Following up on my last post that introduced some key concepts involved in Efficiency of Practice, let's get specific about three ways to get started.
In case you are new to my posts, this is part of an ongoing series that started with an overview of clinician burnout, providing practical approaches to addressing the root causes of burnout, build on the premise that The Problem with Burnout is the Workplace, Not the Worker. While we need resilience support, we must fix the dysfunction in the clinical workplace.
Why should we focus on efficiency?
How much of your day do you spend, not on what you love to do, but on administrivia that you have to do in order to get the job done?
How much do those things add to your time demands, leaving you with hours of work to do at the end of the day?
How often is your attention and focus diverted away from caring for your patients to fixing little things that go wrong? . . . things which seem to keep happening over and over again?
When we focus on improving efficiency for the right reasons -- not to force us to see more patients, but to improve our ability to focus and spend less time working outside of scheduled work hours -- we all benefit.
So let's get started.
Three approaches to improving practice efficiency
There are many ways to improve efficiency. The most effective approaches in my experience (25 years practicing family and emergency medicine and 15 years as a medical group leader and executive coach) focus on
daily management,
workflow redesign, and
tech infrastructure.
We'll look at each of these to get a basic idea of what they are, how they differ, and the benefits of each.
Daily Management - AKA Huddles
Would you spend 15 minutes a day to reduce key drivers of burnout, build teamwork, and help your day to go better? Huddles, done right, do this very effectively.
Yet, too many healthcare teams in offices or hospital units, do huddles poorly or don't do them at all. They are missing a valuable opportunity.
A huddle done right brings together everyone on the team for 15 minutes or less and
includes a minimum of four steps:
Start with recognition - thanking someone on the team for how they helped a teammate or a group or individual achievement. Starting on a positive note helps the rest of the huddle go much better.
Second, prepare for the day ahead, looking at the demand (schedule or census) vs capacity (staffing, supplies, equipment, etc). Often we start the day with capacity that feels inadequate to meet the demand. If so, the team can develop contingency plans to make the day go better, reducing surprises that lead to overwhelm.
Third, review performance metrics. The organizations we work in have an agreed-upon set of values. We demonstrate how we honor those values through performance metrics (quality, safety, patient experience, access, staff engagement, and financial performance).
The organization-wide metrics are the result of the work that happens at the front lines. Front-line metrics should be relevant to our work and something we can control at that level.
For example, to improve access we may focus on the number of open slots at the beginning of the day, and to improve financial performance focus on the number of those slots that get filled.
If a metric is on track with projections, great! There is no need to spend extra time there. If a metric is off track, it's an opportunity for the next step - problem solving.
And, review only one metric each day, and each metric only once a week. There is not enough time to review everything every day, and few metrics change on a daily cadence.
Fourth, solve problems. Solving problems in a 15-minute huddle is different from tackling big hairy challenges.
There are a few problems that can be solved on the spot. Most will require that a few team members work off line and bring a suggested solution back to the team after a week or so.
The problems to be solved may be a metric that is off track.
There are also little problems that happen frequently and can be quite irritating - a supply missing from a drawer, a malfunctioning piece of equipment, or a schedule disconnect leaving patients or clinicians waiting inappropriately.
These little problems, think of them as "pebbles in your shoes" can be solved on a local level. Each one may not amount to much, but as each gets resolved, your day gets easier.
I often hear a concern that clinicians feel they get mixed messages, being told to increase productivity at the same time they are told to give up one potential appointment slot for the huddle. Invariably, practices that huddle have higher productivity and lower work overload because the function more effectively.
Workflow Redesign
Redesigning a process from end-to-end has great potential. Whether this process is described as Lean value stream management, design thinking, or innovation, they all share core concepts. A group of leaders and front line clinicians and staff:
Analyze a process from the starting point to when it is completed.
Create a map of every step along the way, and evaluating whether each step is necessary, adding value, or simply wasteful.
Redesign key segments of the workflow to enhance the valuable activities and reduce the wasteful steps in the process.
This work is guided by coaches with expertise in redesign processes, but not driven by them. The people who do the work are the experts who identify the steps, assess the value, and come up with the ideas for improvement, not an outside "expert" with predetermined solutions.
Once the process is mapped and improvement recommendations are agreed upon, subsequent work involves 3-5 day events to redesign a segment of the work and implement the new workflow.
This work takes a significant investment of time and money, AND the return on that investment if often 5-10 times to cost.
Technology Optimization in the Healthcare Setting
Over the past 20-30 years, healthcare has moved from a paper-based system to being fully dependent on technology, primarily with the EHR, but also in other key systems for scheduling, billing, and diagnostics.
We continue to see advances in hardware and software, with smaller and more mobile devices, enabling changes to care including telehealth, bedside imaging, and real-time clinical advisories to name a few.
When the EHR was first introduced, we essentially added a computer on top of the paper process, resulting in far more work for physicians and variable improvements in safety and quality. We turned physicians into data-entry clerks spending more time relating to the computer than to patients and colleagues.
We have learned a lot and made progress, albeit more slowly than most of us would like. Too many clinicians do not access tp established solutions to reduce the burden such as single-sign-on to reduce password burden or scribes, either in person or virtual, to reduce data entry.
With the advent of AI we are finally seeing potential to optimize our technology
This allows clinicians to focus on what is most important, our patients, and reduce the time and energy we currently invest in the computer itself. The challenge will be to:
incorporate new technology into workflows using design thinking so that we maximize the benefit of these innovations
investing sufficiently in the tech so that it works well
balancing the urge to quickly adopt new tech and AI with a process to ensure clinical safety
The one thing we can't do is not get involved. Tech advances will continue to accelerate and we have to keep up. Done right, IT provides excellent opportunities for practice efficiency.
Putting it all together - Enhancing Practice Efficiency
The key to enhancing practice efficiency is not to focus on increasing productivity - defined as visits, procedures, or RVUs - but to focus on removing the wasteful activities that pull clinicians away from the meaningful work that only they can do.
Done right, you can "flip the ratio" in your organization, giving clinicians back the time they need for work-life balance and the opportunity to focus on what is truly most important. This enables everyone to spend more time doing what they went into healthcare to do, to find deeper professional fulfillment.
There is much more we could discuss regarding practice efficiency. Fortunately, there are many skilled people working intensely in this arena. In my next post, I'll begin to talk about the third area of improving professional fulfillment - culture of wellness. This is the area with the least focus and the most opportunity for improvement.
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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