Here is the second in a series of vignettes from our book Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine. In this post we’ll learn how, by removing frustrations from patient care, a small practice has dramatically reduced the burnout driver of work overload.
Northeast Georgia Physicians Group (NGPG) is a large, multispecialty group with more than 50 locations in northern Georgia. One clinic, located in the small town of Cleveland, served as a model site for the group’s Lean implementation. Providers at the primary care clinic include three physicians and a nurse practitioner. According to James Murphey, MD, an internist and pediatrician at the clinic, one of the most pressing problems for care providers there was the daily struggle—and failure—to keep on schedule. It was not unusual for patients to wait an hour or more to see their care provider. Murphey told us, “I was struggling with being behind all day. There was a snowball effect, with longer and longer delays as the day went on and no chance to catch up. It was stressful for providers and patients.”
Removing Frustrations by Managing Time Pressure
After identifying inefficiencies in their daily work through rapid improvement events (RIEs), the clinicians and staff made a number of changes aimed at removing frustrations from their workflow. Staff adapted the schedule to account for triage time and for appointment duration. They also included time in the schedule for documentation. The clinicians and staff standardized certain processes to streamline the workflow.
Murphey admitted to feeling wary about standardization when the idea was first introduced. He said, “A lot of providers shy away from standardization when they hear about it. A year ago I would have felt the same way.” Murphey told us that what sold him was learning about Lean principles and seeing the processes at work during a study trip in which he observed a clinic that had implemented Lean. “I really needed to see it for myself to believe,” he said.
What Murphey and the other care providers at the clinic have found is that standardizing the operational aspects of the patient visit has freed up time to deal with the variability that inevitably arises. As he put it, “By controlling all that we can, we can deal with the unknown better.” Murphey feels the changes have allowed him to practice medicine the way he had hoped to when he entered the profession. “My time with patients has not changed, but the rest of the office processes and operations around that time have changed. The improvements have preserved the kind of medicine we want to practice.”
According to Murphey, all the providers experienced benefits from the practice changes, although the degree to which they were affected varied. He told us, “One provider was already very efficient with documentation. It took several RIEs before he noticed changes, like staying on time with his scheduled appointments, less staff overtime, and improved morale.” Murphey noticed changes immediately, with a substantial reduction in his “after-hours” documentation work.
Improved Productivity with Less Work Effort = Less Burnout
Physicians at the clinic had expected their productivity to decline with the new processes, especially with the time set aside in the schedule for documentation. However, following an initial dip during the first few months after launching the Lean implementation, the physicians’ productivity has increased 10 percent over baseline. Additionally, the number of appointments starting on time has doubled, and the average time a patient spends in the clinic per appointment has decreased from 80 minutes to 45 minutes.
Murphey sees the practice changes that the group instituted as being essential for avoiding burnout and for continuing to practice over the long haul. Although he was just six years out of training, before the Lean implementation Murphey questioned whether he could keep up the pace, especially with the way work was impinging on his home life. “I don’t know how long I could have continued to work as I was. Now I have time for more of a life—to exercise and spend with family. It has made my life more balanced. Now I can see myself practicing for 20 or 30 years.”
Have you tried removing frustrations from your work flow? If so, how has it gone? Click “Comments” at the top of this post to share your thoughts.
If you haven’t given this a try, it’s time. It’s not easy, and takes a commitment from everyone. But as Dr. Murphey’s experience shows, it is well worth it.
Feel free to reach out to me if you’d like some help.