciansfortheUnderserved,CapitolHillstaffers,NAM,AMA
Mini-Z/ACP2016MemberSurvey• 10%arenotsatisfiedwiththeircurrentjob(76%satisfied)• 58%feelagreatdealofstressbecauseoftheirjob• 19%haveprofessionalvaluesthatarenotwellalignedwiththoseoftheirdepartmentleaders(59%havewell-alignedvalues)
• 31%areburnedout(69%donotfeelburnedout)• 35%havemarginalorpoorcontrolovertheirworkload(35%havegoodoroptimalcontrol)
• 51%haveinsufficient(marginalorpoor)timefordocumentation(22%havesatisfactorytimeavailable)
• 40%describetheatmosphereintheirprimaryworkareaaschaotic(5%describeitascalm)
• 4%havemarginalorpoorproficiencywithEHRuse(96%areproficient)• 6%workwithamarginallyorpoorlyfunctioningcareteam(94%experiencegoodteamwork)
DevelopmentofToolkit• Topicsincluded
• Resourcelists• Description/summaryofACPefforts• Timemanagementskills• Negotiationskills• EMRefficiency• Howtogetcreditfortheworkyoudo• Teambasedcare• Howtointegratewellnessintomedicaleducationprograms• Howtodevelopawellnesscommittee• Personalwellnessstrategies
Whatistheoneprofessionalchallengethatconcernsyoumost?
Challenge PercentLimitedtimewithpatients 14.5Toomuchpaperwork 11.9Work/lifebalance 11.8Lossofphysicianautonomy 10.7Physicianburnout 6.9Maintenanceofcertification(MOC) 5.8Malpractice threats/needtopracticedefensivemedicine 5.6Staying currentonclinicalknowledge 5.5Electronichealthrecords(EHRs) 4.7Physicianreimbursementandpaymentissues 4.1
Source:ACP2015MemberSurvey
ACPeffortstomakeinternalmedicinepracticemoresatisfying…
• Clinicaldocumentation• EHRs:functionality,usefulness,clinicalrelevance• PatientsBeforePaperwork(CapturesallofACP’sactivitiestoreduceadministrativeburdens)
• Paymentreform:paymoreforcognitivecare,chroniccare,coordination,communication
• Qualitymeasures:relevance,burdenofreporting
Written by Shari Erickson and BrookeRockwern on behalf of the Medical Practice and Quality Committee
http://annals.org/aim/article/2614079/putting-patients-first-reducing-administrative-tasks-health-care-position-paper
• ProvisionofPayment• EnsuringCareisHigh-Quality&Safe• ReductionofExcessUtilization,Fraud&Abuse• EnsuringFinancialSecurity&ProfitfortheEntity
• LackingClearIntent
IntentsofAdministrativeTasks
• Billing&Insurance-RelatedActivities
• Measurement&ReportingImpacts
• EHR/HealthITImpacts• ImpactonClinical&PatientCare
• ImpactonPhysicianSatisfaction
ImpactsofAdministrativeTasks
ACPPolicyRecommendations:1. Stakeholderswhodeveloporimplementadministrativetasks
shouldprovidefinancial,time,andqualityofcareimpactstatements forpublicreviewandcomment.
2. Tasksthatcannotbeeliminatedmustberegularlyreviewed,revised,alignedand/orstreamlinedwiththegoalofreducingburden
3. Stakeholdersshouldcollaboratetoaimforperformancemeasuresthatminimizeunnecessaryburden,maximizepatient-andfamily-centeredness,andintegratemeasurementofandreportingonperformancewithqualityimprovementandcaredelivery
4. StakeholdersshouldcollaborateinmakingbetteruseofexistinghealthIT,aswellasdevelopmoreinnovativeapproaches.
Solutions
ACPPolicyRecommendations(cont.)
5. AsUShealthcaresystemsevolvestofocusonvalue,stakeholdersshouldreviewandconsiderstreamliningoreliminatingduplicativeadministrativetasks
6. Rigorousresearch isneededontheimpactofadministrativetasksonourhealthcaresystem
7. Researchonanddisseminationofevidence-basedbestpracticestohelpphysiciansreduceadministrativeburdenwithintheirpracticesandorganizations
• PublicandPrivatePayers• GovernmentEntitiesandOversight• OversightbyPrivateEntities• VendorsandSuppliers• OtherHealthcareOrganizations• MeasurementofPatientExperienceandEvolvingConsumerExperience
ExternalSourcesofAdministrativeTasks
PatientsBeforePaperworkEffortscontinued
•ACPhasmetwiththefollowingorganizationstodiscussourconcernsandefforts:
• CMS• OfficeoftheNationalcoordinator• EHRAssociation• America’sHealthInsurancePlans• Bluecross/BlueShieldAssociation• MedPAC
PatientsBeforePaperworkcontinued
• PracticeSupportEfforts:• ACPPracticeAdvisor®- www.practiceadvisor.org – online,interactivetooltohelppracticesimprovetheirworkflowsandoperatemoreefficientlyandeffectivelyintheevolvingenvironment.
• ThePhysicianandPracticeTimeline– www.acponline.org/timeline - canhelppracticesknowkeyregulatorydeadlines,includingchanges(andideallyimprovements)inthoseprograms,andprepareforthem!
• ComingSoon:ACPQualityPaymentAdvisor– willhelpphysiciansandpracticestobesuccessfulunderthenewQualityPaymentProgram/MACRA
10BoldStepstoPreventBurnout
1. Ensurethatmetricsforinstitutionalsuccessincludephysiciansatisfactionandwell-being
2. Incorporatemindfulnessandteamworktraining fortraineesandpracticingclinicians
3. Decreasestressfromelectronichealthrecords4. Addresschallengingworkconditionsinprimarycare5. Cover predictablelifeeventswith“clinicianfloatpools”
Linzer,etal,.,JGIM,2014
10BoldStepstoPreventBurnout
6.Developpracticemodelsthatpreserveworkcontrol(standardizationvs.flexibility)7.Supportmanageableprimarycarepanelsizes,highly-functioningcareteamsandlengthenedvisits8.Allowclinicianstimetodowhattheyaremostpassionate about9.Promotecareeropportunitiesfor part-timephysicians10.Prioritize physicianself-care asanelementofprofessionalismLinzer,etal,.,JGIM,2014
SystemicSolutions:PromotingPhysicianWellness
Coaching(directobservation)• Improveefficiency/outcomes• Atul Gawande 2011
IncreasingSatisfaction
• Honoryourvalues• Dowhatyoulove• Assumebestintentions• Seekjoy• Practicegratitude
Tips:Stayconnected
• Havediversesocialresourcesandvariedinterests• Ventifyouneedto,buttrytokeepworkatwork• Investyourresourcesinpositivespirals• Beavailableforyourpartners,friends,family
Tips:DoWhatYouLove
• Dividetheworkintotasksandtrytoalignthosewithinterests• Taketimeeverydayatworktodowhatyoulove• Makingtimeeveryweekathometodowhatyoulovesustainsyouduringtheworkweek