Hospitals look inward, add C-suite officer to boost staff wellness

https://www.healthcaredive.com/news/hospitals-look-inward-add-c-suite-officer-to-boost-staff-wellness/516451/

Chief wellness officers are becoming more mainstream.

As healthcare organizations look for ways to reduce physician burnout, some are placing their bets on a new C-suite role: chief wellness officer.

Hospitals that appoint an executive to oversee wellness anticipate not only happier employees but also improved patient experience and outcomes.

Physician burnout is at an all-time high. In a recent Medscape survey, nearly two-thirds of doctors reported feeling burned out, depressed or both. Worse, 33% of respondents said those feelings impacted their patient interactions. Burnout rates were highest among family physicians, intensivists, internists, neurologists and OB-GYNs, and were higher among women than men.

This epidemic, if you will, comes as the nation faces a growing shortage of doctors. The Association of American Medical Colleges projects the physician shortage could reach 105,000 by 2030.

Among factors fueling burnout are long hours, increasing regulatory and recordkeeping requirements and administrative and computer tasks. An Annals of Family Medicine report in September found that primary care physicians spend more than half their workday on EHR tasks. But the implications go beyond the looming shortage; physician burnout has been linked to lower productivity and absenteeism, medical errors, poorer outcomes and lack of engagement with patients.

Enter the chief wellness officer, or chief physician wellness officer as the title is sometimes called. The idea is not new, says Linda Komnick, a senior partner and co-leader of the physician integration and leadership practice at Witt/Kieffer. Companies and large organizations have employed them for more than a decade. However, it’s only in the past couple of years that they’ve started cropping up in healthcare.

“I would not call it a ‘trend’ yet,” she told Healthcare Dive. “What is a definite trend is that healthcare organizations are trying to be more holistic in supporting employees.”

The idea of CWOs aligns with the shift toward value-based, patient-centric care. Hospitals are trying to differentiate themselves culturally while they manage cost and risk. And there’s growth in self-insured plans and the overall societal thrust toward wellness.

Last summer, Stanford Medicine became the first academic medical center in the U.S. to designate a CWO, naming Dr. Tait Shanafelt, a hematologist who spearheaded an anti-burnout initiative at the Mayo Clinic.

Creating incentives for wellness

Concerns about chronic disease and rising healthcare costs led the Cleveland Clinic to appoint the C-suite role a decade ago. The question was “could we change the culture and environment of the organization by figuring out incentives to help people stay well and then reward them for staying well?” explains CWO Dr. Michael Roizen. “And what would that do to absenteeism and productivity?”

To do that, the clinic asked employees to achieve six “normal” vital signs — blood pressure, fasting blood sugar, body mass index, LDL cholesterol, healthy urine, learn to manage stress and see a primary care physician once a year. Those who meet those targets or are on a clear path to achieving them get the insurance rates and benefits in effect in 2008, when the CWO program took off. Everybody else gets rates in line with the current economy.

Preventing burnout is a big part of Roizen’s role. He says stress levels for healthcare workers were five deviations above the mean in 1983 when the Perceived Stress Scale was developed. To address the problem, the clinic offers an online stress management program. Those who take it see their stress and burnout levels fall by about 75% and 44%, respectively, he says.

The clinic also designated two physicians to work solely on reducing EHR clicks for physicians and uses scribes to assist its primary care practices.

There have been environmental changes as well, such as removing sugary products from vending machines, eliminating fried foods and trans fats in its eateries and making on-campus fitness centers free to employees.

The effort has paid off. In 2008, about 6% of clinic employees had six normal vital signs. Today, 63.8% of employees are in chronic care management programs and 40% have the six normal numbers. “That’s saved us, compared with competitors, $254 million for 101,000 employees in the past three years,” Roizen tells Healthcare Dive.

In addition, absentee rates have dropped from 1.07% to 0.70%. That change alone, if all the clinic did was replace the nurses, saves about $7 million a year, he adds.

It’s a win for employees, too, Roizen notes. The lower insurance rates translate to about $200,000 more in retirement funds, and employees live about eight years younger, meaning their risk of getting a chronic disease is that of someone younger.

A holistic approach

Dr. Edward Ellison, executive medical director and chairman of Southern California Permanente Medical Group, hired a CWO six years ago after physicians ranked the organization “very low” on wellness support in an internal survey. The response stood in contrast to that of managers and other staff.

The survey was trigger of sorts, Ellison says. “I had been a practicing physician and I knew the stresses. I knew the challenges of the electronic health record and how it had made many positive gains for systems of care and caring for patients, but created an added burden for physicians.” The survey was a “data point for me and what really prompted me to appoint a chief physician wellness officer,” he adds.

To increase physician satisfaction, the group now offers flexible and alternate work schedules, reduced hours, mental health resources and peer-to-peer support. Specified teams help physicians prioritize administrative tasks so that others can handle the clerical work. There is also a physician concierge to help with non-work life planning, social events aimed at reducing the isolation physicians can feel in their job. Doctors are taught to practice personal preventive care and provided access to workout equipment.

“You have to take a very holistic approach,” Ellison tells Healthcare Dive. “It starts with culture, but it’s also about the practical, tactical time in your day. It’s about reducing the hassle factor and some of the bureaucracy of systems, and it’s about personal care and resilience and connecting people so that they don’t feel isolated.”

SCPMG has repeated the survey that showed physicians did not feel the organization supported their wellness. The response today: double-digit improvements on culture and wellness, Ellison says.

An evolving role

So what qualities does a CWO need? Healthcare organizations are still figuring that out, says Komnick. Some are tacking physician and employee wellness onto medical director, chief human resource officer or chief experience officer roles. For those focused on physician wellness, it helps to have someone with a medical degree or research credentials. Other assets include the ability to lay out a vision for long-term wellness and supportive programs and exceptional collaborative and communication skills to get people on board with new ways of working in organizations that are traditionally resistant to change, she says.

The challenges for CWOs are huge and call for a wide continuum of solutions. “It’s not one size fits all, and we have to do this in the face of enormous change in healthcare, a lot of ongoing changes in reimbursement strategies and systems of care,” says Ellison, noting CWOs have to navigate all of that while focusing on wellness and resilience.

Meanwhile, the problem of burnout is only getting worse. Ellison sees a parallel in airline passengers being told to don their own oxygen mask before helping others. “We need to make sure that our physicians are as healthy as they can be because they are then going to be able to be their for their patients and support them,” he says. “It is in line with taking care of our patients.”

 

 

Medicine Must Start Caring for the Caregivers

http://www.realclearhealth.com/articles/2017/12/18/medicine_must_start_caring_for_the_caregivers_110757.html?utm_source=morning-scan&utm_medium=email&utm_campaign=mailchimp-newsletter&utm_source=RC+Health+Morning+Scan&utm_campaign=2ee2060ff3-MAILCHIMP_RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b4baf6b587-2ee2060ff3-84752421

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Practicing medicine is bad for your health. Mounting evidence shows that stress-related burnout is a significant and growing threat to doctors – and their patients. If there is a silver lining, it is that the medical community is beginning to acknowledge and address the complex factors at play, recognizing that good health care must include caring for the caregivers.

Numerous studies reveal that physician burnout – generally defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment – is a major problem.

A Medscape survey found that 51 percentof doctors surveyed in 2016 said they suffered from burnout, an increase of more than 25 percent since 2013. This dovetails with a 2015 paper published in Mayo Clinic Proceedings, which reported a burnout rate of 54.4 percent in 2014, compared with a 45.5 percent rate in 2011. These burnout rates are almost twice as high as those found in the general population.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. They are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether – an ominous trend as the U.S. experiences a growing doctor shortage.

Many forces are driving this trend: long work days (doctors work an average of 50 hours per work, 10 more than other Americans), the demands of juggling busy careers with family obligations and the pressures caused by student debt (the average medical school graduate with student loans owes about $190,000 upon graduation).

These and other factors – especially the challenges of balancing work-home obligations – take a special toll on female doctors, whose burnout rates as twice as high as their colleagues, making them more likely to leave the profession.

Still, there is one significant new development that seems to be driving the recent increase in burnout: electronic health records (EHRs). It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of EHRs. Someday, EHRs may revolutionize health care by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks. It can take 32 clicks to order and record a single flu shot. Some studies show that doctors now spend about two hours on paper and desk work for every hour they devote to deliver direct patient care.

It is hard to overstate how much this dispiriting lack of personal contact, which is the major reason people choose careers in medicine, leads to the depersonalization and depression that are the hallmarks of burnout.

Perhaps the best evidence that practicing medicine is bad for one’s health is studies showing that medical students begin their training with stronger mental health profiles than their fellow college graduates. This advantage vanishes and a deficit emerges as they progress through their schooling, residency and professional practice.

As in medicine, we must identify the problem before we can treat it. A crucial step was taken in July when the National Academy of Medicine called on researchers to identify interventions that ease burnout. Many universities and academic hospitals have already been exploring ways to address the problem.

At the University of Michigan we established two groups earlier this year – one to look at burnout among our doctors, the other among our younger residents. It is still too early to say what might work. But ideas to help physicians achieve a better work-life balance, including more flexible scheduling that recognizes family commitments as well as better child care assistance, seem promising. So, too, does the use of “scribes” to handle some paperwork chores and drawing a sharper distinction between the care only doctors can deliver and that which can be provided effectively by physician’s assistants and other trained personnel.

Above all, we must allow doctors to ask for help and provide them with the care they need without penalty. Medicine has long been hampered by the ancient myth of invincibility – the notion that physicians must never show weakness, every embodying grace under pressure. This is not only wrong, it’s dangerous.

Physician burnout is a national crisis. Unfortunately, it does not offer a quick fix. Medicine will always be a uniquely demanding profession, requiring years of training and long hours of service to be ready to make life and death decisions.

Fortunately, a broad consensus has emerged in the medical community that doctors cannot provide the best care for their patients if we don’t figure out how to take care of them.

 

Diagnosing why innovation hasn’t stopped healthcare productivity declines

Diagnosing why innovation hasn’t stopped healthcare productivity declines

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Autonomous vehicles. Augmented reality. Artificial Intelligence.

The world is undergoing radical transformation via technological innovation. Healthcare is not immune to this trend and has lately unleashed its own wonders from CRISPR to 3D-printed prosthesis to sensor-enabled pills. We can truly transform lives in ways unimaginable even just 10 years ago.

In other ways, however, healthcare lags.

In transportation, Google’s first “driverless” Street View cars were on the road a scant few years after the DARPA Grand Challenges of the mid-2000s that paved the way for them, and Uber become a verb in the same amount of time it takes to implement a current EHR system. Furthermore, Amazon’s chatty Alexa now interacts with you in your home, having arrived just a short time after Siri became the personal assistant in your pocket.

Healthcare innovation has been incapable of gaining similar traction even with profound technological advances.

There is an unmentionable dark side of healthcare innovation.

Advances in productivity via utilization of new tools and technologies has been anemic. Healthcare is struggling to keep pace with other industries. In fact, in a recent McKinsey study, healthcare is one of only two industries (construction is the other) that has shown a productivity decline. Read that again: Despite IT spending growth increasing by over 5 percent per year over the last 10 years, we’ve actually seen the healthcare labor pool and service environment become less efficient!

7 quotes from Geisinger’s Greg Burke on engaging patients and improving clinical hospitality

http://www.beckershospitalreview.com/patient-engagement/7-quotes-from-geisinger-s-greg-burke-on-engaging-patients-and-improving-clinical-hospitality.html

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At Danville, Pa.-based Geisinger Health System, Greg Burke, MD, an internal medicine physician and chief patient experience officer, aims to ensure the system’s patients are treated with the same type of respect and attention comparable to that delivered to guests at upscale hotels.

In November 2015, Geisenger made national headlines when the system’s CEO David Feinberg, MD, announced patients dissatisfied with their care experience could request refunds for out-of-pocket costs. To date, the system has issued $400,000 in refunds to patients.

Recently, Dr. Burke spoke with U.S. News & World Report on issues surrounding the patient experience, as well as Geisenger’s patient refund program.

Here are seven quotes from Dr. Burke’s interview in U.S. News & World Report.

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

http://www.annfammed.org/content/12/6/573.full?utm_source=State+of+Reform&utm_campaign=2fc34edc06-5+Things+Jan+%2802%29&utm_medium=email&utm_term=0_37897a186e-2fc34edc06-272256165

http://www.vox.com/2016/3/15/11157552/medical-errors-stories-mistakes