Round On Your People

It is as simple as that ... and here is the monumental tragedy of current healthcare leadership behavior.

I have asked thousands of physician leaders - both physicians and non-doctor senior leaders - if they schedule time to round on or shadow their people. Their response is always the same. Just yesterday in a room of 30 CEO's and CMO's from independent groups around the USA, I asked that question -- and how many hands went up do you think??

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ZERO - not a single one

The next words out of my mouth were "shame on you." I am sure that is something they have never heard from a speaker before -- and yet they knew my critique was spot on.

Two Leadership Consequences of NOT Rounding

What about the doctors who don't return the burnout study - the non-respondents?

Are they different than the ones who do respond ?Specifically, are they more or less burned out than the people who send in the survey the first time they are asked??

For years this has been the biggest mystery surrounding any survey of physician burnout rates. It is a question I field often at our live training events. Up until now I have not been able to quote any research that attempted to answer the question.

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Well now we have answer

The recent edition of the original physician burnout Super Study we wrote about in the last blog post contains a hidden second wave of surveys that solves this fundamental mystery. 

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Related:
The Fatal Flaws in the Burnout Survey Industry
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This survey modification actually gives us three important new data points:

Mayo's physician burnout super-study finally released their third round of data from the 2017 survey.

This was that infamous first study documenting burnout rates above 50% in US physicians in Mayo Clinic Proceedings using US physician burnout surveys performed in 2011 and 2014 compared to burnout in the general US population.

It is probably the single most important data point in the birth of the movement to track and address burnout in physicians. That movement has spread far and wide since 2011, culminating in the current wave of industry-wide confabs like the NAM Action Collaborative on Clinician Wellbeing and Resilience.

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Since 2014 we have been waiting patiently for that third round of surveys to report out. Show us the 2017 data please, please, please ... and here it is.

It's not Physician Burnout dammit - it's Moral Injury, Victim Shaming, Human Rights Abuses, Right?

There is a wave of righteous indignation sweeping the online discussion of physician burnout recently. It is spawning a series of increasingly outraged new terms to define burnout as a symptom of systematic, deliberate abuse perpetrated by "the system".

Some even go so far as to accuse physician burnout coaches of "cannibalizing the corpses of their colleagues" - one of the more inappropriate and creepy examples of alliteration I have heard in a while. But hey, jump on the bandwagon.

Even the Z Dogg is in on the trend and his video is worth watching for sure.

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Here's my question

Will using terms like these change anything or make anything easier, better, less stressful for doctors?  

My answers are YES and NO and MAYBE

Stop Physician Burnout - 4th grade math shows the epic fail of the current practice of medicine

We don't need no stinking spreadsheets

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Let me show you a simple, reproducible, fourth grade math demonstration of the power of team based care and up-staffing the back office. Along the way you will begin to sense the staggering waste in the current practice of medicine, caused in part by industry standards like the MGMA annual staffing survey.

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We Build, Install & Support Corporate Burnout Prevention Strategy
Using Experience with 165 Clients to date -- CLICK to learn more
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The reason EMR is killing doctors is simple -- OVERWHELM

Doctors were never meant to handle both
1) the complex interactions and thought processes of diagnose and treat, teach and manage patients
2) AND the digital documentation of those interactions via any one of the current truly demonic user interfaces.

The implementation of EMR doubled the workload on the doctors.

Most employers did not staff up to handle it. Instead, relying on annual staffing surveys to show them the average back office staffing ratio is the same as it was back in paper chart days - 1 Doc + 1 Medical Assistant. 

That's right, the work load doubled without a change in the number of hands on deck.  The documentation falls on the doctor simply because:

- we are ultimately liable for what is in the chart
- we don't punch the clock and stop working at 5PM

It is as if someone designed the system of care specifically to burn out doctors and now they use industry averages to reinforce the travesty. You can't design a more perfect meat grinder for the average doctor and now it is considered the standard of care.

The result:

• Two hours in the chart for each one hour of face time with patients - "Pajama time"
• Burnout rate in US physicians hovering at 50%
• It's a healthcare delivery failure of epic proportions

A 4th Grade review of the numbers reveals a way forward

Putting pen to paper in a personal journal is a powerful burnout prevention tool for doctors ...

- and the research says a keyboard is not a substitute for pen to paper.

The unexamined life is not worth living ~~ Socrates

The palest ink is better than the best memory ~~ Chinese proverb

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One of the best ways to step out of the whirlwind of your daily life is to develop the habit of journaling about your experience.

Every single time you pick up your journal you put a process in motion that supports you building a more meaningful life and and practice. Writing in your journal automatically transports you to a new perspective, outside the whirlwind of ordinary events.  You pause and reflect.

The notes in your journal come from a new level of consciousness rather than the day-to-day rat brain of survival. Problems and dilemmas can be seen much more clearly and new action steps stand out like neon lights. 

No problem can be solved from the same level of consciousness that created it ~~ Einstein

It all happens so fast it is easy to miss the power of process. Let's slow things down and take a closer look.

Here are the steps to journal self-reflection:

When burnout forces you to reverse the bad habits of our training - normal self-care can seem like an act of courage

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Burnout is your destiny trying to get your attention. It's objective - wake you up and knock you onto a path with more purpose.

Most of the time, it must grind you to a state of complete exhaustion, before you will begin to challenge the habits that got you here. Those survival habits were learned in the crucible of your residency. Learning to take better care of yourself won't come easily.

And if you are lucky, burnout finally gets you to look in the mirror and ask, "Is THIS what I really want in my life and my practice?"

If you recover, better self-care will be a significant piece of your strategy. You realize you don't have to live your life like a resident. There are other options.

• You will learn how turn off your "the patient comes first" programming when you are not at work
• You will find new ways to take better care of yourself - to put your mask on first
• Rest - Nutrition - Vacations/Holidays - even a little pampering here and there - will all play a role. 

Then you run into the next obstacle. 

As soon as you start taking better care of yourself, GUILT will often rear its ugly head.

The consensus is clear, EMR and documentation overload is the single largest source of stress for most physicians.

How did it come to this?

Because forcing physicians to both take care of patients AND perform as a data entry clerk is bad for everyone involved - the patient, the doctor, the doctor's staff and family ... EVERYBODY.

We already have studies showing two hours of documentation chores for every one hour of direct patient care. This documentation disaster already has a slang term for its ability to destroy doctor's family life - "pajama time".

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In this blog post let me show you:

• A single graph that perfectly expresses the overwhelm, specifically for US doctors - check it out
• Four reasons why this is happening, specifically to US doctors
• Four ways to immediately ease your documentation workload - things you can do now, rather than wait for the EMR industry to fix itself
  
  

1) A Single Graph that Says it All for US Doctors

Last week, the major healthcare organizations in Massachusetts all agreed that the physician burnout epidemic is a public health crisis ...

... and then missed the mark with their recommendations. 

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The Mass Health and Hospital Association, Mass Med Society, Harvard T. Chan School of Public Health and Harvard Global Health Initiative published a position paper titled: 

"A crisis in health care:
A call to action on Physician Burnout"

What took them so long you might wonder. 

Since they are coming late to the party, you would expect they will rock the RECOMMENDATIONS section of their White Paper, right?

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In this post, let me use the sharp edge of our 10,000 hours of real world experience treating and preventing burnout with 163 client organizations to date --

... to show you exactly how the four main recommendations of this consensus statement of academics Miss the Mark.

I can assure you things are a little different at ground level than they may appear from a literature review in the ivory tower. 

Let's Dive In. 

Primum Non Actio Stupidus

• STOP making the doctors and nurses do stupid things

• If you want to know what these stupid things are ... all you have to do is ask the doctors and nurses

Primum Non Actio Stupidus