Benjamin Franklin once said that “an ounce of prevention is worth a pound of cure…”
While I’m a physician, which means that I’m a scientist, which means that I am fully immersed in the metric system, which means I don’t know what an ounce or a pound are...I’m going to go out on a limb here and presume that what Ben meant is that it is generally much easier to prevent a problem from occurring than to try to fix the problem once it exists.
Which brings us to today’s chronic shortage of healthcare workers and the scramble to fix it. I use the word chronic because this has been an issue for a long time and the COVID-19 pandemic just happened to shine a spotlight on it. The reality is grim: a 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of healthcare workers are considering leaving their profession altogether, and nearly 60% reported impacts on their mental health stemming from their work during the COVID-19 pandemic. What is a healthcare system to do?
We know what the “pound of cure” looks like so far, and it is not working. In the last two years, hospitals around the U.S. have hired temporary workers to fill sorely needed clinical positions. While this relieved some (but certainly not all) of the pressure of so many sick patients due to the SARS-CoV-2 virus, its costs cannot be absorbed by healthcare systems that typically run razor-thin margins. Supplemental monies from the federal government have helped, but those funds are rapidly drying up.
To mitigate or prevent the burnout and stress that is significantly contributing to the healthcare worker shortage, systems should leverage tried-and-true methods to promote “joy in medicine.” There are clinical and operational efficiencies that can not only decrease burnout but also promote the quadruple aim. Some of these strategies involve technology, while others are effective with pen and paper. None of these suggestions are rocket science.
Teamwork makes the dream work. Ensure that all your clinicians are acting at the top of their licenses. In other words, with respect to physicians, I like to say that “unless one needed to go to medical school to do it, please don’t ask a doctor to do it.” This seems obvious, but it is so incredibly common to hear, “Well, it’s easy to just have the physician fill out that paperwork,” or, “Let’s have the ordering doctor document the pregnancy status because it’s only one click.” These fail the “med school test” and hence, someone else should perform these tasks.
A team is not just a group of people with assigned tasks, however. Much like a sports team, an office-based team needs a coach and team members who take responsibility for doing their best to win the game. While the physician is likely the coach in this scenario, it does not always need to be that way for the team to win. Perhaps the office manager is calling the game plan for the day. There should be a pre-game meeting so that the expected flow of patients can be discussed, along with any special needs that might be anticipated. Team members might need to step outside of their comfort zone if circumstances demand it (while remaining inside their scope of practice, naturally).
Most folks in healthcare expect to work hard, but in return, they reasonably expect to not have to do dumb things. What’s that you ask? What sort of dumb things might a nurse or physician be asked to do? Documenting the smoking status of a newborn, being required to “order” a return visit, or needing to print out an after-visit report only to scan it back in minutes later after it’s signed with ink by the patient all seem like things that are “sub-optimal.” See the well-regarded paper in the New England Journal of Medicine titled “Getting Rid of Stupid Stuff.” Need I say more? I think not.
One way to take care of the same number of patients without needing more staff is to not admit patients to the hospital in the first place. Remote patient monitoring (RPM) can be leveraged to care for folks who are sick, but not quite sick enough to require inpatient monitoring or treatment. A command center approach is used to regularly check in on these patients, with nurses, therapists, and physicians intervening when necessary and visiting consistently as required. For added effectiveness, AI tools can be used to alert the appropriate clinician when disturbing trends are identified (e.g., blood pressure creeping up, decreased mobility with fewer trips to the bathroom, or failure to do their deep breathing exercises regularly).
Much like vaccines are used to prevent the devastating effects of full-blown disease, some relatively straightforward interventions in the way we provide healthcare can have significant downstream effects. Making the provision of healthcare just a bit saner and less stressful can make all the difference to those who provide it.