What would your initial reaction be if one of the leaders in your organization offered to help improve the efficiency of your healthcare practice?
Would you feel offended at a possible implication that you are not managing your practice effectively?
Would you be worried that this offer contained a hidden agenda intent on forcing you to cram more patients into your already overburdened schedule?
Would you be suspicious that they were going to have an efficiency expert show up full of ideas about how you could do more with less?
Would you think that finally you are going to get the extra help you need?
What is Efficiency of Practice in Healthcare?
Efficiency of Practice is one of the three areas of focus in the Stanford WellMD model for improving physician wellbeing. The other two are Personal Resilience and Culture of Wellness. I discussed Personal Resilience briefly in my prior post. Culture of Wellness will be a focus in future posts.
In many ways Efficiency of Practice is the area that can make the biggest difference in physician's lives, by reducing work overload.
Studies have shown that physicians, particularly primary care physicians, spend about a third of their time doing meaningful work (directly working with patients, doing procedures, educating learners, or working on innovation or quality improvement. The other two thirds of the time are consumed with non-value added activities (entering data into the EHR, pursuing prior authorizations, etc.) I refer to this work as administriva.
Much of this administrivia is unnecessary or can be done by others. It's hard to think of another job where the professionals who have 7 - 12 years of post-graduate education are doing such work themselves rather than having an executive assistant who does this for them, allowing them to focus on the work that only they can do.
There are a number of reasons we feel the need to hold onto this work rather than have others do it:
Patient Privacy - many communications between a clinician and a patient need to be confidential.
Accuracy and Safety - there are subtleties in many communications between clinicians and patients where the message can be confused or errors can be made.
The inefficiency of training others - in the moment, for each individual issue, it is faster to do this ourselves rather than train others. However, once others are trained, and you don't have to do the task yourself, you gain A LOT of efficiency.
GROSS: Getting Rid of Stupid Stuff
We know that a lot of what we do is "stupid" - work that, if designed from scratch would be different, but are done due to a result of past processes, a reaction to one isolated incident, or an over-interpretation of a regulation. We have a significant opportunity to redesign workflows to change this.
There is a movement developing focused just on this. It's called "GROSS", an acronym for "Getting Rid of Stupid Stuff". The basic concepts are that:
You can think of a lot of stupid stuff you waste your time on every day.
You have a lot of good ideas about how to fix this.
You rarely get the opportunity - the time and support needed - to test your good ideas.
The GROSS movement is designed to help teams colloborate to reduce the unnecessary workload.
"Flipping the Ratio" in Healthcare to Avoid Physician Burnout
Imagine the potential if we could "flip the ratio" - that ratio of spending 1/3 of your time on meaningful activities and 2/3 of your time on administrivia. What difference would it make in the lives of:
you and your family,
your support staff,
your patients, and/or
your organization
It may sound impossible, but it can be done. It takes commitment from you, your staff, and your leadership.
It also takes a willingness for everyone to step out of their comfort zone and try something new. This includes being willing to invest your own time in participating in process improvement work.
I'll talk more about that in my next blog post. Until then, take some time observing how much of what you do you don't need to be personally doing, how many opportunities there are to GROSS out your practice, and how doing so would make a difference.
Thank you for what you do, whether you take care of patients or take care of those who do.
If you would like more information, or specific recommendations, you can email me at paul@pauldechantmd.com
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