Redesigning Clinical Workflows to Return Joy to Patient Care

Each week for the next six weeks I will post a vignette from our book “Preventing Physician Burnout” that highlights actions leaders take to reduce the impact of physician burnout.  Here is the first, on engaging physicians in strategic planning as a way to connect vision and values…

Engaging Physicians in Strategy

Located in Washington State across the Columbia River from Portland, Oregon, the Vancouver Clinic is a multi-specialty medical group with about 250 care providers. Despite the fact that the organization is owned and governed by physicians, leaders saw increasing dissatisfaction and a growing lack of engagement among physicians. According to Sharon A. Crowell, MD, an internist and chair of the board of Vancouver Clinic, they received comments such as, “Over the past 10 years there has been a steady deterioration in the physicians’ influence over the operations of the clinic…Every major decision is heavily influenced by non‐physician administrators…This has led to a clinic that is very much top-down oriented.” The practice scored an abysmal 11th percentile on a national survey of provider satisfaction.

The drop in satisfaction followed an intense focus by the CEO on infrastructure and finance after a downturn in the economy and a constriction of the market. According to Alfred H. Seekamp, MD, obstetrician and chief medical officer of the organization, when the CEO announced his retirement in 2011, leaders and the board feared that the incoming executive leader was doomed to fail unless the existing gulf between the administration and physicians was resolved. Seekamp was concerned about burnout from an individual and an organizational perspective. “Burnout can be a disaster in an organization where you need engagement.”

To ensure that the organization could achieve its mission and goals, leaders fully engaged frontline providers in the development of the group’s strategy. They also adopted a new approach to leadership—one that was grounded in respect and bidirectional communication. In January 2012, organizational leaders implemented the nominal-group technique to better understand physicians’ work experiences. They convened informal focus groups of physicians and asked them to describe their daily frontline experience at the clinic. At a dinner meeting, a group facilitator asked two simple questions: What would make your life at Vancouver Clinic rich and meaningful? What’s getting in the way?

Nominal Group Process for Engaging Physicians

41393284 - colleagues at an office meeting

Physicians wrote their responses to the questions on index cards, engaged in short table conversations to identify broad themes, and presented a summary to the group. According to Crowell, the process generated extremely valuable data. She explained, “In two and a half hours, we had hundreds of individual comments, from which we developed a list of themes that reflected the physicians’ hopes and dreams. We brought that information into a leadership retreat and used it to guide the creation of our new strategic vision.” After the retreat, leaders shared the written vision at the organization’s monthly meeting to confirm its accuracy and to demonstrate that the physicians’ input was valued. “The process was so successful that we use it for every big decision now,” Crowell told us.

Seekamp explained that the iterative technique used in the new strategic planning process was key to re-engaging physicians. “The process works as an engagement spiral. We show physicians that they have the ability to influence leadership, which leads to trust. Trust leads to engagement.” The planning process also identified key pain points that were affecting the physicians’ daily work experience. Department chairs followed up by asking physicians about specific problem areas and potential solutions. The interventions were included in the organization’s strategic plan. For example, pediatricians wanted to maintain continuity with their panel of patients, but when a provider had a full day’s schedule, patients with acute issues would be scheduled for a same-day appointment with another care provider, which then limited same-day appointments for his or her own patients. As a solution, the group now schedules patients with their assigned care provider on another day or triages them to the urgent care clinic. The organization is also testing the use of medical scribes to alleviate the data-entry burden identified by physicians.

Daily Management System for Engaging Physicians

Vancouver Clinic also adopted a daily management system to improve communication across the organization. Seekamp believes it may help prevent burnout. “The management system allows clinicians to be more effective at their work and helps alleviate the sense of being overwhelmed and burned out. Plus, it engages both physicians and staff.”

Seekamp and Crowell described the improvement in culture and physician engagement at the organization. A recent survey showed that physician satisfaction scores had risen to the 75th percentile. According to Crowell, there is a perceptible increase in physicians’ joy in practice. “Once physicians see they can influence leadership, they readily engage in solving problems to improve their work environment.” Other metrics support her observations: provider turnover has decreased, recruitment of new physicians has become easier, and physicians’ productivity, as measured by RVUs per FTE, has increased.

Seekamp summed up the shift in strategic planning this way: “This process is not top-down decision-making. It is understanding what’s working well and where problems exist in the organization by asking appropriate questions. Leaders don’t solve the problems for people. Instead we help them find and implement solutions.”

What do you think? Would this approach work for your organization?

Click on “Comments” at the top of this post to share your thoughts.

Leave a reply