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2 Sides of the Same Coin: Clinician Engagement and Patient Experience

October 13, 2021

Yale Cancer Center Grand Rounds/Iris Fischer Memorial Lecture | October 12, 2021

Presentation by: Dr. Jessica Dudley

ID
7037

Transcript

  • 00:00Thank you all for joining on
  • 00:01behalf of Doctor Nita Ahuja,
  • 00:03our interim Cancer Center
  • 00:04director at Yale Cancer Center,
  • 00:06doctor David Fisher.
  • 00:08Want to invite everyone to
  • 00:10sit back and enjoy this?
  • 00:12It's going to be a wonderful
  • 00:14presentation by Doctor Jessica Dudley.
  • 00:16But before we get to Doctor,
  • 00:18Dudley wanted to talk about the Iris Fisher
  • 00:22Lectureship which was endowed in 1999.
  • 00:26And since then, we've been very fortunate
  • 00:28to have some pretty amazing speakers.
  • 00:31I think last year was Doctor Ethan Bosch,
  • 00:34when I remember Doctor Fisher
  • 00:36has over a 60 year history with
  • 00:39with Yale School of Medicine.
  • 00:41He was and and is the first medical
  • 00:44oncologist for the New Haven community.
  • 00:47It was in private practice,
  • 00:49but then came over full time faculty in 1995.
  • 00:52Obviously he's had countless contributions
  • 00:54to the Yale School of Medicine.
  • 00:56Yelp Cancer Center.
  • 00:58The Smilow Cancer Hospital and our community.
  • 01:02But really important for today is
  • 01:05Doctor Fisher's wife.
  • 01:06Iris was the diagnosis,
  • 01:08sarcoidosis and incurable disease and
  • 01:10really a lot of the decision making
  • 01:14in terms of you know what types of
  • 01:17treatment and quality of life in terms
  • 01:20of her personal well being are really
  • 01:22immortalized in this in this lectureship.
  • 01:25So you know,
  • 01:25it's a it's really phenomenal that we get
  • 01:28to do this every year and bring them,
  • 01:30you know,
  • 01:31fantastic faculty.
  • 01:32And people around the country and
  • 01:34around the world to to be able to
  • 01:37present we of course wish that doctor
  • 01:39Jessica Dudley was here in person,
  • 01:41but maybe we'll get a rain check.
  • 01:44Or, you know, inviter.
  • 01:45Invite her in the next couple of months
  • 01:48if things clear up a little bit more.
  • 01:50Moving on to doctor Jessica Dudley,
  • 01:53she's the Chief clinical officer for Press,
  • 01:55Gainey,
  • 01:55and you know this is what the focus
  • 01:58of her talk is going to be on.
  • 02:00But really,
  • 02:01I'm I wanted to take a few moments
  • 02:03just to talk about my personal
  • 02:05relationship with Doctor Dudley.
  • 02:07She was my chief medical officer
  • 02:09when I was on faculty at Brigham
  • 02:11Women's Hospital in the Brigham and
  • 02:13Women's physician or organization.
  • 02:15And really, you know,
  • 02:17looked up to her as my mentor.
  • 02:18She really helped me navigate many.
  • 02:22Crises,
  • 02:22whether it was in the care of our
  • 02:26patients in my area specifically
  • 02:27and in breast cancer patients,
  • 02:29and he really even personally through
  • 02:31some of the things that I had to go through.
  • 02:32And you know,
  • 02:34a huge loss for for the Brigham,
  • 02:36you know,
  • 02:37real amazing game for a press ganey.
  • 02:39And it's absolutely phenomenal that
  • 02:43that she's here with us today.
  • 02:45I did want to share one quick
  • 02:47picture because I'm not dressed up,
  • 02:50but this was my 2010 clinical
  • 02:53collaboration award.
  • 02:54That I want from was awarded by the
  • 02:56Brigham Women's Physician Organization.
  • 02:58I had a little bit more here.
  • 03:00There Doctor Dudley has not changed a bit,
  • 03:03and with that I'd like to pass
  • 03:05on the floor to to Jessica.
  • 03:08Thank you so much for being
  • 03:09here. Thank you so much and for
  • 03:13making me laugh. With that photo,
  • 03:16not 'cause you're ended up.
  • 03:18Very proud of you, but 'cause I was
  • 03:22thinking about when I took the job
  • 03:24at the Brigham hold and I'm just
  • 03:26trying to get to the to my slides.
  • 03:28When I took the chief medical
  • 03:30officer job at the Brigham.
  • 03:32In my job description,
  • 03:34actually was hosting that gala
  • 03:36and I know I thought, you know,
  • 03:39I had this big population health
  • 03:40background and was very focused on care,
  • 03:42innovation, and then the gala,
  • 03:44which was a wonderful event to
  • 03:46celebrate all of our physicians.
  • 03:48But having to pick out a dress
  • 03:50to go to the Gallic you just
  • 03:51brought back a lot of stress,
  • 03:53but that's it's all good.
  • 03:54It's all behind me now.
  • 03:56Great, so thank first one.
  • 03:59So honored to be here to speak
  • 04:01with all of you today.
  • 04:03And thank you Doctor Fisher for this
  • 04:07incredible honor to be presenting
  • 04:10at this specific grand rounds and
  • 04:14Mira and all for inviting me here.
  • 04:17I am really excited to spend this
  • 04:20time with all of you and I have quite
  • 04:23a few slides and my goal is not to
  • 04:26kind of bury you in these slides.
  • 04:28My goal is to hopefully engage
  • 04:31you in thinking about.
  • 04:33These issues,
  • 04:34and I think things that
  • 04:36you've probably come I know,
  • 04:38think about quite a bit,
  • 04:41but hoping that by the end of this,
  • 04:43maybe I can shine a different light
  • 04:45on it and share a little bit of a
  • 04:49different perspective and one that
  • 04:51hopefully going forward we can work
  • 04:52with each other and continue to grow.
  • 04:56Richard, sorry to present.
  • 05:00You're showing like the next slide.
  • 05:02OK, so let me work on that
  • 05:03'cause I was worried about this
  • 05:05and I I'm trying to get it in.
  • 05:07Sorry yeah it's supposed to
  • 05:09be in the slideshow mode,
  • 05:10but it sounds like it's not.
  • 05:13Not yet. Hold on one second.
  • 05:15Give me a second.
  • 05:18Give me one second stop share.
  • 05:21Share and I wanna share.
  • 05:24This screen.
  • 05:29And I have that sound on share screen
  • 05:32and then this should pop it into.
  • 05:37Is it still? Are you still
  • 05:39getting my notes page?
  • 05:40Oh, got it, you're great.
  • 05:43OK, let me know if they pop up 'cause
  • 05:45I'll just kill it if that happens.
  • 05:46Seems fine, OK, great.
  • 05:50OK, let's get going.
  • 05:51So I called this two sides of the same coin.
  • 05:55UM, patient experience
  • 05:57and clinician engagement.
  • 05:59And I came to press ganey Asmira
  • 06:02was saying two years ago and I
  • 06:05don't think I really understood
  • 06:06then what I do understand now.
  • 06:09Which is it really is two sides of the same
  • 06:12coin meaning and and I can like feel that,
  • 06:15but I'm going to show you data to
  • 06:17hopefully convince you of that.
  • 06:18I'll also.
  • 06:19Add my bias, which is the coin does
  • 06:24not exist without the foundation of
  • 06:27a really engaged clinical workforce.
  • 06:30And that also means that the Clinton
  • 06:34clinicians have to be able to do
  • 06:37their jobs well and have to be well,
  • 06:40so we'll go through that.
  • 06:41I know that you know all of you are still
  • 06:44addressing the challenges of kobid,
  • 06:47and I suspect that's going to
  • 06:48be with us for awhile,
  • 06:49and I'm going to share with you.
  • 06:51Our data for both patients and
  • 06:54the workforce regarding kovid,
  • 06:56but then I really want to spend time
  • 06:58showing you things that organizations
  • 06:59are doing to solve for a lot of the
  • 07:03challenges that have appeared and
  • 07:04hopefully give you some ideas and
  • 07:06maybe think a little bit more about
  • 07:08how you're solving these challenges.
  • 07:09Because I I know having talked to
  • 07:11doctor stamped and I work closely
  • 07:13also with Doctor Bennett that you're
  • 07:15already pretty much on your way to
  • 07:17addressing a lot of these issues
  • 07:19and have been for a long time.
  • 07:21So some of you may have seen this slide,
  • 07:24maybe not,
  • 07:25but this is really the UM perspective
  • 07:28that press ganey has when we use
  • 07:30the term patient experience.
  • 07:32A lot of people say patient satisfaction,
  • 07:34but we're really focused on calling
  • 07:37it the full experience and making
  • 07:39sure when we're using that language,
  • 07:41we are absolutely talking about quality,
  • 07:44safety, Clinical Excellence,
  • 07:45and then we know none of this happens
  • 07:49without the foundation of the care team.
  • 07:52And it's a team and I know you
  • 07:54all in cancer care.
  • 07:55Know that probably better than anybody else
  • 07:57in medicine and then the other point is,
  • 07:59while we often capture data
  • 08:02in specific settings,
  • 08:03we know patients are getting their
  • 08:05experience across the continuum
  • 08:07often when they're not even
  • 08:08actually directly getting care.
  • 08:10So I just want to put that
  • 08:13definition out there.
  • 08:14I also know that we all have our own story,
  • 08:18even as clinicians of being patients
  • 08:20and experienced care in care,
  • 08:22often in our own systems.
  • 08:25And you know,
  • 08:26I think all of us as caregivers
  • 08:28kind of often cross our fingers
  • 08:30and just like hope it goes OK,
  • 08:31'cause sometimes we know how many things
  • 08:33have to go right for it to go well.
  • 08:36And this was just an experience
  • 08:38I had over the summer.
  • 08:40My husband finally was able
  • 08:42to get an elective surgery
  • 08:44completed in June and we actually did
  • 08:47it at one of our organizations where
  • 08:51I practiced and I'm going to say.
  • 08:55Overall, everything went very well,
  • 08:58so we got in there.
  • 08:59UM, the nurse after the doctor
  • 09:01checked us in said the doctor forgot
  • 09:03to mark which side of your body
  • 09:05we're going to do this procedure on.
  • 09:07She needs to come back and do it.
  • 09:09I'm paging her now and I was like so
  • 09:11relieved as a patient that as a family
  • 09:13member that that happened and there
  • 09:14was no hesitation from the nurse.
  • 09:16And I thought that's so awesome.
  • 09:18They have their safety culture down.
  • 09:20And then an anesthesiologist
  • 09:21came by and he said hi, I'm Josh,
  • 09:24I'm your lead anesthesiologist,
  • 09:26I have these four other people.
  • 09:27He introduced all their names and talked
  • 09:29through what everybody was going to do.
  • 09:31So I had another kind of OK,
  • 09:32great like they have team culture.
  • 09:34This is all good and then he got through
  • 09:36surgery and we were in the pack.
  • 09:38You and this nurse was just all over it.
  • 09:41My husband was totally out of it
  • 09:43so I came in there and she was just
  • 09:46explaining everything to me in a
  • 09:48very kind of incredibly constructive.
  • 09:50Detailed way,
  • 09:51which is exactly what I needed and
  • 09:53I said wow,
  • 09:54you know this is you're you're so helpful.
  • 09:56Thank you so much and they've been
  • 09:58doing this for a long time and she said,
  • 10:01well,
  • 10:02I've been here for 20 years but I've
  • 10:05only been in the pack you for nine
  • 10:07months and I said well, what happened?
  • 10:09She said well COVID happened and
  • 10:13after you know nine months or so
  • 10:15of COVID in this unit after I've
  • 10:17been here for 20 years,
  • 10:19I just couldn't do this.
  • 10:20Anymore,
  • 10:21and in fact all of our all of my
  • 10:23colleagues have left.
  • 10:24There's only three of the senior
  • 10:27nurses remaining and I was
  • 10:30going to leave altogether.
  • 10:32She said,
  • 10:33but then I remembered when I
  • 10:35first came here 20 years ago.
  • 10:37They said to me nurses are
  • 10:40like potted plants.
  • 10:41They come, they stay, they never leave.
  • 10:45And that was not how I was
  • 10:48feeling at that moment,
  • 10:49but I was able to get some support
  • 10:52and engage with my colleagues.
  • 10:54The hospital sponsored some very
  • 10:56informal peer groups and that helped
  • 10:58me realize I did want to stay and I'm
  • 11:00actually thrilled to be working down here.
  • 11:03I needed a change of scenery,
  • 11:04but I'm still here.
  • 11:06So I just wanted all of you to know
  • 11:09that I know for many this has been
  • 11:11like an incredibly challenging time.
  • 11:13On top of, you know,
  • 11:15an incredibly challenging,
  • 11:16probably decades of careers for many.
  • 11:20And I'm worried because I don't
  • 11:23want folks to leave and I loved
  • 11:26the image of that potted plant
  • 11:28and I just wanted to share that.
  • 11:31So I'm going to share some patient
  • 11:34experience findings and then I
  • 11:36will go ahead and share some
  • 11:38workforce findings and then we'll
  • 11:40talk about solutions.
  • 11:43So you know, most of you probably
  • 11:45that press ganey has a lot of data
  • 11:47and I'm going to like briefly flat,
  • 11:50flip up a slide to show you that,
  • 11:52so you can believe me when I tell you we do,
  • 11:55but I don't want to ping, you know pain,
  • 11:57you make it painful for you to have to
  • 11:59sort through all the data when we look
  • 12:02at our kind of hundreds of thousands
  • 12:05and millions of comments from patients
  • 12:07and we look at them across all settings.
  • 12:11Inpatient ambulatory emergency medicine.
  • 12:13And then all different outpatient sites.
  • 12:17Ultimately there are a few big themes
  • 12:20that really shine through and I
  • 12:22put them on this slide and they're
  • 12:24very similar to what I felt with my
  • 12:26husband in the story I just told you
  • 12:29the first is about keeping me safe,
  • 12:31so marking that side of the face known that
  • 12:34you know balls aren't going to be dropped.
  • 12:36That's really critical.
  • 12:37Of course, the working together.
  • 12:41Is of course the most important,
  • 12:43because this is a team sport and
  • 12:46then the caring piece and I know
  • 12:48you all have worked really hard.
  • 12:50I think across your system on the
  • 12:53carrying on communicating the caring
  • 12:56piece which is a huge component of that,
  • 12:59but that all like doesn't happen
  • 13:02unless we have this engaged workforce.
  • 13:06This is the data that we're going to skip,
  • 13:08so you don't have to like try
  • 13:10to figure out the slide,
  • 13:12but I have one for inpatient
  • 13:14ambulatory emergency medicine.
  • 13:15It has gone through it all and those
  • 13:18trust me that in that purple box
  • 13:21are those three themes of keep me
  • 13:24safe work together and care for me.
  • 13:26They look slightly different.
  • 13:28'cause in the inpatient setting it's,
  • 13:30you know,
  • 13:31the room clean is the measure
  • 13:33of safety in that setting.
  • 13:34But trust me, these themes are the same.
  • 13:36Yeah, come across all of the settings so.
  • 13:44This is now data you may not have seen
  • 13:47because this is some newer data from
  • 13:50COVID and we recently acquired a company
  • 13:53that's able to take unstructured data.
  • 13:56So comments that people put into
  • 13:59surveys that patients put into
  • 14:01surveys and then organize that.
  • 14:03So instead of just anecdotally remembering
  • 14:06the last thing that somebody said or
  • 14:08trying to sift through these, you know,
  • 14:11literally hundreds of thousands.
  • 14:12Or in this case 18 million.
  • 14:15Comments that were collected.
  • 14:17We can actually now using this
  • 14:20kind of pet to patented technology,
  • 14:22extract the real themes and this is
  • 14:25just to show you that these themes of
  • 14:28gratitude of kindness and empathy they
  • 14:31are shining through in this COVID time
  • 14:33mid more than we've ever seen before.
  • 14:36This is from our national data.
  • 14:39We do have your data,
  • 14:40so yells data and this is just a kind of
  • 14:44graphic way of grouping the comments.
  • 14:47So when we look at your positive
  • 14:50comments from this past year,
  • 14:52these are the main themes.
  • 14:55So this kind of courtesy, respect, kindness.
  • 14:58That's that.
  • 14:59The size of the box represents
  • 15:02the end of the comments.
  • 15:05The proportionality of them,
  • 15:06and that is what patients
  • 15:07take the time to write.
  • 15:09And about, yes, of course.
  • 15:11Skills and knowledge are important.
  • 15:12And yes, of course some of the logistics,
  • 15:15but the big bulk of the positive
  • 15:17feedback is in the space of the caring,
  • 15:20courtesy and respect, and those are
  • 15:22just a few quotes that you can read.
  • 15:24Their doctor axe is the kindest,
  • 15:27most courteous and knowledgeable physician,
  • 15:29kind and knowledgeable,
  • 15:32etc.
  • 15:33So of course we want to hear it all,
  • 15:35and these are the negative comments.
  • 15:38And and honestly,
  • 15:39and I've seen your data to the positive
  • 15:41comments are almost always more than the
  • 15:44negative comments like the volume of them.
  • 15:47We tend to focus on the negative.
  • 15:48Can't help ourselves with that.
  • 15:49But trust me,
  • 15:52the passives are outweighing
  • 15:53the negatives when we look at
  • 15:56the negative comments though.
  • 15:58You know they're slightly different,
  • 15:59and they're very,
  • 16:00very focused on what I'm going to
  • 16:03call logistice and reliability and
  • 16:05scheduling is that biggest block here,
  • 16:08and we have seen this a lot in COVID,
  • 16:10and we know how hard it was
  • 16:12for everybody to change,
  • 16:13innovating and deliver care
  • 16:14in a very different way.
  • 16:16I'll tell you one place where we've really
  • 16:18seen challenges around logistics was
  • 16:20initially in the telemedicine paste space,
  • 16:22which patient actually loved,
  • 16:23and we had a ton of positive comments
  • 16:26about connecting with providers.
  • 16:28I'm feeling so grateful that
  • 16:29that was able to happen,
  • 16:30but a lot of frustration with using
  • 16:33the technology that comes up in this.
  • 16:35You know,
  • 16:36very inefficient as far as
  • 16:38managing time for patients,
  • 16:39and then these delays down there.
  • 16:42And I meant to tell you, please,
  • 16:44if you want put questions in the chat and
  • 16:48I'll try to respond to them as we go.
  • 16:51OK,
  • 16:51so this is also a newer slide you probably
  • 16:53haven't seen, and it's a
  • 16:55little bit complicated.
  • 16:56It's how we group our data and flow it,
  • 16:59but this is your data, by the way,
  • 17:01this is y'all's data, so this is
  • 17:05really trying to demonstrate that even
  • 17:08when you have patients who are very loyal,
  • 17:13so that blue ball on the left says
  • 17:16that you've got of the 30,000 patients
  • 17:19that were included in this particular.
  • 17:22Measurement that 87.1% of them,
  • 17:26which is benchmark at the 76 percentile.
  • 17:29This is the cohort that says,
  • 17:32you know I'm going to score
  • 17:34this the highest possible.
  • 17:35You know my and that loyal
  • 17:38to this organization.
  • 17:39And that's I'm giving it the
  • 17:41highest possible or top box score.
  • 17:44What happens, though,
  • 17:45and what we've been looking at now is
  • 17:49that when patients have friction points,
  • 17:54so hassle experiences before their visit,
  • 17:59and that actually greatly impacts how
  • 18:02what happens to their kind of likelihood
  • 18:05to recommend or loyalty to the practice.
  • 18:09So in this example,
  • 18:11a little more than half they
  • 18:13didn't have the friction.
  • 18:14And I'll tell you what those points are in a
  • 18:17minute and their scores went up even higher.
  • 18:20So even more likely to recommend
  • 18:2390th percent 99th percentile.
  • 18:25But a little less than half
  • 18:27did have some friction,
  • 18:28and their scores go down,
  • 18:30so they then score you at
  • 18:33this 73.2 the 9th percentile.
  • 18:35So that's for friction points
  • 18:37that happened before my visit.
  • 18:39Those are things like courtesy of
  • 18:43registration staff, ease of contacting,
  • 18:45ease of scheduling, the appointment.
  • 18:47Providing information about
  • 18:49delays and wait time at clinic.
  • 18:51Those are all the components that
  • 18:53make up this before friction points.
  • 18:56And then, UM, the care happens.
  • 19:00And there's another kind of
  • 19:01logistics piece that that happens,
  • 19:03or can create friction during the care.
  • 19:07And again, all of this is outside of
  • 19:09the experience with the care provider,
  • 19:10and this is cleanliness of the room
  • 19:13is one of the examples in this space,
  • 19:15so when that doesn't score,
  • 19:19when that is not kind of up to snuff,
  • 19:22per the patient,
  • 19:24the score drops even further.
  • 19:26So you go down to this.
  • 19:2834.3 or the first percentile.
  • 19:31It's forgiving,
  • 19:32though patients are forgiving,
  • 19:33so if you,
  • 19:34even if you have all those
  • 19:35friction points before the visit,
  • 19:36but then you deliver on the
  • 19:38cleanliness of the room,
  • 19:39you kind of come back up here to this.
  • 19:458888 point 484th percentile.
  • 19:47Hopefully you all followed me on
  • 19:50this with the take home message
  • 19:52being like these friction points.
  • 19:54These hassles really impact
  • 19:56overall experience and how
  • 19:57patients rate their experience.
  • 19:59I know not no surprise to you
  • 20:02all and I also know that hassles
  • 20:05are impacting all of you.
  • 20:06But I think it's really important
  • 20:09that we've now can show this with the
  • 20:12data because it enables practices.
  • 20:14Or units to really focus now on these
  • 20:17areas that otherwise might have gotten
  • 20:19kind of wrapped up and bucket did it
  • 20:22and we wouldn't have that level of detail.
  • 20:25OK, so in a shift to
  • 20:28clinician specific findings.
  • 20:29So just like we have a
  • 20:31lot of data on patients,
  • 20:33we actually have a tremendous
  • 20:35amount of data on clinicians.
  • 20:37And honestly,
  • 20:37I didn't even realize this
  • 20:39when I came to press ganey.
  • 20:40I knew that we had a good amount of
  • 20:42data on the workforce like I know that
  • 20:45press Gainey was survey our employees,
  • 20:47but I didn't realize that that
  • 20:49we have the largest clinician
  • 20:51database in the country also.
  • 20:53So we are serving approximately
  • 20:57125,000 physicians annually.
  • 20:59And about 50,000 advanced practice providers,
  • 21:04so it's a very big data set.
  • 21:07So,
  • 21:08uhm,
  • 21:08we're also now able to kind of look and
  • 21:11dive deep into that data set to see,
  • 21:13at least at the aggregate levels,
  • 21:15what's most important to physicians
  • 21:18and what's most important to APS.
  • 21:21And so we did that by looking at
  • 21:23one of our survey driver questions,
  • 21:26which is intent to stay for three years.
  • 21:29So we asked that question,
  • 21:31and when we asked that of our physicians,
  • 21:34these three themes kind of surface
  • 21:37to the top.
  • 21:38So the first for physicians is about kind of
  • 21:42certainty and success of the organization,
  • 21:45and this is what kind of makes
  • 21:47them feel most confident and about.
  • 21:50And this is the number one key
  • 21:53driver for actually both male and
  • 21:55female physicians is the certainty
  • 21:57of the organization's success.
  • 22:00So the second key driver it's
  • 22:02again the same for men,
  • 22:04male and female physicians is
  • 22:06work life balance and this.
  • 22:08This is literally that this location
  • 22:11supports me and balancing my
  • 22:13work life and my personal life.
  • 22:15And and I think this is really about,
  • 22:18UM,
  • 22:19the importance to all of us that
  • 22:22we are in this profession.
  • 22:26And want to be in it,
  • 22:27but it has to kind of be a part
  • 22:29of our lives because we all have
  • 22:32lives outside of it.
  • 22:34And if our organization can't
  • 22:36help deliver that,
  • 22:37that makes it really difficult
  • 22:39for us to want to stay.
  • 22:41And then the third one,
  • 22:44which is again,
  • 22:44this creates this link and not surprising.
  • 22:46I'm sure to anybody here is
  • 22:50that the location provides high
  • 22:52quality patient care and service.
  • 22:54That is an absolute driver like we
  • 22:57need to know that if we're going
  • 23:00to stay at our organizations.
  • 23:02So for APS it's similar,
  • 23:05but a little bit different,
  • 23:07and these are the themes and
  • 23:09I think that that's
  • 23:10probably a good way of thinking
  • 23:12about APS in our data in general,
  • 23:15and I actually often feel like
  • 23:18APS is kind of the last cohort
  • 23:21because they spend a lot of time.
  • 23:24I think our AP spent a ton
  • 23:26of time with physicians,
  • 23:27but they're not always measured with them,
  • 23:29and there are some differences and.
  • 23:32They're not really sitting in with any other,
  • 23:35so we've been really active at looking at
  • 23:38them both separately and then aggregating
  • 23:41their data into this clinician space.
  • 23:43But for APS and again, we've looked at
  • 23:46it from male and female AP separately.
  • 23:48But these are the big four themes that
  • 23:51we find for their kind of interest and
  • 23:54intent to stay for three year period.
  • 23:56So the first is this.
  • 23:58I feel like I belong in this organization.
  • 24:01That's the number one key
  • 24:02driver for male and female APS.
  • 24:05I like the work that I do.
  • 24:07Then we have the patient
  • 24:09quality and service that had.
  • 24:11Also,
  • 24:11we just saw with the physicians
  • 24:14and then another interesting driver
  • 24:16here is this respect.
  • 24:18And confidence in our leader,
  • 24:20both the direct person I'm reporting
  • 24:22to and then senior management overall,
  • 24:25and that's become.
  • 24:27I think that's a really interesting
  • 24:30insight into thinking about kind
  • 24:32of where many of our AP's are
  • 24:35connecting and what is going to
  • 24:37be really important to keep them.
  • 24:43And and I will answer questions.
  • 24:45So the great question.
  • 24:47So if I'm if I've showed you any like,
  • 24:50yell any data,
  • 24:51right now it's Yale New Haven Health.
  • 24:55Overall, I do have and I can send it
  • 24:58to Terra the Smilow specific data.
  • 25:01So I had that I have like a smile,
  • 25:03a specific breakout for those that circle
  • 25:06picture with the hassle factors drivers.
  • 25:10It actually looks quite similar to Yale,
  • 25:12New Haven but better.
  • 25:14In certain areas,
  • 25:15and maybe a little bit different
  • 25:16in a couple of others,
  • 25:18and I will make that point about the data in
  • 25:21general to actually like make change happen.
  • 25:23All of us need to look at that data
  • 25:26at the practice level in order,
  • 25:29I think to really ultimately
  • 25:31understand what's driving what
  • 25:33the drivers are for each practice.
  • 25:36So this is the this is everybody's
  • 25:39moment for interaction.
  • 25:40So if you could take a second and
  • 25:44look at this picture and tell me
  • 25:47where you think you are and if
  • 25:49you like you can you can say like
  • 25:51this where I think I am and or
  • 25:53you could say well this is where
  • 25:55my colleagues are but but this is
  • 25:57this phases of disaster slide.
  • 25:58Some of you may have seen this before.
  • 26:01You know I use this early on in the pandemic.
  • 26:03It's not.
  • 26:04It's not COVID related at all, it's a.
  • 26:07Kind of used for national disasters?
  • 26:10Or are there other instances?
  • 26:12And it's on the kind of stamps
  • 26:14and mental health support site.
  • 26:17So what it shows is and I'm
  • 26:19waiting for anybody who's ready to
  • 26:21type who's already ahead of me.
  • 26:23But what it shows is as a an event unfolds.
  • 26:30There's this kind of anticipation
  • 26:32and we saw this across the country.
  • 26:35By the way.
  • 26:36We formed a caregiver collaborative
  • 26:38right when COVID started last March,
  • 26:40and we included lots of folks from New York,
  • 26:43Connecticut, New Jersey who got hit hard,
  • 26:45fast,
  • 26:45and the rest of the country was
  • 26:48kind of sitting and waiting,
  • 26:50so we actually lived through this.
  • 26:52And then there was the heroics and
  • 26:54the honeymoon period where lots of
  • 26:55support and cheering and people felt like,
  • 26:57OK, we got this, and we have treatments.
  • 27:00Now and then we got a vaccine and
  • 27:02we can do this and then this kind
  • 27:05of disillusionment phase.
  • 27:06So I'm looking here and I see a
  • 27:08lot of people saying like five.
  • 27:09Well,
  • 27:10not a lot of people,
  • 27:11but I see five from most people and
  • 27:14some people are saying 6 and I'll tell you,
  • 27:18this is.
  • 27:18I've also showed this slide with a lot
  • 27:21of folks and there's been a lot of force.
  • 27:24I showed it a couple weeks ago and I got
  • 27:27the feedback that my slide is wrong.
  • 27:30And that I need to fix it and make it up.
  • 27:34This kind of downward sloping bucket
  • 27:37needs to happen again and again and again.
  • 27:40'cause that's how they are feeling right now,
  • 27:43but I will say most leaders
  • 27:45feel like they're somewhere
  • 27:46between five and six and
  • 27:47that they can see a light.
  • 27:52So we have a, uh,
  • 27:54a colleagues at press ganey,
  • 27:56who actually lead a lot of our safety work,
  • 27:58and I think some of them worked with
  • 28:00have worked with you guys over the years.
  • 28:02Are HPI safety Consulting Group
  • 28:04and a number of them have military
  • 28:07experience and they spent a couple
  • 28:09months kind of looking at our data
  • 28:12talking to folks around the country
  • 28:14and really landed on why they think
  • 28:16health care workforce experience
  • 28:18during COVID is actually been.
  • 28:22Far more difficult than UM,
  • 28:24experiences in the military,
  • 28:26and for these four reasons and
  • 28:29the kind of relentlessness of the
  • 28:32experience that you you can't get go
  • 28:36home especially early on and get away
  • 28:39from it because there was so much
  • 28:42concern about safety and exposing
  • 28:45families for women or for men who are
  • 28:48the kind of principle caregiver for their.
  • 28:52If they have kids or a.
  • 28:56Parents that they're caring for
  • 28:58that going to work and coming home
  • 29:00was around the clock the entire
  • 29:02time and really felt relentless.
  • 29:05And then what?
  • 29:06We're seeing a lot more is this
  • 29:08oppositional piece that I think
  • 29:11is driving a lot of compassion,
  • 29:12fatigue, and secondary trauma
  • 29:15for many folks right now.
  • 29:19So this is, uhm,
  • 29:20I don't think anybody seen this.
  • 29:22You might have seen it,
  • 29:23it was tweeted a couple weeks ago,
  • 29:25but it's not yet published.
  • 29:26This is from this epic research data of like
  • 29:29350 organizations that are using at Beck.
  • 29:32And there they were just tracking the
  • 29:35percent difference in digital messages
  • 29:37that are coming from patients directly
  • 29:40to providers right now to physicians.
  • 29:43And they have.
  • 29:44There's been 157% increase
  • 29:46in that volume of digital.
  • 29:48Messaging now it's not an absolute,
  • 29:50so you could have had four messages a day
  • 29:53before and now you have seven messages,
  • 29:56but it's a huge shift and the glass
  • 29:58half full piece of this is like
  • 30:01fantastic patients have finally
  • 30:02figured out how to use the portal.
  • 30:04That's great.
  • 30:05The glass half empty is Oh
  • 30:08my goodness we built it,
  • 30:10they came but we didn't actually
  • 30:12figure out how to manage it.
  • 30:14So it's this overwhelming amount
  • 30:16and this is when I talked to
  • 30:18my colleagues in primary care.
  • 30:20They are overwhelmed by this
  • 30:22amount of messaging and lack.
  • 30:24They haven't had a chance to build the
  • 30:27system to manage this influx appropriately.
  • 30:31So I wanted to share with you just a
  • 30:33couple of the terms that we use a lot.
  • 30:361 is resilience and this is really
  • 30:38this ability to recover or adjust
  • 30:41when challenging things happen
  • 30:44and we measure resilience with
  • 30:47two different sets of metrics.
  • 30:50One is about activation and it's the
  • 30:52ability to kind of get charged up,
  • 30:53ready to go and find meaning
  • 30:55in every encounter,
  • 30:57and then the other is to decompress to
  • 30:58be able to go home, recharge and recover.
  • 31:00And we.
  • 31:01Absolutely need to do both if
  • 31:04we want to remain resilient.
  • 31:06So I'm sorry for the like small font on this,
  • 31:10but I do want to point out and I'm going
  • 31:12to talk about engagement in a minute
  • 31:14that physicians of all the professions
  • 31:17in the hospital scored the lowest
  • 31:20for both resilience and engagement.
  • 31:24Will talk about engagement in
  • 31:26it and for resilience.
  • 31:28So this is physicians down here.
  • 31:31This score overall score is
  • 31:32made up of two components.
  • 31:34Activation physicians are great at
  • 31:36getting activated and treating each
  • 31:38patient individual as individuals and
  • 31:40finding meaning and where physicians
  • 31:42really are struggling is their ability
  • 31:44to decompress to be able to go home and
  • 31:47disconnect from work communications
  • 31:49to be able to sleep, recover,
  • 31:51and be able to come back the next day.
  • 31:53And this is what we're going to talk about.
  • 31:55I will make one.
  • 31:57I've seen the resilience data for this
  • 31:59past year and the one flip that I thought
  • 32:01was interesting is teaching faculty
  • 32:03have now dropped below physicians.
  • 32:06Their resilience is lower.
  • 32:09Again due to decompression.
  • 32:12So now, as tough as this is,
  • 32:16we are seeing places where there are
  • 32:19some kind of hopes and bright spots,
  • 32:22and I'm going to call this one of them.
  • 32:23So this is looking at engagement.
  • 32:26So engagement is how we measure.
  • 32:28We have a six out of six questions that
  • 32:30we use to measure kind of an individual's
  • 32:33likelihood to go above and beyond with
  • 32:35the organization that they're working,
  • 32:38and we capture things like pride
  • 32:39and likelihood to recommend
  • 32:41the organization and send.
  • 32:42Family there and so as you can see from
  • 32:45this over the past couple of years,
  • 32:47although there is a cohort that's having
  • 32:49a dip down and engagement and we are
  • 32:52seeing this and and from many that
  • 32:55the engagement scores are going down,
  • 32:57there is a group of organizations
  • 33:00where physician engagement is actually
  • 33:03going up during the pandemic,
  • 33:05and I like to think that's because of UM,
  • 33:09honestly,
  • 33:09the concept of high reliability.
  • 33:12And, uh, leadership.
  • 33:13Stopping and recognizing that they might
  • 33:16not have the answers for many things,
  • 33:19but those on the front lines probably do.
  • 33:22And actually creating the space to listen
  • 33:24and take that information and act on that.
  • 33:28And we've seen all across,
  • 33:29and I actually seen 'cause Michael shared
  • 33:32with me the the depth and breadth of
  • 33:35the communication approaches you all
  • 33:37had throughout your pandemic where you
  • 33:40know your frontline voices could work,
  • 33:42heard.
  • 33:42And actually,
  • 33:43I think greatly informed decisions
  • 33:45that were made,
  • 33:46and that's something that you
  • 33:48know we don't often see UM.
  • 33:50And when like times are normal in healthcare.
  • 33:53So,
  • 33:53so we now need to like I want to
  • 33:56focus on how do we move forward
  • 33:58and address these challenges.
  • 33:59So I do think these are four major
  • 34:03challenges facing most organizations
  • 34:04right now and we're going to go through.
  • 34:08Will go through them.
  • 34:09They're actually pretty connected
  • 34:11because when I use the term well being,
  • 34:13it's it's far more than my
  • 34:15individual well being.
  • 34:16It's thinking about the organizational
  • 34:18kind of well being as well.
  • 34:21But I suspect that these issues of trust,
  • 34:23uncertainty and staffing are ones
  • 34:26that you're all challenged by.
  • 34:28I will say then I'll get to this
  • 34:31later that the accountability for like
  • 34:34addressing and solving these challenges
  • 34:37can't just happen at an individual
  • 34:40level or at an organizational level.
  • 34:43It's gotta happen.
  • 34:44Also at a leader level and at a team level.
  • 34:48These problems are too
  • 34:49complex and for some of them.
  • 34:51Like getting like I talked
  • 34:54about earlier to the unit of
  • 34:56measurement that's most important,
  • 34:58and that might be your practice in your
  • 35:00clinic is going to be really critical
  • 35:02if we're going to solve these problems.
  • 35:05So I have.
  • 35:06I'm going to talk a little bit about
  • 35:08well being and these first three
  • 35:09slides are a case study from an
  • 35:12organization that decided they wanted
  • 35:13to really go deeper to understand
  • 35:16what was driving for things.
  • 35:19They were very worried about.
  • 35:20That was resilience,
  • 35:22both activation and decompression,
  • 35:25and this was for their clinicians.
  • 35:27Their AP is and physicians.
  • 35:29They were also very focused on
  • 35:31productivity and on intent to stay
  • 35:33'cause they really don't want to lose.
  • 35:36A single physician or AP,
  • 35:39given the challenges right now,
  • 35:41so they had a very.
  • 35:42They've had a very kind
  • 35:43of robust look at this.
  • 35:44They did kind of what many people
  • 35:46do is as the engagement survey,
  • 35:48but then they've dug deeper and
  • 35:50they've dug deeper into the data,
  • 35:52and they've dug deeper into
  • 35:54listening to their front lines.
  • 35:55And then they've used this information
  • 35:57to help prioritize and begin to
  • 35:59build their road map going forward.
  • 36:01So this is just a schematic for the data,
  • 36:04and I don't want to get lost in this.
  • 36:06'cause trust me, it's a lot of detail.
  • 36:09But basically we are taking survey data.
  • 36:11We are taking your HR utilization data,
  • 36:14so the minutes that people are in it
  • 36:16and the time of day that they're in it.
  • 36:19We're also looking at productivity data
  • 36:22from your human resources platform,
  • 36:25and we can integrate all of
  • 36:27that together and then surface.
  • 36:29What are the key drivers for these areas
  • 36:32that were very focused on addressing?
  • 36:35And this is again a schematic
  • 36:37that's just trying to show you.
  • 36:39It is not going to be one
  • 36:41thing that pops out.
  • 36:43Uhm, and most things fall,
  • 36:45I think into these three big areas.
  • 36:48What we can learn by going deep here though,
  • 36:50is the actual impact.
  • 36:52And what will happen?
  • 36:54The likelihood of something
  • 36:55happening if we go to fix it.
  • 36:57So for example,
  • 36:58for this group.
  • 37:00There was a.
  • 37:01It became very clear that a huge
  • 37:04driver of the challenges for
  • 37:06doctors to decompress was around
  • 37:08the EMR efficiency and proficiency
  • 37:11and the challenges of resources
  • 37:14and workflow in the clinic.
  • 37:15And this came out when we looked at
  • 37:17their decompression data and saw that,
  • 37:19like those people who are doing
  • 37:21really well versus those who weren't,
  • 37:22it was due to things like the amount
  • 37:24of time that they were spending
  • 37:26charting or how many days until
  • 37:28their next appointment was available.
  • 37:31And those who were kind of swamped.
  • 37:32We're doing far worse than those who weren't.
  • 37:34So again, things that you would think,
  • 37:37OK, I get it.
  • 37:38But the fact that the data revealed
  • 37:39it then gave them something to kind
  • 37:41of stand on to try to then help
  • 37:43address what the challenges are.
  • 37:45Lots of other areas and I think these
  • 37:47are probably ones you're well aware of,
  • 37:50which is the role of leadership
  • 37:51and addressing kind of culture.
  • 37:53And and then what do we do to better
  • 37:56support individuals and teams?
  • 37:57And actually some of those things came
  • 37:59up when we were looking at the earlier data.
  • 38:03So I was going to show this video,
  • 38:07but I'm a little worried I'm going to run
  • 38:10out of time so I'm not going to show it,
  • 38:12even though I think it's really powerful and
  • 38:14I will send it and anybody can watch it.
  • 38:17It's a really wonderful 3 minute heartfelt
  • 38:20video and I'm using it as an example.
  • 38:24Of how important it is,
  • 38:26and then I know, you know this to
  • 38:29feedback these comments from patients.
  • 38:33The positive ones so your providers can
  • 38:36hear them and remember just how important
  • 38:38they are and the work that they're doing,
  • 38:41how much they are changing
  • 38:44people's lives and these.
  • 38:45This is not just physicians,
  • 38:47it's transport folks,
  • 38:49it's the helicopter, EMTs,
  • 38:52and they're all reading letters.
  • 38:54Of patients that that were
  • 38:56written to them specifically,
  • 38:57and they're all kind of recognizing.
  • 39:00Gosh, I didn't realize I needed this.
  • 39:01Thank you,
  • 39:02but I did and it really makes a difference.
  • 39:06There are a couple other areas in
  • 39:08well being that we're seeing folks do,
  • 39:10and again I suspect you're doing
  • 39:11some of this here.
  • 39:12I would say the concept of peer support
  • 39:15has kind of never been more important,
  • 39:17and it can be like simple or it can
  • 39:21be very complex and we are seeing
  • 39:25organizations do all variations of this.
  • 39:28These the kind of themes of what
  • 39:30happens with peer support and why
  • 39:32it's so important or what I wanted
  • 39:35folks to just focus on for a minute.
  • 39:37But it for sure is true that well
  • 39:40one we as colleagues know each other
  • 39:43and might pick up and sense things
  • 39:45that you know somebody that you don't
  • 39:48know wouldn't necessarily pick up on.
  • 39:50And we also,
  • 39:52unfortunately,
  • 39:53there is still often a stigma around
  • 39:57getting help,
  • 39:58and this is something that you
  • 40:00know we all have to work more
  • 40:02aggressively to fix that stigma around.
  • 40:04The need for emotional support.
  • 40:06And there's been.
  • 40:07And I'm really hopeful right
  • 40:09now that we are going to change
  • 40:12the paradigm around them.
  • 40:14And that's something that I I.
  • 40:16I'm I'm working really hard for
  • 40:17us to focus on and address that
  • 40:19we have to make it easy for folks
  • 40:22to access mental health and meet
  • 40:24them wherever they're at.
  • 40:26And that's what these three examples that
  • 40:28I threw up here show this first one,
  • 40:31which may be hard to see this
  • 40:33resilience check in list.
  • 40:34This was created by an organization,
  • 40:37actually Valley Health.
  • 40:38System in New Jersey they copy
  • 40:40catted from an organization in the
  • 40:43Pacific Northwest in our mountain and
  • 40:45Intermountain did it as a going home.
  • 40:47Checklist Valley Health did it as
  • 40:50a coming in checklist but the goal
  • 40:52was we need to remind our colleagues
  • 40:55that we are here for them that
  • 40:57they need to check in and make
  • 40:59sure they're OK and that there
  • 41:01are resources to support them and
  • 41:03will meet them where they're at.
  • 41:05You know,
  • 41:06Columbia has a very comprehensive program.
  • 41:07I suspect you all have a pretty
  • 41:10comprehensive program for
  • 41:11accessing mental health when folks
  • 41:14really need professional support,
  • 41:16and then the bottom one is an example
  • 41:18from New York City health and hospitals
  • 41:20that have really built a kind of
  • 41:22pyramid type model to try to capture
  • 41:24for their entire workforce workforce
  • 41:26and those who need support and create
  • 41:29a buddy system and then really work
  • 41:31their way up the pointy part of that is
  • 41:34the seeking help from a professional.
  • 41:38Coaching is another area that we
  • 41:40are seeing folks kind of lean into
  • 41:43more actively than before,
  • 41:44and I think part of that is
  • 41:46this recognition that wow,
  • 41:47you can do this virtually and
  • 41:48it works really well.
  • 41:49Some organizations are building that,
  • 41:51others are outsourcing it.
  • 41:53If you build it internally,
  • 41:56you have this like win win opportunity
  • 41:59because most folks who take the
  • 42:01time and coach also get a benefit.
  • 42:04As well as the person being coached.
  • 42:06Trust after well being was another area,
  • 42:10and it's something that we're
  • 42:13all working really hard.
  • 42:15And I know it's again you all have.
  • 42:17You know,
  • 42:18maybe have trained up more folks in
  • 42:20communication than any other organization,
  • 42:22at least that I'm aware of,
  • 42:24and I think like,
  • 42:26uhm.
  • 42:27Keeping that dial turned up is going
  • 42:29to be really important on this.
  • 42:31This is really talking about communicating
  • 42:33and connecting with the workforce,
  • 42:35so not let's put it.
  • 42:36It's so critical.
  • 42:37Of course we do that for patients,
  • 42:39but it's really critical we do
  • 42:41it right now for the workforce,
  • 42:44so this is rounding reliably,
  • 42:46so not just times one and there's
  • 42:49no way like a senior level
  • 42:51leader could round on every.
  • 42:53Unit or department?
  • 42:54I mean they they can and they do and we
  • 42:57see folks around the country doing that.
  • 42:59It will take them a year right
  • 43:01to get to everybody.
  • 43:02So this is where again this rounding
  • 43:04has to happen and at a very like
  • 43:07small team level so that that
  • 43:08leader is present and hears from
  • 43:11their team how they're doing,
  • 43:12how they're not doing.
  • 43:14We have seen this for nurses,
  • 43:15physicians,
  • 43:16APS and just like showing that you are
  • 43:20present that you care that you're listening.
  • 43:23That you are transparently communicating
  • 43:25back what you can fix and what you
  • 43:28can't has really gone a long way for
  • 43:30folks and something that you know.
  • 43:32The trick with this is to do it reliably,
  • 43:35meaning the same on a
  • 43:38consistent way overtime,
  • 43:39not just times one or once a month.
  • 43:44I suspect all of you are
  • 43:45pretty familiar with.
  • 43:46Well, actually I don't know 'cause I have
  • 43:48a mix when I tell people about this.
  • 43:50This concept of psychological safely
  • 43:52DI know Mary is 'cause we took a
  • 43:55course together and Amy Edmondson
  • 43:57is one of the folks who really talks
  • 43:59about this a lot using examples from.
  • 44:04All sorts of other industries,
  • 44:05especially spaceflight, but the important,
  • 44:09but she's also really done a lot
  • 44:12of her work in hospitals.
  • 44:13In fact, that's where she started,
  • 44:15and this concept.
  • 44:17This is a picture of Gramercy
  • 44:19Tavern in New York,
  • 44:21because even in a restaurant where you
  • 44:24think the stakes might not be so high,
  • 44:25although this pretty expensive restaurant,
  • 44:27so the stakes are pretty high
  • 44:29to get it right,
  • 44:30the expectation is that the
  • 44:32wait staff on their first shift.
  • 44:34An will ask for help at least
  • 44:3710 times and they are encouraged
  • 44:39to do that so their leaders.
  • 44:42They're kind of team lead.
  • 44:45Models that it is OK for them
  • 44:47to help ask for help.
  • 44:49In fact they expect them to do it,
  • 44:51so they're framing this.
  • 44:52In that way they the leaders demonstrate
  • 44:55that they are far from perfect,
  • 44:58and then they thank people
  • 44:59when they ask for help.
  • 45:01So this kind of psychological safety concept,
  • 45:05the set of tools or things that
  • 45:07we need to train our leaders in
  • 45:09and and we this the clinicians.
  • 45:11On this call you our leaders,
  • 45:13whether you may have a leadership title.
  • 45:16Or not for sure whatever practice you're in,
  • 45:19I'm sure you are perceived as the leader,
  • 45:22so knowing how to have the skills to
  • 45:25help other people speak up and engage
  • 45:29them and support them is really critical.
  • 45:32This is from an organization that
  • 45:34actually is one of our top performers.
  • 45:37It's a large system and they have
  • 45:42been on a journey just like you.
  • 45:45Just like many organizations have
  • 45:47for many years to improve both
  • 45:49patient experience and then in
  • 45:51the last three or four years very
  • 45:54focused on their workforce,
  • 45:55specifically their clinicians and aips.
  • 45:58But when they started their journey
  • 46:00back in 2012, they've been very.
  • 46:03Desperate,
  • 46:03they came together and they were very
  • 46:05focused on how do we become a system?
  • 46:07How do we create that communication?
  • 46:09How do we create some bit of sameness but
  • 46:12also permit permit some local autonomy?
  • 46:15They ultimately embraced high reliability
  • 46:18as they're kind of building block
  • 46:21foundation for doing this work.
  • 46:23They have been rigorous about
  • 46:25measurements and then in the last
  • 46:28few years they're kind of solved for
  • 46:31the clinician well being challenges.
  • 46:33Has been both a fix the system and
  • 46:36then assist the clinician UM approach,
  • 46:40but I did want to just spend a
  • 46:42second on high reliability.
  • 46:43I know you have a framework here.
  • 46:46You use the Champ acronym.
  • 46:50Actually asked Michael about this,
  • 46:52'cause I talked to press Gainey
  • 46:54colleagues who had years ago.
  • 46:56Worked with folks and we used
  • 46:58this acronym and Michael
  • 46:59whipped out a card and showed me that
  • 47:02indeed you do have this and I think this
  • 47:04is a very helpful way of remembering
  • 47:07those high reliability behaviors
  • 47:09that are so important if we want to
  • 47:12deliver care to every single patient
  • 47:14and get it right every single time.
  • 47:17And so these communications,
  • 47:19all of the things. And that, uhm, I know.
  • 47:23All of you work to practice work
  • 47:26to do already. How do we kind of,
  • 47:28uhm, why hardwire that end so that
  • 47:31we do it not just with patients,
  • 47:34but even as we're working to support
  • 47:36our workforce even as we're working
  • 47:38to find ways to be more efficient
  • 47:41and to deliver care,
  • 47:42that is of the highest quality.
  • 47:45So this is the performance of
  • 47:48that system and they really are.
  • 47:51Super performers and these are
  • 47:53the highest percentiles that we
  • 47:55have for employee experience.
  • 47:57This rising tide of physician
  • 48:01engagement and then patient experience.
  • 48:05So. I am actually a going so for
  • 48:08staffing I I'm going to mention.
  • 48:12Just very briefly,
  • 48:13there is no silver bullet,
  • 48:14just like there is no silver
  • 48:16bullet with any of these things.
  • 48:18We work with organizations,
  • 48:21many of them.
  • 48:22They're all everybody is struggling
  • 48:25right now with staffing and it's mostly
  • 48:28nursing or like Technical Support
  • 48:32and then like respiratory therapy
  • 48:35or other kind of skilled positions.
  • 48:38Where folks are choosing to
  • 48:39leave and do something else,
  • 48:41or dramatically cut back their hours
  • 48:43or go and do the same thing but in
  • 48:46a site of care that's easier than
  • 48:48the rigors that they're experiencing
  • 48:50where they're currently working.
  • 48:52So this all for this,
  • 48:53honestly,
  • 48:54are those the same concept of
  • 48:57high reliability,
  • 48:58really taking the time to communicate.
  • 49:00So one of our Western California
  • 49:03based health systems have set up ways
  • 49:06of communicating and listening to.
  • 49:08Nurses beyond the rounding they
  • 49:10are surveying them actually every
  • 49:12quarter to make sure they get their
  • 49:14voices heard and then they are
  • 49:17responding immediately and again.
  • 49:18It's with this communication,
  • 49:20even if we can't solve exactly
  • 49:21what you're asking for.
  • 49:23Here's what we're doing and why.
  • 49:25For most places,
  • 49:27figuring out how to what's called
  • 49:29force multiply so that really
  • 49:31is this concept of practicing
  • 49:33at the top of your license.
  • 49:35So how can we take the stuff off of the.
  • 49:38Physician PA nurses plate that they
  • 49:40don't have to be doing and support
  • 49:43them within another set of resources.
  • 49:46So in some places folks that had
  • 49:48stopped using LP ends or pulling
  • 49:50LPN's back in to provide that type
  • 49:53of support figuring out how to
  • 49:55change the inbox messaging system.
  • 49:57So all of those messages aren't
  • 49:59going to directly to the provider
  • 50:02are examples of this.
  • 50:03Uhm?
  • 50:04I do and I'm seeing some of
  • 50:06the questions in the chat,
  • 50:08so one of them is about how do
  • 50:10we get leadership to respond
  • 50:12to concerns with action,
  • 50:14which I think is a really great questions.
  • 50:17So we're going to get to that in a minute
  • 50:19and I'm going to get to that, actually.
  • 50:21After my next slide,
  • 50:23so we've covered a lot and I think
  • 50:27it's really important to remember the
  • 50:29connection between working to support
  • 50:31our clinicians and the work you're
  • 50:34already doing to take care of patients.
  • 50:36I'm going to start with this concept
  • 50:38of removing the hassles because
  • 50:40we know that's what's making it so
  • 50:42challenging for folks to decompress
  • 50:43the patient quality and service.
  • 50:45Kind of that that's the kind of sweet
  • 50:47spot for all of us and then really
  • 50:49focusing on trust and belonging.
  • 50:51And that includes the psychological
  • 50:52safety that we were talking about.
  • 50:54This is what's going to,
  • 50:57like propel us forward and kind
  • 50:59of enable us to be successful
  • 51:03using high reliability concepts.
  • 51:05Really, for.
  • 51:06Every single thing,
  • 51:07whether it's safety,
  • 51:09whether it's a engagement of our people,
  • 51:12whether it's looking at resources,
  • 51:14being able to deliver these types
  • 51:19of aspirations reliably every time,
  • 51:22so that every individual,
  • 51:23whether it's a patient or a caregiver,
  • 51:25or having these experiences,
  • 51:27is really what we need to hardwire and
  • 51:31then to answer the question in the chat.
  • 51:33This is how I think we need to
  • 51:35change our thinking on this.
  • 51:37So instead of thinking of UM
  • 51:41solutions that belong and this
  • 51:43is something I mentioned earlier,
  • 51:46either to an individual like go,
  • 51:48get yes Jessica, if you're struggling,
  • 51:51here's the number.
  • 51:52Go get the support you need and
  • 51:55we have it available for you.
  • 51:57We need to recognize that every layer
  • 51:59here plays a role in almost all of
  • 52:03the things that we're talking about.
  • 52:05So there is a role and everybody
  • 52:08actually needs.
  • 52:09To have some ownership and
  • 52:10accountability for that,
  • 52:11and this is where the measurement
  • 52:13is so important.
  • 52:14So there are things that the
  • 52:16organization can take ownership of,
  • 52:18and I've listed some of them over here.
  • 52:21I would say the biggest opportunity
  • 52:23right now is in addressing the
  • 52:26workflow and operational inefficiencies
  • 52:28that folks are challenged by.
  • 52:31You know,
  • 52:31that's what we saw with the
  • 52:33patient hassle data.
  • 52:33The friction points in the clinic,
  • 52:35and that's what we hear all the time
  • 52:38from those. Who are practicing that?
  • 52:40We have got to stop and retool.
  • 52:43How we're doing this work so
  • 52:45that we can keep doing this work?
  • 52:48I think we skip a lot the two layers
  • 52:51in the middle and this to me is
  • 52:53going to be the game changer here.
  • 52:55How do we build stronger teams
  • 52:58and how do we grow leaders?
  • 53:00Because at the end of the day you may
  • 53:03have a very senior level C-Suite of folks,
  • 53:06and that's great,
  • 53:06and they're going to keep your
  • 53:08kind of ship steady.
  • 53:09But the real work is going to
  • 53:11happen at this level,
  • 53:13so training these folks making sure
  • 53:15they have the data and the support
  • 53:17that they need to advance this work.
  • 53:19And yes,
  • 53:20it may be a negotiation if they
  • 53:22need resources.
  • 53:22And how do they get those
  • 53:24resources so that they
  • 53:25can, you know, do their job and be the
  • 53:28leader and advance with their team.
  • 53:30And then I do as you all know already,
  • 53:33if we don't take the time to
  • 53:35take care of ourselves first,
  • 53:36we can't do any of this work and
  • 53:39giving ourselves kind of permission,
  • 53:41not just permission,
  • 53:42but insistence that we take that
  • 53:45time to take care of ourselves
  • 53:48first is absolutely critical.
  • 53:50For ourselves,
  • 53:51but for our teams and for organizations,
  • 53:53and of course, for our patients.
  • 53:56K So I think I've gotten to my
  • 53:59last slide with my one minute left.
  • 54:02UM, hopefully you all followed
  • 54:06me through this.
  • 54:09That and there's a reminder in the
  • 54:13chat about recording CME attendance,
  • 54:16but hopefully all of you you
  • 54:19know are with me on this kind
  • 54:20of two sides of the same coin.
  • 54:22Two different perspectives,
  • 54:24but really the same set of solutions
  • 54:26for addressing patient experience and
  • 54:29really supporting clinician engagement.
  • 54:31The importance of measurement,
  • 54:32especially if we're going to hold
  • 54:34all of those layers accountable.
  • 54:36I don't think can be overstressed,
  • 54:38and it's also really critical
  • 54:39to use it so we can prioritize.
  • 54:41Not have kind of a shotgun like
  • 54:44approach to what we're doing.
  • 54:47I think I've gotten it all in,
  • 54:49so I'm going to stop.
  • 54:51Thank you all for your time and uhm,
  • 54:53I hope that this was helpful.
  • 54:55Thank you, Mara.
  • 54:56Thank you so much, Jessica.
  • 54:58This is fantastic and.
  • 55:00You know will open it up for even
  • 55:02though I wear it one o'clock maybe
  • 55:04for a question or two and then.
  • 55:06You know I have one that wanted to see if.
  • 55:10The work that you and Lisa
  • 55:12Rodan Steen did at the Brigham,
  • 55:14looking at gender differences
  • 55:16and burnout and fulfillment,
  • 55:18is that was that's specific to the Brigham.
  • 55:21Or do you see that translatable
  • 55:23really across the country
  • 55:25with your press ganey? Such
  • 55:28a great question.
  • 55:29Thank you for bringing that up,
  • 55:30so I think some is very translatable
  • 55:32across the country and I would
  • 55:34love to come back and talk to
  • 55:35you about the gender differences.
  • 55:37'cause I really worry about them a lot.
  • 55:41And then some was very.
  • 55:41It was specific to our data and I don't
  • 55:44know if that's gonna come kind of.
  • 55:47Beach, something that we're
  • 55:48going to see everywhere,
  • 55:50but certainly in our data nationally
  • 55:52and also the work that we have
  • 55:54been doing with the Brigham data.
  • 55:56We are seeing the themes of the
  • 55:59challenges that female physicians
  • 56:01and female APS have with being able
  • 56:04to decompress with feeling like
  • 56:06they have the support and resources
  • 56:08that they need to get the work
  • 56:09done in the time that they have.
  • 56:11We have lots of good data that show
  • 56:13that female patients probably take
  • 56:15more time and female physicians.
  • 56:17Often have more female patients.
  • 56:19You know, physicians often take more time,
  • 56:21so there's a lot of drivers in this space.
  • 56:25One of the things that we found in that
  • 56:28paper was the lack of self compassion
  • 56:30and how female physicians score.
  • 56:33You know,
  • 56:35worse on that than male physicians,
  • 56:39and actually,
  • 56:39that explained a lot of the difference,
  • 56:41and I think that that is true,
  • 56:43and that is a societal challenge and a lots
  • 56:46been written on that in other industries.
  • 56:48The kind of how women tend to
  • 56:51kind of set a really high bar
  • 56:52and then beat themselves up.
  • 56:53I mean play with men do this too.
  • 56:56But it's more common,
  • 56:57I think in a lot of women,
  • 57:01and certainly something we found in our data.
  • 57:04Uhm, Doctor Fisher or anyone
  • 57:06else with last moment questions?
  • 57:08I know we're out of time and again,
  • 57:11thank you so much.
  • 57:13Just the cover coming down even
  • 57:15though you're not here in conquered,
  • 57:18but hopefully we'll be able to bring
  • 57:20you here soon to visit us in person.
  • 57:23Thank you so much for having me
  • 57:24and I would love to come visit.
  • 57:26Thank you everyone.