Physician dissatisfaction is common today, with around 54 percent1 of physicians reporting at least one major symptom of burnout, which leads to disengaged care providers and lower productivity. In some cases, physicians with severe burnout leave the profession and on average it costs $500,000 to $1 million to replace them.2
Clinician burnout presents healthcare executives across the country with similar challenges. The organizations most successful at overcoming these challenges build clinician teams with high self-perceived service capability. When providers don't feel highly capable, it's often a reflection of their environment and leadership. On Nov. 13 at the Becker's Hospital Review 7th Annual CEO + CFO Roundtable in Chicago, athenahealth Executive Director Jessica Sweeney-Platt led an executive roundtable discussion titled "Positioning for Change: Building High Capability Teams."
For the purposes of her discussion, Ms. Sweeney-Platt defined "capability" as the ability for clinicians to make the right decisions and deliver the best treatment possible to their patients. Athenahealth conducted a survey to gather insight on physician capability; the survey was not an assessment of clinical abilities, but rather a tool to gauge the latitude, resources and organizational support physicians receive. Unsurprisingly, many physicians cited technology and EMR challenges as a hindrance to patient care and the reason for burnout, but the survey also found physicians face the structural challenges of isolation. Physicians are now more likely employed by hospitals, spread across large geographic footprints and spend less time rounding on patients than they did in previous decades.
"But I don't think these challenges are unsolvable," Ms. Sweeney-Platt said. "The data would suggest that the answer to, or antidote to, a frenetic pace of practice and isolation is capable teams, appropriately staffed with work divided thoughtfully and correctly amongst colleagues who respect and trust each other."
An athenahealth survey found physicians who perceived themselves as highly capable were:
• More productive in terms of work relative value units per day
• More likely to report engagement with the organization
• More likely to report job satisfaction
• Less likely to see themselves exiting the organization within three years
• Less likely to show signs of burnout
The gulf between burnout among high capability and low capability physicians was significant; 32 percent of high capability physicians showed signs of burnout, compared with 50 percent of low capability physicians.
"Burnout is taking a tremendous toll on organizations of all sizes," Ms. Sweeney-Platt said. "It's taking a toll at the human level, it's taking a toll at the patient care level and it's taking a toll at the business level. Burnout is associated with a much higher rate of both turnover and reduction in productivity. To replace a physician who decides that he or she no longer [wants to] practice is an extraordinarily expensive undertaking."
Just 5 percent of the respondents replied positively to all questions in the survey, reporting adequate human resources to care for patients, strong connections with team members and confidence in the organization's personnel to provide high quality care; however, 96 percent of those respondents also met the criteria for high capability.
"This is, in our opinion, one of the areas where we think leaders in the organization can really focus and have a meaningful impact across a not-terribly long period of time," Ms. Sweeney-Platt said. "It's thinking about the degree to which there are adequately staffed teams with a good mix of clinical and non-clinical personnel and that there are high trust levels within those teams, and between those teams and the rest of the organization."
5 physician capability trends influencing burnout and productivity
After taking a deeper dive into the survey data, athenahealth researchers found five key trends in physician capability:
1. Most physicians feel rushed more than once per week, and the more rushed physicians were less likely to feel capable. There is about a 15 percent productivity increase among physicians who perceive high capability compared to those who don't. "On a per provider per day basis, when you start to multiply that out across every working day [and] every physician in an organization, that 15 percent productivity lift is a pretty significant one," Ms. Sweeney-Platt said. "We know that capability and productivity correlate with one another."
2. When physicians feel rushed, they are less likely to develop genuine connections with their team and more likely to experience isolation; a quarter of the physicians surveyed reported feeling isolation at least once per week. "Physicians with the highest levels of capability are two times as likely to report working in practices where they have close relationships and open communication with their clinical colleagues," Ms. Sweeney-Platt said. "Those who said they have strong connections with their colleagues were also more likely to say they feel well supported by their organizations."
The physicians with a sense of connection also exhibited fewer symptoms of burnout and were less likely to exit the organization. Reducing isolation and increasing rapport through peer-to-peer networks, weekly huddles or encouraging social ties amongst colleagues can drive increased physician engagement. An executive from a hospital based in a metropolitan area in the Midwest explained how his organization builds strong patient care teams.
"We're moving away from just physician training," he said. "We actually bring the entire care team together … We actually go out to their site. We sit for two weeks, redesign the flow, and then retrain the entire care team, not just the provider. You get some more congealing of the care team, and then everybody understands the workflows."
3. When physicians have the right staff in the right roles as well as the right relationships, they are more likely to feel highly capable. However, developing a sense of collegiality can be a challenge for large, sprawling organizations and those in rural areas. The CEO of a Midwestern health system discussed how her organization supports the primary care physicians, both independent and employed, that aren't all based at the centralized hospital.
"We started a private counsel," she said. "They all come together once a month to talk about what things are going on that impact them. That has been really well-received. We do quarterly Saturday symposiums for them on what's current in the literature that they need to know about. I think those two things have connected people much more, even though they're in disperse areas outside of the organization."
4. Physicians who are satisfied with the organization's leadership and communication are also more likely to have high capability ratings. Fifty-three percent of physicians with high capability ratings also met the criteria for engagement.
"That is a really good sign," Ms. Sweeney-Platt said. "These are individuals who are not just satisfied with their job, but they're actually willing to lean in. They're willing to extend discretionary effort, roll up their sleeves, go above and beyond, and they are much less likely to attempt to leave the organization. I thought that was really interesting from a pure stability perspective."
5. The survey covered both employed and independent physicians, identifying lower capability scores among employed physicians. Ms. Sweeney-Platt theorized the lower scores for employed physicians were tied to a lack of ownership mentality. "We typically see higher levels of capability in independent physicians in independent practices," she said. "We see higher levels of productivity and higher levels of engagement in that analysis as well."
A chief medical officer from another Midwestern health system discussed how his organization promotes ownership mentality among its employed physicians, even as the system implements organizationwide standardization.
"As we come together, we are beginning to create a structure that operates 'like each other' to take control away from the individual," he said. "We give the providers a sense of ownership by drawing them into the problem-solving process. Before we are fully integrated, we are trying to problem solve more individually and we can give providers the space to come up with more local solutions."
Take the first step to highly capable teams
Over the years, athenahealth has done significant research into organizational leadership by using data from its networks to generate insights, lessons and stories for healthcare leaders. The company provides expertise through athenainsight.com with the mission of combatting burnout and helping healthcare organizations build highly capable teams.
References
1. Mayo Clinic study of 2,778 physicians conducted from 2011 to 2014
2. AMA Wire. "How much physician burnout is costing your organization," posted online Oct. 11, 2018.