From a major push for the improvement of quality of care provided via shifts in payments made to physicians to the rise of physician burnout, healthcare is facing some unique challenges affecting hospitals and health systems throughout the U.S.
Addressing these areas within the continuum of care may be easier said than done. And due to the country's physician shortage, administrative staff members at healthcare facilities are now looking to new ways to keep their personnel engaged in healthy lifestyles.
While digital health is also drastically transforming care, it may be particularly difficult to adapt to the changes it presents as using electronic health records is too burdensome for some physicians and telemedicine, which provides new treatment options, is facing financial and regulatory barriers. But with the right tools and approaches, tackling these challenges can be made a much easier process.
The Cleveland Clinic has managed to tackle the aforementioned issues and it was ranked the #2 best hospital in the U.S. earlier this year. The medical center’s Chief of Staff Dr. Brian Donley shared some of the clinic's strategies and success factors in a recent interview with Healthcare Dive. Here's what he had to say.
Healthcare Dive: As the industry focuses more on keeping hospital beds empty by improving care quality and patient safety, rather than filling them, what steps is Cleveland Clinic taking toward this direction?
Dr. Brian Donley, Cleveland Clinic Chief of Staff: Some of the things that we’ve done to continually get better is working on bringing the patient more and more into the design of how we provide healthcare. We think that’s really helpful for quality and safety and experience of care. So when we’re designing different programs we actually have patient input.
One example would be our breast cancer program. It's a multi-disciplinary program and when we got together to design it, we brought physicians of the breast cancer center, we brought radiation oncology physicians, we brought radiologists, we brought oncologists, and we brought breast surgeons. But we brought patients into that group also so we could have the voice of the patients in this process. What we’ve done is we’ve shifted the question from, "How are we?" to "How are you?"
Telemedicine has received initial pushback from physicians due to a fear that their business will lose customers and lack of reimbursement. Meanwhile, the federal government has touted its ability to expand access to care, with HHS recently reporting to Congress its current telemedicine efforts. What has the clinic been able to accomplish so far with adopting telemedicine and how have its physicians reacted to it?
Donley: Certainly change is always difficult, but when you're able to articulate the significant benefits of change that exist for the patient, it’s much easier to get people to adapt to it. We actually have had very good adoption of telemedicine with our workforce. We’ve taken it past what people think as routine telemedicine and we got what you call an electronic I.C.U.
In every one of our intensive care unit beds throughout Ohio, we actually have a camera on them and we have all the monitors hooked up to a central site. We have physicians who monitor all the beds and we bring algorithms for the monitors. When the algorithm picks up a difference, that’s a concern. It sets an alarm off to a person sitting in a room with all the monitors. They can then heighten their awareness to look at that patient and they can signal to a regional hospital, which is 20 miles away. The nurse can go into the room and the physician or the nurse can come up with an exam to evaluate the patient and start an intervention before it actually becomes a concern. This has also allowed us to increase the quality of the care that we provide in our ICUs and also at a more affordable rate. EHR usability varies widely and its use is leading to physician burnout because it takes up too much time. A study published last month in the Annals of Internal Medicine showed physicians are spending around two hours on EHR tasks for every one hour they spend with patients. Have there been any recent efforts at the clinic to improve EHR use?
Donley: EHRs certainly have been mainly a positive thing for patient care but certainly do create some angst for the provider. And when you look at the significant problem with the physician burnout across the country, one of the biggest concerns that leads to that burnout is electronic medical records. Our IT group has put a lot of time and effort into lessening the burden of electronic medical records for providers.
Part of that is what we call reducing the click strategy. We have central support operations from our IT group that work with our physicians to go out and evaluate their workflow and spend time with them on how they can make their workflow more efficient, which is reducing clicks. We also have looked at other programs where you can have other providers help support physicians with some of the workflow in electronic medical records, such as pharmacists evaluating medication refills for patients.
The country is facing a physician shortage and the shortfall is expected to be between 61,700 and 94,700 by 2025. Some physicians are even planning to accelerate their retirement plans or switch to concierge medicine. Employees can be kept satisfied with their everyday lives with wellness programs, according to The Institute for Healthcare Consumerism. What kind of employee wellness efforts has the clinic focused on?
Donley: We’ve done a lot on employee wellness to enrich their lives. We provide programs for weight reduction and have been very successful with that. We actually at this point don't hire smokers and we offer programs to help people to stop smoking to our employees.
We started this year to randomly test all of our employees for drugs, drug testing for all of our employees, not just new hires, and the reason that we do that is because we care about our employees. If they are positive, we actually have programs set for them to help them with their addiction and that has been positively received.