This is Margaret Cary and I’m with Jay Bhatt, who’s the chief medical officer for the American Hospital Association and Arika Trim, Associate Director of Media Relationships for AHA. It’s May 7, 2018 and we are at the AHA’s Annual Membership Meeting, in Washington, DC
MC: Jay, what do you think about this conference?
JB: What’s exciting is the energy of the members that are coming together to be able to share their efforts on advancing health in America and to think about new ways to continue to deliver on their missions for patients, families, and communities. And as someone who’s a practicing geriatrician, to see colleagues that are there 24/7 to help patients and families and communities – that’s exciting.
MC: So tell me a little bit about how you became the Chief Medical Officer of the American Hospital Association.
JB: I was interested in this vision for the future, the society of healthy communities where each individual has their highest potential for health. And that’s the vision I can sign up for because that’s what we should be aspiring to do, this work as caregivers. We’re seeing really amazing examples of that across the country and I’m interested in driving impact at scale. And so this opportunity to work with a great team at AHA with our members, at the cutting edge in transforming the delivery system and developing the workforce of the future is helping to provide health care.
MC: I heard your presentation at the National Academy of Medicine. One of the things I was struck by was the effect the electronic health record (EHR) has on clinician burnout. I wrote one of the first books on telemedicine, published in 2000. At that time I really promoted telemedicine. I thought the EHR was really going to change health care for the better. What I learned from that conference and others is while the EHR captures data it also contributes a huge amount to clinician burnout. Any comments?
JB: When it becomes burdensome, it can be challenging. It’s in how we use the technology. There are great examples of that in clinical decision support, where we see improved quality and help manage the extensive amount of information that is needed to deliver care.
I think that healthcare technology, if used appropriately, can be an enabler for helping deliver and support care to patients. The advantages are that the EHR makes it easier to do the right thing, and helps capture and organize information that can be fragmented.
We’re seeing our members use the EHR where they’re teaching care teams, and provide feedback on how the care teams can improve documentation. Other members of the care team leverage information in the EHR to provide early trends to the care team for the patient visit. You can provide feedback on how you might improve the way that you’re documenting or using it for information for you. There are also other members of the care team that are leveraging the information there to provide
MC: What do you see as ways to mitigate against clinician burnout?
JB: The issue of burnout is a critical one. It’s not just physicians, it’s with other caregivers in the workforce. As more pressures are put on the system, both externally and for internal change processes that need to happen in order to continue advancing health in communities. Eighty percent of burnout has a systemic contribution and 20% personal.
From a system point of view, it’s about training care teams to be more effective in each of the roles. Think about the team-based model. When we were kids we were taught to do projects together and work together. We lose that in medical school. Perfecting the team-based model is critically important, as is addressing the EHR challenges and minimizing inappropriate clicks. In the end, that will improve care delivery.
On the personal side, we need to reconnect caregivers to their purpose – why they’re doing this work. I went through burnout when I was a resident in an emergency department. Five patients each month, on average, died, despite doing the best we could. That takes a toll on you that we did not acknowledge. We tend to just put on a mask and say “This is how it’s supposed to be. We’re supposed to handle it and figure it out.” I was disconnected and not managing effectively. I felt I was slipping into clinical depression and so I finally asked for help.
We should make it easier for people on our care teams to ask for help and get it. Help could be a connected community, support from mental health, or an intentional space to talk about how we’re addresses the issues impacting our own health. It can be peer support – the Brigham has a great program. We need to bring back a sense of community, whether that’s through the doctors’ lounge or other ways to create a sense of social connectedness in community care teams.
Rewiring our brains to think positively is critically important because our brain defaults to negative frames. So we encourage documenting positive experiences at the end of the day and doing that consistently.
We’ve created intentional spaces in our organization (AHA) to discuss things that matter to us. For example, at the end of meetings, we ask each individual to share a picture from their life that matters to them. That creates purposeful communication, which helps individuals manage their lives better and get the support they need – to make it easy to ask for help.
MC: Talk a little bit about the AHA’s Physician Leadership Group.
JB: AHA has a program that partners administrative leadership with physician leadership to deliver on the vision of a society of healthy communities. We’re building modules to help physicians think about social determinants and to understand how they can help care for patients and connect them to community resources.
Coaches are critical. I’m thinking about high performing teams in sports or other areas. We’re testing the use of coaches to help improve performance for care teams and help them manage their personal lives. This has implications for burnout and this week we’re bringing 25 physicians together from around the country, to test this approach that’s grounded in life coaching and reconnecting individual purpose so that they can understand themselves and manage the challenges that they encounter every day.
This model we’re testing has improved engagement scores from 40 percent to 97 percent. Our partner is putting half their employed physicians through this program, OneTeam Leadership at Novant Health.
MC: What do you see in that future of healthcare?
JB: Healthcare is going through the largest changes it’s ever seen. When organizations go through change management they ask for help. It’s important we help folks as soon as possible.
If I would have asked for help earlier, it would have been really impactful to me much earlier this process of being exposed to burnout and depression. I asked my program director for some time off and I worked with a coach. When I came back, I was in a different mindset, so I could manage stress trauma, what happens to the patients that I cared for, and effectively engage in patient care teams.
Because we’re trained to try to solve the problem and help patients as quickly as possible, we sometimes don’t think of delivering patient care with additional support. So the care team looks different. The care team of the future will include social workers, community health workers, data scientists, and pharmacists, to name a few. So now we’re rewiring and relearning how to work together and understand the strengths that individuals can bring to a collective effort.
Our physician leadership development is key to this. When physicians think about how they can help care for patients and connect them to community resources, outcomes improve and costs go down. Health systems are really thinking hard about creating the care teams of the future, care teams with empathy and compassion.
“Compassion is the oldest medicine.”