For years I wondered why despite being a confirmed urbanite, I love camping. Then I realized that camping gives me full permission to improvise—to make creative use of the limited materials I have to get the job done. Hence, shirt tails are fair game for wiping coffee grounds out of measuring spoons.
Similarly, I am inspired by people and groups that use the resources we have at our disposal in health care in creative new ways. Like the first explorers, these folks are testing approaches to provide care that are more effective than the status quo. Given the escalating health care costs, we need to be looking for ways to make the available financial resources work better for us. And, studies have shown that health care delivery includes a lot of wasted time, resources, and supplies, due in part to use of higher-priced services with no health benefits over less-expensive alternatives.
At a recent meeting on patient safety, I heard about a novel way of using a previously untapped resource—emergency medical technicians (EMTs), those courageous first responders to 911 calls. I followed up with Matt Zavadsky, MS-HSA, NREMT, who is the chief strategic integration officer at MedStar Mobile Healthcare, which provides emergency medical services (EMS) in the Fort Worth, Texas area, to learn more about it. Here’s what he told me.
For decades EMS units have been paid only to respond to emergency calls and transport people to the hospital. If they were to transport a person who needed less intense care to a lower acuity setting, like a walk in center or a clinic, they would not be paid—representing overuse of higher-priced services. In addition, EMTs, especially those based in fire departments, often spend a substantial portion of their shift waiting for emergency calls—representing underutilized human resources.
I am VERY resistant to burnout solutions that focus solely on the individual, as these seem to imply that the problem originates in the affected person. This approach pokes at a sore spot, because of the years I spent secretly worried that the reason I left practice was personal weakness or inadequacy, something I lacked or failed to do.
When in 2013, I ran across the research on burnout, I learned otherwise. By definition, professional burnout is caused by workplace stress. It is not due to a personal weakness, and it can happen to anyone.
My presentations and the book I co-authored make this point—that while individual-based solutions like mindfulness and medication practice are very valuable, they must not distract a health care organization from dealing with the underlying causes of stress in the workplace: broken processes, disrespectful culture, inefficient electronic health records (EHRs), lack of team-based care.
A recent interview caused me to rejigger my thinking on the topic. Tom Jenike, MD, is chief human experience officer at Novant Health, an integrated health system in North Carolina. (Love the title.) He began our interview describing an initiative at his organization that focuses on building resiliency in clinicians. A dime a dozen, I thought. Yet another health system placating frontline physicians and nurses with stress reduction techniques.
But within the span of the call, I changed my mind about the relationship between individual and systems solutions. Why? Because of the results—not just the engagement and satisfaction outcomes, but the culture and systems changes that the initiative has catalyzed.