Practice Environment Impact on Physician Health & Wellness

Flexible work environments can support work-life integration for pediatricians. It can also be a recruiting strategy for organizations as well as a tool for providing patient care. Some flexible options might include:

• Float pools: Use part- or full-time float teams to cover gaps in staffing, vacation and leave time.
• Job-sharing.
• Alternative scheduling: Allow pediatricians to design their own clinic and administrative hours. A 9 to 5 might not be the best fit for everyone or your patients.
• Telecommuting: This is often for office staff but can be offered as work-from-home administrative time for direct service providers.

Team-Based Care

Team based care engages a greater number of staff in patient care and affords physicians, as the team lead, additional time with patients and their families. Team members should be aware of the health history, status, and unique needs of the patient and family, and are assigned different responsibilities, which together are designed to result in continuous, comprehensive, coordinated care during and between visits. As a result, all members of the team feel engaged in their key role of caring for the patient.

A successful collaborative team environment includes the following:

• A culture of trust
• Clearly defined roles and responsibilities
• Strong leadership
• Respectful and empathetic open communication
• Appreciation of diversity
• Equal participation among all team members
• Established goals
• Consensus decision making
• Solution focused problem solving
• Ongoing evaluation

Read more:

• YouTube video: Creating Efficiency – Team Huddles
• Key Elements of Highly Effective Teams, Council on Medical Students Education Pediatrics 2019

Team Documentation

Team documentation or “scribing” is a process where team members assist with documenting visit notes, entering orders and referrals and preparing prescriptions during a patient visit (AMA Steps Forward Team Documentation). Medical scribes have been shown to enhance clinical documentation, improve revenue collection, increase physician satisfaction, and reduce burnout. (JAMA 2015; J Am Board Fam Med 2015)

Read more:

• Team Documentation: Improve Efficiency, Workflow, and Patient Care, AMA Steps Forward (CME bearing module)

Assess the Physical Practice Environment

The physical practice environment can also influence physician dissatisfaction. Challenging work environments such as a lack of meeting space, equipment, room availability, etc. can contribute to frustration and ultimately burnout. Assessing the barriers within the physical practice environment may offer opportunities to build a success in creating wellness strategies or organizational changes. Some common changes to the physical environment might include:

• Select furniture that enables eye to eye contact with families.
• Organize patient rooms that promote communication
• Offer a well-designed family or waiting area
• Create public spaces that encourage team interaction and communication such as open workstations
• Offer sources of natural light and/or images of nature
• Space for scribes or other team members to help with EMR input
• A respite or wellness room for staff to rest or recover after stressful encounters.
• Access to healthy foods and drinks in meeting or lounge spaces

Lengthen Visit Time If Possible

The number of recommendations and tasks pediatricians are expected to complete during a well-child visit continues to grow. Lengthening the time a pediatrician can spend with each family is a possible strategy for reducing the administrative burden. This extra time can be offered as family discussion or supplemental administrative time to complete prescriptions, documentation, or anticipatory guidance.

Read more:

• Patients Over Paperwork, Centers for Medicare and Medicaid Service

Pediatricians reported spending a mean time of 3.4 hours per day on clinical documentation on a typical day (Journal of Pediatrics 2019)

The electronic health record (EHR) is a common source of inefficiency and contributor to burnout. On average, pediatricians spend 3 hours on clerical work per day (Journal of Pediatrics 2019). There are several ways practices can reduce their time in the EHR, in addition to the strategies for reducing administrative burden listed above. Initially, organizations should appoint a practicing physician to the organization decision making bodies with the task informing how to streamline and reduce clerical work. This decision making body can focus on the following questions:

• Must this process be performed?
• If so, can it be made more efficient? (Does it need this many “clicks”?)
• Can it be executed by other staff? *Adapted from An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice The Joint Commission 2017

Invest in Training

EHR training can decrease time spent documenting patient visits and increase physician satisfaction. Individually tailored EHR training has been shown to improve physician confidence and efficiency. (J Oncology Practice 2018)

One on one or small group trainings can offer physicians time to practice utilizing and exploring the EHR. This can also create opportunities for identifying redundancies and opportunities for customization- both important tools against excess physician clerical time.

In addition to continued training and technical support, consider building small staff workgroups to identify inefficiencies within your EHR. Make sure this team meets regularly (at first weekly then monthly) and receives training and technical support often.

Read more:

• One-on-one EHR training improved physician satisfaction, saves time, Modern Healthcare 2018

Pediatric Functionality

Pediatricians and other clinicians who care for children have specific needs for health information technology tools. The 2016 Electronic Health Records Periodic Survey found that features most likely missing from EHRs of office based pediatricians were those related to pediatric functionality such as reminders for interventions, tests for preventive care, adherence to well-child visits, and calculation of catch-up immunizations (Journal of Pediatrics 2019)

The AAP Child Health Informatics Center identified eight priorities essential to increasing the functionality of HIT tools for pediatric providers.

• Use biometric-specific norms for growth curves and support growth charts for children.
• Ability to document all guardians and caregivers
• Segments access to information
• Synchronize immunization histories with registries
• Age-and weight specific single dose-range checking
• Transferrable access authority
• Associate mother’s demographics with newborn
• Identify incomplete preventive care opportunities

Read more:

• Electronic Health Records for Pediatricians: A Shopper’s Guide
• Children’s Electronic Health Format, Agency for Healthcare Research and Quality

Organizational leadership and professional satisfaction have both been linked to prevention of burnout and increased provider engagement. Physicians who spend at least 20% of their professional time on work they find most meaningful are at a dramatically lower risk for burnout. (Mayo Clinic Proc. 2017)

“Leaders play a critical role in the professional satisfaction, well-being, and productivity of the individuals whom they lead.” – Tait Shanafelt MD.

Effective leaders have been shown to create greater staff satisfaction and prevent burnout. These leaders tend to have similar characteristics:

Organizational strategies for building better leaders and increasing professional satisfaction:

• Choose and evaluate leaders based on skills related to engagement, mentorship, partnerships, and communication.
• Support leadership development for all providers including part time staff.
• Create leadership opportunities or eliminate barriers for promotion for part time staff such as stopping the tenure track during family leave or creating flexible hours for leadership positions.
• Designate FTE for professional passion or development interests.