EHR Implementation Struggles and 3 Ways to Do It Well

In this article, I will share three important concepts that will take a lot of the struggle out of your EHR implementation. Each one of these are simple to implement and produce immediate results.

Let’s face it … doctors don’t like documentation requirements no matter what form they take. Remember back to the days of paper charts for a moment … you hated those too … piles of them on your desk and sometimes on the office floor … reminding you of the visits you still needed to remember and document.

The Electronic Health Record takes away the piles … and puts a whole bunch of new stresses on us to keep our charts complete. Are things worse than in the days of paper? A significant number of physicians say yes

Here is what a recent AmericanEHR survey learned in 2012

~  39% of doctors would not recommend their EHR to a colleague
~  34% were very dissatisfied with their EHR’s ability to decrease workload
~  32 % had not “returned to normal productivity” since EHR implementation
~  37% were dissatisfied with their EHR’s ease of use
~  And every time physicians are surveyed about stress and burnout … documentation and EHR workload make the top 5 list

In my work with hundreds of overstressed doctors, many of whom blame their EHR for much of their burnout, I have noticed three areas where a slight change of attitude and focus can make a huge change in the quality of your documentation and take a lot of the struggle out of your work day.

1) Don’t Be a Hater

One of the biggest problems with EHR implementation is our attitude toward the technology. We treat the computer and the programs as if they rose from the very fires of hell to torment us. This blaming and hatred produces a very interesting behavior.

We fail to embrace the technology and never learn how to use it well

Let me ask you a question. Do you really think the EHR is going away? This is the future. If you don’t embrace  it and learn to be an expert at it … you are only guaranteeing you will struggle. Here is an important mantra to adopt:

Every User … A POWER USER

There are three ways to become a Power User:

a) Take all the training your vendor gives you – twice. Make sure your nurses and receptionist do too. Learn everything there is to learn from the vendor’s trainings and realize that is just a basic foundation.

b) Develop every single ounce of the customization options for your software so that it matches your personal  practice
Templates
Quick Keys
Any type of templated automatic entry the system is capable of
Take the time to match as much automation as you can to the diagnoses, procedures and patient encounters you see the most in your practice.

Any time you find yourself doing the same keystrokes or typing our mouse patterns (the “broken record”) that is a cry to customize that piece of your EHR to automate that sequence

c) Study your existing Power Users
Who are the people in your practice that DO NOT COMPLAIN about the EHR?
Who are the doctors/nurses/receptionists that everyone acknowledges are the existing Power Users in your practice?

Sit just over their shoulder – the way an umpire in the major leagues leans on the back of the catcher – and watch exactly what they do when they are charting. If that means you accompany them into the exam room … so be it.

And don’t ask them what their favorite shortcuts are … have them show you EXACTLY what they are doing that makes it looks easy. Then you do that too.

Just one tip from a Power User colleague can make a huge difference in each patient encounter

2) End the Death Match

Many doctors overlay the new documentation requirements of the EHR on top of their paper chart patient flow process. You change your documentation to EHR and then try to jam it into a patient  flow process that you perfected in the days of Paper Charts. Don’t do that. This sets up a Death Match between your old flow systems and your new EHR.

The Death Match dynamic magnifies the frustration and struggle for everyone involved

Meld the two … don’t make them duke it out. Look for ways you can alter the way you see patients so the EHR documentation is built into your patient flow.

You will have to alter your patient flow processes to accommodate the EHR. Accept it. Notice the ways you see patients that get in the way of EHR charting and brainstorm ideas on how to meld the two. And please don’t think you have to come up with all the answers here. Because solution #3 is just around the corner

3) Use Your Team

EHR implementation is the perfect time to rise above your Lone Ranger Programming and utilize all the brainstorming power of your patient care team. Gather your receptionist and nurse (or anyone who is involved in your patient flow before and after you see them) and get everyone’s ideas on how to refine the process.

This involves you stepping out of the traditional doctor leadership paradigm as the person with the answers who “gives orders” to the team. Here you are asking powerful, open ended questions that start with the words What or How. Here are some examples.

~  What do you see me doing that I can stop – or  you can do better?
~  What ideas do you have on how we can do things differently to make documentation easier?
~  How can we share the charting activities more effectively?

In most cases your team has important ideas they have not shared with you because you have not given them the green light in this way.

There you have it
1) Don’t be a Hater – Become a Power User instead
2) End the Death Match – and meld your Patient Flow and Documentation Systems
3) Use your Team – Tap Everyone’s Skills and Experience

If you would like specific suggestions tailored to your experience contact me directly using this form

PLEASE LEAVE A COMMENT on your experience with EHR Implementation, especially the tools that have worked for you.

Here is a link to an EHR Implementation success story in a rural, solo practice in Wisconsin from this weeks Medical Economics Magazine

Employed Physicians Top Four Gripes

Medscape published an article this week titled, “4 Top Complaints of Employed Doctors” and it was a very interesting read. Turns out the things employed physicians complain about are basically that they are employees!  Go Figure …

Let me lay out these employed physicians gripes for you with a little detail so you will see what I mean. I will finish this article with a solid way to address all of them. These gripes are basically a cry for effective Physician Leadership.

Although the numbers are not exact, these days about half of doctors are employed physicians, either by a hospital, a medical group or a larger healthcare system. That number is rising pretty rapidly as the industry consolidates to grab the bonus pools soon available to groups large enough to qualify as ACO’s.

This move to become employed physicians is so popular, I have even seen articles lamenting “the death of private practice” and “killing Marcus Welby”.

What is certain is that thousands of doctors have traded in the leadership of their practices for a W-2 and the honor of working for “MegaHealthCorp” in the last few years.

Here is what Medscape identified as the four things employed doctors dislike the most and my suggestion of the best way to avoid these in your organization.

Here is a link to the original article
- it does require you register as a Medscape member

1) Being “Bossed Around by Less Educated Admins”

As an employee, you no longer have the final say in the decisions affecting the logistics of your practice. The person actually in charge is often not a physician. They work for the institution, not you. They report to the heads of the administration, not you. They can literally tell you what will and will not be done. You are treated just like any other employee.

The article uses the term “loss of autonomy” over and over again.

You do retain most of your autonomy over clinical decisions in the exam room (notice I said “most”) and lose the decision making power over the way the office/hospital is run.

That is a big “duh” for me looking in from the outside. I would hope everyone saw this coming as the ink was drying on their MegaHeathCorp Inc. boilerplate physician employee contract.

2) Not Being Able to Make Decisions About Staff and Personnel

That is because you are no longer their boss. You are not the leader/manager/person responsible for any of these decisions in the Org Chart.  If you had an office manager in your private practice, you probably lost them in the transition. Your medical assistant and receptionists are hired and fired by a middle manager, sometimes without your input, consent or awareness. “Duh” number two.

3) Having Less Authority over Billing and Charge Coding

In many cases your employer has a remote and centralized billing office that takes over billing on day one. They may not have much experience with your specialty or outpatient medicine in general. They will require documentation in enough detail to survive an audit. You may not have been as thorough in your private practice as you are required to be now. It can sometimes feel like you have to learn documentation and coding all over again.

4) Being Forced to Use New Equipment and Technology

MegaHealthCorp Inc. has its own equipment, EMR, supply chains and procedures. You will now comply with their systems, just like any other employee – systems you did not choose, request or approve along the way.

If a copier breaks down in your office you will have to go through the bureaucracy and policies and procedures to get a new one. That is much more difficult than handing your office manager the credit card and sending them down to the local office supply store to pick up a new one.

In some cases there are reports of groups “telling employed surgeons which kinds of joint implants to use, and according to a New York Times article even whether to implant defibrillators in Medicaid patients.”

What Don’t Employed Doctors Complain About?

Turns out Medscape’s answer is Practice Guidelines. The reason is simple. Most groups don’t enforce them … yet. Many organizations have established guidelines, they can even be built into the meat of the EMR, however few are strictly enforcing them at this time. As ACO’s grow and shoot for quality bonuses, you can certainly expect that to change.

Physician Leadership is the Answer to These Concerns

Leaders have influence and power, Employees do not. So how can physicians get these features of autonomy back as employees? The key is a strong physician leadership structure on the clinical side of the business.

Doctors must step up and play a leadership role WITHIN the organization. Don’t fight and object and resist. Dive in and lead. Without strong physician leadership in your organization, you have little or no influence on the administration and in the board room.

Worst Case Scenario:
I have seen recently formed hospital owned provider groups of over 300 doctors who have a single physician leader representing the entire 300 physician pool at the board level. There are multiple medical director spots vacant. The physicians are the classic “herd of cats” with no influence over the way the business is run. It is not going well. And I know there are many recently formed groups around the country with a similar physician leadership vacuum.

It is incredibly important to build a physician leadership structure to match the administrative structure you see on the business side of your MegaHealthCorp. And it is equally important that you allow your physician leaders to lead. You must allow them to represent you and provide solid input from our clinical side of the house to all the decision making committees in the organization.

Without physician leadership, the gripes will continue and the feeling of powerlessness will not change.

There is a famous quote, “Lead, follow or get out of the way”. My encouragement is that these gripes be addressed by a wave of effective physician leadership that accompanies your move to become an employee. Just because you are not in private practice, does not mean leadership stops. It is perhaps even more important when you are inside MegaHealthCorp than when  you were in private practice.

The two biggest challenges to employed physicians taking this leadership role are:

1) Bandwidth

Where do you find the time for the committee work to represent the doctor’s interests in your busy practice?  Does your organization respect these leadership activities enough to compensate you fairly for them?

2) Learning how to lead inside a large and established bureaucracy

The rules of influence here are VERY different than in your smaller, physician lead private practice.  It is a whole different ballgame

The bottom line is some group of physicians in the organization MUST step powerfully into this new style of leadership. It is the only way the doctors as a group can hope to maintain any influence or autonomy as members of a large group of employed physicians in a much larger organization. There is an alternative that might become viable in the near future. I will only mention it here. That option is for physicians to unionize.

Please Leave a Comment:

Physician Burnout Training Video [5 min]

Find more Satisfaction at Work when You Break out of Survival Mode using Intention Journaling and the “Treasure Hunt” Process.

Dramatic improvement in the quality of your work day can happen when you set a conscious intention for your experience. WATCH this 5 minute video training to learn how to use the Treasure Hunt this week in your practice.

CLICK HERE for the full training handout

PLEASE LEAVE A COMMENT. What is your favorite patient encounter (your treasure) and how did the Treasure Hunt Process work for you?

Physician Burnout and How To Break Out of Survival Mode

There is a tipping point when doctors are under stress … it happens silently, slowly and when you pass through this threshold your downward spiral will frequently accelerate.

I am talking about when you drop into Survival Mode.
When you unconsciously begin to focus your energy 100% on simply getting through the day and dragging your exhausted butt home.

How do you know you are in Survival Mode ?

It is when you start to see the majority of your job duties as a hassle.
You begin to feel like the patients, your nurse, the lab reports, the phone calls … they are all out to get you. You feel you have no control over what happens in your day … you are swinging in the breeze of everyone else’s needs and urgency.

Your entire focus is to get through your patients and out of there as quickly as possible. You are focused on surviving your practice day, dreaming of the moment when you can put your key in the ignition and get out of there.

In survival mode you are blind to the positive things in your day because even a positive patient encounter gets between you and getting home on time.

This is also a time when Compassion Fatigue kicks in and you may find yourself being increasingly sarcastic and cynical – especially under your breath or in your inner dialog. I have even seen doctors in survival mode post internet chat comments about how they would like to use a nail gun on patients or light them on fire – it’s true.

What has happened in psychological terms is you have lost your inner “locus of control”. You have assumed the role of the victim … helplessly at the mercy of forces that you cannot control. This change is usually gradual and takes place when your energetic bank accounts drop into a negative balance. You simply don’t have the energy to be proactive and “fight the good fight” any more.

How can you turn Survival Mode around?

The “Treasure Hunt” Process

Here is a simple, powerful process to take back your locus of control and put yourself back in charge of your daily experience. I learned it from one of my coaching clients who calls this “the Treasure Hunt”.

The Treasure Hunt allows you to move from the unconscious intention to simply survive the day … to a conscious intention to have at least one meaningful encounter at work every time you are in the office or hospital. But it is much more powerful than that last sentence can convey.

Before I show you the process, just imagine for a moment … in your next day in the office or the hospital, you are consciously looking for a satisfying, enjoyable, fun encounter with a patient or staff member … just one. You are open to having a meaningful encounter and on the lookout for its appearance.

When my coaching client decided to switch from Survival Mode to this conscious intention to look for a spark in his day … he said that would be like turning the day into “a Treasure Hunt.”

This change in stance from unconscious victim, hassled on all sides, to actively seeking out meaning and connection makes a night and day difference in your attitude. You get your locus of control back. The control over your awareness (on the lookout for good things) and your emotions – curious and engaged rather than defensive and hassled.

2 Steps to the Treasure Hunt

[Click Here for a .pdf document of the full Treasure Hunt Process ]

[ Click Here to see this physician burnout training as a YouTube Video ]

1) Define Your Treasure

Take a piece of paper or open a new document and write down the last meaningful patient encounter you remember. That interaction where afterwards you said, “Oh yeah, THAT right there is why I became a doctor” with a smile on your face.

When you are done writing it down … use as much detail as you can remember … read it  back to yourself and focus on how it felt. Where did you notice that feeling of satisfaction in your body? Invite that feeling to become even more clear in your awareness so you recognize it easily.

This is your Treasure. This feeling is what you are looking for in your days when you take step two.

2) Start the Hunt

Before you go in for your next shift, open your journal and write down your intention to be on the lookout for this kind of a meaningful encounter and this feeling of satisfaction today. Writing it down takes it from a desire in  your head into physical reality. The pen strokes on the paper reinforce your intention. They bring you back into control of your experience and take you out of the unconscious grip of Survival Mode.

Your intention might be as simple as this,
“I am open to and on the lookout for a satisfying interaction with a patient or staff member today.”

Write it, say it out loud, feel what it will feel like when you find that treasure, close your journal and head in to work. Now watch what a difference this makes in your experience of the day.

Power Tips:

1) Release Attachment

It is very important to release attachment. By that I mean don’t get attached to actually having that encounter today. Be on the lookout for it and don’t get attached to whether it happens or not.

If you don’t have that interaction today, set your intention again tomorrow. Here is why.

Just writing down your intention changes your focus and dramatically increases the chance of having that fun interaction … dramatically. You will never find treasure unless you are looking for it. The treasure is there when your intention is on finding it.

2) Soak it up

When you find yourself in the middle of treasure … you notice you are having that meaningful patient encounter right now … soak it up like a sp0ngue. Revel in it, savor it, roll around in it and enjoy the heck out of it. Release yourself totally into the experience. Feel how it connects to your intention for the day and into your deeper purpose of making a difference in people’s lives.

3) Close the Loop

Journal about your experience at the end of the day. Sit down with the same journal for just five minutes at the end of your day and write down what happened around your intention today. How did it go? What treasure did you find and how did that feel? What treasure will you look for tomorrow and how will it feel when you find it?

4) Make Being Intentional an Every Day Habit

A large part of recovering from physician burnout is taking back control over you life and being more intentional about your actions and awareness. The Treasure Hunt process is just one example where you get clear on what you want and then go get it.

I encourage you to set an intention every day, even your days off

On your next day off, decide what your one intention is for today. Perhaps it’s to be really present with your spouse/significant other or children or really enjoy yoga class or take a nap in the sun and completely let your cares fall away. When you set that intention, it is very likely to come true. All it takes is deciding what you want and writing it down in the early part of your day and then being open to your wish coming true.

5) Enroll Your Team

Ask your team members what their favorite patient encounter in the last month was. You may not know what they enjoy most about their job at this point. Tell them about the Treasure Hunt and encourage them to journal their intention. Share your stories of treasure in your days and encourage them to share theirs. This simple change can make a huge difference in your work environment for everyone on the team.

The Treasure Hunt Triggers Your Turn Around

As you read the description of Survival Mode above, did that feel familiar? The Treasure Hunt is one of the ways to stop the downward spiral and begin to find peace, joy and fulfillment in your practice again. It does not make the hassles go away – that is another topic for another day and there are hundreds of ways to improve your practice efficiency. Today we are talking about your intention, your awareness and your experience of your day. This article is about who you are being in your practice and your life.

Take the 5 Day Challenge

I know intention journaling will fundamentally change your experience of your days – on and off work – when you take it on as a habit. I challenge you to take it on for your next five days at work and see what a difference it makes for you. The steps are outlined above. I encourage you to release attachment and close the loop by journaling in the evening too. Do this for just five days. Then you decide whether you want to make it a habit.

Enjoy !

PLEASE LEAVE A COMMENT

• Are you taking the 5 Day Challenge?
• If you do, please come back and tell us what you learned

Physician Wellness and Transformation Retreat 2013

 What if you were able to create a new relationship with your career as a busy physician. A “New Normal” where you designed your practice so it worked for you … instead of struggling to practice the way your current organization says you have to.

What if you could restore a sense of accomplishment and happiness to your work day and balance to your life? What if you could learn how to stop working so hard and create m ore life balance?

You can plan and create that transformation here in 2013 at the “Heart of the Healer” Physician Wellness Retreat on Orcas Island in Washington State this September, 2013.

Click Here for full details and download your application

This physician retreat is a 4-day private intensive for only 6 doctors where we will focus on

• Rest, Relaxation and Rejuvenation
• Creating a Plan for a new relationship with your career
• Learning new skills to lower stress and prevent burnout

The Heart of the Healer Program then goes one giant step further

All participants receive 4 full months of weekly follow up and support to complete the transformation to your “New Normal”. We will meet weekly by phone for additional coaching, training and support to walk your action plan.

The retreat is on beautiful Orcas Island in the American San Juans north of Seattle, Washington. We will be at the Rosario Resort with its turn of the century charm and full spa facilities. In addition to the trainings on stress management, mindfulness, and life balance, you will also experience

• Whale watching
• Yoga, meditation and massage
• A climb to the top of Mount Constitution with its jaw dropping views
• Even a float plane flight back to Seattle and a graduation dinner overlooking Elliott Bay

And then 4 full months of follow up support to make sure the changes you want in your life actually STICK.

When you are ready for a change … to rest, recharge and then fundamentally change your experience of being a physician … I give you my personal invitation to the Heart of the Healer Physician Wellness Retreat this fall.

We are going to have SUCH a good time!

Click Here for full details and download your application

I hope to see you in September and support you in the adventure ahead

Dike

Dike Drummond MD
TheHappyMD.com

Time Management is a Myth

There is no such thing as time management.

You and I get 24 hours in each day – 168 of them in a week. No more and no less. The seconds in an hour are a fixed resource that no one can manipulate or manage or finagle or cajole or multiply. So let’s all stop focusing on ” time management ” and do something MUCH more productive instead.

Manage Your Priorities and Intentions Instead
- and create more work-life balance this week.

Does this feel familiar. ..

You have had a very busy week filled with LOTS of activity – at work and at home. And as you sit here on the weekend you reflect on “Gee, I sure wish I could have had a date night with my spouse/significant other this week” and you begin to judge yourself or your career because that didn’t happen?

You may find yourself longing to

• Exercise more frequently
• Read a book
• Have some alone time with each of your children
• Take a vacation
• Go for a walk
• Plant or weed your garden
• (fill in your desires here ____________ )

The reasons these things did not happen has nothing to do with your skills at Time Management.

Let me go out on a limb and make a bet with you here. I will bet that you long for these things and have not made them a priority. You didn’t set a conscious intention to put them into this week and they did not appear anywhere on your schedule/calendar as the days rolled by.

“Be assured that you’ll always have time for the things you put first.”
~ Liane Steele

4 Steps to Get More of What You Really Want This Week
with Priority Management

[ Click Here for a .pdf download of the priority management steps ]

Most over stressed physicians will spend the weekend feeling bad about the things you did not accomplish in the last seven days. We tend to cop to the belief that, “I am no good at time management”.

If you really want to exercise more or spend some alone time with your kids, here are four steps to get that to actually happen … no matter how busy your life and practice are.

Step 1: Write down the things you want more of – make a list

I encourage you to make your list with a pen on paper. I admit I am old school on this and here is the reason why. When you transfer a desire into a phrase written in ink on paper … that is a step of creation. You have translated your desire into physical reality – perhaps for the first time. Somehow typing it into a computer and having a printer make the hard copy is just not the same.

Step 2: Pick just one of them to do this week

Pick JUST ONE to put into action this week. You are working on the skill of implementation here. You will probably want all of them at once and you will fail if you choose more than one at this point. Once you nail that one … you can move on to the next … and start with just one. Circle it on your list. Use a colored marker if that makes this more fun (I do).

Step 3: Make it a Priority

I know your priorities by the schedule you carry with you. I suspect you carry one calendar/schedule with you right now … probably on your phone. I will also bet the only thing on there is your work schedule.

The key to getting more LIFE in your week is NOT time management … it is having that life activity on a schedule that you are carrying at all times. Here is a Schedule HACK training on exactly how to do this (with no tech skills).

Get your chosen activity on your schedule and in your phone.

Step 4: Do It – Savor It – Celebrate It

Do It:
When your scheduled time rolls around, make this activity your #1 Priority and Intention in that time slot. Don’t let anything (short of some life threatening emergency) stop you from carrying out your plan.

Savor It:
When your time arrives, take a deep breath and let go of the stress and strain of the day. Become completely present for whatever this activity is. Invite it to soak into all the right places in just the right amounts. Savor it. Make a memory.

Celebrate It:
When you are done, give yourself a big pat on the back and congratulations. Be grateful for the experience and acknowledge yourself for your skills of Priority Management!

REPEAT that sequence weekly

With this four step Priority Management  Process … I guarantee you will get more of whatever you choose to make a priority in your life … this week.

PLEASE LEAVE A COMMENT … on how you bust the time management myth in your life as a busy doctor and the one thing you want more of this week.

Keywords:
time management, time management myth, priority management, time saving tips, time saving tips for physicians, physician burnout, dike drummond, Physician coach

Batch Processing, Patient Flow and the science of how to Get Home On Time

Do you find yourself spending too much time on things that have nothing to do with seeing patients – and then getting home later than you would like?

Do you notice that for every 15 minutes you spend with a patient you spend WAY more than that messing around in the EMR and being distracted by things like prescription refills, test results and a hundred other forms of two bit clerical work in your day?

Does your organization expect you to access your EMR from home to complete chart notes in the evenings after you have tucked your kids into bed? ARRRGGGGHHH !   :-(

I wish I had a chance to shadow you in your office, because there are a number small changes you can make right now that will shave hours off of your “non-clinical activities”.

They don’t teach these things in residency … so let me share the top two tools I have found to get you home on time – with your charts done – more often. If you are not doing these two simple tasks every day in the office you are working WAY too hard and getting home at least an hour later than you have to.

NOTE:
There is no way to get home on time every single day – much as our perfectionist tendencies would like that to be the case – and 75 – 85% is a worthy goal to aim for. Just because these things don’t work on every single office day – don’t let that stop you from doing them every day. They will make every day better than if you DON’T use them. I will promise you that for sure.

Home-on-time tool #1
The BID Team Huddle (when done well)

Here is a full training on BID Team Huddle Technology

Home-on-time tool #2
Batch Processing (don’t be a dog)

Doctors are a lot like Dogs in some ways. If a dog is sitting on the porch and I get their attention and throw a tennis ball … they can’t NOT chase it. They can’t resist.

With doctors … the tennis ball is a refill request that pops up on your EMR screen. It is not  urgent and yet how often do you drop what you are doing to address it?

We mistake EVERY action as a URGENT one and chase them just like the dog and the tennis ball.

Add in test results, phone messages, referral paperwork … and your day is fractured into a hundred pieces for one simple reason. You are taking care of these items one at a time and allowing them to interrupt your patient flow.

Sure, they only take 2-3 minutes each. Add it up though and you will get 60-90 minutes of wasted time in your day. No other industry would allow that kind of inefficiency. Yet in medicine, it is every doctor for themselves when it comes to figuring out how to handle these non-urgent tasks. AND no one teaches you how to do a good job.

The solution is Batch processing

All the tasks that are non urgent should be batched and done in a batch twice a day. In the days of paper charts we used to put out a basket for each task type. Refills go in this basket. Test results go in that one when they return.

Twice a day you “run the basket” and boom, boom, boom … all of the tasks are done.

In a standard office day where you have an AM and PM schedule, some good times to do batch processing are 11:30 AM and 4:30 PM. That way the morning’s work is done before lunch and the afternoon’s work before you go home.

EMR’s make this a little different because often these non urgent tasks pop up as alerts on your tablet, laptop or desktop screen. These prompts are equally enticing to our dog-like “fetch” mechanism and even more powerful time wasters.

Batch these too by NOT addressing them when they come in. Make a “virtual basket” that you run in a batch twice a day.

What can you batch in your practice?

Your answers to this question (and the BID Huddle) are the keys to getting home on time more often.

Power Tip #1:

Ask your team this same question and let them join in the effort to get you out of the office by 6.

“What tasks happen every day – things that are not urgent, yet have to be done before the day is over – are one’s can we put in batches and do all at once, in batches twice a day?”

“Which ones require my MD-level attention and which can be done by someone else on the team?”

Power Tip #2 – Old School

I have a client who was extremely distracted by the Instant Messenger function on her EMR. All of  the staff would relay IM’s for each patient phone message and refill. They would pop up on her tablet computer as a little flashing counter – like the old “You’ve got mail” function back in the day.

Her IT people said there was no way to disable the counter so we went Old School.

Now she uses a little post it note. She puts in on the screen over the counter so she can’t see the messages as they come in because that small portion of the screen is covered by the post it note. She takes it off at 11:30 AM and 4:30 PM to run the batch of messages.

Sometimes you have to get creative to batch in our modern electronic environment and it can be done. Ask your team (see above) if you are having trouble coming up with solutions on your own. (BTW, you are never alone in the office. Use your team!)

====================

What can you batch?
How can your team help?
When will you get started?
(AND did I mention the importance of the BID Huddle done twice a day Every Day?)

With these two tools and the discipline to do them every day, you will shave a minimum of 45 minutes off of each half day at work – barring one of those “days from hell” that come up every other week. This is the best way my clients have found to start getting home earlier and the first two tools I recommend to all my coaching clients.

PLEASE LEAVE A COMMENT on your experience with batch processing and/or the BID Team Huddle.

Physician Burnout and the risk of CHD

A new research paper published in the journal “Psychosomatic Medicine” in 2012 is showing a solid link between Burnout and the risk of CHD for the first time. This new information proves a connection that has been suspected for decades and adds to the list of ways burnout can actually kill.

Previous research has shown a correlation between burnout and the following

• Risk of Type II Diabetes
• Sleep disturbance
• Musculoskeletal pain
• Impaired fertility
• All cause mortality
• Dyslipidemia, metabolic syndrome and inflammation biomarkers
• Alcoholism and drug addiction
• higher rates of suicide

The current study is:
“Burnout and Risk of Coronary Heart Disease: A prospective study of 8838 Employees“
Psychosomatic Medicine 74:840-847 (2012)

They studied a cohort of 8838 healthy, white collar workers in Israel for an average of 3.4 years.

At baseline they measured burnout using a validated instrument called the Shirom-Melamed Burnout Measure. This is a tool similar to the Maslach Burnout Inventory.

They adjusted their analysis to eliminate risk differences for all of the following:
age, gender, workload (subjective and by hours worked), depression, physical activity, smoking, body mass index, family history, blood pressure and fasting blood sugar.

Burnout emerged as an independent risk factor for CHD when the individuals with the top 20% of burnout scores were compared to the rest of the cohort.

The increase in risk from burnout for this “top quintile” was 79% (hazard ratio = 1.79)

Note that this study is not specifically about burnout in physicians or healthcare workers. It is in a relatively healthy, white collar group of workers. The authors expressed the concern that a more normal worker cross section might have shown an even stronger correlation.

A landmark study in 2012 showed that burnout is more prevalent in doctors than the general population making this study a shot across the bow for doctors suffering from physician burnout as well.

Burnout is bad for you, your family, your patients … this is just another indicator of how deep and wide burnout’s negative effects extend.

Physician Burnout and the Power of an Enlightened CFO

What your CFO doesn’t know about physician burnout is hurting you right now. They are pounding the boardroom table for projects that only increase the stress for the front line care providers. We must teach them the financial impact of burnout because an enlightened CFO can be your biggest ally in battle against stress and burnout.

“Fun” Burnout Fact:

On average, 1 in 3 doctors are suffering from physician burnout on any given office day, worldwide, regardless of specialty. Unless your organization performs a physician stress and burnout survey at least twice a year, you can assume the burnout rate on your staff is greater than this average.

Your CFO needs to know this ASAP and that is not all

We have to show them the massive negative effect burnout has on your bottom line profitability. If they knew what you are about to read, they would be pounding the boardroom table for a physician burnout prevention committee with a sizable budget.

As I show you this list of research proven effects of physician burnout, imagine for a moment you are a CFO. What impact would you expect the following to have on your organization’s bottom line?

Physician burnout causes …

- Lower levels of clinical care quality and patient satisfaction
- Higher levels of medical errors and malpractice risk
- Higher levels of physician and staff turnover
- Higher levels of physician divorce, alcohol and drug addiction and suicide

Do you feel the trend here?

You don’t have to be a CFO to see how just one of these physician burnout effects hammers your bottom line. Put them together and what have you got? If your business was a ship, you are taking on water from a dozen different holes in your hull and everyone is bailing as fast as they can to keep you afloat.

The tragedy is … this is how a normal healthcare organization operates.

Here’s why the CFO is silent. This whole process is invisible to them.

No one tells CFO’s what you just learned in the bullet points above. No one shows them the tax untreated physician burnout is placing on the Profit and Loss statement.

What they do pound the table for is higher patient flow and increased efficiency.  The CEO is leaning over their shoulder and that is the most obvious place to make improvements they can see.

Burnout is an elephant standing in the board room of every healthcare organization. Everyone does their best to ignore it. Most physicians and administrators have given up on things ever changing. It has gotten to the point where overwhelming workloads, barely manageable stress, compassion fatigue and turnover are considered normal for healthcare.

Physician Burnout is not normal … it is a known complication of a specific risk factor.

AND Physician Burnout is

– Identifiable
- Preventable
- Treatable

The research is strong.  To think that a burnout rate of 1 in 3 is NORMAL for doctors and there is nothing they can do about it is lunacy. And it is exactly how 95% of administrators see their doctors and staff.

So they just keep cracking the whip for you to see more patients. The C-suite pushes for more volume while the doctors are maxed out and only barely able to keep their heads above water.  No one realizes the resulting burnout is exactly what keeps everyone bailing like crazy just to keep the ship afloat.

An enlightened CFO understands the impact of physician burnout. They pound the boardroom table for things like …

Funds for twice a year physician and staff stress and burnout surveys

Funds for a standing Physician Burnout Prevention Committee charged to minimize the stress inherent in the business systems in any way necessary

Funds for improvement projects based on the survey results

Funds for onsite training in recognizing physician burnout and the most common prevention techniques for all doctors and staff

They understand that happy doctors are the source of happy patients and quality care

They realize that taking great care of your workers has multiple benefits that drop immediately to the bottom line

AND they can show the CEO the importance of physician burnout prevention funding

In the next several years,organizations with this kind of enlightened CFO will develop a competitive advantage in their respective marketplace. The patients will want to be seen there and the doctors will want to work there. Their ship will float high in the water without all the bailing their competitors require just to stay afloat.

PLEASE LEAVE A COMMENT:

Does your CFO understand physician burnout?
What do they pound the table for in your organization?
Feel free to share this article with them and have them give me a call!

Keywords:
Physician burnout, physician burnout prevention, physician burnout complications, healthcare CFO

Prevent Physician Burnout with a Mobile App? … you betcha … here are my two favorites

Forget Angry Birds and other mobile apps that do a great job of helping you waste time. And set aside for now the apps that help you find information and practice clinical medicine more efficiently.

It was only a matter of time before mobile apps would be developed that can actually help you prevent physician burnout.

Here are my two favorite mobile apps to help you lower stress and create more work life balance

I have been using a pair of mobile apps on my iPhone for a while now that are doing a really good job of keeping me (and my coaching clients) focused on the simple daily steps that make all the difference in preventing physician burnout.

1) Insight Timer

Research shows meditation and other forms of mindfulness based stress relief (MBSR) – like the 1 Minute Stress Relief Program – are the most effective way to lower your stress level and prevent physician burnout.

And most of us struggle to maintain a regular meditation habit …

That is where Insight Timer comes in.

I use this free iPhone mobile app every day in my own meditation practice and every coaching client I have shared it with raves about it too! There is also a “full” version for iPhone and Android that costs $1.99

If you have struggled to get a meditation habit off the ground in the past, I encourage you to play with the Insight Timer mobile app and see for yourself just how powerful it is.

With just a couple taps on your phone, you can

• Set up a meditation session of any length
• Include bell and singing bowl tones at whatever interval you want to help you stay present
• Insight Timer keeps track of all of your meditation sessions so you can always see how many sessions and what length, average length and total meditation time since you started using the app
• It allows you to put a note after each one
• Join the Worldwide Community in a Virtual Sangha of meditators
• You can see and connect with hundreds of people all over the world that are meditating using the Insight Timer mobile app at the same time you are. As I write this post, 136 people are meditating around the world. The map on the face of the app shows you exactly where they are too
• We even have an Insight Timer group for physician meditators in our Happy MD community. Come and join us. Just search the groups function for “The Happy MD” and join up. You will see me on the map every day and I hope to see you too.

Here is a video tour of Insight Timer from the developer

Find Insight Timer in the Apple App Store

Here is their home website

2) Lift

Lift is perfect for all the other actions you want to turn into life balance habits.

Things like Exercise / Yoga / Going for a walk / Planning your day / Writing in your journal / Being grateful / Spending time with your spouse/significant other/children/dog/cat/gerbil/goldfish

You get the picture.

With Lift you load it with the activities you want to do and it helps you track your checklist with a big green checkmark. You can also connect with everyone else on Lift who has that same To Do item on their list.

I have “Plan my day” loaded as an activity in my Lift app and there are thousands of other people with that as one of their action steps too. You can connect, form a group, give them a thumbs up when they check the box.

You can set up Lift to give you daily reminders for each activity and send you an occasional “supportive message” if you wish. It sends me a message about every other day telling me I am on a consecutive day streak in one of my activities as in, “You have walked for 7 days in a row. What can  you do today?”

Lift will also track all your check ins, and has simple little graphs showing your weekly success .. all in that lovely shade of check mark green.

Find Lift in the Apple App Store

Here is their home website

====================

Insight Timer and Lift are two mobile apps I use every day to support my mindfulness/meditation practice and create more life balance.

Check them out for yourself and please LEAVE A COMMENT on how they work for you.

P.S. in case you were wondering, the author has no conflict of interest to disclose. I am recommending these based on my own experience and the experience of my coaching clients and have  never even met the developers of either web app – I just love the way they keep me in action and think you will too.

Keywords:

physician burnout, prevent physician burnout, physician burnout mobile apps