The Webinar will begin shortly

Transcription

1 The Webinar will begin shortly You can download the slides from this presentation at: OR

2 Welcome to the Webinar All attendees are on mute - to ask a question, please type it into the Q&A box in the control panel on your screen Download the slides from this presentation at: OR To minimize the control panel so that you can see more of the screen, click on the white arrow in the small orange box and the control panel will be minimized. Click again to open the panel.

3 Paul DeChant, MD, MBA Deputy Chief Health Officer Simpler Healthcare / IBM Watson Health ZurickDavis Webinar December 13, 2018 Aligning Physicians and Executives Beating Burnout and Building the Bottom Line

4 What Drives Professional Fulfillment? Meaningful Patient Relationships Opportunity to connect in a deep and personal way with many people, They tell us things they tell no one else, They allow us to examine parts of their bodies no one else can see or touch, They trust us that we have their best interest as our priority, and That we will do our best to heal them. Watson Health IBM Corporation

5 What Is Burnout? Exhaustion Exhaustion: depleting emotional resources to cope with the work environment. A loss of enthusiasm for work. Nothing More to Give Inefficacy Cynicism Depersonalization (cynicism): Distancing oneself from patients or the organization. Self-protective mechanism Inefficacy: a sense of low personal accomplishment, or feeling ineffective, at work. Physicians feel ineffective, but patients value their care. Maslach, C., & Leiter, M. P. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass

6 What Causes Burnout? Result of Interaction between the worker and the workplace Highly motivated professional into a dysfunctional workplace where unable to succeed without constant vigilance and focus Unsustainable => Toxicity Workplace Worker Watson Health IBM Corporation

7 The Six Workplace Drivers of Burnout: Work Overload Chaotic work environment Time Pressure Information Overload Loss of control Insufficient reward Breakdown of community Absence of fairness Conflicting values Linzer, M: J Gen Intern Med Jan; 29(1): Maslach, C., & Leiter, M. P. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass 7 Watson Health IBM Corporation 2016 Watson Health IBM Corporation 2016

8 Linking Drivers of Burnout to the Manifestations: Work Overload Chaotic work environment Time Pressure Information Overload Loss of control Insufficient reward Breakdown of community Absence of fairness Conflicting values Linzer, M: J Gen Intern Med Jan; 29(1): Linked to Emotional Exhaustion Linked to Cynicism Maslach, C., & Leiter, M. P. (1997). The truth about burnout: How organizations cause personal stress and what to do about it. San Francisco, CA: Jossey-Bass 8 Watson Health IBM Corporation 2016 Watson Health IBM Corporation 2016

9 Physician Burnout and Work Life Balance BURNOUT From 2011 to 2014 percent of US physicians with burnout grew from 45% - 54% Avg US workers steady at 28% EFFECT Reduced performance on key metrics Safety Quality Patient Satisfaction Access Physician and Staff Engagement Physician Turnover WORK-LIFE BALANCE 41% of US physicians satisfied with Work Life Balance Down from 49% in % of average US workers satisfied with WLF, Up from 55% in 2011 EFFECT Loss of Revenue Physicians are reducing productivity to regain WLB Avg PCP contributes $1.5M to hospital net revenue Avg FP # visits/wk: 2010=99, 2016=83, a 16% decrease Impacts how much you get paid for each RVU Impacts how many RVUs you produce 9 Watson Health IBM Corporation 2016 AAFP.2015 Practice Profile. July 2016

10 How Did This Happen? External Drivers EHR M&A Workplace Clinician yelp MOC Payers Watson Health IBM Corporation

11 We Have Added the Last Straw And People are Breaking!

12 Burnout s Impact on Physicians and their Families Depression Substance Abuse Family Dysfunction Physician Suicide 130% HIGHER: The suicide rate among female doctors than among women in general 40% HIGHER: The suicide rate among male doctors than among men in general Lose physicians a year to suicide 12 Schernhammer E. NEJM 2005 Watson Health IBM Corporation 2016 Slide Courtesy of the Center for Professionalism 12 and Peer Support, Brigham and Women s Hospital

13 1 3 Burnout in Nurses: Kronos survey, May percent of hospital nurses said their work is physically and mentally demanding 85 percent noted that their nursing jobs make them fatigued overall 63 percent reported that their work has caused nurse burnout 44 percent worry their patient care will suffer because they are so tired 41 percent have considered changing hospitals during the past year due to burnout Watson Health IBM Corporation

14 Burnout also Affects Administrators Watson Health IBM Corporation

15 What Should You Do? Watson Health IBM Corporation

16 A Five Step Approach to Reduce Burnout: Step 1 Diagnostic Step 2 - Planning session Step 3 Clinician Wellbeing Support Step 4 Management System and Culture Improvement Step 5 Practice Efficiency Improvement Watson Health IBM Corporation 2016 Stanford Well MD Model, Shanafelt,

17 MANAGEMENT SYSTEM AND CULTURE CHANGE THE MOST IMPORTANT OPPORTUNITY, AND THE MOST CHALLENGING PART OF THE PLAN Because YOU have to change WHAT you do and HOW you do it Watson Health IBM Corporation

18 What s Most Important?

19 Leader s Role Can t Be Delegated to Others Power of Leadership - Each 1% increase in Mayo Leader Score ~4% decrease in burnout - Each 1% increase in Mayo Leader Score ~9% increase satisfaction - Implement a physician leadership development program Be Seen and Heard - If people know it s important to the leader, it will be important to them Rounding - Shadow clinicians to understand their problems - Play Undercover Boss - Attend huddles as a coach/mentor, not the one with the answers Shanafelt, Mayo Clinic Proceedings 90:432

20 Leadership Focus 1) Respect for People 2) Continuous Improvement Without Respect for People You Can Get Improvement, but It Won t Be Continuous

21 Respect for People A Challenge in Healthcare Leadership is the stewardship of the lives entrusted to you. - Bob Chapman Watson Health IBM Corporation

22 Respect for People in Mergers and Acquisitions Mission and Vision Statements Identify Core Values Create a Compact Set of reciprocal agreements that support the Core Values A physician can expect the organization will provide X The organization can expect the physician will do Y Use the Mission, Vision, and Compact to guide decisions

23 Continuous Improvement A3 Thinking PDSA Huddles Value Stream Improvement Events Watson Health IBM Corporation

24 Continuous Improvement = Empowering Clinicians to Solve Their Problems Continuously fixing broken patient care processes, by eliminating clinician frustrations, led by the clinicians, in their clinical sites, under the caring guidance of a mentor. Preventive Medicine for Burnout 24 Watson Health IBM Corporation 2016

25 Identify Your Workflow Dysfunctions & Design a Systematic Plan to Fix Them Value Stream Mapping Analyze work flow Identify Barriers and Frustrations Plan improvement activities Done by and with the people who do the work, therefore Physicians and nurses must be involved in events that address their frustrations The most valuable time you spend NOT seeing patients 25 Watson Health IBM Corporation 2016

26 Effective Huddles 15 minutes maximum standing up, at the huddle board Acknowledgement/Appreciations Prepare for the day / Capacity to meet the demand Adequate Staffing Equipment Is it working & where it should be? Supplies any shortages? Problem solving What happened yesterday that we don t want to happen again? Get rid of the pebbles in your shoes Metric performance At the local level - Review only one metric each day of the week Spend time on it only if the metric is off target Watson Health IBM Corporation

27 Daily Management System: Tiered Huddles Staff Supervisors CEO / COO VPs Directors Managers Prepare for the Day Track Metric Performance Identify and fix problems Tiered Huddles Escalate problems as needed Flow of Information 27 Watson Health IBM Corporation 2016

28 Paired Leadership Organization Chart Watson Health IBM Corporation

29 True North Metrics: Aligning Around a Focused Few Goals Quality and Safety Delivery / Service Patient Satisfaction Cost / Productivity Growth Human Development Staff & Physician Engagement Joy in Patient Care Aligning the Organization to Succeed - Including C-level executive bonus metrics linked to reducing burnout 29 Watson Health IBM Corporation 2018

30 Deploying Strategy: Connecting Leaders with Clinicians Flow of Information Watson Health IBM Corporation 2016 Mission and Vision Compact Based on Core values True North Metrics Dyad/Triad Leadership Teams Coaches and Mentors CEO / COO VPs Directors Managers Supervisors Staff Huddles Prepare for the Day Track Metric Performance Identify and fix problems Escalate problems as needed Flow of Information 30 Watson Health IBM Corporation 2016

31 A Lean management system and culture A healthy and effective organization of empowered and aligned problem solvers that can quickly adapt in an external environment of volatility and uncertainty Workplace Clinician It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. Charles Darwin Watson Health IBM Corporation

32 PRACTICE EFFICIENCY IMPROVEMENT Watson Health IBM Corporation

33 The Physician-Patient Relationship: The Primary Driver of Professional Fulfillment

34 In few other sectors of the economy is the highest level professional responsible for the majority of production, customer service, and clerical work SGIM Blue Ribbon Panel Report. Redesiging the Practice Model for General Internal Medicine: A Proposal for Coordinated Care. J Gen Intern Med 2007; 22: Watson Health IBM Corporation

35 Key Focus areas to Improve Efficiency Collaborative Care Teams Inpatient and Outpatient EHR Changes Inbox Management Redesign clinical space Integrated Facility Design Watson Health IBM Corporation

36 Potential Impacts 36 Watson Health IBM Corporation 2016

37 Best in State Two Years in a Row Sutter Gould Medical Foundation was rated Highest in Overall Care by Consumer Reports among 170 California medical groups two years in a row: February 2014 & Watson Health IBM Corporation 2016

38 Provider Satisfaction Improvement: Returning Joy to Patient Care Personal experience at SGMF as CEO 38 Watson Health IBM Corporation 2016

39 A Caveat: Maintain both Patience and Urgency Most people overestimate what they can accomplish in 2 years, and underestimate what they can accomplish in 10 years. - Bill Gates The speed at which we fix this depends on how much the doctors and administrators invest, not just with dollars, but with their own time and attention. Watson Health IBM Corporation Paul DeChant

40 Focusing Only on the Triple Aim => Burnout 4 0 Watson Health IBM Corporation 2018

41 Pursuing the Quadruple Aim Returning Joy to Patient Care & Achieving Professional Fulfillment 41 Watson Health IBM Corporation 2018

42 Or as a primary care physician in Georgia put it: I don t know how long I could have continued to work as I was. Now I have time for more of a life to exercise and spend with family. It has made my life more balanced. Now I can see myself practicing for 20 or 30 years. Watson Health IBM Corporation

43 How Will YOU Change Your Work to Reduce Clinician Burnout and Improve Your Bottom Line? 43 Watson Health IBM Corporation 2016

44 Discussion Contact info: Paul DeChant, MD, MBA LinkedIn: PaulDeChantMD Blog: Watson Health IBM Corporation 2016

45 L Disclaimer Copyright Simpler Consulting, an IBM Company IBM, the IBM logo and ibm.com are trademarks of IBM Corporation in the United States, other countries or both. Simpler Consulting LLC, Simpler Healthcare, Simpler Business System, and Simpler, and its respective logo are trademarks of Simpler Consulting LLC, an IBM Company. All other company or product names are registered trademarks or trademarks of their respective companies. A current list of IBM trademarks is available on the Web at Copyright and trademark information at The information in this document is provided as is without any warranty, express or implied, including without any warranties of merchantability, fitness for a particular purpose and any warranty or condition of non-infringement. IBM products are warranted according to the terms and conditions of the agreements under which they are provided The client is responsible for ensuring compliance with all applicable laws and regulations applicable to it. IBM does not provide legal advice or represent or warrant that its services or products will ensure that the client is in compliance with any law or regulation. The performance data and client examples cited are presented for illustrative purposes only. Actual performance results may vary depending on the specific configurations and operating conditions. It is the user s responsibility to evaluate and verify the operation of any other products or programs with IBM product and programs Statement of Good Security Practices: IT system security involves protecting systems and information through prevention, detection and response to improper access from within and outside your enterprise. Improper access can result in information being altered, destroyed, misappropriated or misused or can result in damage to or misuse of your systems, including for use in attacks on others. No IT system or product should be considered completely secure and no single product, service or security measure can be completely effective in preventing improper use or access. IBM systems, products and services are designed to be part of a lawful, comprehensive security approach, which will necessarily involve additional operational procedures, and may require other systems, products or services to be most effective. IBM does not warrant that any systems, product or services are immune from, or will make your enterprise immune from, the malicious or illegal conduct of any party.

46 Thank you for joining us today You can download the slides from this presentation at: OR We will be posting the recording at the same location on our Website within the next day so you can access it. We hope you enjoyed this presentation. To make sure you receive invitations to future Webinars, follow or on Linkedin at ZurickDavis or ZDinterim