AspiringtotheQuadrupleAim

Tellthepersonnexttoyouaboutonepatientwhoinspiredorchangedyou

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

MitigatingBurnout

OrganizationalChange

PersonalResilience

Wellness

QuestiontoPonder

WhyisTigerWoodssuchagreatputter?

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

OurGoldMedalTeam!InitialcohortoftheACPWellnessChampions!

TheWellnessChampionsInitiativeObjectives

• ACPleaderstoserveasresources fortheCollegeanditsChapters• Createadataregistrybyestablishingbaselinesandtrackingchangesovertime

• FormalorganizationalrecognitionofscopeandseverityofInternalMedicinephysicianburnout

• Developacurriculumand/ortoolkit forChapters• Encourage healthylifestylesamongmembersandhealthyworkenvironmentsthatpromotelongevity,engagementandqualityofcare

•Work toputpatientsbeforepaperwork

Whathavewebeenupto?

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)

CreatingResources

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

PatientsbeforePaperworkInitiative

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

Figure1:AFrameworkforAnalyzingAdministrativeTasks

• 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

QuestiontoPonder

Whydon’tpeoplewashrentalcars?

MitigatingBurnout

OrganizationalChange

PersonalResilience

Wellness

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:KnowYourself

• Exploreself-awareness• Reflection• Practicemindfulness

Tips:DoWhatYouLove

• Dividetheworkintotasksandtrytoalignthosewithinterests• Taketimeeverydayatworktodowhatyoulove• Makingtimeeveryweekathometodowhatyoulovesustainsyouduringtheworkweek

Tip:TakeCareofOneAnother