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.
The prevalence of burnout among physicians is estimated to be more than 50 percent and has grown in recent years. This alarming trend is largely due to changing patient demographics, increasing cost constraints, new federal and state regulations, and other external factors that have reshaped the daily work experience of physicians. Too often today, physicians spend more time on data entry than in direct patient care.
Professional burnout, as it has been defined by researchers, is a response to stress in the workplace. It consists of three components: emotional exhaustion, depersonalization or cynicism, and a low sense of personal accomplishment in one’s work. It is caused by a “mismatch” between the worker and the workplace in one or more of six domains: workload, control, reward, community, fairness, and values.
Burnout among physicians has significant negative consequences, including effects on patient safety, quality of care, the patient experience, and personal costs to the individual physician: depression, substance use, suicide. It also affects health care organizations and our health care system as a whole, as physicians choose to cut back on clinical hours, retire early, or leave clinical practice for other careers.
Effectively addressing burnout requires an understanding of its true causes—just as an accurate diagnosis of respiratory distress is essential to effective treatment. Despite the fact that the cause is quite often systemic, frequently individual physicians and the health care organizations in which they work respond as if it were a problem solely within the individual. Too often, physicians and leaders “neglect the organizational factors that are the primary drivers of physician burnout.”
As a physician who left clinical medicine because of burnout and as a writer, I’m drawn to stories of physicians whose professional and personal lives have improved after reasoned interventions. So my ears jumped to attention earlier this month when a colleague at a summit on physician burnout described the positive results his practice had achieved in reducing burnout. Read Pierce, MD, is interim director of the Hospital Medicine Group (HMG) and is the associate director of the Institute for Healthcare Quality, Safety and Efficiency at the University of Colorado.
Leaders in HMG, a hospital-based internist group that includes 85 physicians, physician assistants, and nurse practitioners, conducted a detailed survey three years ago as the first step in an effort to better understand the existing culture at work. The survey gathered information from frontline clinicians on engagement, satisfaction, burnout, mentorship, safety culture, and other topics. Results indicated that 45 percent of clinicians were experiencing some degree of burnout. Initially, leaders were unsure how to respond to the results, but they made a firm commitment to action, in part based on frustration with prior institutional surveys in which similar challenges were identified but little definitive change followed.
Pierce told me that the group sifted through the data and brainstormed on possible interventions. Over time, they chose 13 (an interesting number!) to take on. Here are three of them…