As we talk to health care leaders around the US and around the world about the challenges they face, we hear common and familiar themes. They worry about clinical outcomes and how to deliver optimal care. They also worry about financial outcomes and sustainability. But the one theme that comes up over and over again is workforce challenges. In fact, one leader described their top three challenges as, “workforce, workforce, workforce.”
The challenges of working in health care receive a significant amount of coverage – both in the trade and lay press – for good reason. The COVID-19 pandemic stretched health workforces past the breaking point, while poorly designed systems did little to help clinicians manage the emerging complexity. Many left their clinical professions, and many others were dissuaded from pursuing careers in health care. These trends, which existed before the pandemic, accelerated during and after it. And while there appears to be some encouraging news on burnout among physicians, rates are still alarmingly high, with nearly 50% of physicians reporting at least one symptom of burnout. The reasons are well documented though we’ve yet to fully understand how chaotic and unpredictable system performance impacts the experience of giving care. It’s critical we explore this as the predicted shortage of health workers, estimated to reach 100,000 by 2028, will only exacerbate the problems clinicians face every day.
While understanding of these challenges continues to evolve, emergence of potential solutions continues to be lacking. Health care leaders understand the critical importance of employee engagement in health care, and many, if not most, are working hard to improve it. Valuing and empowering the people in their organizations is a core responsibility for leaders, but too many efforts to improve engagement, culture, and retention focus on trying to fix the people, instead of focusing on the complex and high-priced systems in which they work.
A central tenet of improvement science is that changing outcomes requires changing systems. People are, without a doubt, the most important parts of those systems, but merely exhorting or incentivizing people to work more, harder, or with fewer errors, simply doesn’t work. What does work is redesigning the way our systems function. We have seen a small, but growing number of organizations in health care that are implementing comprehensive systems of care that are improving worker well-being by reigniting a sense of joy and purpose in their daily work. We call these systems “care operating systems.”
Care operating systems share several key principles and features such as transparent and actionable insights built into workflows, a commitment to understanding the steadily increasing complexity in health care, the need to communicate with clinicians in language they understand, and the full integration of all the dimensions of quality – from safety and clinical effectiveness, to efficiency, flow, equity, and patient-centeredness. As we work to help health systems install such operating systems, we see three primary components, each of which has a sensing system and an effector system:
- A safety & effectiveness management system which includes a sensor system to understand safety risk on a regular basis while continually evaluating clinical performance, and an effector system that enables improvement of both daily operations and large-scale enterprise priorities.
- An efficiency and flow management system which begins with evaluating flow and clinical variance. And effector systems including a flow management program and waste reduction program.
- Finally, an experience management system takes in data from both patients and clinicians about the experience of both providing and receiving care in the system. The system responds to those experiences with clinical coaching and supports to staff and providing service improvement efforts to patients.
These systems are dependent on enterprise level leadership and buy-in, a data system that is configured to provide operating information back to front-line care teams, and workflow configurations that support local improvements in how care is delivered.
Technology plays a key role in such operating systems. Fortunately, most health care organizations already have invested in the technology they need. It just needs to be optimized and integrated into a more effective system to realize true value. The unarguable urgency of implementing electronic health records in recent decades regrettably drove fragmentation and frustration due to limited interoperability. Instead of lessening the burdens on the workforce, new technologies, in many instances, created new ones. We believe Care operating systems can reverse this narrative. Technology-enabled systems of care have the power to restore the crucial connection between clinician and patient by automating time-intensive tasks and processes to create more time and room for direct patient care. In other words, more time and space to do the job they hoped for when entering the health workforce. Health workers are our institutions’ most precious and valuable resource, and we owe it to them to create the best possible systems in support of them delivering excellent care to their patients.