Medical Practice Roundtable: UUH Helps Providers Meet Patient, Physician Needs

Added on Oct 30, 2019

By Diana Mahoney

In the first of an ongoing series of interviews focusing on ways high-performing medical practices are meeting some of today’s most pressing care delivery challenges, Mari Ransco, Director of Patient Experience at University of Utah Health, discusses how that organization is helping its provider groups create work environments that address both patient and physician needs.

pexels-photo-433267Just as physician group practices in the U.S. have grown and changed significantly in terms of ownership type, size, management, and team composition in recent years, the environment in which they operate has transformed into one that would have been unrecognizable just a few decades ago. In addition to the changing reimbursement landscape and the need to manage evolving quality measures, today’s practices have to navigate the complexities of increased consumerism; staff development, retention, and turnover; and clinician burnout.

How can practices address these challenges? What can they do to meet consumer expectations, develop and retain engaged caregivers, make their practices great places to work, and keep burnout at bay, while also consistently delivering safe, high-quality, patient-centered care?

These are some of the questions we will be asking leaders and others from high-performing practices over the next few months to gain insight into the strategies and tactics their teams are using to ensure success.

This month, Mari Ransco, Director of Patient Experience at University of Utah Health (UUH), talks about how that organization’s provider practices incorporate the patient voice into the fabric of their work. She also addresses how system leadership is helping their physicians meet some of the workforce challenges that are top of mind for physician groups, including engagement, resilience, and burnout.

Q: As a pioneer in the patient experience transparency movement, UUH has long demonstrated its commitment to using the patient voice to drive improvement across the organization. How is this reflected in the provider group practices?

A: The patient voice at the University of Utah is directly reflected in daily operations through a few different mechanisms. Every week, my patient experience team reads every single patient comment that has come in for that week. As we’ve grown, so has that number. It’s now about 3,000 comments every week. We distribute those throughout the system, highlighting the issues—both the positive ones to help practices recognize staff and providers, but also negative comments that need to be addressed. All of the practices have this constant flow of the patients’ voice.

We also developed a model, called the Five Elements of Patient Experience, that we use to help teams interpret and act on patient feedback. The five elements are caring, listening, explaining, teamwork, and efficiency. Using this model, we are able to help providers recognize what matters to patients, both the positive things to continue doing and the things that detract and erode patient loyalty. I think it's easy when you're a frontline care team member to get lost in the day-to-day work, because of this we have invested in supporting teams to understand the trends, and then infuse the patient voice as we work on solutions. We also bring active improvement work to our patient family advisory council, which we call our Patient Design Studio. Their feedback provides actionable, timely, and specific feedback directly to ​providers.

Q: Among the many challenges facing today’s medical practices, attracting and retaining clinical and administrative staff is an ongoing struggle and has become a strategic priority for many practices, not only from a human resources perspective but also from a safety and quality perspective, as these considerations are tightly interwoven. What is UUH doing to make its physician practices great places to work?

A: One of the appealing aspects of working in a practice within an academic medical center is being able to experiment and innovate, and we are absolutely offering those opportunities to our providers. Sometimes, this comes with challenges in terms of finding time in their schedules, but there are several models throughout our system where a provider takes on a role that essentially protects some of their time to work on particular projects that they're passionate about, or where we need a physician champion to help figure out the best solution.

We are also engaging our providers by actively partnering with them to build cohesion with the teams that serve the same purpose: delivering patient-centered, safe care to patients and their families. We are an integrated health system, but we continue to work on building strong partnerships between our providers, our administrative managers, and the physician leadership.

Q: You mentioned burnout. We know that physician burnout is complicated and influenced by multiple internal and external factors. It’s also dangerous, both for the physicians experiencing it and for the patients under their care. Is physician burnout a topic of discussion at Utah Health, and if so, what is being done to address it?

A: Burnout is something that is being discussed all the time at every level of our organization, and we are addressing it in several ways. Our Chief Medical Officer, Dr. Tom Miller, is very committed to addressing the systemic causes of burnout in practice. For the last few years, he has convened a group of physician leaders representing each of our clinical departments (one inpatient and one ambulatory) to provide direct feedback on improvements. This group is called Chief Value Officers (CVOs). They weigh in on issues big and small. For example, we received feedback from physicians that they felt so much pressure to respond to myChart messages that they were working into the night. The CVOs recommended updating language sent to patients after a message is sent to their provider to help set the expectation and balance the load. This discussion reflects a larger, ongoing conversation around the burden of electronic medical records, from charting visits to returning messages. It’s an effort to bridge strategy and execution by including those who do the work in the decision-making process.

One of the big things that we’ve done as an organization in the last five years has been the development of a physician-led Resiliency Center, which serves as a hub for innovative programming and services that support professional fulfillment and help faculty and staff remain passionate and energized.

The Center is led by a family practice physician, Dr. Amy Locke, a general surgeon, Dr. Ellen Morrow, and a psychologist, Dr. Megan Call. The Center focuses on supporting personal resilience and creating optimal work environments using evidenced-based methods like mindfulness practices, communication skills training, crisis intervention, and peer-to-peer support. The faculty and staff meet regularly with executive leadership to report provider well-being and to suggest methods for burnout reduction. In this way, I think it's given a cohesive voice to the issues of burnout and resiliency at the top levels of our organization.

Q: How have providers responded to the Resiliency Center and its resources?

A: It has been well received. Programs have expanded from mindfulness classes to include various employee support resources and unique interventions, such as our Wellness Champion project. A Wellness Champion is someone who is tasked with leading wellness efforts for their teams. What we have found is that the solutions to burnout are local. It's hard at the system level to come up with one a one-size-fits-all solution, so the Wellness Champion program has been really key in engaging local leaders to come up with solutions that work for their teams.

Q: You have also noted that some of the programs designed by UUH to transform care delivery have influenced physician engagement and may help to protect against burnout. Can you provide an example? 

A: Our Chief Medical Information Officer, Dr. Maia Hightower, is leading a program called “Home for Dinner.” The program’s goals are just what it sounds like: making sure that providers aren’t spending excessive time in the EMR and that they can be “home for dinner.” This program focuses on provider efficiency and wellness surrounding their EMR use. Providers receive individualized EMR coaching and personalized work flow optimization, led by our value engineers, provider, and nursing informatics team. It is being piloted currently, and we’re hoping to learn from early work to spread to the organization.

Next month, Craig Loundas, associate vice president for the Penn Medicine Experience at Penn Medicine, will discuss the importance of building a feedback-rich environment across that organization’s more than 500 ambulatory practice sites.