2 Sides of the Same Coin: Clinician Engagement and Patient Experience

Transcript

• 00:00Thank you all for joining on
• 00:01behalf of Doctor Nita Ahuja,
• 00:03our interim Cancer Center
• 00:04director at Yale Cancer Center,
• 00:06doctor David Fisher.
• 00:08Want to invite everyone to
• 00:10sit back and enjoy this?
• 00:12It's going to be a wonderful
• 00:14presentation by Doctor Jessica Dudley.
• 00:16But before we get to Doctor,
• 00:18Dudley wanted to talk about the Iris Fisher
• 00:22Lectureship which was endowed in 1999.
• 00:26And since then, we've been very fortunate
• 00:28to have some pretty amazing speakers.
• 00:31I think last year was Doctor Ethan Bosch,
• 00:34when I remember Doctor Fisher
• 00:36has over a 60 year history with
• 00:39with Yale School of Medicine.
• 00:41He was and and is the first medical
• 00:44oncologist for the New Haven community.
• 00:47It was in private practice,
• 00:49but then came over full time faculty in 1995.
• 00:52Obviously he's had countless contributions
• 00:54to the Yale School of Medicine.
• 00:56Yelp Cancer Center.
• 00:58The Smilow Cancer Hospital and our community.
• 01:02But really important for today is
• 01:05Doctor Fisher's wife.
• 01:06Iris was the diagnosis,
• 01:08sarcoidosis and incurable disease and
• 01:10really a lot of the decision making
• 01:14in terms of you know what types of
• 01:17treatment and quality of life in terms
• 01:20of her personal well being are really
• 01:22immortalized in this in this lectureship.
• 01:25So you know,
• 01:25it's a it's really phenomenal that we get
• 01:28to do this every year and bring them,
• 01:30you know,
• 01:31fantastic faculty.
• 01:32And people around the country and
• 01:34around the world to to be able to
• 01:37present we of course wish that doctor
• 01:39Jessica Dudley was here in person,
• 01:41but maybe we'll get a rain check.
• 01:44Or, you know, inviter.
• 01:45Invite her in the next couple of months
• 01:48if things clear up a little bit more.
• 01:50Moving on to doctor Jessica Dudley,
• 01:53she's the Chief clinical officer for Press,
• 01:55Gainey,
• 01:55and you know this is what the focus
• 01:58of her talk is going to be on.
• 02:00But really,
• 02:01I'm I wanted to take a few moments
• 02:03just to talk about my personal
• 02:05relationship with Doctor Dudley.
• 02:07She was my chief medical officer
• 02:09when I was on faculty at Brigham
• 02:11Women's Hospital in the Brigham and
• 02:13Women's physician or organization.
• 02:15And really, you know,
• 02:17looked up to her as my mentor.
• 02:18She really helped me navigate many.
• 02:22Crises,
• 02:22whether it was in the care of our
• 02:26patients in my area specifically
• 02:27and in breast cancer patients,
• 02:29and he really even personally through
• 02:31some of the things that I had to go through.
• 02:32And you know,
• 02:34a huge loss for for the Brigham,
• 02:36you know,
• 02:37real amazing game for a press ganey.
• 02:39And it's absolutely phenomenal that
• 02:43that she's here with us today.
• 02:45I did want to share one quick
• 02:47picture because I'm not dressed up,
• 02:50but this was my 2010 clinical
• 02:53collaboration award.
• 02:54That I want from was awarded by the
• 02:56Brigham Women's Physician Organization.
• 02:58I had a little bit more here.
• 03:00There Doctor Dudley has not changed a bit,
• 03:03and with that I'd like to pass
• 03:05on the floor to to Jessica.
• 03:08Thank you so much for being
• 03:09here. Thank you so much and for
• 03:13making me laugh. With that photo,
• 03:16not 'cause you're ended up.
• 03:18Very proud of you, but 'cause I was
• 03:22thinking about when I took the job
• 03:24at the Brigham hold and I'm just
• 03:26trying to get to the to my slides.
• 03:28When I took the chief medical
• 03:30officer job at the Brigham.
• 03:32In my job description,
• 03:34actually was hosting that gala
• 03:36and I know I thought, you know,
• 03:39I had this big population health
• 03:40background and was very focused on care,
• 03:42innovation, and then the gala,
• 03:44which was a wonderful event to
• 03:46celebrate all of our physicians.
• 03:48But having to pick out a dress
• 03:50to go to the Gallic you just
• 03:51brought back a lot of stress,
• 03:53but that's it's all good.
• 03:54It's all behind me now.
• 03:56Great, so thank first one.
• 03:59So honored to be here to speak
• 04:01with all of you today.
• 04:03And thank you Doctor Fisher for this
• 04:07incredible honor to be presenting
• 04:10at this specific grand rounds and
• 04:14Mira and all for inviting me here.
• 04:17I am really excited to spend this
• 04:20time with all of you and I have quite
• 04:23a few slides and my goal is not to
• 04:26kind of bury you in these slides.
• 04:28My goal is to hopefully engage
• 04:31you in thinking about.
• 04:33These issues,
• 04:34and I think things that
• 04:36you've probably come I know,
• 04:38think about quite a bit,
• 04:41but hoping that by the end of this,
• 04:43maybe I can shine a different light
• 04:45on it and share a little bit of a
• 04:49different perspective and one that
• 04:51hopefully going forward we can work
• 04:52with each other and continue to grow.
• 04:56Richard, sorry to present.
• 05:00You're showing like the next slide.
• 05:02OK, so let me work on that
• 05:03'cause I was worried about this
• 05:05and I I'm trying to get it in.
• 05:07Sorry yeah it's supposed to
• 05:09be in the slideshow mode,
• 05:10but it sounds like it's not.
• 05:13Not yet. Hold on one second.
• 05:15Give me a second.
• 05:18Give me one second stop share.
• 05:21Share and I wanna share.
• 05:24This screen.
• 05:29And I have that sound on share screen
• 05:32and then this should pop it into.
• 05:37Is it still? Are you still
• 05:39getting my notes page?
• 05:40Oh, got it, you're great.
• 05:43OK, let me know if they pop up 'cause
• 05:45I'll just kill it if that happens.
• 05:46Seems fine, OK, great.
• 05:50OK, let's get going.
• 05:51So I called this two sides of the same coin.
• 05:55UM, patient experience
• 05:57and clinician engagement.
• 05:59And I came to press ganey Asmira
• 06:02was saying two years ago and I
• 06:05don't think I really understood
• 06:06then what I do understand now.
• 06:09Which is it really is two sides of the same
• 06:12coin meaning and and I can like feel that,
• 06:15but I'm going to show you data to
• 06:17hopefully convince you of that.
• 06:18I'll also.
• 06:19Add my bias, which is the coin does
• 06:24not exist without the foundation of
• 06:27a really engaged clinical workforce.
• 06:30And that also means that the Clinton
• 06:34clinicians have to be able to do
• 06:37their jobs well and have to be well,
• 06:40so we'll go through that.
• 06:41I know that you know all of you are still
• 06:44addressing the challenges of kobid,
• 06:47and I suspect that's going to
• 06:48be with us for awhile,
• 06:49and I'm going to share with you.
• 06:51Our data for both patients and
• 06:54the workforce regarding kovid,
• 06:56but then I really want to spend time
• 06:58showing you things that organizations
• 06:59are doing to solve for a lot of the
• 07:03challenges that have appeared and
• 07:04hopefully give you some ideas and
• 07:06maybe think a little bit more about
• 07:08how you're solving these challenges.
• 07:09Because I I know having talked to
• 07:11doctor stamped and I work closely
• 07:13also with Doctor Bennett that you're
• 07:15already pretty much on your way to
• 07:17addressing a lot of these issues
• 07:19and have been for a long time.
• 07:21So some of you may have seen this slide,
• 07:24maybe not,
• 07:25but this is really the UM perspective
• 07:28that press ganey has when we use
• 07:30the term patient experience.
• 07:32A lot of people say patient satisfaction,
• 07:34but we're really focused on calling
• 07:37it the full experience and making
• 07:39sure when we're using that language,
• 07:41we are absolutely talking about quality,
• 07:44safety, Clinical Excellence,
• 07:45and then we know none of this happens
• 07:49without the foundation of the care team.
• 07:52And it's a team and I know you
• 07:54all in cancer care.
• 07:55Know that probably better than anybody else
• 07:57in medicine and then the other point is,
• 07:59while we often capture data
• 08:02in specific settings,
• 08:03we know patients are getting their
• 08:05experience across the continuum
• 08:07often when they're not even
• 08:08actually directly getting care.
• 08:10So I just want to put that
• 08:13definition out there.
• 08:14I also know that we all have our own story,
• 08:18even as clinicians of being patients
• 08:20and experienced care in care,
• 08:22often in our own systems.
• 08:25And you know,
• 08:26I think all of us as caregivers
• 08:28kind of often cross our fingers
• 08:30and just like hope it goes OK,
• 08:31'cause sometimes we know how many things
• 08:33have to go right for it to go well.
• 08:36And this was just an experience
• 08:38I had over the summer.
• 08:40My husband finally was able
• 08:42to get an elective surgery
• 08:44completed in June and we actually did
• 08:47it at one of our organizations where
• 08:51I practiced and I'm going to say.
• 08:55Overall, everything went very well,
• 08:58so we got in there.
• 08:59UM, the nurse after the doctor
• 09:01checked us in said the doctor forgot
• 09:03to mark which side of your body
• 09:05we're going to do this procedure on.
• 09:07She needs to come back and do it.
• 09:09I'm paging her now and I was like so
• 09:11relieved as a patient that as a family
• 09:13member that that happened and there
• 09:14was no hesitation from the nurse.
• 09:16And I thought that's so awesome.
• 09:18They have their safety culture down.
• 09:20And then an anesthesiologist
• 09:21came by and he said hi, I'm Josh,
• 09:24I'm your lead anesthesiologist,
• 09:26I have these four other people.
• 09:27He introduced all their names and talked
• 09:29through what everybody was going to do.
• 09:31So I had another kind of OK,
• 09:32great like they have team culture.
• 09:34This is all good and then he got through
• 09:36surgery and we were in the pack.
• 09:38You and this nurse was just all over it.
• 09:41My husband was totally out of it
• 09:43so I came in there and she was just
• 09:46explaining everything to me in a
• 09:48very kind of incredibly constructive.
• 09:50Detailed way,
• 09:51which is exactly what I needed and
• 09:53I said wow,
• 09:54you know this is you're you're so helpful.
• 09:56Thank you so much and they've been
• 09:58doing this for a long time and she said,
• 10:01well,
• 10:02I've been here for 20 years but I've
• 10:05only been in the pack you for nine
• 10:07months and I said well, what happened?
• 10:09She said well COVID happened and
• 10:13after you know nine months or so
• 10:15of COVID in this unit after I've
• 10:17been here for 20 years,
• 10:19I just couldn't do this.
• 10:20Anymore,
• 10:21and in fact all of our all of my
• 10:23colleagues have left.
• 10:24There's only three of the senior
• 10:27nurses remaining and I was
• 10:30going to leave altogether.
• 10:32She said,
• 10:33but then I remembered when I
• 10:35first came here 20 years ago.
• 10:37They said to me nurses are
• 10:40like potted plants.
• 10:41They come, they stay, they never leave.
• 10:45And that was not how I was
• 10:48feeling at that moment,
• 10:49but I was able to get some support
• 10:52and engage with my colleagues.
• 10:54The hospital sponsored some very
• 10:56informal peer groups and that helped
• 10:58me realize I did want to stay and I'm
• 11:00actually thrilled to be working down here.
• 11:03I needed a change of scenery,
• 11:04but I'm still here.
• 11:06So I just wanted all of you to know
• 11:09that I know for many this has been
• 11:11like an incredibly challenging time.
• 11:13On top of, you know,
• 11:15an incredibly challenging,
• 11:16probably decades of careers for many.
• 11:20And I'm worried because I don't
• 11:23want folks to leave and I loved
• 11:26the image of that potted plant
• 11:28and I just wanted to share that.
• 11:31So I'm going to share some patient
• 11:34experience findings and then I
• 11:36will go ahead and share some
• 11:38workforce findings and then we'll
• 11:40talk about solutions.
• 11:43So you know, most of you probably
• 11:45that press ganey has a lot of data
• 11:47and I'm going to like briefly flat,
• 11:50flip up a slide to show you that,
• 11:52so you can believe me when I tell you we do,
• 11:55but I don't want to ping, you know pain,
• 11:57you make it painful for you to have to
• 11:59sort through all the data when we look
• 12:02at our kind of hundreds of thousands
• 12:05and millions of comments from patients
• 12:07and we look at them across all settings.
• 12:11Inpatient ambulatory emergency medicine.
• 12:13And then all different outpatient sites.
• 12:17Ultimately there are a few big themes
• 12:20that really shine through and I
• 12:22put them on this slide and they're
• 12:24very similar to what I felt with my
• 12:26husband in the story I just told you
• 12:29the first is about keeping me safe,
• 12:31so marking that side of the face known that
• 12:34you know balls aren't going to be dropped.
• 12:36That's really critical.
• 12:37Of course, the working together.
• 12:41Is of course the most important,
• 12:43because this is a team sport and
• 12:46then the caring piece and I know
• 12:48you all have worked really hard.
• 12:50I think across your system on the
• 12:53carrying on communicating the caring
• 12:56piece which is a huge component of that,
• 12:59but that all like doesn't happen
• 13:02unless we have this engaged workforce.
• 13:06This is the data that we're going to skip,
• 13:08so you don't have to like try
• 13:10to figure out the slide,
• 13:12but I have one for inpatient
• 13:14ambulatory emergency medicine.
• 13:15It has gone through it all and those
• 13:18trust me that in that purple box
• 13:21are those three themes of keep me
• 13:24safe work together and care for me.
• 13:26They look slightly different.
• 13:28'cause in the inpatient setting it's,
• 13:30you know,
• 13:31the room clean is the measure
• 13:33of safety in that setting.
• 13:34But trust me, these themes are the same.
• 13:36Yeah, come across all of the settings so.
• 13:44This is now data you may not have seen
• 13:47because this is some newer data from
• 13:50COVID and we recently acquired a company
• 13:53that's able to take unstructured data.
• 13:56So comments that people put into
• 13:59surveys that patients put into
• 14:01surveys and then organize that.
• 14:03So instead of just anecdotally remembering
• 14:06the last thing that somebody said or
• 14:08trying to sift through these, you know,
• 14:11literally hundreds of thousands.
• 14:12Or in this case 18 million.
• 14:15Comments that were collected.
• 14:17We can actually now using this
• 14:20kind of pet to patented technology,
• 14:22extract the real themes and this is
• 14:25just to show you that these themes of
• 14:28gratitude of kindness and empathy they
• 14:31are shining through in this COVID time
• 14:33mid more than we've ever seen before.
• 14:36This is from our national data.
• 14:39We do have your data,
• 14:40so yells data and this is just a kind of
• 14:44graphic way of grouping the comments.
• 14:47So when we look at your positive
• 14:50comments from this past year,
• 14:52these are the main themes.
• 14:55So this kind of courtesy, respect, kindness.
• 14:58That's that.
• 14:59The size of the box represents
• 15:02the end of the comments.
• 15:05The proportionality of them,
• 15:06and that is what patients
• 15:07take the time to write.
• 15:09And about, yes, of course.
• 15:11Skills and knowledge are important.
• 15:12And yes, of course some of the logistics,
• 15:15but the big bulk of the positive
• 15:17feedback is in the space of the caring,
• 15:20courtesy and respect, and those are
• 15:22just a few quotes that you can read.
• 15:24Their doctor axe is the kindest,
• 15:27most courteous and knowledgeable physician,
• 15:29kind and knowledgeable,
• 15:32etc.
• 15:33So of course we want to hear it all,
• 15:35and these are the negative comments.
• 15:38And and honestly,
• 15:39and I've seen your data to the positive
• 15:41comments are almost always more than the
• 15:44negative comments like the volume of them.
• 15:47We tend to focus on the negative.
• 15:48Can't help ourselves with that.
• 15:49But trust me,
• 15:52the passives are outweighing
• 15:53the negatives when we look at
• 15:56the negative comments though.
• 15:58You know they're slightly different,
• 15:59and they're very,
• 16:00very focused on what I'm going to
• 16:03call logistice and reliability and
• 16:05scheduling is that biggest block here,
• 16:08and we have seen this a lot in COVID,
• 16:10and we know how hard it was
• 16:12for everybody to change,
• 16:13innovating and deliver care
• 16:14in a very different way.
• 16:16I'll tell you one place where we've really
• 16:18seen challenges around logistics was
• 16:20initially in the telemedicine paste space,
• 16:22which patient actually loved,
• 16:23and we had a ton of positive comments
• 16:26about connecting with providers.
• 16:28I'm feeling so grateful that
• 16:29that was able to happen,
• 16:30but a lot of frustration with using
• 16:33the technology that comes up in this.
• 16:35You know,
• 16:36very inefficient as far as
• 16:38managing time for patients,
• 16:39and then these delays down there.
• 16:42And I meant to tell you, please,
• 16:44if you want put questions in the chat and
• 16:48I'll try to respond to them as we go.
• 16:51OK,
• 16:51so this is also a newer slide you probably
• 16:53haven't seen, and it's a
• 16:55little bit complicated.
• 16:56It's how we group our data and flow it,
• 16:59but this is your data, by the way,
• 17:01this is y'all's data, so this is
• 17:05really trying to demonstrate that even
• 17:08when you have patients who are very loyal,
• 17:13so that blue ball on the left says
• 17:16that you've got of the 30,000 patients
• 17:19that were included in this particular.
• 17:22Measurement that 87.1% of them,
• 17:26which is benchmark at the 76 percentile.
• 17:29This is the cohort that says,
• 17:32you know I'm going to score
• 17:34this the highest possible.
• 17:35You know my and that loyal
• 17:38to this organization.
• 17:39And that's I'm giving it the
• 17:41highest possible or top box score.
• 17:44What happens, though,
• 17:45and what we've been looking at now is
• 17:49that when patients have friction points,
• 17:54so hassle experiences before their visit,
• 17:59and that actually greatly impacts how
• 18:02what happens to their kind of likelihood
• 18:05to recommend or loyalty to the practice.
• 18:09So in this example,
• 18:11a little more than half they
• 18:13didn't have the friction.
• 18:14And I'll tell you what those points are in a
• 18:17minute and their scores went up even higher.
• 18:20So even more likely to recommend
• 18:2390th percent 99th percentile.
• 18:25But a little less than half
• 18:27did have some friction,
• 18:28and their scores go down,
• 18:30so they then score you at
• 18:33this 73.2 the 9th percentile.
• 18:35So that's for friction points
• 18:37that happened before my visit.
• 18:39Those are things like courtesy of
• 18:43registration staff, ease of contacting,
• 18:45ease of scheduling, the appointment.
• 18:47Providing information about
• 18:49delays and wait time at clinic.
• 18:51Those are all the components that
• 18:53make up this before friction points.
• 18:56And then, UM, the care happens.
• 19:00And there's another kind of
• 19:01logistics piece that that happens,
• 19:03or can create friction during the care.
• 19:07And again, all of this is outside of
• 19:09the experience with the care provider,
• 19:10and this is cleanliness of the room
• 19:13is one of the examples in this space,
• 19:15so when that doesn't score,
• 19:19when that is not kind of up to snuff,
• 19:22per the patient,
• 19:24the score drops even further.
• 19:26So you go down to this.
• 19:2834.3 or the first percentile.
• 19:31It's forgiving,
• 19:32though patients are forgiving,
• 19:33so if you,
• 19:34even if you have all those
• 19:35friction points before the visit,
• 19:36but then you deliver on the
• 19:38cleanliness of the room,
• 19:39you kind of come back up here to this.
• 19:458888 point 484th percentile.
• 19:47Hopefully you all followed me on
• 19:50this with the take home message
• 19:52being like these friction points.
• 19:54These hassles really impact
• 19:56overall experience and how
• 19:57patients rate their experience.
• 19:59I know not no surprise to you
• 20:02all and I also know that hassles
• 20:05are impacting all of you.
• 20:06But I think it's really important
• 20:09that we've now can show this with the
• 20:12data because it enables practices.
• 20:14Or units to really focus now on these
• 20:17areas that otherwise might have gotten
• 20:19kind of wrapped up and bucket did it
• 20:22and we wouldn't have that level of detail.
• 20:25OK, so in a shift to
• 20:28clinician specific findings.
• 20:29So just like we have a
• 20:31lot of data on patients,
• 20:33we actually have a tremendous
• 20:35amount of data on clinicians.
• 20:37And honestly,
• 20:37I didn't even realize this
• 20:39when I came to press ganey.
• 20:40I knew that we had a good amount of
• 20:42data on the workforce like I know that
• 20:45press Gainey was survey our employees,
• 20:47but I didn't realize that that
• 20:49we have the largest clinician
• 20:51database in the country also.
• 20:53So we are serving approximately
• 20:57125,000 physicians annually.
• 20:59And about 50,000 advanced practice providers,
• 21:04so it's a very big data set.
• 21:07So,
• 21:08uhm,
• 21:08we're also now able to kind of look and
• 21:11dive deep into that data set to see,
• 21:13at least at the aggregate levels,
• 21:15what's most important to physicians
• 21:18and what's most important to APS.
• 21:21And so we did that by looking at
• 21:23one of our survey driver questions,
• 21:26which is intent to stay for three years.
• 21:29So we asked that question,
• 21:31and when we asked that of our physicians,
• 21:34these three themes kind of surface
• 21:37to the top.
• 21:38So the first for physicians is about kind of
• 21:42certainty and success of the organization,
• 21:45and this is what kind of makes
• 21:47them feel most confident and about.
• 21:50And this is the number one key
• 21:53driver for actually both male and
• 21:55female physicians is the certainty
• 21:57of the organization's success.
• 22:00So the second key driver it's
• 22:02again the same for men,
• 22:04male and female physicians is
• 22:06work life balance and this.
• 22:08This is literally that this location
• 22:11supports me and balancing my
• 22:13work life and my personal life.
• 22:15And and I think this is really about,
• 22:18UM,
• 22:19the importance to all of us that
• 22:22we are in this profession.
• 22:26And want to be in it,
• 22:27but it has to kind of be a part
• 22:29of our lives because we all have
• 22:32lives outside of it.
• 22:34And if our organization can't
• 22:36help deliver that,
• 22:37that makes it really difficult
• 22:39for us to want to stay.
• 22:41And then the third one,
• 22:44which is again,
• 22:44this creates this link and not surprising.
• 22:46I'm sure to anybody here is
• 22:50that the location provides high
• 22:52quality patient care and service.
• 22:54That is an absolute driver like we
• 22:57need to know that if we're going
• 23:00to stay at our organizations.
• 23:02So for APS it's similar,
• 23:05but a little bit different,
• 23:07and these are the themes and
• 23:09I think that that's
• 23:10probably a good way of thinking
• 23:12about APS in our data in general,
• 23:15and I actually often feel like
• 23:18APS is kind of the last cohort
• 23:21because they spend a lot of time.
• 23:24I think our AP spent a ton
• 23:26of time with physicians,
• 23:27but they're not always measured with them,
• 23:29and there are some differences and.
• 23:32They're not really sitting in with any other,
• 23:35so we've been really active at looking at
• 23:38them both separately and then aggregating
• 23:41their data into this clinician space.
• 23:43But for APS and again, we've looked at
• 23:46it from male and female AP separately.
• 23:48But these are the big four themes that
• 23:51we find for their kind of interest and
• 23:54intent to stay for three year period.
• 23:56So the first is this.
• 23:58I feel like I belong in this organization.
• 24:01That's the number one key
• 24:02driver for male and female APS.
• 24:05I like the work that I do.
• 24:07Then we have the patient
• 24:09quality and service that had.
• 24:11Also,
• 24:11we just saw with the physicians
• 24:14and then another interesting driver
• 24:16here is this respect.
• 24:18And confidence in our leader,
• 24:20both the direct person I'm reporting
• 24:22to and then senior management overall,
• 24:25and that's become.
• 24:27I think that's a really interesting
• 24:30insight into thinking about kind
• 24:32of where many of our AP's are
• 24:35connecting and what is going to
• 24:37be really important to keep them.
• 24:43And and I will answer questions.
• 24:45So the great question.
• 24:47So if I'm if I've showed you any like,
• 24:50yell any data,
• 24:51right now it's Yale New Haven Health.
• 24:55Overall, I do have and I can send it
• 24:58to Terra the Smilow specific data.
• 25:01So I had that I have like a smile,
• 25:03a specific breakout for those that circle
• 25:06picture with the hassle factors drivers.
• 25:10It actually looks quite similar to Yale,
• 25:12New Haven but better.
• 25:14In certain areas,
• 25:15and maybe a little bit different
• 25:16in a couple of others,
• 25:18and I will make that point about the data in
• 25:21general to actually like make change happen.
• 25:23All of us need to look at that data
• 25:26at the practice level in order,
• 25:29I think to really ultimately
• 25:31understand what's driving what
• 25:33the drivers are for each practice.
• 25:36So this is the this is everybody's
• 25:39moment for interaction.
• 25:40So if you could take a second and
• 25:44look at this picture and tell me
• 25:47where you think you are and if
• 25:49you like you can you can say like
• 25:51this where I think I am and or
• 25:53you could say well this is where
• 25:55my colleagues are but but this is
• 25:57this phases of disaster slide.
• 25:58Some of you may have seen this before.
• 26:01You know I use this early on in the pandemic.
• 26:03It's not.
• 26:04It's not COVID related at all, it's a.
• 26:07Kind of used for national disasters?
• 26:10Or are there other instances?
• 26:12And it's on the kind of stamps
• 26:14and mental health support site.
• 26:17So what it shows is and I'm
• 26:19waiting for anybody who's ready to
• 26:21type who's already ahead of me.
• 26:23But what it shows is as a an event unfolds.
• 26:30There's this kind of anticipation
• 26:32and we saw this across the country.
• 26:35By the way.
• 26:36We formed a caregiver collaborative
• 26:38right when COVID started last March,
• 26:40and we included lots of folks from New York,
• 26:43Connecticut, New Jersey who got hit hard,
• 26:45fast,
• 26:45and the rest of the country was
• 26:48kind of sitting and waiting,
• 26:50so we actually lived through this.
• 26:52And then there was the heroics and
• 26:54the honeymoon period where lots of
• 26:55support and cheering and people felt like,
• 26:57OK, we got this, and we have treatments.
• 27:00Now and then we got a vaccine and
• 27:02we can do this and then this kind
• 27:05of disillusionment phase.
• 27:06So I'm looking here and I see a
• 27:08lot of people saying like five.
• 27:09Well,
• 27:10not a lot of people,
• 27:11but I see five from most people and
• 27:14some people are saying 6 and I'll tell you,
• 27:18this is.
• 27:18I've also showed this slide with a lot
• 27:21of folks and there's been a lot of force.
• 27:24I showed it a couple weeks ago and I got
• 27:27the feedback that my slide is wrong.
• 27:30And that I need to fix it and make it up.
• 27:34This kind of downward sloping bucket
• 27:37needs to happen again and again and again.
• 27:40'cause that's how they are feeling right now,
• 27:43but I will say most leaders
• 27:45feel like they're somewhere
• 27:46between five and six and
• 27:47that they can see a light.
• 27:52So we have a, uh,
• 27:54a colleagues at press ganey,
• 27:56who actually lead a lot of our safety work,
• 27:58and I think some of them worked with
• 28:00have worked with you guys over the years.
• 28:02Are HPI safety Consulting Group
• 28:04and a number of them have military
• 28:07experience and they spent a couple
• 28:09months kind of looking at our data
• 28:12talking to folks around the country
• 28:14and really landed on why they think
• 28:16health care workforce experience
• 28:18during COVID is actually been.
• 28:22Far more difficult than UM,
• 28:24experiences in the military,
• 28:26and for these four reasons and
• 28:29the kind of relentlessness of the
• 28:32experience that you you can't get go
• 28:36home especially early on and get away
• 28:39from it because there was so much
• 28:42concern about safety and exposing
• 28:45families for women or for men who are
• 28:48the kind of principle caregiver for their.
• 28:52If they have kids or a.
• 28:56Parents that they're caring for
• 28:58that going to work and coming home
• 29:00was around the clock the entire
• 29:02time and really felt relentless.
• 29:05And then what?
• 29:06We're seeing a lot more is this
• 29:08oppositional piece that I think
• 29:11is driving a lot of compassion,
• 29:12fatigue, and secondary trauma
• 29:15for many folks right now.
• 29:19So this is, uhm,
• 29:20I don't think anybody seen this.
• 29:22You might have seen it,
• 29:23it was tweeted a couple weeks ago,
• 29:25but it's not yet published.
• 29:26This is from this epic research data of like
• 29:29350 organizations that are using at Beck.
• 29:32And there they were just tracking the
• 29:35percent difference in digital messages
• 29:37that are coming from patients directly
• 29:40to providers right now to physicians.
• 29:43And they have.
• 29:44There's been 157% increase
• 29:46in that volume of digital.
• 29:48Messaging now it's not an absolute,
• 29:50so you could have had four messages a day
• 29:53before and now you have seven messages,
• 29:56but it's a huge shift and the glass
• 29:58half full piece of this is like
• 30:01fantastic patients have finally
• 30:02figured out how to use the portal.
• 30:04That's great.
• 30:05The glass half empty is Oh
• 30:08my goodness we built it,
• 30:10they came but we didn't actually
• 30:12figure out how to manage it.
• 30:14So it's this overwhelming amount
• 30:16and this is when I talked to
• 30:18my colleagues in primary care.
• 30:20They are overwhelmed by this
• 30:22amount of messaging and lack.
• 30:24They haven't had a chance to build the
• 30:27system to manage this influx appropriately.
• 30:31So I wanted to share with you just a
• 30:33couple of the terms that we use a lot.
• 30:361 is resilience and this is really
• 30:38this ability to recover or adjust
• 30:41when challenging things happen
• 30:44and we measure resilience with
• 30:47two different sets of metrics.
• 30:50One is about activation and it's the
• 30:52ability to kind of get charged up,
• 30:53ready to go and find meaning
• 30:55in every encounter,
• 30:57and then the other is to decompress to
• 30:58be able to go home, recharge and recover.
• 31:00And we.
• 31:01Absolutely need to do both if
• 31:04we want to remain resilient.
• 31:06So I'm sorry for the like small font on this,
• 31:10but I do want to point out and I'm going
• 31:12to talk about engagement in a minute
• 31:14that physicians of all the professions
• 31:17in the hospital scored the lowest
• 31:20for both resilience and engagement.
• 31:24Will talk about engagement in
• 31:26it and for resilience.
• 31:28So this is physicians down here.
• 31:31This score overall score is
• 31:32made up of two components.
• 31:34Activation physicians are great at
• 31:36getting activated and treating each
• 31:38patient individual as individuals and
• 31:40finding meaning and where physicians
• 31:42really are struggling is their ability
• 31:44to decompress to be able to go home and
• 31:47disconnect from work communications
• 31:49to be able to sleep, recover,
• 31:51and be able to come back the next day.
• 31:53And this is what we're going to talk about.
• 31:55I will make one.
• 31:57I've seen the resilience data for this
• 31:59past year and the one flip that I thought
• 32:01was interesting is teaching faculty
• 32:03have now dropped below physicians.
• 32:06Their resilience is lower.
• 32:09Again due to decompression.
• 32:12So now, as tough as this is,
• 32:16we are seeing places where there are
• 32:19some kind of hopes and bright spots,
• 32:22and I'm going to call this one of them.
• 32:23So this is looking at engagement.
• 32:26So engagement is how we measure.
• 32:28We have a six out of six questions that
• 32:30we use to measure kind of an individual's
• 32:33likelihood to go above and beyond with
• 32:35the organization that they're working,
• 32:38and we capture things like pride
• 32:39and likelihood to recommend
• 32:41the organization and send.
• 32:42Family there and so as you can see from
• 32:45this over the past couple of years,
• 32:47although there is a cohort that's having
• 32:49a dip down and engagement and we are
• 32:52seeing this and and from many that
• 32:55the engagement scores are going down,
• 32:57there is a group of organizations
• 33:00where physician engagement is actually
• 33:03going up during the pandemic,
• 33:05and I like to think that's because of UM,
• 33:09honestly,
• 33:09the concept of high reliability.
• 33:12And, uh, leadership.
• 33:13Stopping and recognizing that they might
• 33:16not have the answers for many things,
• 33:19but those on the front lines probably do.
• 33:22And actually creating the space to listen
• 33:24and take that information and act on that.
• 33:28And we've seen all across,
• 33:29and I actually seen 'cause Michael shared
• 33:32with me the the depth and breadth of
• 33:35the communication approaches you all
• 33:37had throughout your pandemic where you
• 33:40know your frontline voices could work,
• 33:42heard.
• 33:42And actually,
• 33:43I think greatly informed decisions
• 33:45that were made,
• 33:46and that's something that you
• 33:48know we don't often see UM.
• 33:50And when like times are normal in healthcare.
• 33:53So,
• 33:53so we now need to like I want to
• 33:56focus on how do we move forward
• 33:58and address these challenges.
• 33:59So I do think these are four major
• 34:03challenges facing most organizations
• 34:04right now and we're going to go through.
• 34:08Will go through them.
• 34:09They're actually pretty connected
• 34:11because when I use the term well being,
• 34:13it's it's far more than my
• 34:15individual well being.
• 34:16It's thinking about the organizational
• 34:18kind of well being as well.
• 34:21But I suspect that these issues of trust,
• 34:23uncertainty and staffing are ones
• 34:26that you're all challenged by.
• 34:28I will say then I'll get to this
• 34:31later that the accountability for like
• 34:34addressing and solving these challenges
• 34:37can't just happen at an individual
• 34:40level or at an organizational level.
• 34:43It's gotta happen.
• 34:44Also at a leader level and at a team level.
• 34:48These problems are too
• 34:49complex and for some of them.
• 34:51Like getting like I talked
• 34:54about earlier to the unit of
• 34:56measurement that's most important,
• 34:58and that might be your practice in your
• 35:00clinic is going to be really critical
• 35:02if we're going to solve these problems.
• 35:05So I have.
• 35:06I'm going to talk a little bit about
• 35:08well being and these first three
• 35:09slides are a case study from an
• 35:12organization that decided they wanted
• 35:13to really go deeper to understand
• 35:16what was driving for things.
• 35:19They were very worried about.
• 35:20That was resilience,
• 35:22both activation and decompression,
• 35:25and this was for their clinicians.
• 35:27Their AP is and physicians.
• 35:29They were also very focused on
• 35:31productivity and on intent to stay
• 35:33'cause they really don't want to lose.
• 35:36A single physician or AP,
• 35:39given the challenges right now,
• 35:41so they had a very.
• 35:42They've had a very kind
• 35:43of robust look at this.
• 35:44They did kind of what many people
• 35:46do is as the engagement survey,
• 35:48but then they've dug deeper and
• 35:50they've dug deeper into the data,
• 35:52and they've dug deeper into
• 35:54listening to their front lines.
• 35:55And then they've used this information
• 35:57to help prioritize and begin to
• 35:59build their road map going forward.
• 36:01So this is just a schematic for the data,
• 36:04and I don't want to get lost in this.
• 36:06'cause trust me, it's a lot of detail.
• 36:09But basically we are taking survey data.
• 36:11We are taking your HR utilization data,
• 36:14so the minutes that people are in it
• 36:16and the time of day that they're in it.
• 36:19We're also looking at productivity data
• 36:22from your human resources platform,
• 36:25and we can integrate all of
• 36:27that together and then surface.
• 36:29What are the key drivers for these areas
• 36:32that were very focused on addressing?
• 36:35And this is again a schematic
• 36:37that's just trying to show you.
• 36:39It is not going to be one
• 36:41thing that pops out.
• 36:43Uhm, and most things fall,
• 36:45I think into these three big areas.
• 36:48What we can learn by going deep here though,
• 36:50is the actual impact.
• 36:52And what will happen?
• 36:54The likelihood of something
• 36:55happening if we go to fix it.
• 36:57So for example,
• 36:58for this group.
• 37:00There was a.
• 37:01It became very clear that a huge
• 37:04driver of the challenges for
• 37:06doctors to decompress was around
• 37:08the EMR efficiency and proficiency
• 37:11and the challenges of resources
• 37:14and workflow in the clinic.
• 37:15And this came out when we looked at
• 37:17their decompression data and saw that,
• 37:19like those people who are doing
• 37:21really well versus those who weren't,
• 37:22it was due to things like the amount
• 37:24of time that they were spending
• 37:26charting or how many days until
• 37:28their next appointment was available.
• 37:31And those who were kind of swamped.
• 37:32We're doing far worse than those who weren't.
• 37:34So again, things that you would think,
• 37:37OK, I get it.
• 37:38But the fact that the data revealed
• 37:39it then gave them something to kind
• 37:41of stand on to try to then help
• 37:43address what the challenges are.
• 37:45Lots of other areas and I think these
• 37:47are probably ones you're well aware of,
• 37:50which is the role of leadership
• 37:51and addressing kind of culture.
• 37:53And and then what do we do to better
• 37:56support individuals and teams?
• 37:57And actually some of those things came
• 37:59up when we were looking at the earlier data.
• 38:03So I was going to show this video,
• 38:07but I'm a little worried I'm going to run
• 38:10out of time so I'm not going to show it,
• 38:12even though I think it's really powerful and
• 38:14I will send it and anybody can watch it.
• 38:17It's a really wonderful 3 minute heartfelt
• 38:20video and I'm using it as an example.
• 38:24Of how important it is,
• 38:26and then I know, you know this to
• 38:29feedback these comments from patients.
• 38:33The positive ones so your providers can
• 38:36hear them and remember just how important
• 38:38they are and the work that they're doing,
• 38:41how much they are changing
• 38:44people's lives and these.
• 38:45This is not just physicians,
• 38:47it's transport folks,
• 38:49it's the helicopter, EMTs,
• 38:52and they're all reading letters.
• 38:54Of patients that that were
• 38:56written to them specifically,
• 38:57and they're all kind of recognizing.
• 39:00Gosh, I didn't realize I needed this.
• 39:01Thank you,
• 39:02but I did and it really makes a difference.
• 39:06There are a couple other areas in
• 39:08well being that we're seeing folks do,
• 39:10and again I suspect you're doing
• 39:11some of this here.
• 39:12I would say the concept of peer support
• 39:15has kind of never been more important,
• 39:17and it can be like simple or it can
• 39:21be very complex and we are seeing
• 39:25organizations do all variations of this.
• 39:28These the kind of themes of what
• 39:30happens with peer support and why
• 39:32it's so important or what I wanted
• 39:35folks to just focus on for a minute.
• 39:37But it for sure is true that well
• 39:40one we as colleagues know each other
• 39:43and might pick up and sense things
• 39:45that you know somebody that you don't
• 39:48know wouldn't necessarily pick up on.
• 39:50And we also,
• 39:52unfortunately,
• 39:53there is still often a stigma around
• 39:57getting help,
• 39:58and this is something that you
• 40:00know we all have to work more
• 40:02aggressively to fix that stigma around.
• 40:04The need for emotional support.
• 40:06And there's been.
• 40:07And I'm really hopeful right
• 40:09now that we are going to change
• 40:12the paradigm around them.
• 40:14And that's something that I I.
• 40:16I'm I'm working really hard for
• 40:17us to focus on and address that
• 40:19we have to make it easy for folks
• 40:22to access mental health and meet
• 40:24them wherever they're at.
• 40:26And that's what these three examples that
• 40:28I threw up here show this first one,
• 40:31which may be hard to see this
• 40:33resilience check in list.
• 40:34This was created by an organization,
• 40:37actually Valley Health.
• 40:38System in New Jersey they copy
• 40:40catted from an organization in the
• 40:43Pacific Northwest in our mountain and
• 40:45Intermountain did it as a going home.
• 40:47Checklist Valley Health did it as
• 40:50a coming in checklist but the goal
• 40:52was we need to remind our colleagues
• 40:55that we are here for them that
• 40:57they need to check in and make
• 40:59sure they're OK and that there
• 41:01are resources to support them and
• 41:03will meet them where they're at.
• 41:05You know,
• 41:06Columbia has a very comprehensive program.
• 41:07I suspect you all have a pretty
• 41:10comprehensive program for
• 41:11accessing mental health when folks
• 41:14really need professional support,
• 41:16and then the bottom one is an example
• 41:18from New York City health and hospitals
• 41:20that have really built a kind of
• 41:22pyramid type model to try to capture
• 41:24for their entire workforce workforce
• 41:26and those who need support and create
• 41:29a buddy system and then really work
• 41:31their way up the pointy part of that is
• 41:34the seeking help from a professional.
• 41:38Coaching is another area that we
• 41:40are seeing folks kind of lean into
• 41:43more actively than before,
• 41:44and I think part of that is
• 41:46this recognition that wow,
• 41:47you can do this virtually and
• 41:48it works really well.
• 41:49Some organizations are building that,
• 41:51others are outsourcing it.
• 41:53If you build it internally,
• 41:56you have this like win win opportunity
• 41:59because most folks who take the
• 42:01time and coach also get a benefit.
• 42:04As well as the person being coached.
• 42:06Trust after well being was another area,
• 42:10and it's something that we're
• 42:13all working really hard.
• 42:15And I know it's again you all have.
• 42:17You know,
• 42:18maybe have trained up more folks in
• 42:20communication than any other organization,
• 42:22at least that I'm aware of,
• 42:24and I think like,
• 42:26uhm.
• 42:27Keeping that dial turned up is going
• 42:29to be really important on this.
• 42:31This is really talking about communicating
• 42:33and connecting with the workforce,
• 42:35so not let's put it.
• 42:36It's so critical.
• 42:37Of course we do that for patients,
• 42:39but it's really critical we do
• 42:41it right now for the workforce,
• 42:44so this is rounding reliably,
• 42:46so not just times one and there's
• 42:49no way like a senior level
• 42:51leader could round on every.
• 42:53Unit or department?
• 42:54I mean they they can and they do and we
• 42:57see folks around the country doing that.
• 42:59It will take them a year right
• 43:01to get to everybody.
• 43:02So this is where again this rounding
• 43:04has to happen and at a very like
• 43:07small team level so that that
• 43:08leader is present and hears from
• 43:11their team how they're doing,
• 43:12how they're not doing.
• 43:14We have seen this for nurses,
• 43:15physicians,
• 43:16APS and just like showing that you are
• 43:20present that you care that you're listening.
• 43:23That you are transparently communicating
• 43:25back what you can fix and what you
• 43:28can't has really gone a long way for
• 43:30folks and something that you know.
• 43:32The trick with this is to do it reliably,
• 43:35meaning the same on a
• 43:38consistent way overtime,
• 43:39not just times one or once a month.
• 43:44I suspect all of you are
• 43:45pretty familiar with.
• 43:46Well, actually I don't know 'cause I have
• 43:48a mix when I tell people about this.
• 43:50This concept of psychological safely
• 43:52DI know Mary is 'cause we took a
• 43:55course together and Amy Edmondson
• 43:57is one of the folks who really talks
• 43:59about this a lot using examples from.
• 44:04All sorts of other industries,
• 44:05especially spaceflight, but the important,
• 44:09but she's also really done a lot
• 44:12of her work in hospitals.
• 44:13In fact, that's where she started,
• 44:15and this concept.
• 44:17This is a picture of Gramercy
• 44:19Tavern in New York,
• 44:21because even in a restaurant where you
• 44:24think the stakes might not be so high,
• 44:25although this pretty expensive restaurant,
• 44:27so the stakes are pretty high
• 44:29to get it right,
• 44:30the expectation is that the
• 44:32wait staff on their first shift.
• 44:34An will ask for help at least
• 44:3710 times and they are encouraged
• 44:39to do that so their leaders.
• 44:42They're kind of team lead.
• 44:45Models that it is OK for them
• 44:47to help ask for help.
• 44:49In fact they expect them to do it,
• 44:51so they're framing this.
• 44:52In that way they the leaders demonstrate
• 44:55that they are far from perfect,
• 44:58and then they thank people
• 44:59when they ask for help.
• 45:01So this kind of psychological safety concept,
• 45:05the set of tools or things that
• 45:07we need to train our leaders in
• 45:09and and we this the clinicians.
• 45:11On this call you our leaders,
• 45:13whether you may have a leadership title.
• 45:16Or not for sure whatever practice you're in,
• 45:19I'm sure you are perceived as the leader,
• 45:22so knowing how to have the skills to
• 45:25help other people speak up and engage
• 45:29them and support them is really critical.
• 45:32This is from an organization that
• 45:34actually is one of our top performers.
• 45:37It's a large system and they have
• 45:42been on a journey just like you.
• 45:45Just like many organizations have
• 45:47for many years to improve both
• 45:49patient experience and then in
• 45:51the last three or four years very
• 45:54focused on their workforce,
• 45:55specifically their clinicians and aips.
• 45:58But when they started their journey
• 46:00back in 2012, they've been very.
• 46:03Desperate,
• 46:03they came together and they were very
• 46:05focused on how do we become a system?
• 46:07How do we create that communication?
• 46:09How do we create some bit of sameness but
• 46:12also permit permit some local autonomy?
• 46:15They ultimately embraced high reliability
• 46:18as they're kind of building block
• 46:21foundation for doing this work.
• 46:23They have been rigorous about
• 46:25measurements and then in the last
• 46:28few years they're kind of solved for
• 46:31the clinician well being challenges.
• 46:33Has been both a fix the system and
• 46:36then assist the clinician UM approach,
• 46:40but I did want to just spend a
• 46:42second on high reliability.
• 46:43I know you have a framework here.
• 46:46You use the Champ acronym.
• 46:50Actually asked Michael about this,
• 46:52'cause I talked to press Gainey
• 46:54colleagues who had years ago.
• 46:56Worked with folks and we used
• 46:58this acronym and Michael
• 46:59whipped out a card and showed me that
• 47:02indeed you do have this and I think this
• 47:04is a very helpful way of remembering
• 47:07those high reliability behaviors
• 47:09that are so important if we want to
• 47:12deliver care to every single patient
• 47:14and get it right every single time.
• 47:17And so these communications,
• 47:19all of the things. And that, uhm, I know.
• 47:23All of you work to practice work
• 47:26to do already. How do we kind of,
• 47:28uhm, why hardwire that end so that
• 47:31we do it not just with patients,
• 47:34but even as we're working to support
• 47:36our workforce even as we're working
• 47:38to find ways to be more efficient
• 47:41and to deliver care,
• 47:42that is of the highest quality.
• 47:45So this is the performance of
• 47:48that system and they really are.
• 47:51Super performers and these are
• 47:53the highest percentiles that we
• 47:55have for employee experience.
• 47:57This rising tide of physician
• 48:01engagement and then patient experience.
• 48:05So. I am actually a going so for
• 48:08staffing I I'm going to mention.
• 48:12Just very briefly,
• 48:13there is no silver bullet,
• 48:14just like there is no silver
• 48:16bullet with any of these things.
• 48:18We work with organizations,
• 48:21many of them.
• 48:22They're all everybody is struggling
• 48:25right now with staffing and it's mostly
• 48:28nursing or like Technical Support
• 48:32and then like respiratory therapy
• 48:35or other kind of skilled positions.
• 48:38Where folks are choosing to
• 48:39leave and do something else,
• 48:41or dramatically cut back their hours
• 48:43or go and do the same thing but in
• 48:46a site of care that's easier than
• 48:48the rigors that they're experiencing
• 48:50where they're currently working.
• 48:52So this all for this,
• 48:53honestly,
• 48:54are those the same concept of
• 48:57high reliability,
• 48:58really taking the time to communicate.
• 49:00So one of our Western California
• 49:03based health systems have set up ways
• 49:06of communicating and listening to.
• 49:08Nurses beyond the rounding they
• 49:10are surveying them actually every
• 49:12quarter to make sure they get their
• 49:14voices heard and then they are
• 49:17responding immediately and again.
• 49:18It's with this communication,
• 49:20even if we can't solve exactly
• 49:21what you're asking for.
• 49:23Here's what we're doing and why.
• 49:25For most places,
• 49:27figuring out how to what's called
• 49:29force multiply so that really
• 49:31is this concept of practicing
• 49:33at the top of your license.
• 49:35So how can we take the stuff off of the.
• 49:38Physician PA nurses plate that they
• 49:40don't have to be doing and support
• 49:43them within another set of resources.
• 49:46So in some places folks that had
• 49:48stopped using LP ends or pulling
• 49:50LPN's back in to provide that type
• 49:53of support figuring out how to
• 49:55change the inbox messaging system.
• 49:57So all of those messages aren't
• 49:59going to directly to the provider
• 50:02are examples of this.
• 50:03Uhm?
• 50:04I do and I'm seeing some of
• 50:06the questions in the chat,
• 50:08so one of them is about how do
• 50:10we get leadership to respond
• 50:12to concerns with action,
• 50:14which I think is a really great questions.
• 50:17So we're going to get to that in a minute
• 50:19and I'm going to get to that, actually.
• 50:21After my next slide,
• 50:23so we've covered a lot and I think
• 50:27it's really important to remember the
• 50:29connection between working to support
• 50:31our clinicians and the work you're
• 50:34already doing to take care of patients.
• 50:36I'm going to start with this concept
• 50:38of removing the hassles because
• 50:40we know that's what's making it so
• 50:42challenging for folks to decompress
• 50:43the patient quality and service.
• 50:45Kind of that that's the kind of sweet
• 50:47spot for all of us and then really
• 50:49focusing on trust and belonging.
• 50:51And that includes the psychological
• 50:52safety that we were talking about.
• 50:54This is what's going to,
• 50:57like propel us forward and kind
• 50:59of enable us to be successful
• 51:03using high reliability concepts.
• 51:05Really, for.
• 51:06Every single thing,
• 51:07whether it's safety,
• 51:09whether it's a engagement of our people,
• 51:12whether it's looking at resources,
• 51:14being able to deliver these types
• 51:19of aspirations reliably every time,
• 51:22so that every individual,
• 51:23whether it's a patient or a caregiver,
• 51:25or having these experiences,
• 51:27is really what we need to hardwire and
• 51:31then to answer the question in the chat.
• 51:33This is how I think we need to
• 51:35change our thinking on this.
• 51:37So instead of thinking of UM
• 51:41solutions that belong and this
• 51:43is something I mentioned earlier,
• 51:46either to an individual like go,
• 51:48get yes Jessica, if you're struggling,
• 51:51here's the number.
• 51:52Go get the support you need and
• 51:55we have it available for you.
• 51:57We need to recognize that every layer
• 51:59here plays a role in almost all of
• 52:03the things that we're talking about.
• 52:05So there is a role and everybody
• 52:08actually needs.
• 52:09To have some ownership and
• 52:10accountability for that,
• 52:11and this is where the measurement
• 52:13is so important.
• 52:14So there are things that the
• 52:16organization can take ownership of,
• 52:18and I've listed some of them over here.
• 52:21I would say the biggest opportunity
• 52:23right now is in addressing the
• 52:26workflow and operational inefficiencies
• 52:28that folks are challenged by.
• 52:31You know,
• 52:31that's what we saw with the
• 52:33patient hassle data.
• 52:33The friction points in the clinic,
• 52:35and that's what we hear all the time
• 52:38from those. Who are practicing that?
• 52:40We have got to stop and retool.
• 52:43How we're doing this work so
• 52:45that we can keep doing this work?
• 52:48I think we skip a lot the two layers
• 52:51in the middle and this to me is
• 52:53going to be the game changer here.
• 52:55How do we build stronger teams
• 52:58and how do we grow leaders?
• 53:00Because at the end of the day you may
• 53:03have a very senior level C-Suite of folks,
• 53:06and that's great,
• 53:06and they're going to keep your
• 53:08kind of ship steady.
• 53:09But the real work is going to
• 53:11happen at this level,
• 53:13so training these folks making sure
• 53:15they have the data and the support
• 53:17that they need to advance this work.
• 53:19And yes,
• 53:20it may be a negotiation if they
• 53:22need resources.
• 53:22And how do they get those
• 53:24resources so that they
• 53:25can, you know, do their job and be the
• 53:28leader and advance with their team.
• 53:30And then I do as you all know already,
• 53:33if we don't take the time to
• 53:35take care of ourselves first,
• 53:36we can't do any of this work and
• 53:39giving ourselves kind of permission,
• 53:41not just permission,
• 53:42but insistence that we take that
• 53:45time to take care of ourselves
• 53:48first is absolutely critical.
• 53:50For ourselves,
• 53:51but for our teams and for organizations,
• 53:53and of course, for our patients.
• 53:56K So I think I've gotten to my
• 53:59last slide with my one minute left.
• 54:02UM, hopefully you all followed
• 54:06me through this.
• 54:09That and there's a reminder in the
• 54:13chat about recording CME attendance,
• 54:16but hopefully all of you you
• 54:19know are with me on this kind
• 54:20of two sides of the same coin.
• 54:22Two different perspectives,
• 54:24but really the same set of solutions
• 54:26for addressing patient experience and
• 54:29really supporting clinician engagement.
• 54:31The importance of measurement,
• 54:32especially if we're going to hold
• 54:34all of those layers accountable.
• 54:36I don't think can be overstressed,
• 54:38and it's also really critical
• 54:39to use it so we can prioritize.
• 54:41Not have kind of a shotgun like
• 54:44approach to what we're doing.
• 54:47I think I've gotten it all in,
• 54:49so I'm going to stop.
• 54:51Thank you all for your time and uhm,
• 54:53I hope that this was helpful.
• 54:55Thank you, Mara.
• 54:56Thank you so much, Jessica.
• 54:58This is fantastic and.
• 55:00You know will open it up for even
• 55:02though I wear it one o'clock maybe
• 55:04for a question or two and then.
• 55:06You know I have one that wanted to see if.
• 55:10The work that you and Lisa
• 55:12Rodan Steen did at the Brigham,
• 55:14looking at gender differences
• 55:16and burnout and fulfillment,
• 55:18is that was that's specific to the Brigham.
• 55:21Or do you see that translatable
• 55:23really across the country
• 55:25with your press ganey? Such
• 55:28a great question.
• 55:29Thank you for bringing that up,
• 55:30so I think some is very translatable
• 55:32across the country and I would
• 55:34love to come back and talk to
• 55:35you about the gender differences.
• 55:37'cause I really worry about them a lot.
• 55:41And then some was very.
• 55:41It was specific to our data and I don't
• 55:44know if that's gonna come kind of.
• 55:47Beach, something that we're
• 55:48going to see everywhere,
• 55:50but certainly in our data nationally
• 55:52and also the work that we have
• 55:54been doing with the Brigham data.
• 55:56We are seeing the themes of the
• 55:59challenges that female physicians
• 56:01and female APS have with being able
• 56:04to decompress with feeling like
• 56:06they have the support and resources
• 56:08that they need to get the work
• 56:09done in the time that they have.
• 56:11We have lots of good data that show
• 56:13that female patients probably take
• 56:15more time and female physicians.
• 56:17Often have more female patients.
• 56:19You know, physicians often take more time,
• 56:21so there's a lot of drivers in this space.
• 56:25One of the things that we found in that
• 56:28paper was the lack of self compassion
• 56:30and how female physicians score.
• 56:33You know,
• 56:35worse on that than male physicians,
• 56:39and actually,
• 56:39that explained a lot of the difference,
• 56:41and I think that that is true,
• 56:43and that is a societal challenge and a lots
• 56:46been written on that in other industries.
• 56:48The kind of how women tend to
• 56:51kind of set a really high bar
• 56:52and then beat themselves up.
• 56:53I mean play with men do this too.
• 56:56But it's more common,
• 56:57I think in a lot of women,
• 57:01and certainly something we found in our data.
• 57:04Uhm, Doctor Fisher or anyone
• 57:06else with last moment questions?
• 57:08I know we're out of time and again,
• 57:11thank you so much.
• 57:13Just the cover coming down even
• 57:15though you're not here in conquered,
• 57:18but hopefully we'll be able to bring
• 57:20you here soon to visit us in person.
• 57:23Thank you so much for having me
• 57:24and I would love to come visit.
• 57:26Thank you everyone.