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

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ID: 7037
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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.