Many healthcare providers feel undervalued, unappreciated, and overworked.

(“Yeah,” I can hear you saying, “Name one provider that doesn’t feel that way!”)

I know that for many providers, it feels like their work is disposable, that it’s not valuable, and that they’re a cog in the wheel.

In reality, however, healthcare providers are in short supply and of extreme value to hospitals. In fact, the cost of replacing a physician is estimated to be $500,000 to $1 million. And Fierce Healthcare reports that the provider shortage is bad and getting worse. They quote Bill Haylon, CEO of Leaders for Today as saying, “The findings tell us is that there simply isn’t enough qualified talent to go around and that frustration levels are rising."

So you would think that the healthcare system, in particular major hospitals, would be "all hands on deck" to retain their healthcare providers and to leverage their time and expertise.

In reality, my observation is that hospitals simply aren't doing enough to retain their providers. In 2014, 54% of U.S. physicians reported burnout, much of their frustration coming from ever-increasing clerical loads. Of course, physicians with symptoms of burnout are more likely to report having made a major medical error in the past 3 months and to receive lower patient-satisfaction scores. Many, perhaps most, feel under-appreciated, under-supported, and overworked.

Further, most medical practices and hospital systems are not leveraging their providers' time with hybrid store-and-forward telemedicine or healthcare collaboration. The pressure on providers to perform at the highest levels, with no mistakes, is high. But the tools provided to support care coordination or healthcare collaboration -- which can reduce workload, and decreased mistakes, while easing burnout -- are inadequate. 

We believe that the key challenge here is for us to connect the dots. We need to connect the dots between hiring challenges that hospital administrators face... and burnout... and the lack of healthcare collaboration tools that can significantly leverage providers time, and ease burnout. Ultimately, the right tools -- like healthcare collaboration using iClickCare Hybrid Store-and-Forward® -- can make the challenges around the provider shortage much less severe.

To learn more about how to start a program at your hospital, download our free guide: 

A common critique of healthcare collaboration in general — and iClickCare in particular — is that it will never become widespread because doctors are too rational and self-centered to do something “altruistic.”

We’ve even seen hospital administrators make widespread strategy decisions with the assumption that doctors care most about money and status and “what’s in it for me.”

That perspective never resonated with us. And we’ve seen hundreds of people thrive with iClickCare, both because it saves them time, has a great ROI, and for the “altruistic” reason that it is better for their patients. But it wasn’t until today that our hunch was truly confirmed by a medical journal.

The New England Journal of Medicine published two articles recently that dig into the phenomenon of burnout and debunk a lot of myths we have about it — ultimately getting at what motivates doctors.

In “To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis,”  Dzau et al. look at the causes and manifestations of burnout.

Of course, the consequences of allowing burnout to persist are serious:

• Physician suicide.
• Patient safety. “Some studies have revealed links between clinician burnout and increased rates of medical errors, malpractice suits, and health care–associated infections.”
• Costs to productivity. “In one longitudinal study, the investigators calculated that annual productivity loss in the United States that is attributable to burnout may be equivalent to eliminating the graduating classes of seven medical schools.”

It's a critical problem that demands real solutions. As for what those solutions should be, common wisdom is that doctors need more time, money, or efficiency.

But as Dzau et al. share, in many cases, what doctors really need more of is connection to the meaning and fulfillment in their work. “The ethical principles that guide clinical care — a commitment to benefiting the patient, avoiding harm, respecting patient autonomy, and striving for justice in health care — affirm the moral foundation and deep meaning underlying many clinicians’ views of their profession as a worthy and gratifying calling… Clinicians are human, and it takes a personal toll on them when circumstances make it difficult to fulfill their ethical commitments and deliver the best possible care.”

So although people sometimes challenge iClickCare on the grounds that doctors are too rational or self-centered to use it, iClickCare allows doctors to connect with colleagues, do healthcare collaboration and care coordination, and make better diagnoses and fewer mistakes. In other words, iClickCare connects directly to doctors' sense of fulfilling their ethical commitments and delivering the best possible care. And in doing so, iClickCare relates directly to easing burnout.

In “Beyond Burnout — Redesigning Care to Restore Meaning and Sanity for Physicians,” Wright and Katz quote Dr. Christine Sinsky as saying, “We’re spending our days doing the wrong work. At the highest level, we are disconnected from our purpose and have lost touch with the things that give joy and meaning to our work.” Doctors spend 1-2 hours doing the clerical or administrative work for every hour they see patients. (Patients who are often double-booked, back to back.) As high achievers, they fit this work into spaces in their day that don’t exist. Administrators, facing their own severe pressures, aren’t compensating doctors for this "around the edges" time and they are not giving them the tools they need to feel, and be, supported in the work.

The demands on doctors increase, but with decreasing access to the parts of the job that fulfill them — decreasing access to the parts of the job that keep a doctor from burning out. 

David Whyte, the poet, says: "The antidote to exhaustion may not be rest. It may be wholeheartedness." And ultimately, when we think about iClickCare, we're motivated to help doctors find that wholeheartedness in their work. You don't need your hospital's support and you don't need all of your colleagues to take it on. All you need to do is to make the tiny choice to act on your own behalf. 

Downloading iClickCare takes 10 seconds and is free. Try it today:

We talk a lot about medical collaboration. The best healthcare providers know that we give better care when we work together. Medical collaboration lets us make better diagnoses, do care coordination more effectively, teach the next generation of providers, and prevent patients or findings from falling between the cracks.

And we don't have hard data on it, but all signs point toward providers being increasingly "siloed." Specialization increases every year. The amount of time that we have to discuss a good case with a colleague is non-existent. The disincentives (HIPAA, etc) that exist to work with other providers increase all the time.

But it's often hard to pin down the ways that this is happening, and to what extent. An interesting parallel to this dynamic is the polarization we are seeing in our political system. We hear a lot of talk about how there is a lot of division and polarization in the US political context, but similarly, we often can't pinned down whether this is really true, and to what extent.

So I was fascinated to see an academic study that quantified and visualized the level of cooperation between Democrats and Republicans in the U.S. House of Representatives from 1949 until 2012.

Their findings were pretty stark: "We find that despite short-term fluctuations, partisanship or non-cooperation in the U.S. Congress has been increasing exponentially for over 60 years with no sign of abating or reversing. Yet, a group of representatives continue to cooperate across party lines despite growing partisanship." This image shows the ways that the polarization has occurred over that period of time. Each dot is a representative, and lines connecting pairs of representatives who vote together. The dots for each representative are placed according to how frequently the Representatives vote together overall.

As I said we don't have hard data about it, but our anecdotal observation is that polarization, non-cooperation, and siloing of healthcare providers has also risen exponentially, during about the same time period. 

And just as US citizens suffer when politicians don't cooperate, patients suffer when providers don't collaborate. Here's why:

1. Trust, satisfaction, and sustainability degrade. Cooperation and collaboration are valuable ends in themselves for the mental health and efficacy of healthcare providers. With so many healthcare providers suffering from burnout, feeling separate from each other and our patients can hurt our health, our sustainability as providers, and our performance.

2. Results aren't as good. Whether it is the citizens of the US or our patients that we're talking about, our results can be very poor when we don't work together effectively. Medical collaboration isn't a "nice to have" -- it's a crucial component of providing the best possible standard of care.

 

Ultimately, the only solution to fixing the polarization problem is to start drawing more lines between more congresspeople (in the case of politics) and between our colleagues in the medical world. It is said that "there is no path; the path is made by walking." Similarly, the only way to a more connected and cooperative world is by connecting and cooperating. We can give you the telemedicine tool -- and it's up to you to do it. 

 

The great podcast Freakonomics has been doing some powerful episodes recently, as part of their "self improvement month."

One episode seemed particularly relevant to the ways that the ClickCare community does healthcare collaboration and why it makes such a dramatic difference in healthcare as a whole.

First, let me back up.

K. Anders Ericsson is a professor of psychology at Florida State University. He has studies how people become world-class at anything from surgery to music to sports.

And it turns out that, for the most part, human beings are getting better and better at learning how to learn. For instance, in order to qualify to run the Boston Marathon today, a male in the 18- to 34-year-old group has to have a time of 3 hours and 5 minutes. That time is only 6 minutes slower than the WINNER of the marathon in the 1896 olympics.

Ericsson says that "we’ve gotten so much better primarily because we’ve learned how to learn." And he links this ability to learn things to something he calls "deliberate practice." Not just logging hours, but practice involving "well-defined, specific goals, and [it] often involves improving some aspect of the target performance. It is not aimed at some vague, overall improvement.”

Interestingly, Ericsson cites studies that show that for doctors, their ability to diagnose heart sounds actually decreases the longer they are in practice. He says that this is because most physicians are in a fairly isolated environment, and that because they don't have coaching, input, challenge, support, or feedback during the diagnosis process -- they don't get better. In other words, doctors practice, but it's not deliberate practice, so they don't improve.

“Once a person reaches that level of “acceptable performance and automaticity,” Ericcson writes, "the additional years of 'practice' don’t lead to improvement.”

This data resonates with us because we see such significant gains in patient results, decrease in readmissions, decrease in length of stay, and even a drop in provider burnout when healthcare providers use a telemedicine tool for healthcare collaboration.

A few reasons why telemedicine-based healthcare collaboration can have such dramatic results:

• Providers get immediate feedback, to support improvement. 
  When I get the relief of asking another provider for her consult on a case, I'm not just helping make my day easier and improving care for that patient -- I'm also getting what amounts to targeted coaching and feedback on my diagnosis and care overall -- a key component of "deliberate practic." 
• Cases are saved for teaching. 
  One key difference between videoconferencing and hybrid store-and-forward telemedicine is that with something like iClickCare, all cases are saved and searchable so that you can use them to learn from and teach with in the future. That means immediate gains for you and your patients, plus effortless long-term building for the future.
• This kind of collaboration adapts to providers' real lives and real tools. 
  We always tell people that they can do healthcare collaboration however they want, but never to invest in huge hardware infrastructure that is going to go obsolete fast, as well as be a huge learning curve and workflow conundrum for the people using it. For practice to be significant in terms of improving results, it needs to integrate flawlessly into providers' lives and use tools they already have.
• Healthcare collaboration and care coordination go hand in hand. 
  Healthcare collaboration is usually seen as the one-off "conversation" about the patient. But when you can have mutliple providers -- across the continuum of care -- collaborating on cases, that means it's not just collaboration that's happening -- it's meaningful care coordination. 

 

The one thing that differentiates people who use iClickCare from those who don't isn't tech savvy or background. It is simply the sincere desire to have more fun while they do medicine, and to care for each patient as well as they possibly can.

When deliberate practice is part of the equation, using simple tools, it's not hard to see why they succeed so well at those goals.

 

Learn more about what makes hybrid store-and-forward telemedicine different here: 

 

In the day to day of medicine, we're all pretty stoic. We work hard on behalf of the patient, many of us also innovating around care coordination, but we don't stop and think about our safety. I respect that ethos, but we all should be aware of this report in the New England Journal of Medicine.

James P. Phillips, M.D. reports workplace violence directed toward healthcare providers of all types. Of particular note is the very high rate in long term care -- both in skilled nursing facilities and home care.

As Dr. Phillips explains, "Employment in the home health sector carries particular risks. Because workers provide care in the client’s home, the environment is comparatively uncontrolled. Overall, 61% of home care workers report workplace violence annually. Unique concerns include the presence of weapons and drugs, family violence, robbery, and car theft. Homicide is the second leading cause of workplace death in this group, exceeded only by motor vehicle crashes.”

Those numbers are pretty astounding, and disturbing. When you combine these numbers with those about healthcare provider burnout, the picture for healthcare providers is pretty bleak. 

The Bureau of Labor Statistics notes that health care workers are four times more likely to miss work as a result of violence than because of other injury, such as an injury at home. And perpetrators include anyone from former colleagues, to current or former patients, to unrelated individuals, to people with personal relationships to the providers.

The statistics are sobering, but important: 

• Acute Care: 46% of nurses reported work place violence in their past 5 shifts; one third physically assaulted. 
• Long term care: 39% of aides in nursing home were assaulted weekly, 16% daily, 51% physically abused. 
• 61% of home care workers reported violence yearly.
• From OSHA: While 20% of all workplace injuries happen to healthcare workers, 50% of all assaults in the workplace are to healthcare worker.

What can be done? OSHA has an exhaustive review of the problem and a set of checklists to assess safety. They also suggest training of in ways to handle aggression and defuse hostile situations.

Alternatively, what if a root cause of dissatisfaction could be addressed?

We believe that healthcare provider burnout, efficiency, satisfaction, and efficacy can all improve with collaborative care. Can collaborative care and healthcare collaboration save providers' lives?

It may be a stretch, but consider that an unhappy family and an unhappy patient can be expected to be more satisfied and thus less angry when their providers are coordinating with each other and communicating with them. Involved, connected patients and family become part of the solution rather than an addition took these problems. The logic and the hope is the diffused anger will result in more safety for all of us providers.

Having known three colleagues who were murdered, a respected teacher, a fellow resident, and an acquaintance, as well as having had a gun aimed at me, we are very aware of the risks.

We hope that our passion to make things better for the patients also make things better for everyone who cares for the patients. It's personal.

Read stories and case studies of healthcare collaboration across medicine and beyond:

 

 

As a company, and as doctors, we've always had a close relationship with dentists and dentistry.

My Dad was a dentist (and was even President of the American Dental Association in 1979); my brother is a dentist. One of our most important investors and advisors is a dentist (and colleague.) Also, as a reconstructive surgeon (doing a lot of work with cleft palates), dentists have always been valued and respected colleagues in the creative work of caring for these complex patients.

Dentists face unique challenges and opportunities in the world of medicine, though. When we talk about the isolation and siloing of medical providers, dentists often face the worst of it. So many of the ClickCare customers we've had who are dentists have said that the biggest benefit is care coordination.

We see one manifestation of this challenge that dentists face with care coordination in the data showing a steady rise in ER vists (many unnecessary) for dental issues.

This well documented report highlights the need of access of care. Dentistry is not alone, but the report clarifies nicely that access to care is a fundamental reason that the expensive, time wasting, inappropriate use of the emergency department is a problem. Not coincidently over 40% of this use of the emergency room is for the patient who is labeled “self pay”.

This report is worrisome for us at the patient level, the populational level, and as evidence that there is more work to be done when it comes to making the coordination of care possible and effective. Underlying the technology -- and more importantly the mission -- of ClickCare is our drive to facilitate access to care for the patient, collaboration for the providers, and education of colleagues, medical students (of all kinds), patients, and families.

Given that these ER visits will not stop immediately, and given that there are other places that could be called “originating sites”, would it not make sense to use Hybrid Store-and-Forward telemedicine to help the patient get the right care at the right time without burning out the providers and the system? Access doesn't have to mean in-person visits with every provider -- and telemedicine (especially a platform that works on your existing hardware or smartphones) can be an economical way to improve access and prevent last-ditch emergency visits.

If nothing else, medical collaboration helps with provider burnout. Decreasing telephone calls about unknown patients with unclear descriptions is important. (Home many of you know where the distal part of a tooth is?)

Finally, education about disease alone, is important, but also, educating each other about our roles, expertise and importance is, in the end, maybe more important.

The ultimate goal of care coordination is prevention -- prevention of disease, provention of unnecessary costs, prevention of conditions that could have been treated more simply in the office rather than later, in the ER. 

Are you a dentist interested in using telemedicine in your practice? You can try iClickCare for free by clicking here.

 

"The secret of the care of the patient is in caring for the patient.”

- Dr. Francis Peabody

The "classic" picture of good care is the family doctor sitting with a patient, having an in-depth conversation. It's about time, and connection, and listening, and experience. It's about a single patient and a single expert connecting about health.

These days, that picture is nonexistent. The demands on care have increased. The time to sit with patients has been stripped. And the idea of a single provider caring for a patient is -- for better and for worse -- no longer ever the situation.

In fact, as Dr. Diane E. Meier in American Medical News, patients see an average of more than 10 specialists in their last 6 months of life; and the number of providers that go through a patient's room in 24 hours is more than 60.

So in this new context, what does it mean to provide the quality of care that used to be the standard, but in a new way?

One question that Dr. Meier brings up is the additional time required to communicate and coordinate care. "How does a team this diverse and large avoid further fragmenting the patient's care? Just the amount of time required for a team of this size to stay in close communication with one another could result in even less time available to be with the patient. How do high-functioning teams avoid falling into this trap?"

The components of this collaboration are identified within the article, and align well with the principles we used in designing the functioning of iClickCare, including:

• Role clarity
• Regular, respectful and open communication among all members
• Attention to quality metrics and quality improvement
• Appropriate, ongoing training.

Ideally, care coordination and communication doesn't add appreciable amounts of time to a providers day. Ideally, collaboration is integral to the work and the workflow. And the ONLY way for this to occur is if the team is able to communicate simply, with tools that are already available, and in ways that integrate with their workflow.

Meier adds, "Serving our patients and their loved ones means understanding what is important — what matters most to them, what their fears are, what their hopes are, what they are hoping medical care can do for them." 

No longer is it enough to know that a single provider -- like the family doctor -- will know the patient, their needs, their context, and their family. We now work in teams. So the only option available to us is to use tools that support us in collaborating effectively (and without a huge investment in time) so that the patient is at the center of care -- and that our collaboration tools allow us to understand and share who the patient is as a whole person. 

 

When doctors at Sacred Heart Hospital in Oregon heard that the hospital would be outsourcing their hospitalist care to an outside company (rehiring the existing hospitalists), many were not happy, to say the least. They expected that they'd be pushed to see more patients per day -- and were not willing to make that change without a fight.

Eventually, some of the hospitalists left for other jobs -- and the rest formed what became the first single-speciality doctor's union in the country.

We really identified with one line from the recent New York Times article about the unionization: "you get the distinct feeling it is not just their jobs that hang in the balance, but the loss of something much less tangible — the ability of doctors everywhere to exercise their professional judgment."

One big driver of Sacred Heart's push with the hospitalists was that the hospitalists be forced to have some "skin in the game" -- their way of referring to performance-based incentives. One of the hospitalists, Dr. Schwarz, really bristled at this concept.  “It really took all of my self-control to not say, ‘What the hell do you mean skin in the game?’” he said. “We have our licenses, our livelihoods, our professions. Every single time we walk up to a patient, everything is on the line.” 

As decisions become more centralized, as administrators and doctors take up opposite sides of the table, and as the pressure to cut costs, slash readmissions and length of stay, and increase profits and medicine increase at every turn -- yes, the hospital begins to ressemble a factory. And it's not any one person's fault. It's a system that has so much pressure on every aspect of it that it is hard to retain dignity and humanity in the day to day. 

What are the consequences? Well, provider burnout for one. As the American Medical Association found not too long ago, the main pieces of medical providers avoiding burnout are enough one-on-one time with patients, and the sense that they've provided good care. This fits with what is being found in other industries about the need for people having autonomy, mastery, and purpose in their work.

As Dr. Brittany Ellison put it: “We’re trained to be leaders, but they treat us like assembly line workers,”

So what is any individual provider to do?

We think you do what you can, with the hospital, doctors, and administration you have. Administrators and doctors are both doing the best they can, with the constraints they have -- we all would do well to focus on what we can do for the patient in front of us.

iClickCare saves hospital systems money. It improves care. But beyond all of that, it also puts the power of treating patents back in the hands of doctors. Sometimes a whole hospital system comes to us and decides that they want to use telemedicine to meet their goals. Sometimes, though, it is a single doctor who starts using iClickCare for medical collaboration with their colleagues.

That's the beauty of this kind of simple telemedicine -- you don't need everyone to do it, in order for one person to do it.

You can do a great job, for this patient, right here and now.

 

You don't have to wait for permission or incentives to do medical collaboration with telemedicine. You can try iClickCare today, on your own smartphone, for free:

 

Around this time of year, many professionals start feeling a little burned out. The work mounts, you always have to do extra before and after vacation, and many of us feel we need a vacation from our vacation. 

Healthcare providers, it turns out, really have it worst than most, however. In 2011, the Mayo Clinic did a study of healthcare provider burnout and found that the situation was dire, with about 45% of providers showing signs of burnout. 

The bad news, however, is that it's only getting worse. The study was repeated in 2015, and findings were that close to 55% of providers are burned out. And, of course, medicine can't be performed effectively when medical providers are deeply unhappy or just not at their best. 

So what can be done in a situation that seems only to worsen with each passing year? Well, there are a lot of myths about the origins and consequences of the burnout situation in medicine. But, as the Mayo Clinic study, points out, there are some very real and concrete possibilities when it comes to positive impacting this dynamic.

Most saliently -- removing some of the obstacles that provdiers face in doing their job. The things that jump out to us the key ways this needs to happen are: 

• Improve workflow. As the study reports, "The consensus on a possible solution points to first improving the clerical and procedural efficiencies associated with a medical practice.”
• Make it easier to do the healthcare collaboration so necessary to care coordination and cost decreases. Find a simple, telemedicine-based solution to do healthcare collaboration on your schedule, with hardware you already have. It's key to care coordination, it's key to feeling connected and in control, and it's key to keeping costs and good care under control.
• Take the time you need to rest and refresh. It's not ever easy and it's not always possible, but when you are able to take time for yourself -- do it.

 

This week, we're wishing you a bit of breathing room in one of the hardest jobs around. We certainly applaud your efforts -- and we're in the trenches with you. Click to read a bit of inspiration on your colleagues who are also fighting the odds to do healthcare collaboration:

 

 

 

These days, medical providers have to tend to a lot of moving pieces, just to ensure they're keeping pace with the expectations of their institution, insurance companies, and the government -- not to mention providing good care. For instance, these are just a few of the things we providers are held to: 

• Length of stay in the hospital
• Readmissions
• ROI
• Cost effectiveness of the care
• The "triple aim:" patient experience of care, health of populations, and per-capita cost.

In all of these metrics and objectives, there is someone conspicuously absent: the medical provider. 

Whether you are a nurse, WOCN, specialist, or general physician, it would seem from this common list of priorities that you are, well, not a priority. A great recent article on Fierce Practice Management challenged this omission. The article cites a recent study by Bodenheimer, MD and Sinsky, MD that suggests healthcare provider burnout is severe, widespread, and significantly influences the quality of medical care: "The industry can't achieve the Triple Aim's core ideals--providing better care, improving population health, and lowering costs--without first improving the work life of healthcare providers."

Of course, healthcare provider burnout affects one of every two providers, and we've written extensively about how medical collaboration and telemedicine can help to ameliorate it. But this study is one of the the first times that we've heard incisive commentary on why improving burnout for providers is crucial to our overall goals for healthcare. In other words, how happy and healthy medical providers are is crucial to whether their patients will get good care. As the study authors confirm:

"Healthcare is a relationship between those who provide care and those who seek care, a relationship that can only thrive if it is symbiotic, benefiting both parties."

We've always known that the patient can't thrive when the provider is suffering and that the provider can't thrive unless her patients are healthy and successful. Now, we're starting to see the evidence for it. 

 

Image courtesy of schnappischnap on Flickr, used under Creative Commons rights.