More teamwork, fewer unnecessary tasks can improve physician well-being, ASCO speaker says
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System-level strategies that reduce unnecessary work and make team members feel valued can improve clinician well-being and ensure a sustainable oncology workforce, according to presenters at a town hall session during ASCO Annual Meeting.
“These are the people who will deliver on our mission to make advances against cancer,” moderator Ishwaria Subbiah, MD, MS, a medical oncologist and palliative care physician who serves as executive director for cancer care equity and professional wellness at Sarah Cannon Research Institute, said during the session. “These aren’t going to be personal resilience steps clinicians can take, although these steps are important. We’re really going to focus on system-level strategies for professional well-being.”
Presenter Jill O. Jin, MD, MPH, an internal medicine specialist at Northwestern Medicine and a clinical assistant professor at Northwestern University Feinberg School of Medicine, discussed her collaboration with the AMA on enhancing the well-being of the clinician workforce.
“I’ve been working with the AMA since 2015 on system-level strategies to promote professional wellness,” Jin said. “Over the years, we have created a large library of resources and divided it up into three key strategies.”
Reducing unnecessary work
The first strategy Jin outlined involves reducing unnecessary work. This approach aims to not only address the efficiency of practice, but also delves into the meaning of work.
“Doing unnecessary work is what drives the joy out of practice,” Jin said. “Doing less, as physicians, is very difficult, but it’s the best place to start. It’s always easier to take away rather than add.”
Jin cited a recent viewpoint paper published in JAMA Health Forum that likened the reduction of unnecessary work to the selective treatment decision-making process outlined in the Choosing Wisely campaign.
“We want to take away low-value care, de-intensify that, and get to a place of right-sized care,” Jin said. “The author of this viewpoint, Eve A. Kerr, MD, says that this same principle should be applied to low-value clinical work.”
Much of the administrative and clerical work that physicians continue to do in daily practice is not necessarily based on a true need, Jin noted.
“Some of that is due to perceived regulatory compliance,” Jin said. “When you look deeper and get at the root at where a policy or rule originated, it’s often not even relevant.”
Jin has worked with the AMA’s Steps Forward program, which is focused on professional wellness, to create a “deimplementation checklist” for reducing administrative burdens on clinicians.
These include several efforts to streamline electronic health record tasks by minimizing alerts and simplifying the login process. The checklist suggests that institutions consider extending the time for auto-logout and the intervals for password reset requirements. Additionally, the document suggests reducing the need to input excessive or inapplicable clinical data, such as possible pregnancy in men or in women over age 60 years.
“EHR is a big one, of course,” Jin said. “We can minimize alerts, hard stops and those hundreds of extra clicks that each clinician does every day through simple IT support.”
The deimplementation list also includes strategies in the area of compliance, including allowing verbal orders in low-risk situations, reducing signature requirements and reducing mandatory training requirements.
“I won’t go too deeply into these,” Jin said, “but when organizations say, ‘This is all great, but where do I start?’ we always point them to this deimplementation checklist as a good starting point.”
Jin also discussed a Getting Rid of Stupid Stuff (GROSS) initiative, an idea coined by Hawaii-based pediatrician Melinda J. Ashton, MD. GROSS initiatives involve organization-wide polling or surveying of clinicians to identify extraneous or unnecessary tasks.
“They will not be short on responses,” Jin said. “Then, essentially, organizations can have a process of triaging these suggestions and figuring out which ones are easy solutions and easily implemented. They often find that many can be easily removed.”
Sharing the necessary work
Once unnecessary work has been minimized or eliminated, the necessary work to provide high-quality patient care can be made manageable through team-based or advanced team-based care, according to Jin.
“This involves everything from previsit planning and lab testing, standing orders, annual prescription renewables, and, importantly, team-based management of the EHR inbox,” Jin said. “This is not something that physicians can handle alone. It should be a team inbox, not a physician inbox.”
Jin cited a 2022 paper looking at the drivers and rates of provider burnout between 2019 and 2021, at the height of the COVID-19 pandemic. This paper specifically identified key aggravators and mitigators of burnout during that time. The two key aggravators of burnout were chaos in the workplace and poor control over workload, The study showed settings with high levels of chaos had a 78% rate of burnout vs. a 36% rate in workplaces with low chaos. Similarly, settings with poor control over the workload had a 75% burnout rate vs. 39% in locations with better control over the workload.
Key mitigators of burnout include teamwork and feeling valued. The study showed that workplaces with strong teamwork had a 49% rate of burnout vs. an 88% burnout rate in locations with poor teamwork. Clinical settings where clinicians felt valued had a reduction in burnout from 69% to 37%.
When asked about the fact that money was not identified as a mitigator of burnout, Jin was quick to reinforce this message.
“It’s never about the money,” she said. “That is a key point.”
Valuing the individual
The third strategy Jin outlined for clinician wellness focuses on valuing the individual. Specifically, she discussed organizational steps workplaces can take to make team members feel valued. These include offering flexibility and autonomy over daily schedules, providing the option to work from home or use telehealth, and offering the chance for employees to decrease their full-time equivalent (FTE).
“Importantly, this has to come with a reduction in patient volume,’’ Jin said. “You cannot just reduce someone’s FTE and still have them taking care of the same number of patients, because then they’re going to be doing that amount of work after hours. That becomes uncompensated work, which drives burnout further.”
Other recommendations for making employees feel valued include peer support through mentoring programs, professional development opportunities and gatherings, and open lines of communication between clinicians and administrators.
“This last point is key as far as making physicians feel valued,” Jin said. “Truly, the answer is to listen to them. It can be formal forums, or it can be informal, but physicians really just want to feel heard.”
References:
- Kerr EA, et al. JAMA Health Forum. 2022;doi:10.1001/jamahealthforum.2022.4018.
- Linzer M, et al. JAMA Health Forum. 2022;doi:10.1001/jamahealthforum.2022.4163.
- Town Hall: Prioritizing a Sustainable Oncology Workforce through Organizational and System Level Strategies for Professional Wellness. Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
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“Town Hall: Prioritizing a Sustainable Oncology Workforce through Organizational and System-Level Strategies for Professional Wellness.” Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
“Town Hall: Prioritizing a Sustainable Oncology Workforce through Organizational and System Level Strategies for Professional Wellness.” Presented at: ASCO Annual Meeting; June 2-6, 2023; Chicago.
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