Providers are tired—burned out by the emotional stresses of the job, the pressures of the EHR, patient satisfaction, endless metrics . . . the list goes on. How do we balance always wanting to do better for patients without compromising the well-being of the people delivering their care?
When it comes to delivering patient-centered care, there are few places that do it better than Huntsman Cancer Institute (HCI). For the past three years, the cancer center has ranked in the top 5 percent for patient satisfaction among all academic medical centers in the nation. Yet, while faculty and staff have been going above and beyond in caring for patients, their own well-being was taking a hit.
At a retreat HCI hosted two years ago, “people were so burned out, they couldn’t even address goals we normally look at,” says Nursing Director Sue Childress, R.N., M.N. A follow-up survey found widespread burnout among employees, and pharmacists showed the worst decline in several categories—including the pleasure they derive from being able to do their work well. “We’ve always focused on placing the patient first, which is wonderful,” says Childress. “But somehow, we had created a culture that puts staff last.” That needed to change.
Under the harsh neon lights of the small pharmacist’s office across from the nurses’ station, 28-year-old clinical pharmacist Kelly Fritz, Pharm.D., says, “Sometimes I feel like I’m much older.” Her workload has more than doubled over the past four years. On an average day, she sees more than 20 patients. She tries to exercise after work but feels too exhausted when she gets home. She worries that if she “offloads” her day onto her husband, he’ll encourage her to look for another job. Instead, she finds simple comfort in the Labrador mix that she and her husband adopted from the shelter. “I don’t have to tell her how my day went,” says Fritz. “I just give her a hug and she licks my feet.”
Fritz and HCI are far from alone with such struggles. Burnout is rife throughout health care, reaching troubling proportions among health care providers nationwide. For a long time, provider satisfaction was ignored or relegated to the bottom of a growing and pressing list of priorities for health care systems. But now institutions are worried. “Unless we solve this problem, we’re not only going to lose some of our current providers, but we’ll disenfranchise our future workforce,” says Dan Lundergan, M.H.A., executive director of Service Lines, Specialty Clinics and Support Services. Beyond the human imperative to create a healthy workplace, there’s also a business one. Studies show that stress, burnout and depression are associated with decreased patient satisfaction, increased medical errors and higher costs.
Providing For Providers
What’s not clear is who exactly is responsible for the physical, emotional and mental well-being of health care providers? Compounding the confusion is that there’s no one-size-fits-all solution.
At our campus alone, there are more than a dozen initiatives trying to address the issue of well-being. At HCI, Childress and her team increased staffing, opened up lunchtime exercise and yoga classes, introduced art therapy and a writer-in-residence program and got approval to buy 14 recliners that massage employees on their breaks. In October, more than 30 people from across campus gathered at a Wellness Strategy retreat to try to chart the way forward. In the meantime, Rick Smith, M.B.A., senior director for human resource management, started a back-up childcare and eldercare program for staff and faculty. And the cafeteria created individually packaged meals so providers don’t have to pick up fast food on the way home. Smith admits these efforts don’t get at the root of the problem. “But I think people put up with a lot more in the workplace if it is somewhere they feel supported and empowered and have resources to help them through hard times,” he says.
Other efforts target mindfulness and resilience. But Kyle Jones, M.D., assistant professor (clinical) of family and preventive medicine, cautions that too much focus on these areas sends the wrong message: “We’re going to teach you how to deal with this crappy system or profession,” he says. “The real solution requires a much broader change in the way we train and practice.” Community Physician Group Executive Medical Director Susan Terry, M.D., agrees. “We need to find ways to get providers off of the hamster wheel. They’re constantly running,” she says. But it can’t be a one-way street and, curiously, sometimes the resistance comes from the very people such changes are meant to benefit. People have to believe that things can be better, and that’s one of the hardest challenges, says Terry. “Sometimes, they have a hard time seeing the possibilities.”
That’s especially true of older physicians, who are often perplexed by the idea of physician wellness, says Michelle Vo, M.D., assistant professor (clinical) of psychiatry She is tasked with addressing medical students’ wellness needs. “We’re trying to help students feel that it’s possible to be a caregiver and a wider human being, but often that’s not the message they’re getting from their mentors.” Eventually, says Vo, we’ll need to bridge that generational disconnect.
Getting providers to a place where they are energized by medicine’s challenges requires that they are engaged and aligned with their workplaces. But nationwide, only one third of physicians report being engaged, according to a 2016 Physician Executive Council Advisory Board study. Why aren’t more doctors doing system-based changes? “Because we aren’t asking them to think with us, we’re telling them what to do,” says Chief Medical Quality Officer Robert Pendleton, M.D.
Lundergan thinks the answer may lie in asking providers themselves what change they want to see. This year, he launched the “Exceptional Provider Experience,” which grew out of a remarkably successful initiative started in 2008 called the Exceptional Patient Experience (EPE). “We’ve been very successful at making it a great place for patients,” says surgeon Blake Hamilton, M.D. “Now we need to figure out how to make it an exceptional place to work.”
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