Thanks to the stress imposed by the pandemic, patients’ frustrations and anger have soared and clinicians’ are exhausted emotionally, mentally, and physically. Health care leaders are eager to improve the patient experience but are concerned that doing so will further antagonize clinicians. But it is necessary and possible to improve both the patient experience and clinicians’ well-being at the same time. It entails emphasizing to physicians the positives about the care they are delivering, create a work environment where staffers feel psychologically safe to give and receive feedback, and tap the expertise of frontline caregivers to develop systemic fixes.
Is the work of improving patient experience in conflict with physician well-being? The tension between them has been magnified by the challenges of the pandemic.
Patients have faced complex new care delivery models, including telemedicine, increased reliance on digital messaging, and restrictions on family members accompanying them on visits for procedures. And many clinicians are exhausted emotionally, mentally, and physically as they have sacrificed their own safety and well-being to take care of their patients, shouldered even greater workloads due to staff reductions and lack of resources to support new care models, and have had to contend with frustrated patients’ increased anger. As a result, many are in no mood to receive information about how to improve the patient experience and may feel “this is just one more thing you are asking me to do.”
This situation may make health care leaders feel that they have to make one or the other the priority. But both are essential; in fact, it is impossible to have one without the other.
A path forward is suggested by what philosophers call Hegel’s triad (thesis, antithesis, synthesis). In this construct, the thesis is the idea that health care delivery needs to improve. The antithesis is the resistance that idea generates — in this case, the anger of exhausted clinicians. The synthesis is a third idea that emerges as a result of the debate.
We believe that there is a synthesis that can help drive improvement and sustain clinicians. It has three parts.
1. Emphasize the Positive
Instead of telling clinicians they must become better, help them recognize when their care is at its best, and support them in providing such care with high reliability. We believe in the improvement methodology appreciative inquiry, which asserts that if people understand their strengths and apply them reliably, their weaknesses become irrelevant. And the fact is that the vast majority of patient experience data highlights clinicians’ strengths, not weaknesses.
Physicians worry that the people who respond to patient experience surveys are more likely to be critical of their care. In fact, more than 80% of patients who respond to our company’s surveys give the highest possible ratings for their likelihood to recommend their physicians or practices after ambulatory visits. Even as concerns for their safety intensified during the pandemic, we found the same 4:1 positive-to-negative ratio among 2.2 million insights extracted from patients in the ambulatory setting between January 1, 2020 and September 30, 2021.
Many organizations do not share these comments with physicians; they should. Our data shows that physicians and everyone else in health care are deeply motivated by the experience of giving good, patient-centered care.
The reason to do this isn’t just to be nice; it is an important tactic for keeping people in the organization and health care itself. An analysis of our workforce database of over 1.2 million health care employees, including 120,000 physicians, reveals that individuals who like what they are doing, are highly connected to their work, are able to see patients as individuals, and believe the organization is doing its utmost to deliver great care for patients are four to six times more likely to stay with the organization in both the short term and long term than an employee who doesn’t.
2. Build Psychological Safety
To support improvement of all types of quality, health care organizations need cultures that support psychological safety. They need clinicians to trust and respect each other and openly share lofty values that include a commitment to principles of high reliability. And a core element of any high-reliability culture is the psychological safety necessary to give and take feedback.
Our data on the engagement of physicians and other employees with their organizations over the last few years underlines the importance of such cultures. It shows that “the pack has separated” during the pandemic: stronger institutions improved engagement, and weaker ones weakened it. And when we looked for the themes that characterize the organizations where engagement strengthened, we found that clinicians and others described environments that supported teamwork and nurtured respect.
Our data consistently shows strong correlations between the engagement of clinicians and every outcome of interest — including safety, patient experience, and other quality metrics. The strongest cultures are those so committed to excellence that leaders create the space for team members to speak up and speak out when they see opportunities for improvement, small or large. We know that those closest to the work are the ones with the experience and expertise to know when things are not working, but this knowledge can be lost if they do not speak up due to fear of retribution.
3. Fix the Systems
The observation that “every system is perfectly designed to deliver its current performance” seems to be true. Whenever we see marked improvement in patient experience and other quality metrics, we can virtually always identify a systemic improvement. The explanation is never “we put more pressure on individual physicians to do a better job.”
To develop these systemic fixes, health care organizations need to tap the expertise of those on the frontlines of care: both clinicians and non-clinicians. Caregivers experience dysfunction and understand its impact on themselves and patients. They are also best positioned to appreciate the benefits of improvements.
An example of a systemic improvement initiative that enhances clinician well-being and supports their engagement with their organization is the GROSS (Get Rid of Stupid Stuff) program that was started at Hawaii Pacific Health, which invited all employees to help weed out meaningless documentation requirements and other wasted activity. This program was quickly adopted at the Cleveland Clinic and other organizations. One benefit has been the reduction in things that didn’t contribute to better patient care and wasted caregivers’ time, but another has been conveyance of the message that their organizations understand the duress of working in health care today and are committed to improving work processes.
So while it may appear we are at a stalemate, with burned out physicians who cannot tolerate additional stress and an experience in health care that is far from perfect for many patients, there is a path forward. First, focus on the positives, including those things highlighted by patient-feedback data, to spread the understanding of what is working. Next, work to create cultures that are committed to the high reliability and the psychological safety needed for improvement. Finally, work relentlessly to improve systems to make the work of patient care a more doable job with more reasonable amounts of stress.