Why Do We Care Mukta Panda MD MACP Connecting Passion With Purpose In The Clinical And Learning Environments Why Do We Care Mukta Panda MD MACP

WHAT ARE WE REALLY TALKING ABOUT? 4 4

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Controlled Interventions to Reduce Burnout in Physicians February 2017 Controlled Interventions to Reduce Burnout in Physicians A Systematic Review and Meta-analysis Maria Panagioti, PhD1; Efharis Panagopoulou, PhD2; Peter Bower, PhD1; et al George Lewith, MD3; Evangelos Kontopantelis, PhD1,4; Carolyn Chew-Graham, MD5; Shoba Dawson, PhD6; Harm van Marwijk, MD6; Keith Geraghty, PhD7; Aneez Esmail, MD6 Author Affiliations JAMA Intern Med. 2017;177(2):195-205. doi:10.1001/ “This finding provides support for the view that burnout is a problem of the whole health care organization, rather than individuals” J Gen Intern Med. 2014 Jan; 29(1): 18–20. Published online 2013 Sep 4. doi: 10.1007/s11606-013-2597-8 PMCID: 10 Bold Steps to Prevent Burnout in General Internal Medicine Mark Linzer, MD, Rachel Levine, MD, MPH, David Meltzer, MD, PhD, Sara Poplau, BA, Carole Ward Medscape Family Medicine Physician Burnout: It Just Keeps Getting Worse Carol Peckham Disclosures January 26, 2015

Burnout RATES NATIONALLY: Residents 50-75%, Physicians 55% Linzer et al. Am J Med 2001;111:170-75. Turnover costs related to Burn out: average $250,000/departing physician Buchbinder et al. Am J Manag Care 1999;5:1431-8 Of 17,000 Physicians surveyed, 48% cutting back, retiring early, trying to find ways to limit patient care secondary to burnout 2016 American Physicians Foundation Survey Relative to physician burn out health care organizations have: reduced patient access to care, reduced patient satisfaction, reduced patient medication adherence Linn et al. Med Care 1985; 23:1171-78; DiMatteo. Health Psychol 1993;12: 93-102 Female physicians are 2.3 X’s more likely to commit suicide than women in the general public 400 physicians per year Example of impact: Typical Panel size=2300 1 million patients per year lose their physician to suicide 11

“Burnout- Heading In the Wrong Direction” Shanafelt et al, 2015 Mayo Clinic Proceedings Highest rates in front- line specialties: Family Medicine, General IM and Emergency Medicine 12

HOW DID WE GET HERE? TOP 10: Electronic Medical Record 13 Electronic Medical Record Workplace demands Culture of Medicine has changed Inefficient chaotic work environments Limited or no control over workload or schedule Less resources available to complete the work Less ability to shape career to focus on interests Work load is commonly part of the home environment Insufficient time to document adequately Medical decision-making completed more by outside guidelines of which we may not agree Misalignment of our values

EHR / EMR: Time Sinks 14

WHY CARE? 15 WHY ARE SMART ACADEMIC CENTERS, HEALTH SYSTEMS AND MEDICAL ORGANIZATIONS LOOKING AT THIS VERY CAREFULLY? Medical Organizations (i.e. ACP, Amer Coll of Surgeons, AMA AAMC, SGIM) Academic Health Care Centers, (ie Mayo, Cleveland Clinic, NYU, Univ of Mass Gen, VCU) Large Health Care Organizations (ie Kaiser, Accensia, Banner)

Organizational Climate, Stress and Error in Primary care: The Memo Study Advances in Patient Safety 16 30% more likely to leave job in 2 years  PATIENT CARE outcomes linked to organizational work conditions- such as burn out! When we assess with the tools –such as Mini Z, we can predict: Every 1 point increase in burnout on Mini Z = 30-40% increase in likelihood a physician will be reducing their work effort in next 24 months

IMPACT ON HEALTH CARE: $$$$ 17 1. Less committed and less productive physicians Statistics show us poor quality of care with higher burn out scores Less desire for patient and team engagement $$$$ Value Based Pay $$$ Loss of staff and poor patient outcomes $$$

Impact on Health Care: 18 Statistics show an increased rate of patient safety errors with higher burn out scores Lower patient satisfaction scores with higher physician burn out scores Decreased professional effort At risk: Reputation, medical malpractice costs, health system or practice reporting to regulatory agencies $$$ Loss of patients $$$$$$ $$$$$

Key Initiatives/Targets Health System's and Organization's Key Initiatives/Targets 19 Clinical Performance Re-admissions, and Length of Stay Patient safety errors, Recruitment and Retention Access to Care

The quality indicator now available on all web sites! Don’t avoid the burned-out physician, 20 Avoid the organization/practice who burned them out PHYSICIAN BURN OUT SCORES: The quality indicator now available on all web sites! 20

Solutions need to be organizationally driven 21 Organizational analysis Weill Cornell- Physicians averaged 15.1 hr/week processing quality metrics- 785.2 hours per physician per year (Med Rec, Documenting for the right code, No copy paste, yet note from day before is 2/3 the same, no clinical benefit in the work they are doing, documentation stuck in the fee for service era) Organizational think tank Solutions Team based documentation and order proposals Decrease data entry for highest paid professionals as much as possible Clinical Informatics and Pharmacy techs on each team

Solutions need to be organizationally driven 22 Organization analysis: Mayo Clinic- “Solutions are not the responsibility of an individual physician”. Designed a 9 step approach for organizations to promote physician Well-Being Sample solutions Promoting less than full time work- to improve recruitment and retention Use of daily huddles Use of Scribes Decreased email fatigue Increased use of allied health professionals on the teams Focused on efficient work environment and