Atrius Health is in the process of creating communities of practice, says Steven Strongwater, as one of their core tactics in reducing burnout. These are hubs for specialty medicine that give itinerant doctors — those who typically travel from site to site without interacting with their peers — a chance to literally rub elbows every day. “We believe [this] will help to create that sense of community,” he says.
“It’s a bit of an experiment right now, so we’ll have to watch and see how that works, but that’s our hope — that it will create better interaction for the docs, truthfully better access for patients,” Strongwater says. “We’re expecting that that will reduce things like ER use and improve patient experience.”
The structure of the professional environment helps too, says Brent James, and so does having an understanding of the larger context. “I would argue that often in a clinical environment, we have a series of experts who are trying to interact together, usually applying their own expertise to a particular person in need, a patient, this person who sought us for help. I think that when you structure that environment of how the knowledge is applied so that more than one person can handle it, that makes the interaction more transparent and easier along the way. That’s how I think of a shared baseline protocol,” James says.
With an organizational flow chart, you see where you fit and how your work clicks with someone else’s, giving you a larger context, says James, describing a trauma unit at Intermountain Healthcare that runs on 12 protocols, which are also all used as a teaching model for the residents and fellows. Senior nurses lead rounds on each of the protocols, and this structure helps tie the teams together. “It worked, frankly. Most of us regarded our time in Terry’s unit as a high point of our training. So maybe it’s not just teamwork. Maybe it’s a structure around the teamwork,” says James.
Another important piece is to build evolving technology into the workflow, specifically e-consults and telehealth, adds Strongwater. “We want to give our primary care docs access to specialties so they feel confident and comfortable with the work that they’re doing, and so that they don’t feel abandoned,” he says. “By using e-consults and telehealth, we think we can help the primary care morale improve. Because it’s almost like having a lifeline. ‘I don’t have to struggle with this. I now have an immediately available lifeline.’”
From the NEJM Catalyst event Physicians Leading | Leading Physicians at Intermountain Healthcare, July 12, 2017.