The State of Workforce Engagement: Helping Physicians Find Balance

Added on Jan 30, 2020

By Lauren Keeley

New research reported in Health Care Workforce Special Report: The State of Engagement, a recent Press Ganey white paper, highlights a troubling reality: Physicians are the least engaged, least resilient segment of the health care workforce. Furthermore, according to the findings presented in the white paper, although physicians in private practice have slightly better engagement than peers who are employed by large health care organizations, they demonstrate slightly lower resilience, which for all physicians appears to be driven by the trouble they have disconnecting from their work. This post, the third installment in an ongoing series exploring the research findings in more detail, considers the implications of these phenomena and suggests ways to start addressing physicians’ burgeoning needs.

tired doctorProvider business relationships contribute to the day-to-day experience of practicing medicine, both inside and outside the exam room. It is generally understood that private practice physicians have more autonomy in decision-making, more flexibility around the patient load, more predictability in their schedules, and greater opportunity for connecting with patients and their medical practice colleagues than those who are employed by large health care systems. These advantages, though, are counterbalanced to some degree by the burdens of independently running a practice. Although employed physicians can sometimes have faster paced environments and less predictable patient loads than their private practice counterparts, they are less directly involved in addressing overhead costs, resource limitations, and the financial risks of running an office.

Therefore, it may come as a surprise that, according to Press Ganey’s engagement report, employed physicians are slightly less engaged than private practice physicians. While employed physicians avoid many of the administrative responsibilities associated with running a private practice, there remain many factors that contribute to physician burnout, and these differentially affect each group.

For example, as Deirdre Mylod, Press Ganey Senior Vice President of Analytics/Solutions and director of the Institute for Innovation, explained in a Harvard Business Review article, given the hierarchical nature of the business relationship, employed physicians are likely more vulnerable to the effects of poor management and weak leadership, which can lead to dysfunctional teams and process inefficiency. These avoidable stressors put both physicians and patients at risk for safety events, and ultimately impact the quality and patient experience of care. Employed physicians, unlike most private practice physicians, are also potentially subject to excessive policies and procedures of their employer that can impact meaningful engagement.

The report also revealed that, although employed physicians are less engaged, they are a more resilient group. The variation is primarily due to their difference in average decompression scores, with employed physicians’ decompression average slightly higher than that of private practice physicians. Like engagement, this ability to disconnect from work is tied up in many aspects of modern health care, from extensive charting and challenges with the EHR that consume doctors’ time, to uncertainty surrounding the rising climate of mergers and acquisitions. Although each provider business relationship yields its own unique set of obstacles to decompression, the overall picture is still the same: Administrative burden continues to plague doctors, leaving them feeling overwhelmed and under-supported.   

According to Brad Pollins, manager of Transformational Services at Press Ganey, the core issue is that physicians’ individual work demands often exceed capacity when administrative tasks are included in the equation. “What’s most frustrating is that most of these additional duties could be better performed by other individuals, whether it’s a physician assistant, a billing coder, or a scribe,” he asserted.

To mitigate these added administrative stressors and promote operational efficiency, health system and private practice organizations first must take a holistic view of their unit or practice, Pollins advised. Quick-fix solutions to alleviate physician burden often leave nurses, who already find themselves overburdened and susceptible to high turnover rates, flooded with the spillover from physicians’ workloads.

“Organizations need to identify: What are nurses doing? What are medical assistants doing? What about the check-in staff?” Pollins suggested. “From here, they can get a better sense of the distribution of tasks and ultimately take a first step toward improving organizational alignment across the workforce.”

It is also imperative to listen to physicians’ voices from the start. Pollins recommended beginning the journey with an engagement survey strategy that includes annual and pulse surveying, which together can provide both the global view of physician engagement that is needed to generate comprehensive action plans and the nuanced view needed to spot early trends. In the early “diagnostic” phase, targeted focus groups are another valuable tool for giving physicians a voice and gaining a better understanding of the stress factors that impact their daily work.

“The focus groups, if done well, are interventions in and of themselves,” Pollins stated. “Once trust has been established within the group, doctors will begin to open up. They genuinely appreciate having a platform for voicing the issues they are most concerned about.” 

These focus groups, aside from being a space to express concerns, are also fertile ground for discussing future initiatives around what physicians want. For example, when talking about organizational alignment, most physicians ask for greater investment in leadership development and more involvement in large-scale decisions that impact patient care, Pollins recalled from a recent experience.   

To home in on process inefficiencies, organizations can increase the use of scribes and utilize Lean principles to identify and eliminate non-value-added activities, Pollins said. Time motion studies are also a valuable tool, as they use systematic observation, analysis, and measurement of the separate steps in a physician’s day to establish the standard time it takes to complete each step, improve procedures, and increase productivity. However, this intervention is better suited to employed physicians, who have the support and resources of the health system, because they usually require the participation of industrial engineers to shadow the physicians, Pollins clarified.

Finally, self-reported job task analyses can be used to identify all the duties a physician performs across a given week. In his own consulting, Pollins gives doctors a simple form prompting them to document the duties that give them great joy in practice and the additional, onerous tasks that have crept into their roles. Then they compare this form to a self-reported task record from a typical work week. 

Fortunately, these external factors are amenable to positive change. Since most of these improvement initiatives for helping doctors find balance can be tweaked to target the specific needs and structure of health systems and private practices, leaders must first prioritize meaningful change.

“I’ve worked in health care for over 20 years and most of the physicians I’ve run into are completely dedicated to delivering the best possible care for their patients,” concluded Pollins. “A strong engagement improvement framework starts with an all-encompassing look at what prevents that from happening.”