Value Based Care: Stewardship of Clinician Time & Energy

Scott Newton, DNP, RN, MHA, EMT-P, Vice President of Care Model Solutions at TeleTracking—and a patient flow expert with more than 25 years of clinical experience—shared his thoughts on this topic during a webinar on April 18.  The following is a recap, along with questions that were submitted from audience members.

Today’s caregivers—and consequently patients—face challenges that can result in long waits for care. For example:

• 20 million unnecessary patient days—while instead an additional 3-5 million patients could be served.
• 37,000 deaths correlated with ED boarding annually—while there is $100 billion in operational inefficiency.
• 9 million patients leave without being seen each year—while 39% of hospital beds remain unoccupied.

To address these types of issues, it’s critical to have sufficient people, processes and tools interacting and providing consistent, reliable and sustainable outcomes.  And that’s also why value based care is essential—since it leads to better individual care, better population health, and lower costs.

Regarding the people piece, we know we are facing a decreasing healthcare workforce.  By 2025 we are looking at a nursing shortage as large as anything we’ve experienced in the United States.  In addition, the demand for physicians will exceed supply by a range of 61,700 to 94,700 patients.  At the same time, this reduced number of physicians will be looking at treating an increased number of patients—according to the United Nations, the world’s population is expected to increase by one billion people by 2025 and of that billion, 300 million will be people aged 65 or older.

With this increasing demand, we need to be judicious with the two resources clinicians have to contribute— time and energy.  There needs to be a way to effectively and efficiently balance their cognitive workload—clinical practice, assessment and re-evaluation of patients, and therapeutic communication, with their operational task load—regulatory tasks, equipment sourcing and literally walking miles each day across units.  Keep in mind, it’s gotten to the point where physicians spend just 27% of their workday with patients.

So how do we give time back to caregivers and let them fulfill their mission?

• We need to let experts be experts—they should be working on the right tasks and off-loading the others.
• We have to drive clinicians and staff to do the highest value work in the process chain. They need to be focused on doing impactful work that has the highest value—while abandoning the tasks that don’t support or produce outcomes.
• We need to provide them with the tools that provide them with continuous and contextual awareness—meaningful messages that are timely and relevant, and reduce information overload.

When we do those things, the positive impact is remarkable:

• Staff satisfaction—both from a retention and recruitment perspective—as well as an improved work experience, enhanced patient time and reduced physical and mental fatigue.
• Improved patient flow—and an impact on population health—which improves access to care, decreases boarding time and reduces hand-off variability issues.
• Improved patient experience—both from an engagement and safety perspective—which reduces wait time and frustration, the risk of errors and hospital acquired conditions, and the chance of fragmented care occurring.

Thank you to everyone who submitted questions after the webinar. We’re happy to answer them here.

How does Value-based Work improve the care environment?

• The care environment is challenging with constant parallel and sequential workflows. Blending clinical expertise with routine tasks often leaves our clinicians with little time for critical thinking. Patients are increasingly presenting to us with complex care issues that require focus and careful consideration. As patient volumes increase, along with clinical complexity, our clinician time and cognitive abilities become more quickly consumed. When we offload non-clinical tasks, route operations, and provide meaningful guidance through cognitively consumable decision support, the burden on caregivers is reduced. When the burden is reduced, patient / clinician interaction is enhanced—in both quality and time. Clinicians report improved satisfaction in work, and burnout is reduced. Overall, the work environment becomes more effective, sustainable and scalable to meet the community’s demand for care through a more fulfilled workforce.

We are all challenged with “doing more, with less”, how do we balance workloads best for our clinicians?

• There is no doubt that workloads within healthcare have been increasing for quite some time, and that clinicians are facing competing demands on their time. First, we need to acknowledge the need for patient / clinician interactions in order to provide high-quality care. Focusing on the high-value clinical practice actions of clinicians, while reducing non-clinical regulatory and logistical activities is foundational. Our clinician workloads should be re-tooled to reduce fatigue, distraction and multi-tasking by defining standard clinical workflows. Then moving non-standard, non-clinical work to operational logistics experts in care delivery. These operational experts provide the highly reliable systems that enable care to be provided by assuring patients, processes and tools are choreographed to be available when and where needed. A proactive approach is much more efficient, than ad hoc problem solving across a system of care. Overall, more will be done with less by placing a focus on the purposeful use of time and energy.

Tell us more about the impact of clinician time and energy stewardship. 

• The impact of clinician time and energy stewardship is going to affect three general areas: staff satisfaction, patient flow, and patient experience. Clinician’s report improved ability to deliver care when they have ample time with patients, are not overloaded with non-clinical tasks, and are able to affect an outcome. When clinicians are able to focus on highest value work through prioritized messaging and closed loop communications the quality and pace of work can be enhanced. Over the next several years the demand for care will continue to grow as we endure a shortage of qualified clinicians. Stewardship of clinician time will allow for the preservation of this scarce resource and apply it where needed to improve care for patients.