A Practical Approach to "Returning Joy to Patient Care"
“Helping create the conditions where joy, purpose, and meaning in work are possible for physicians and their teams”.
In my recent conversation with Christine “Chris” Sinsky, MD, FACP, the Vice President for Physician Satisfaction and Practice Sustainability for the AMA, she shared this as her personal mission statement. It’s also the mission statement for her team at the AMA.
An Early Innovator and Passionate Advocate
Throughout her career Chris has been a passionate advocate for improving the care experience for patients, support staff, and physicians.
Chris is an innovator who early on developed a team-based care approach in her internal medicine practice in Dubuque, Iowa, the process and principles of which she now shares with fellow clinicians around the world.
In addition to being a community-based physician, she has strong credentials in academia, working with The Mayo Clinic, Stanford, the National Academies of Medicine, and other institutions on dozens of articles and opinion pieces published in peer-reviewed journals. She is a driving force behind efforts to reduce clinician burnout by going beyond simply helping clinicians be more resilient, focusing on improving the conditions under which physicians and their teams work.
Noting that the root causes of burnout are based in the dysfunction of the clinical workplace, not in a lack of resilience among physicians, Chris wonders why leaders still see burnout as an individual problem, as though the solution lies in enhancing physician resilience. She is a co-author with Dr. Colin West of the Mayo Clinic on a paper that demonstrated that physicians have higher levels of resilience that the general population.
Aligning Incentives to Reduce Burnout
We discussed the opportunity to focus healthcare provider organizations on clinician wellbeing, but adding as a system metric, not only on the system performance dashboard, but as a material component of senior leader compensation plans. Incorporating wellbeing metrics into executive compensation plans creates an opportunity to align incentives for all stakeholders and would motivate leaders of both clinical and support services to invest in clinician wellbeing.
Focusing on Current Challenges
Chris is focused on the current issues that matter right now. In addition to 5 peer-reviewed articles on burnout published with Mayo and Stanford, in 2021 her team has published 2 with Hennepin County Medical Center on coping with Covid. [CS1]
In her longstanding focus on the EHR as a source of burnout, and through her work at the AMA, her unit has sponsored thirteen studies investigating the use of EHR metrics such as “work outside of work”, to further characterize the physician work environment and track the impact of interventions meant to improve workflow and teamwork.
Her team has prioritized improving the inbox experience for 2022. She cites the work of A Jay Holmgren, PhD, assistant professor of medicine UCSF who reports a 150% increase in patient medical advice requests via the inbox across the entire Epic user base at the start of the pandemic in April 2020, with no decrease since. Chris noted that, analogous to a management quote that people who quit their job don’t leave a company, rather they leave their boss, she hears from physicians who are leaving medicine that they aren’t choosing to leave medicine, they are leaving their Inbox.
A New Focus to Transform the Care Experience for Everyone
Looking for a more constructive way to think about burnout, Chris is exploring an alternative, a motivational aspiration if you will, of enhancing physician undivided attention to the patient. When a clinician is able to give a patient undivided attention, care is safest, most effective, most satisfying, and most cost effective. Redesigning care to maximize the undivided attention physicians can give their patients also maximizes relationships among members of healthcare team.
Over the past ten to twenty years, medical care has evolved into a much more transactional conceptualization process – with technology infrastructures, staffing models, and physical infrastructures that enhance transactional relationships. This is reflected in the metrics by which we are measured – productivity, safety events, care gaps closed, etc.
Chris asks, “What would it be like if we maximized the opportunity for relationship instead? If we built our support staff models, physical facilities, measurement processes, compliance activities, and quality measures with the intent to design care differently, focused on relationships grounded in undivided attention?”
I suspect that such a radical transformation would go further to enhance professional fulfillment than most other efforts we pursue today.
We covered a number of other issues in our hours together, and frankly I wish I had another hour to explore these and other issues more fully with one of the deepest thinkers on physician burnout that I know.
If you’d like to learn more, I encourage you to attend the upcoming Healthcare Burnout Symposium in San Francisco January 24-26, 2022, where Chris will be a keynote speaker, presenting on “Creating a Manageable Cockpit for Clinicians: Fixing the Workplace, not the Worker”.