A new institute at the health system will focus on kindness research, fostering healthier communities, workforce development, and health justice.
CommonSpirit Health has launched the Lloyd H. Dean Institute for Humankindness & Health Justice.
Research has shown that kindness in clinical care can decrease patients' stress and emotional turmoil. The new institute is designed to use the power of kindness to treat the social causes of poor health and advance health justice.
The institute is named after Lloyd Dean, former CEO of CommonSpirit.
Evidence shows that kindness, compassion, empathy, and trust in clinical care impact healthcare outcomes, says Alisahah Jackson, MD, president of the institute.
"We have decades of research about kindness, compassion, empathy, and trust. There are multiple organizations that have been doing this research. CommonSpirit partnered with Stanford several years ago to look at how kindness, compassion, and altruism in a healthcare setting can influence health outcomes. There were a couple of things that were discovered. We found that patients who received compassionate care from their providers were better adherent to their medication regimens. We found that patients who went into surgery and received compassionate and kind care afterwards healed faster," she says.
Kindness is particularly powerful, Jackson says. "We know that kindness can lower anxiety levels. Research has shown that kindness can lower blood pressure. So, there is research that tells use there are tangible outcomes for individuals when they receive kindness and when they give kindness. There is research that shows people have better mental health outcomes when they are participating in random acts of kindness or volunteering for the common good."
The institute has four focal points, she says:
"One is humankindness in action. That will be looking at how we accelerate the research that has already been done in clinical settings. We also want to bring new research forward."
"The second area will continue our organization's focus on healthier communities. We all now recognize the terms social determinants of health or social drivers of health as well as the impact they have on all of us in terms of health outcomes. At CommonSpirit, social determinants of health have long been a component of our mission to build healthier communities."
"The third area is focused on workforce development and pipeline programs. If we are going to be honest about addressing justice in this country, we must make sure we are addressing economic mobility and financial stability. This is important for CommonSpirit because we tend to be anchor institutions in the communities that we serve. One of our goals is to think about pipeline programs earlier. Many times, pipeline programs start in high schools. But we know that girls in particular start losing interest in science, technology, engineering, and math in middle school. We need to see whether there are things we could be doing to keep their interest in STEM fields sooner—even in elementary school."
"The fourth key area is the notion of health justice. This will require a lot of strategy around policies. I like to think of it as 'Big P' policies and 'little p' policies. Big P policies include federal, state, and local government policies. The little p policies are organizational policies—sometimes we have policies in place at healthcare organizations that unintentionally drive disparities. We need to be constantly reviewing policies with a social justice and health equity lens."
Institute as accelerator
The institute is going to build on work that is ongoing at CommonSpirit, Jackson says. "The institute is going to serve as an amplifier and accelerator of great work that is already happening. We are already connecting community resources to clinical care. One of the things that our community health division runs is a program called the Connected Community Network, which is a program that allows for patients to be connected to community resources because they are screened for social needs in our clinical care settings."
The Connected Community Network program is a powerful tool for clinicians, she says.
"As a family medicine provider that means I can screen my patients for social determinants of health. If they screen positive, where there is a Connected Community Network, I can make a referral for my patients to community organizations to have needs addressed. Ultimately, our goal is once those needs are addressed and I can have a conversation with the patient to make sure they are getting the things that they need, by getting those social needs addressed that starts to help them in their healthcare outcomes. Those are the types of programs that the institute will be looking to accelerate across our entire organization."
In some specialties such as nutrition and genetics, telehealth visits can often replace in-person visits, researchers found.
In a new study that looked at more than 30 specialties, most patients who had a specialty telehealth visit did not require an in-person follow-up visit in that specialty over the next 90 days.
Since the beginning of the coronavirus pandemic, telehealth visits have increased dramatically. The millions of telehealth visits that have been conducted since the beginning of the pandemic are an opportunity for researchers to assess the utilization of telemedicine.
The new study, which was conducted by Epic Research, examined more than 35 million telehealth visits conducted between March 1, 2020, and May 31, 2022. The research includes several key findings:
The two specialties that showed the fewest in-person follow-up visits in the 90 days after a telehealth visit were genetics (4% of telehealth visits) and nutrition (10% of telehealth visits)
In specialties that often involve consultations such as genetics and nutrition, telehealth visits could replace the need for in-person visits
The two specialties that showed the most in-person follow-up visits in the 90 days after a telehealth visit were obstetrics (92% of telehealth visits) and fertility (54% of telehealth visits)
For specialties that showed relatively high numbers of in-person follow-up visits, the in-person visits were likely related to needing additional care rather than duplicative care
Mental health and psychiatry had the highest volume of telehealth utilization as well as one of the lowest numbers of in-person follow-up visits in the 90 days after a telehealth visit (15% of telehealth visits)
"These findings suggest that, for many specialties, telehealth visits are typically an efficient use of resources and are unlikely to require in-person follow-up care. If telehealth is not duplicative of in-person visits for those specialties, it can be an effective tool to help expand access to care," the study's co-authors wrote.
Interpreting the data
The lead author of the study, Jackie Gerhardt, MD, vice president of clinical informatics at Epic, told HealthLeaders that the relatively low numbers of in-person follow-up visits after a telehealth visit is significant.
"We specifically organized the study to look at what happened in the three months following a telehealth visit to find out whether or not someone needed an in-person visit within that three months. Our reasoning was that if you need a follow-up visit in that three months, it was likely that the visit was for the same condition. For example, you might have an orthopedic telehealth visit to talk about hip pain, and if you got the right recommendations that you needed, you probably would not need a follow-up visit in-person within orthopedics. So, we concluded that in specialties that did not need follow-up in-person, it was likely that the telehealth visit was able to stand on its own."
Nutrition and genetics are examples of where telehealth visits could replace in-person visits, she said. "If you are asking for advice on nutrition or reviewing your genetic history, both of those can be transactional such that you get information that you need from a single consult, and it does not necessarily require a physical exam. The ability to do that during a telemedicine visit is very similar to information you would be gathering in-person. So, it could increase access and potentially improve the way that people can get care because they do not have to travel to a clinic and can more readily access their provider."
Telehealth visits are an effective tool to help expand access to care, Gerhardt said. "Telehealth visits are part of our general advancement in healthcare toward being consumer-centric and patient-centric. Different organizations structure telemedicine in different ways; but in some cases, instead of having to stick to the 8-to-5, Monday-through-Friday services of in-person care, you can get more access in terms of the number of days and time slots through telehealth as well as get a visit more quickly than you can get an in-person visit."
The study shows that telehealth visits can supplement or replace many in-person visits, she said. "Telehealth visits will never replace all in-person visits; but for specific specialties and specific types of visits, telehealth can serve as an adjunct or a replacement."
The study's computer model included age-stratified demographics, risk factors, and immunological dynamics of infection and vaccination.
U.S. COVID-19 vaccinations have averted more than 18.5 million additional hospitalizations and about 3.2 million additional deaths, according to a new study.
The coronavirus pandemic is among the deadliest outbreaks in U.S. history, killing more Americans than those lost in the 1918 influenza pandemic. Vaccinations for COVID-19 in the United States started two years ago, and more than 655 million doses have been administered, according to the new study.
The new study, which was conducted by The Commonwealth Fund, is based on a computer model for data from December 2020 to November 2022 that included age-stratified demographics, risk factors, and immunological dynamics of infection and vaccination. The research features four key findings:
COVID-19 vaccinations averted more than 18.5 million additional hospitalizations
COVID-19 vaccinations averted about 3.2 million additional deaths
COVID-19 vaccinations averted nearly 120 million additional infections
COVID-19 vaccinations averted about $1.15 trillion in medical costs
COVID-19 vaccinations have been effective with multiple benefits, the study's co-authors wrote. "The unprecedented pace at which vaccines were developed and deployed has saved many lives and allowed for safer easing of COVID-19 restrictions and reopening of businesses, schools, and other activities. This extraordinary achievement has been possible only through sustained funding and effective policymaking that ensured vaccines were available to all Americans. Moving forward, accelerating uptake of the new booster will be fundamental to averting future hospitalizations and deaths."
The reduction in COVID-19 infections is a crucial accomplishment, the co-authors wrote. "Vaccination also has prevented many millions of COVID infections. Although the acute phase of these infections may not have required medical attention, each infection carries a risk of long COVID and debilitating symptoms. Many of the prevented infections would have been reinfections, which have higher risk of death compared to initial infections."
The averted infections, hospitalizations, and deaths are significant, they wrote. "Without vaccination the U.S. would have experienced 1.5 times more infections, 3.8 times more hospitalizations, and 4.1 times more deaths. These losses would have been accompanied by more than $1 trillion in additional medical costs that were averted because of fewer infections, hospitalizations, and deaths."
The health system is experiencing staff shortages in all areas, including certified nursing assistants, registration, pharmacy, respiratory therapy, and registered nurses.
Workforce shortages are the biggest challenge at Clive, Iowa—based MercyOne, the health system's chief medical executive says.
Hijinio Carreon, DO, MBA, was named chief medical executive of MercyOne in May 2021. At the time he was elevated to the chief medical executive role, Carreon had been with the organization for more than 13 years, starting as an emergency medicine physician. Before being named chief medical executive, he had served as chief medical officer and vice president of medical affairs for MercyOne Central Iowa.
HealthLeaders spoke with Carreon recently about a range of issues, including physician burnout, clinical challenges now that the crisis phase of the coronavirus pandemic has passed, workforce shortages, and patient safety. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: What are the primary challenges of serving as the chief medical executive of MercyOne?
Hijinio Carreon: Similar to other hospitals across the country, we are experiencing critical staffing shortages. We are also seeing seasonal conditions such as RSV, influenza, and COVID that are compounding our capacity challenges.
There are challenges in attempting to stay focused on our strategy and not just the day-to-day operational challenges. The other overwhelming challenge and heightened concern is around moral injury and where our providers are in terms of their distress.
HL: How are you rising to these challenges?
Carreon: We are doing a lot around recruitment and retention. So, we are constantly reevaluating our benefit packages and determining how we can attract people into healthcare services. We are looking at our labor pool and partnering with schools—high schools and colleges. Our human resources staff has been going into high schools to highlight opportunities and increase our pipeline of individuals who might be interested in pursuing a healthcare career.
We are looking at statewide internal nursing traveler programs. We are advancing and redesigning our care models—we were the first in the state to start a virtual nursing program, and we are looking to expand that program. We have looked at our current care models to see how we can reinforce our nurses with care technicians, and we have looked at nursing ratios closely.
We are also focused on employee wellness and engagement—that is always going to be in the forefront. We continue to ensure that we have services in place to provide our healthcare workers with the support that they need.
Hijinio Carreon, DO, MBA, chief medical executive of MercyOne. Photo courtesy of MercyOne.
HL: What is the status of physician burnout at MercyOne?
Carreon: Burnout was pervasive before the coronavirus pandemic. Certain specialties such as the emergency department were reporting burnout levels of 50% of the staff. Now, you add the global pandemic, workforce shortages, and healthcare disruptors that have entered the arena, and it is difficult to suggest that yoga or symposiums are going to be sufficient tools to address burnout. We know all of these factors have had a significant impact on our colleagues, so the prevalence of burnout is extremely concerning to us. The extent has yet to be fully assessed and determined, but we have significant concerns in light of all the challenges we have faced over the past couple of years.
HL: What are the primary initiatives you have in place to address physician burnout?
Carreon: We are integrating with Trinity Health, and Trinity has embraced MercyOne into their culture. We have been leveraging some of their tools and expertise such as their Advancing Together webinars, which focus on a compassionate approach to healthcare.
We have a Colleague Care Circle program that features a peer group of behavioral health professionals and others who connect with our team members in high-volume and high-stress areas to provide high-touch comfort and support for them during real-time situations. The goal of this initiative is to reach all of our colleagues who are working shifts and provide active listening and empathy around concerns that may have arisen during a specific event.
We have been creating social events now that in-person meetings have become more acceptable. We are creating environments where we can build relationships and reestablish trust that may have been lost during the pandemic.
We partner with our employee assistance program. They have done a tremendous amount of work on physician burnout with us, and we have used some of their strategies and tactics in getting the message out about resources that are available to help staff through these difficult times.
HL: What are your primary clinical challenges now that the crisis phase of the pandemic has passed?
Carreon: Staffing is the biggest challenge. We have an aging workforce and some individuals have accelerated decisions to retire or leave healthcare. There are healthcare disruptors that are offering more flexible hours and remote work—those are challenges to our hospitals, and we need to become nimble and flexible and try to compete in this landscape, which has challenged us to be more innovative.
HL: What kind of workforce shortages are you experiencing at MercyOne?
Carreon: All areas are being impacted. It is extensive from certified nursing assistants to registration to pharmacy to respiratory therapy to registered nurses and many other positions. At the national level, there may be a belief that this is just a nursing shortage, but it is not. The shortages that we are seeing at MercyOne are in all areas.
HL: What are the main efforts you have in place to address workforce shortages?
Carreon: A main effort is increasing the pipeline—the individuals who are pursuing careers in healthcare. We are trying to attract staff and determine how we promote education within our organization; so, if they want a career path or higher level of education, we can allow them to do that in their journey as they become employed within the MercyOne organization.
We are trying to reach individuals as early as we can who may be interested in healthcare. Engaging these individuals is important to us. We are strengthening our relationships with universities. We have our Mercy College of Health Sciences in Des Moines, and we have been strengthening that relationship to ensure the offerings they have are consistent with the needs of the organization. We want to ensure that we can support clinical rotations and make them as robust as possible so that the students are getting not only a great education but also a great experience when they are at MercyOne that makes them want to remain a part of the organization.
One of the pieces is reconnecting individuals to professional purpose. That has been a big initiative for us. We want staff to get back to the mission of why they went into healthcare. We lost some of that during the height of the pandemic.
HL: What are the primary elements of patient safety at MercyOne?
Carreon: There are several main areas, and I will name a few. We are looking at preventable hospitalizations, and our 30-day readmissions. We are looking at our OSHA reportable injury rates, and at falls with injury rates.
HL: What are some of the metrics you follow to measure your performance in patient safety?
Carreon: There are the measures that I just mentioned. They are all tied to a specific numerical value. We establish our internal goals based off our historical performance. We are striving to get to zero harm. So, we are trying to improve these numbers with the objective of continuing on the path of high reliability.
HL: What kind of initiatives have you launched to become a high reliability organization?
Carreon: We are still early in our journey. We have been focused on serious safety event reporting. We want to establish a foundation of a just culture—we want individuals to feel comfortable bringing forward concerns and near misses, so that we can continue to refine our processes and try to mitigate any risk of harm to patients.
A 12-week telehealth patient navigator pilot program increased patient visit attendance and generated $11,387 in return on investment.
Patient navigators are a cost-effective way to increase video telehealth visit appointment attendance, according to a new research article.
Since the beginning of the coronavirus pandemic, telehealth visits have increased dramatically. One concern is patients having technological challenges that make it difficult to keep their video telehealth visits.
The new research article, which was published by JAMA Network Open, features data collected from 4,000 video telehealth patients. A patient navigator attempted to reach 1,000 of the patients by phone before their video telehealth visit—the intervention group—and 3,000 of the patients had usual communication including reminders by phone and text—the comparator group.
The 12-week study period was from April to July 2021. The patients were served by a primary care clinic and a gerontology clinic affiliated with an academic medical center. A patient navigator was hired for the pilot program.
The patient navigator contacted patients by phone the day before their video telehealth visit, offering technical assistance and answering questions about accessing the visit. A script was given to the navigator that included the steps for patients to connect to their visits and frequently asked questions.
The study generated three key data points:
91.6% of patients in the intervention group attended their appointment compared to 82.8% of patients in the comparator group
5.8% of patients in the intervention group canceled their appointment compared to 9.2% of patients in the comparator group
The pilot program's return on investment was $11,387
The study's data indicate the telehealth patient navigators can be effective, the research article's co-authors wrote. "The findings of this study suggest that adding a patient navigator to episodic telehealth visits may increase visit attendance and provide a net financial return."
Telehealth patient navigators can improve video telehealth visit attendance with a return on investment, the study's co-authors wrote. "At our institution, the Telehealth Patient Navigator program proved to be an effective, cost-effective, and high-value intervention associated with improving telehealth visit attendance and fewer patient no-shows and cancellations and increased successful video visits over the course of a 12-week pilot. Implementing a Telehealth Patient Navigator may be a high-value proposition for healthcare systems, as it uniquely benefits patients and clinicians while being cost-effective and yielding a positive net return on investment."
The former administrator of the Centers for Medicare & Medicaid Services wants the agency to make more progress in addressing health equity.
A group including health systems, a health plan, a healthcare analytics company, and the association representing Illinois community health centers has launched the Midwest Health Equity Coalition.
Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 healthcare disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.
Two of the prime organizers of the Midwest Health Equity Coalition are Andy Slavitt, former administrator of the Centers for Medicare & Medicaid Services (CMS), and Eric Whitaker, MD, MPH, founder and executive chairman of Zing Health, a payer that features a Medicare Advantage health plan.
Slavitt has expressed frustration about the inability of CMS to address health equity when he was leading the agency, Whitaker says. "While they had a deep interest in addressing health equity under the Obama administration, there were few clinical models for addressing health equity and the ability of CMS to impact health equity was sorely lacking. That included clinical models that CMS could get behind for high-impact diseases and that included data collection."
The coalition is committed to reducing racial health disparities among underserved seniors in Illinois, Indiana, and Michigan.
The primary goal of the coalition is to do foundational work on health equity that leads to policy recommendations, Whitaker says. "By coming together with health systems, federally qualified health centers, payers, and healthcare associations, we wanted to put together the best thinking about health equity, so that we could make policy recommendations to CMS as well as demonstrate and recommend clinical models. We want to see what works."
The coalition held its first meeting last week and features six work groups: clinical, payment, data support, policy coordination, benefit design, and marketing and outreach.
The coalition will be focusing on health equity for one syndrome, Whitaker says. "After consulting with our clinical work group, we decided to focus on metabolic syndrome, which is hypertension, diabetes, and hypercholesterolemia. When you look at seniors—particularly seniors of color—an overwhelming percentage of this population have those conditions. The thought is that if we can make some progress in this area, we would do a great service for the country."
The coalition will be gathering best practices for health equity, he says. "At our first meeting last week, we put together the first draft of a compendium of best practices from the coalition partners that is a living document that will be expanded over time as we identify work that is being done by coalition partners. As part of the compendium, we have done a literature review of best practices related to health equity. One of the things that is true about medicine in the United States is it can take almost two decades before something that is discovered in the lab or the community is rolled out for general consumption by populations that can benefit. We want to accelerate that process for health equity."
A potential health equity best practice that the coalition is looking at is continuous glucose monitoring for diabetic patients, Whitaker says. "At Zing Health, we are making these sensors available to our diabetic members at no cost. Right now, there are no other healthcare payers doing this, and it is not something that CMS is mandating. We are getting this out to our members, who are by and large in low-income communities of color. We are monitoring the impact it has on glucose control."
Collection of data is pivotal in Zing Health's continuous glucose monitoring initiative, he says. "We are going to end up having a data set of the impact of continuous glucose monitoring on blood sugar levels and be able to assess health outcomes. Then we will be able to recommend to CMS criteria if you were to have continuous glucose monitoring as one of the options for measuring blood sugar. We can do on-the-ground work with the institutions we are working with. We can have outcomes, and we can recommend policy as a result of the findings."
The coalition is hoping to have several positive impacts, Whitaker says. "I would be excited if the coalition can point to clinical models that have a good effect on the vulnerable populations we are targeting. I would be excited if we could be able to make policy recommendations to CMS that matter around health equity. I would also be happy if we shine a light on the existing work that is being done at our partner institutions. It would be ideal to find great models that are successful then replicate them across the country."
Institute for Healthcare Improvement president emeritus and co-founder calls for single-payer system in United States.
The focus on profits in U.S. healthcare is "damaging," Institute for Healthcare Improvement President Emeritus and Senior Fellow Donald Berwick, MD, said during this week's IHI Forum in Orlando, Florida.
U.S. health systems, hospitals, and physician practices are committed to addressing the health needs of their patients. But making sure bottom lines are in the black and securing return on investment are also top goals at these healthcare organizations.
Berwick is one of the country's leading authorities on healthcare quality and improvement. The co-founder of IHI served as administrator of the Centers for Medicare & Medicaid Services during the Obama administration. He began his medical career as a pediatrician, serving on the staffs of Boston Children's Hospital, Massachusetts General Hospital, and Brigham and Women's Hospital.
In a meeting with journalists during the IHI Forum, Berwick criticized the financial model of U.S. healthcare. "One of the problems in healthcare is greed. We must address the degree to which the pursuit of profit and the acquisition of money and high valuations and investor-oriented business models has taken over healthcare. It is damaging. It is wrong."
The problem is systemic, he said. "I am not taking the position of people being bad people—it is not for me to judge. But the behaviors are bad on both the payer and provider sides. The pursuit of money is overwhelming the well-being of populations and patients."
Individual patients are being harmed, Berwick said. "At the individual level, this is leading to higher and higher out-of-pocket costs, more and more insurance benefit structures where people have to pay more, and disadvantages to people with lower incomes."
The emphasis on profits limits the ability of healthcare organizations to improve quality, he said. "This is affecting the context in which quality plays out. Our work on improvement depends on a basic foundational structure that can invest in improvement. The distortion in behaviors and the demoralization that results from profit-driven excess is hurting our ability to improve."
Berwick acknowledged that many healthcare organizations have been financially challenged during the coronavirus pandemic, but he said the need for reform remains. "The context is difficult. With COVID, the hospitals are currently in a stressed position, with high labor costs and workforce shortages. They are in the red this year—they are losing money. I understand that, but I don't want to back down on stopping the acquisitiveness in healthcare."
Other countries have established a better business model for healthcare, Berwick said. "I work in many systems around the world, which include single-payer systems in which there is a much stronger sense of collective duty. In many countries, the ministry of health feels responsible for making sure that resources are allocated in a way that will help the population. There is no minister of health in the United States. There is nobody thinking about whether the healthcare system is making sense for people. I remain an advocate of a globally budgeted, single-payer system."
El Camino's CMO says the health system uses artificial intelligence that creates a deterioration index, which alerts physicians when a patient is deteriorating clinically.
Innovative health systems anticipate change, then apply changes in a way that benefits patients, says Mark Adams, MD, chief medical officer of El Camino Health.
Adams has been the CMO of the Mountain View, California–based health system since 2018. Prior to joining El Camino Health, he was interim system chief clinical officer of SSM Health and CMO of PeaceHealth. He earned his MD degree from University of Pennsylvania.
HealthLeaders recently talked with Adams about a range of issues, including CMO leadership, innovation, physician burnout, and workforce shortages. The following transcript of that conversation has been edited for brevity and clarity.
HealthLeaders: What are the primary challenges of serving as CMO of El Camino Health?
Mark Adams: I need to make sure that we have the right resources to provide the best clinical care that we can. The role of the chief medical officer is to oversee all of the clinical care that we provide, so that is my number one responsibility. I need to make sure we have the resources, personnel, and the latest and the greatest equipment to provide the best care that we can.
There are three things that can be challenging given my responsibilities. First, I need to make sure that I stay in touch with our frontline workers to understand their needs. I need to make sure that we can meet those needs. Second, I need to anticipate changes. Healthcare is dynamic—it is changing all the time. Third, depending on how we adapt to change, I must be a strong voice for patients.
HL: How do you keep up with change?
Adams: There are a couple of ways. There is a lot of medical information in literature that is constantly being published. So, I must keep abreast of medical publications. The other way to keep pace with change is through organizations such as the Institute for Healthcare Improvement, which is important for quality and safety issues. There are also organizations that facilitate gathering chief medical officers—it is an opportunity for us to communicate with each other, which is a good source of getting information about what is ahead and how people are adapting to change.
Mark Adams, MD, chief medical officer of El Camino Health. Photo courtesy of El Camino Health.
HL: El Camino Health has a reputation for pursuing innovation. What are the keys to being an innovative health system?
Adams: First, we need to stay abreast of potential changes, then we learn how to adapt those changes in a way that benefits our patients.
We were the first medical organization in the United States to have an electronic health record in the 1970s. It was a primitive contraption compared to what we have today. We have always tried to be on the frontline of innovation. We are a showcase site for Varian, which has advanced radiotherapy systems.
We have many robots throughout our organization. We have da Vinci robots, we have robots for joint replacements, and those that look down windpipes and do surgical procedures on the lungs that avoid making incisions. So, we have been active in areas where either technology or changing practices are applied.
We have taken our electronic health record and added some artificial intelligence that creates a deterioration index. By using AI, we can tell when a patient may be deteriorating clinically, and the EHR alerts us so we can intervene before the patient gets worse.
While pursuing innovation, we want to make sure that we maintain the best quality and safety. We have a high ranking by Leapfrog.
HL: How do you balance pushing the boundaries of innovation and maintaining patient safety?
Adams: We do research, which may be surprising to people because most research is conducted at academic medical centers. We have a robust research institute—the Taft Center for Clinical Research. We participate in rigorous research to make sure that innovations have benefits to the patients that we serve.
We also have an institutional research board, which is an independent board that looks at what we are doing and makes assessments. This board oversees what we do in the innovation space.
HL: What is the status of clinician burnout at El Camino Health?
Adams: Physician burnout is a big issue throughout healthcare, and the past couple of years of dealing with COVID has made the problem worse. The coronavirus pandemic has accelerated burnout for all healthcare workers and physicians in particular. Burnout is something that we always keep top of mind, and we have several ways to try to address it. For extreme cases, we do provide our employee assistance program—physicians can get help from that program.
For most physicians, addressing burnout is a matter of making the work they do easier and more streamlined. We are also trying to reduce bureaucracy, reduce redundancy, and simplify workflows when possible, so physicians do not get burned out doing things that do not add value to taking care of patients. We want our physicians to be able to focus on the work they are trained to do, which is to be diagnosticians and to apply therapies.
HL: Are there other initiatives in place at El Camino Health to address clinician burnout?
Adams: We stay close to our physician leadership, and we have physician leadership embedded in a lot of the activities of the organization—particularly around quality and safety. That is important because it is easy for physicians to become alienated and to feel that things are being done to them instead of with them. We make sure physicians have a strong voice in the organization and they are involved in the decisions we make.
We are also looking at ways to decrease physician workload and to improve our processes. Part of this effort is paying attention to their work-life balance because it is easy for a physician to become overwhelmed on the work side, which then impacts their personal life. We also have programs that target physician stress.
HL: What kind of workforce shortages are you experiencing at El Camino Health?
Adams: We have the same problem that other healthcare organizations have—there is higher demand for healthcare workers. One of the outcomes of the pandemic is that many healthcare workers who were looking at retirement took early retirement, or even changed careers.
We are trying to make sure we keep a steady influx of healthcare workers. We have training programs. For example, nurses who graduate from nursing school—particularly in specialty areas such as operating room, intensive care, and emergency department—can take advantage of our training programs that are like residencies for nurses. We can help them train in specialty areas.
We also have a transition program. For example, we can have nurses who are already in the organization who have specialty experience, but they may want to try something more challenging or more complex such as intensive care. We will transition those nurses over to higher level of care areas and help them grow. The transition program is a way that we can maximize our workforce internally.
We are located in an area with a high cost of living, so we make sure that we stay competitive in terms of compensation.
Generally, El Camino Health has been an attractive workplace. We do better than many other organizations in terms of attracting healthcare workers. In the end, the work environment is critical to recruitment and retention. We make sure our healthcare workers get the resources they need. Healthcare is a people business—it's people taking care of people. Healthcare workers have decided they want to take care of people. It is our job to make sure that we can make that career as successful as we can.
So, maintaining a workforce is about the culture, the work environment, and the camaraderie among the healthcare workers. That is what keeps us all going.
Efforts to start joy in work initiatives at healthcare organizations require a commitment from leadership.
Health system and hospital leaders have a crucial role to play in advancing joy in work initiatives at their organizations, an Institute for Healthcare Improvement executive said yesterday at the IHI Forum.
The IHI Framework for Improving Joy in Work is designed to reduce healthcare worker burnout and increase healthcare worker well-being. Healthcare worker burnout has spiked dramatically during the coronavirus pandemic, with a recent research article finding that 62.8% of physicians reported at least one symptom of burnout in 2021 compared with 38.2% in 2020.
Healthcare organization leadership is foundational in implementing the IHI Framework for Improving Joy in Work, Jesse McCall, MBA, director and improvement advisor at the Institute for Healthcare Improvement, told HealthLeaders at the IHI Forum.
"There must be commitment from individual leaders and leadership teams—that is the first step. Even having a leader ask the question about what matters to you at work is a signal that the leadership team cares—they are interested. However, leaders must go beyond asking about what matters to staff to doing something about it. Leaders can put a team together to surface issues, amplify strengths, or address barriers. Leaders can deputize other leaders across the organization to do this work in individual units or services lines," he said.
Beyond commitment to joy in work, healthcare organization leaders need make joy in work a high-level concern, McCall said. "The first step is to commit to this work as a leader—to say staff satisfaction, staff engagement, wellness, and well-being is important. The next step is to get joy in work in the strategic plan and the organizational dashboard. In addition to asking staff what matters, leaders need to feed back the data that is collected, whether it is qualitative from conversations or quantitative from staff experience surveys. Leadership needs to be transparent about what they are seeing and what they are doing based on the data."
There are four phases to implementing the IHI Framework for Improving Joy in Work, he said.
The first phase is asking staff what matters to them. "We have a lot of resources in how to engage people in these conversations and how to theme that data and turn it into actionable changes for your organization," McCall said.
The second phase is to identify unique impediments to joy in your organization. "What gets in the way of joy? What is frustrating day after day? What are the pebbles in your shoe—the small annoyances? What are the boulders—what are the things that management really needs to get involved in and what needs to change to enable you to do your best work?" he said.
The third phase is for an organization to make joy in work a shared responsibility. "Leadership must set the context to make joy a priority. Then there are specific roles in each organization to create and reinforce systems that foster joy in work," McCall said.
The fourth phase is focused on taking actions. "You use improvement science to test ways to remove impediments and test ways to improve your processes," he said.
Successful adoption of joy in work framework
There are three primary elements to adopting the IHI Framework for Improving Joy in Work, McCall said.
"The first key is making the case for the framework in your organization. You need to understand what problem you are trying to solve—whether it is burnout in a specific unit or whether it is burnout among the entire staff. Then you need to dive deeper and understand what matters to people such as larger things like scheduling, pay, or benefits. It also can be relatively small things such as supply availability. You need to understand the problem you are trying to solve first," he said.
"The second key is leadership support. You need to find the right leaders—finding an executive leader and a clinical champion. These leaders are someone who can say, 'Here is what I am doing. Here are the changes that I am making,'" McCall said.
"The third key is having a methodology. You need to have a model for improvement. It makes joy in work more than a fluffy concept. Having a model for improvement brings some rigor to the process—you are using a scientific method to test process changes and to bring about better outcomes for the staff," he said.
Primary barriers to joy in work initiatives
Healthcare organizations face a daunting hurdle in promoting joy in work, McCall said. "The biggest barrier is time and resources, which go hand in hand. When you think of resources, human capital comes to mind. You also need the time to engage in this work because it does take considerable effort to engage leadership and frontline staff. You must have conversations, develop a theory, and coach people. This takes time."
Organizational perspectives on devoting time and resources to boosting joy in work can also be problematic, he said. "In a progressive organization, you can realize the return on investment from devoting time and resources. But if you are looking at this work from a strictly bottom-line standpoint, it becomes more difficult to make the connections between expending resources and dedicating staff time and affecting the bottom line."
The Boston-based hospital is gaining ground on a racial hypertension disparity.
Community health workers are playing a leading role in addressing health equity among primary care patients at Massachusetts General Hospital, according to a presentation yesterday at the Institute for Healthcare Improvement Forum in Orlando, Florida.
Health equity has emerged as a pressing issue in U.S. healthcare during the coronavirus pandemic. In particular, there have been COVID-19 healthcare disparities for many racial and ethnic groups that have been at higher risk of getting sick and experiencing relatively high mortality rates.
Community health workers can be pivotal in efforts to address health equity, Sarah Matathia, MD, MPH, associate medical director of primary care equity at Massachusetts General Hospital said at the IHI forum. "One of the potential solutions for having diverse representation in the workforce is to include community health workers in your workforce and integrate them as part of the care team."
Community health workers are well-suited to help health systems and hospitals tackle health equity issues, she said. "Community health workers are public health workers with shared life experience, who apply that unique experience such as language or culture or specific issues such as substance use disorder. They try to provide culturally appropriate health education, and they serve as a bridge. They are able to bridge between individuals, families, and the community that they are a part of and the healthcare system."
At Boston-based Massachusetts General Hospital, community health workers are well established, Matathia said. "We are lucky to have a group of community health workers that has grown over the past 25 years. They are working in several key domains. The community health workers help find health-related social needs resources for patients, so they develop expertise in areas such as healthy food and job-finding programs. They are working on system navigation—community health workers help patients get to their appointments by calling patients and giving reminders. They provide care coordination—they help patients make appointments. And increasingly, we have been working with community health workers on models for chronic disease management."
Addressing racial hypertension disparity
Community health workers are an essential element of an effort to address a racial hypertension disparity among Massachusetts General Hospital primary care patients, she said. "We felt it was important for the program to be led by community health workers. We did not just want the community health workers to be helping with medications because we felt this was an opportunity to get to the root causes of hypertension. We incorporated more education around lifestyle, and we built modules such as why high blood pressure matters, what is too high and too low for blood pressure, how do you take blood pressure, medication adherence, nutrition, physical activity, stress management, and sleep."
The community health workers lead patient engagement in the blood pressure program, Matathia said. "We helped the community health workers in facilitating conversations by building them motivational interviewing guides and trying to put everything on one page so they could use the guidance as they were working with patients. For every patient who entered the program, they got a blood pressure cuff, the community health workers met with the patients and taught them how to use the cuff, and the community health workers helped to collect the readings. For each patient doing blood pressure monitoring, community health workers distilled those numbers down to a single value, and they could escalate to the primary care provider and the care team if there was a need for medication changes."
The blood pressure program was launched seven months ago, and so far, the results are promising, she said. "As we have been following our blood pressure control month-to-month, we have seen a 4.8% improvement in blood pressure control in our Black patient population, a 6.4% improvement in our Hispanic patient population, and 4.2% improvement in our non-English speaking population."
While there are challenges in the program such as carving out time for primary care providers to participate in the effort, progress is being made, Matathia said. "These types of initiatives can move the needle in real time, and community health workers are uniquely poised to help bridge the gaps for patients who are not as well served by traditional population health strategies."