The Department of Internal Medicine’s December 7, 2023, Medical Grand Rounds, “Reorienting around Relationships to Achieve Quadruple Aims,” was given by Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association. The presentation was the inaugural Drs. KJ and Linda Lee Visiting Professorship.
Sinsky talked about restoring personal relationships between doctors and patients, and within care teams, to achieve quadruple aim outcomes to optimize healthcare system performance. The outcomes include reducing costs, improving population health and patient experience, and the well-being of the health care team.
“The central question I'd like us to think about today is how would care look different if the whole system was intentionally reoriented around relationships, and how would care look if the culture, the policies, the operations, and the technologies were all intentionally built through and designed through the lens of relationships,” Sinsky said.
On the Transactional Nature of Patient Care
Sinsky pointed out that health care has become increasingly transactional, or what she calls “a series of disconnected episodes and a series of tick boxes and bullet points.”
“Any doctor can round on the patient on any given day,” Sinsky said. “Any clinician can be on the other side of the telemedicine screen. “We have this very transactional notion, and all of our infrastructures, our staffing models, our technology, our payment policy, even our physical plants, are built on this underlying conceptualization of our work.”
Sinsky emphasized the benefits of continuity, in which the same health care team cares for a patient from the time they are admitted to the time they are discharged. “When there's continuity with our patients, quality is better, and costs are lower. There are fewer ER visits and fewer hospitalizations. Mortality is less when you are cared for by a physician who knows you.”
When the same physicians and staff work together, Sinsky said, burnout among physicians and of members of the health care team is also reduced.
“We are better healers when we work in a system that has been intentionally designed to support relationships.”
On Wasted Time
Physicians, Sinsky said, should not be spending as much time “keyboarding.” One example of this is reading emails from patients asking for prescription refills and then placing orders.
“Work that used to be capably done by other members of the care team—by receptionists, pharmacists, and transcriptionists, suddenly became the work responsibility of the physician. We took it on, but we took it on at a cost of time, pressure, and cognitive overload. It involves a lot of work that did not require a medical school and residency education.
The Drs. KJ and Linda Lee Visiting Professorship is an annual lecture series emphasizing physician wellness, creating an exceptional patient experience, and improving the increasingly high rate of physician fatigue and burnout that impacts doctors, their families, and their patients. The professorship, hosted by the Yale School of Medicine Departments of Internal Medicine and Surgery and Yale New Haven Health, includes a keynote address and several other activities designed for medical staff to interact with and learn from the speaker. It has been generously funded by the Lees for a decade.
This event was recorded for those with a Yale net ID to view at Internal Medicine 2023 Medical Grand Rounds.