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A smart administrator knows that taking the pulse of her practice is vital to heading off bad attitudes and cranky docs.
It's maddening. It's exhausting. And it's only getting worse. Healthcare reform initiatives, reimbursement cuts, and economic angst are contributing to a spike in physician stress levels across all specialties. A 2011 survey by Physician Wellness Services and Cejka Search, in fact, found more than 80 percent of U.S.-based physicians are moderately to severely stressed or burned-out on a given day. Another two-thirds say their stress level has increased moderately to dramatically in the past three years, yet only 15 percent say their organizations are doing anything to help them deal with workplace pressure more effectively.
That's a recipe for disaster, says Liz Ferron, a senior consultant for Physician Wellness Services, a company that helps practices create a healthier work environment. "We really encourage organizations to look at physicians as a precious resource," she says. "Consider the unique pressures they are under today, the time they take away from their families to do good work, and their level of education and expertise. We need to be asking what they need and what we can do to help."
It's not just the providers who suffer; the drive to deliver more care in less time has been linked to lower patient satisfaction scores and higher incidence of diagnostic errors. While you can't hope to eliminate stress factors for your physicians entirely, there's plenty you can do to soften the blow. From taking busy work off physicians' plates to scheduling for better work-life balance to providing support mechanisms to help them cope, a culture of compassion can prevent everyday stress from becoming a personal crisis.
Prolonged exposure to workplace stress can result in emotional exhaustion, loss of empathy, depression, and a diminished sense of personal accomplishment. It can also manifest in physical symptoms such as lower back pain, headaches, and high blood pressure. When you see such symptoms on display, says Linda Stiles, administrator for Pacifica Institute of Cosmetic and Reconstructive Surgery in Camarillo, Calif., intervene without delay. "Sit down and talk openly with your physicians about what you've observed and what changes you can make, if any, to alleviate the problem," she says. If the source of stress is related to work flow, ask them to brainstorm solutions and solve the problem together.
"Maybe they're doing more than they should have to be doing because someone else is not picking up the slack," says Donna Knapp, a consultant with Medical Group Management Association Health Care Consulting Group. "If your medical assistant isn't rooming patients quickly enough, for example, the doctor may start rooming them to get their day done. That's something they shouldn't have to do."
If a physician's source of angst is external, on the other hand, such as a family illness or pending divorce, you might instead refer that provider to an employee wellness program, offered by many private consultants, health insurance plans, and local hospitals. Your medical society may also offer seminars on coping skills and resilience techniques including mindfulness meditation. "You have to be an advocate for your physicians and your staff," says Stiles.
Just be sure that any relief initiatives you enact are supportive in nature. It should never be punitive, says Ferron. Except under the most extreme circumstances, demanding that your stressed-out surgeon take time off is typically not the solution. "A heavy-handed approach with this group is not going to work," says Ferron. "It must come from a place of support. Tell them that the work they do for your practice is so valuable that you want to have a lasting relationship and also create a culture of safety. Ask what you can do as the manager to help them maintain a positive relationship with their patients, staff, and people around them."
Walk the talk
A proactive stance is equally important in mitigating the effects of stress on your practice. Make it clear to everyone on your staff that their health and well-being is a top priority, and check in often - even informally over a cup of coffee - to take the pulse of your providers, says Knapp. Physician satisfaction surveys can also yield valuable feedback, especially when used to zero in on one topic at a time - tools and equipment, work flow, administrative response time, or office culture. But some of the best ideas for alleviating unnecessary and redundant workload come from observing your physicians "in the field," says Knapp. "Shadow your physicians for an entire day so you can see what their frustrations are and if there's anything you can resolve," she says. "That gives administrators a 30,000-foot view of what they're going through so you're not in an administrative silo." You may spot opportunities to streamline processes during patient visits, including prepping rooms in advance with the right equipment, ensuring the reports physicians need are in the patient's chart before the visit begins, and delegating tasks that do not require a medical degree to midlevel providers. There may also be ways to cooperate more efficiently with other hospitals and local practices that makes providers' days less complicated.
Scheduling is another perennial headache for doctors. In the Physician Wellness Services survey, one-third of respondents indicated that better work hours, less on-call time, and better work-life balance would help to reduce their stress. For many, that means flexible hours or a permanent part-time schedule. If that's unrealistic for your practice, however, you can still ensure physicians' weekly schedules don't set them up to fail. "Check the master schedule to make sure your physicians have enough time for each patient so they're not constantly late to the next patient," says Knapp. "Dive deeper to determine how much time individual doctors need for patient visits. Some like 15 minutes or 20 minutes, while others need 30."
The front desk also should reinforce the importance of being on time to patients, putting out reminder calls a day or two in advance to minimize no-shows, and educating those who come in late that keeping appointment times is critical, Knapp says. "Patients sometimes think that every doctor in the world runs late so why show up on time, but once they start seeing that you operate on time, and you reeducate them, your practice will run more smoothly," she says.
Finally, keep your physicians well-informed of any changes to their daily routine. "They don't like surprises," says Knapp. "Communicate everything pertinent to their day so it can flow without disruption." Let them know ahead of time, for example, if they're scheduled to do rounds so they can plan their day accordingly. Or, text them when important test results are in.
Docs: Take time for yourself
Physicians, who notoriously put patients first, should also be encouraged to take time out for themselves. That may include 10-minute breaks in the afternoon to decompress, a daily walk during lunch, or scheduling an hour during the day to hit the gym, says Ferron. Built-in breaks during the day also enable doctors to catch up on professional reading, so they don't have to stay late or drag home literature on the weekends. But if you offer breaks, make sure you applaud those who take advantage of them. "The person not taking breaks can't be viewed as a hero," says Ferron, noting the message must be that skipping breaks is an unhealthy work habit. "I see it all the time in organizations that are talking about wellness, but allow their doctors to go 12 hours without a break. Some administrators would just say, 'That's her style,' but we know that not only is that not good for physicians, it's a huge safety issue for patients."
Finally, be prepared to pinch hit when a midlevel provider calls in sick or your doctors are getting slammed, says Stiles. "I've always seen the role of the administrator as someone who backs up the staff as needed," she says. "If that means I need to sit in a room and chaperone patients, take temperatures when we're busy, or help with billing or the phones, I'll wear any hat." Everyone on staff needs to look for ways to be helpful to their coworkers, and that includes managers, she says.
As production and cost pressures mount for healthcare providers, administrators have increasingly become the last line of defense in deflecting workplace stress, a 2013 report by the National Patient Safety Foundation concludes. "Effective leaders shape safety culture through management practices that demonstrate a priority to safety and compassionately engage the workforce to speak about and report errors, mistakes, and hazards that threaten safety - their own or their patient's," the report states. "To create a safe and supportive work environment, health care organizations must become effective, high-reliability organizations, characterized by continuous learning, improvement, teamwork, and transparency."
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 18 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via firstname.lastname@example.org.
This article originally appeared in the July-August 2013 issue of Physicians Practice.