“The men and women upon whom health care depends are running out of reserve because of the cumulative effect of well-intended regulation, performance measurement, and technology,” says Christine Sinsky, the American Medical Association’s Vice President of Professional Satisfaction. “We have to stop doing this. Collectively, we have to stop burning out those who have chosen medicine as a career, and we have to stop giving our patients burned out care.”
Fortunately, there are “bright spots” we can learn from. Sinsky describes Minneapolis-based HealthPartners, for example, which has embarked on an initiative to shorten the physician workday by 90 minutes. One aspect of this is a flow station where physician and nurse are seated side by side. In another example, at a family physician practice in Green Bay, Wisconsin, a medical assistant stays with each patient for the duration of their appointment. Having the MA record the patient’s information and relay it to the physician in this way enables him to give the patient his undivided attention.
“The most impactful solutions are at the systems level, of improving operational efficiency, culture, and teamwork,” Sinsky says. “What if joy in practice were a core metric of our health care system? What if every new policy and technology was assessed in part for its impact on the people who are doing the work?”
Sinsky shares some action steps to bring back joy in practice:
- For institutions: “Be bold.” Recognize the importance of higher staffing rations for optimal patient and provider care, and reengineer workflows to increase physician time spent with patients and with family at home.
- For measure developers: “Keep it simple and add it up.” Add the total time for compliance with all regulations and measures. “Less is more here,” says Sinsky.
- For regulators and technology vendors: “Support advanced models of team-based care.” Physicians often spend more time documenting care than delivering it. Health care regulations and electronic health records designed to support team-based care will help reverse that problem.
“Our work going forward, from wherever we stand in the health care ecosystem, is to consider: How can we contribute to transformation so that our patients no longer receive care from nurses and physicians who feel working in clinic is unbearable, but instead receive care from nurses and physicians who come to work every day feeling entrusted and empowered by technology and by policy and by teamwork?” asks Sinsky. “And can say, ‘practicing medicine is fun again.’”
From the NEJM Catalyst event Leadership: Translating Challenge to Success at Mayo Clinic, June 2, 2016.