Redesigning Clinical Workflows to Return Joy to Patient Care
Front Line Connections
Front Line Connections

Last Sunday I focused on the fifth driver of burnout – Absence of Fairness. Leaders can increase the sense of fairness with front line connections to caregivers by being present in the clinical areas to understand the challenges first hand.  Of course, rapidly solving problems is key to making people feel that they are being heard and treated fairly.  This vignette from our book highlights two processes by which Ron Paulus, MD, the CEO of Mission Health connects with and supports the front lines.

Headquartered in Asheville, North Carolina, Mission Health is a large integrated health system with a medical staff of more than 1,000 physicians. Ronald A. Paulus, MD, president and CEO of the organization, launched an initiative to improve communication between the C-suite and front line clinicians, using an innovative digital platform.

WikiWisdom for Front Line Connections

WikiWisdom was designed by a former election pollster to gather responses to specific questions. It’s anonymous and monitored a third party moderator. A

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series of questions are posed and participants voice their opinions about problems and potential solutions. The moderator identifies the most vocal thought leaders and coordinates their input to create a written report, which a small group presents to Paulus in a face-to-face meeting.

The CEO has used information captured in the WikiWisdom reports to make rapid fixes to problems that had plagued the frontline staff but were never communicated all the way up the chain of command.
For example, through the nurses’ WikiWisdom report, he learned that for years seasoned nurses had objected to having to take the personality test given to new hires when they transferred from one job to another within the system. One week later the requirement was eliminated.

Via the physicians’ WikiWisdom report, Paulus came to appreciate “the hassle factor”—the daily frustrations and barriers to patient care that were burning out physicians. Chief among these was the EHR. According to Paulus, the report made the problem “real and tangible.”

Immersion Day for Board Members

He presented a proposal to the Mission Health board for a program to improve the usability of the EHR and fix inefficient workflow processes. Board members were well-informed about the daily lives of clinicians at the organization through a separate initiative called Immersion Day. During Immersion Day board members and local policymakers don scrubs, sign privacy forms, and spend 9 to 12 hours behind the scenes, watching front line clinicians in their everyday work and gaining insights they could never have acquired otherwise.

The board unanimously agreed to fund the clinician well-being and EHR optimization program, despite the multimillion-dollar price tag. Thanks to these front line connections, board members had seen firsthand the reality of daily practice and were convinced of the necessity of the investment to fix the workplace problems. The program provides funding for several initiatives, including dedicated IT specialists (5 FTEs’ worth) to shadow physicians and identify specific problems in the EHR software. The shadowing aspect is essential, Paulus told us, because finding the specific problems is a challenge. “You can’t crack the surface with the EHR problems, because people don’t remember or can’t describe the problem scenario. The IT shadow can observe and ask pertinent questions of the clinician, and he or she can say, ‘I get insane from this,’ and point out the issue. Then the problem is actionable.”

Paulus told us, “WikiWisdom is a very effective, low-cost, easy, rapid way to get direct visualization on what’s going on in the minds of the people who really matter.” The initiative provides valuable information to leaders and models respect for the frontline doctors and nurses. The feedback from frontline physicians also led Paulus to become more involved on a national level in advocating for solutions to physician burnout.

What have you found to help front line caregivers feel heard?  Click on the comments link above to share your story.

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