He had ignored the pneumonia-like symptoms for weeks, but awoke Sunday so short of breath he feared having to miss a day of work — his first ever.
Clinics were closed and he didn’t want to go the ER, so Bob Pendleton, a hospitalist and Chief Medical Quality Officer at University of Utah Health Care, phoned a colleague to see if he could be squeezed in. “I just happen to be charting in clinic,” the doctor told Pendleton. “Swing by the office, but drop by radiology first. I’ll call up there and tell them to expect you.”
By the time Pendleton made the drive from radiology to the clinic, his doctor was waiting for him, chest x-rays in hand. Pendleton was diagnosed with pneumonia, given a prescription and back home in under 45 minutes.
“It really crystallized for me the patient-centered experience and where we need to be as a health organization,” he says. “It makes you pause and think, ‘Don’t all of our patients deserve that same level of care? What keeps us from making that happen?’”
Since publication of the Institute of Medicine’s landmark “Quality Chasm” report in 2001, the mantra in health care has been: Less doctor-centered, more patient-centered. But the hard-wired realities of our health system — its fragmented nature, outdated payment models and an ever-changing field of regulations — frustrate even the most tireless champions of patient-centeredness.
Clinicians are do-gooders by nature; they want the best for their patients. But they’re under tremendous pressure to balance an ever-increasing number of competing demands on their time.
“We have 648 different quality and safety measures to track and report to the government. That’s at the system level,” says Pendleton. “At the provider level it’s even more challenging. I’ve got my licensing and certification requirements and the inefficiencies of learning and maintaining a new electronic health record system. If you line up all those things our typical providers on the front lines are actually adding 184 hours a year of additional work.”
Is it any wonder that 36 percent of physicians nationally report symptoms of burnout?
Despite these seemingly insurmountable challenges, however, Pendleton remains optimistic. His recipe for keeping clinicians engaged, happy and motivated, despite all the disruptions to their workflow: Remind them of the end goal.
“It’s got to be about the patient,” he says. “We get so caught up in the day-to-day struggles and CEO speak. But for me as a physician straddling the old world and new world it’s most helpful to remember that we’re doing these things because we believe them to be winning strategies for the patient.”
Regulations, payment models and the brick-and-mortar infrastructure of health systems may seem tethered to the past, but it won’t be that way forever.
“We are in this five-to-ten-year period of choppy waters. It will be very challenging because we are living in two worlds,” Pendleton says. “But it’s also the opportune time to innovate and redesign care in a way that would be the kind of system we would want when we’re patients.”
Kirsten Stewart is a senior writer for University of Utah Health Sciences. Video filming, editing and scripting by Charlie Ehlert and Kim Grob.