Burnout Reductions Work If Designs Shape More and Better Team Members
Do you ever get the feeling in health care that those who do the care and caring are getting the short end of the stick? COVID has magnified this problem, but the roots of this go far deeper and over many decades. The Surgeon General has posted some impressive documents regarding health care worker burnout at Health Worker Burnout . Medical Economics posted 11 points that were specific to Local and Tribal Governments. This became my framework for discussion of each point.
Note that the rest of the document does address key areas regarding team members and their worsening situations - worth a review. Most of all I hope that you will see that no intervention can work to help the basic health access team members unless the design shapes more and better team members. And for the returning readers, I continually point out how the health care design in so many ways shapes fewer and lesser
SG Point 1. Invest in Evidence Based Practices, Plans, and Partnerships that ensure the health, safety, and well-being of health workers
There is a great and growing need to invest in health care delivery teams - period. IN my recent posts I have been hard on health care leaders.
Leaders in health care who are mindful, selfless, and compassionate can shape this in their employees - especially those who deliver the care. But the employers and those above that shape designs - abuse delivery team members. They are not mindful, selfless, or compassionate.
Lawmakers and health care leaders of the 1960s and 1970s did initiate new funding and this is the one time that funding supported more and better team members in the half of the population most behind - but policies since 1980 are all a tie for last place.
The heart of health care and caring is the innovation that must occur between delivery team members and patients. There is little doubt that this requires more and better delivery team members. Remember that health care budgets are mostly about personnel. If you short change finances or add more to do or reduce the time to do it, you cause harm to team members. Our designs since 1983 have done all of the harms while adding little support.
Higher functioning, patient centered, and better process all require more and better delivery team members - and are denied by design. This is most evident in half the US population with half enough primary care and even lower levels of delivery team members.
The embarrassingly small health care investments in Native American reservations (to put it mildly) are made worse by high levels of Medicaid contributions - arguably the worst quality health plans of all.
Counties with concentrations of Native American, African American, and Border Hispanic populations have long had some of the worst health care designs but 2621 counties lowest in health care workforce share many of the problems and include these minority dominant counties.
2. Alignment must be across federal, state, local, and employer investments and efforts as outlined in the Equitable Long term Recovery and Resilience Plan
With regard to health care for tribes and for most Americans, our designs need to double primary care spending. This must be specific to most Americans with half enough. Since team members are even further behind, we need to more than double delivery team members to best serve these complex and neglected populations.
Navigators, consultants, scribes, community organizers, prevention, maternal child, transportation, and many other areas need help. Sadly all of these various higher functions are being thrust upon fewer and lesser delivery team members by the abusive and out of touch health care plans in these counties. How can you hire more, with less funding? They never consider this when they make design suggestions.
Stop new plans and actually resolve deficits, access barriers, and impairments to care that impact most Americans before care, during care, and after care - as well as preventing care at all.
3. Prevention of violence in the workplace
...requires investments in the Americans most behind and also their health care workforce so that they can trust health care workforce like they have in the past. Once again, more and better team members and resolution of deficits will improve access and timeliness and continuity and more. More and better team members could help prevent issues and would mean more support when team members need help.
4. Support various resilience and burnout plans
Health care workers are tired of fragmentation, surveys, reports, acronyms, and new training areas to fill out or report. Please listen to them. They need less to do, more time to do it, and more team members to do the work.
Leaders must try to be aware of the daily life and work of those that deliver the care. They are so out of touch.
This graphic is from Mayo Clinical Proceedings prior to COVID. Intent to leave or reduce hours were used as proxies for burnout. See the generalists, general specialists, and front line access team members in the Red Zone. You can bet that this survey if done where there are half enough generalists and general specialists for half the nation would likely be more red shifted.
5. Develop and invest in reimbursement models with the goals of high-quality person-centered care, including prevention and coordination
What better justification is needed for more and better delivery team members who can do the higher functions, patient-centered, or whatever new term is being popularized. More and better is a constant. Terms imply some focus that usually ignores the fact that
Do not forget that 45% of complexity inherently is found in 40% of the population in 2621 counties lowest in health care with 25% of the primary care workforce supported inadequately with less than 20% of health spending on primary care - minus costs of inflation not covered by increases - minus costs of new types of micromanagements since 2008 - minus higher costs of turnover and disruptions - minus lower productivity and lesser revenue due to designs that abuse team members.
You can see the complexity packed into these counties in many dimensions.
6. Build on and evaluate the impact of investments such as the Dr. Lorna Breen Health Care Provider Protection Act of 2022.
How Can We Protect Health Care Team Members when half of the population does not have decent basic health access and promise after promise has not been kept for decades?
We need to skip the political ads and the thoughts and prayers. We must DO something about the support of the team members
7. Examine state health professional licensing board questions regarding working conditions
If you want changes in the process of disciplining
a. Why not discipline health plans - terminate the health plans that are abusive - too many to mention, be sure to start investigations in other states when a plan is terminated in another state. Fair is fair for physicians as well as health plans. Set up a database to track those falling short consistently. States have the ability to force health plans to address complaints and could ramp up this area. But of course states are not known for taking on the most powerful and those that contribute heavily to politician coffers as seen in New Jersey. Health plans continue to promise what they cannot deliver, such as better costs and better quality.
b. Why not discipline health care employers? If a physician applies for recertification, why not realize that the ability of the physician can be limited by their employer. If the employer is not supportive or creates a bad environment, the board could say that they certify the physician but cannot certify their employment. Only when health care employers lose what they treasure - profits - will they stop their abuses.
c. Why not discipline academics and investigate a number of false promises that they make about being able to solve shortages of workforce or other problems? Terminate their ability to train when they train too many too fast and despite marginal curricula and faculty abuses. Force Deans to produce evidence that their schools or training programs have actually increased primary care or general specialists in state counties lowest in health care workforce. There are plenty given 2621 nationwide. This is a loaded question since not even the best pipelines in Nebraska and Kansas have resulted in improved levels. The studies demonstrate 10 - 12 times greater odds ratios of locating a pipeline graduate in one of 70 counties of need in Nebraska, but the levels of primary care remain at the same level far below the 90 per 100,000 recommended by HRSA.
领英推荐
Rearranging the deck chairs is not resolution of deficits. Primary care retention levels for MD DO NP and PA sources continue to plummet. What good is producing more if declines in retention negate any expansion?
Massive expansions over decades of class years reveal the truth of the inability of training interventions to solve basic health access woes.
d. change board certification such that sites that are causing problems are assessed just as much as the candidates. That way the problem sites are exposed and no board certified health professionals can practice there.
What recourse do health care team members have if two or three dominant local health systems are colluding to pay them less with less benefits and lower quality health care plans? Board certification may not be the choice. Perhaps accreditation bodies need to do this work. Since their quality focus has not improved quality, maybe they should focus back on better ratios, better process, more and better delivery teams, and less abusive situations.
When employers throw nurses under the bus for what turns out as systemic errors, there are no real protections at all as we found out.
And by the way, perhaps some responsibility should be indicated for the academics who pump out more and more with less and less experience - due to massive overexpansions.
8. Increase Access to Quality Confidential Mental Health for all health workers
If you shift health care dollars away from procedural, technical, most concentrated to pay more for primary care, mental health, and other front line most abused areas
a. you may not need as much mental health for employees
b. you can recruit and retain better employees
c. health care workforce most abused that have been reduced to half enough for half of the nation - might actually be able to access mental health
Does CMS know that it is the major cause of mental health access problems? Do those who lead CMS understand that past CMS leaders have caused this? Until CMS Behavioral Leaders understand this, then they will expect more and get less - because of the basic health access deficits of the CMS design and its great influence upon Medicaid and private plans across the nation.
CMS Leaders Must Help Mental Health Care By Reversing CMS Designs
9. Recruit, expand, and retain a diverse health care workforce
Enough of the diversity already. Witness academic medicine promises for decades. When medical school graduates were doubled 1965 to 1980, there were claims of improvements in diversity. Of course there was no doubling of underrepresented minorities, increases yes and small, but nothing major.
No small minority is abused in America. The majority of the American public is behind and this gets worse year after year across health care, education, economics, and more. Pay attention to the portions of the US most behind lowest and middle in workforce concentrations that are growing fastest - while their remaining health care is most compromised. Meanwhile for decade the financial design continues to increase workforce, health care dollars, and health care costs in counties top and higher in concentrations that are growing slowly or not at all.
More for fewer and less for most - is the dominant health care design.
Rural or minority populations most behind - are a part of a majority left behind. https://www.dhirubhai.net/pulse/rural-patient-difficulties-likely-experiences-most-americans-bowman/
10. Address societal contributions to health to improve patient outcomes and decrease demand on health workers and health systems.
Good luck with addressing social determinant and other non-clinical factors that not only shape health care outcomes, they shape education, economics, and other outcomes.
Pop Healthcare (like Pop Music. like micromanagement bandwagon) reins in the marketing, advertisements, promotions, and health care literature. Like in music, overpromotion is the key. Innovation matters and sells via more interest, even though the substance is lacking and cannot be sustained. There is no other explanation for the continued focus on micromanagement which has long been demonstrated as ineffective in cutting costs or improving quality.
So for the best help for team members and burnout, you can recommend termination for value based, pay for performance, and other micromanagements that have limited if any ability to change outcomes.
Instead the micromanagers want to measure and expand social determinant focus. So they embrace whatever Pop Health
Non-clinical drivers and performance based - are not compatible with each other. They are compatible with
1. higher costs for practices
2. distortion of budgets away from team members
3. more burdens and complexities for team members, particularly when new wrinkles add new duties for team members in small or medium size practices or hospitals that cannot afford new divisions or a separate person to do these.
4. lower productivity of team members and lowering of revenue.
5. penalties and even lower payments to providers already paid lowest who serve patients with inherently lower outcomes that will require generations of consistent investment to change them generation to generation.
Stop short term thinking about outcomes.
11. Resilience and disaster preparation - The best response to COVID and other emergencies is a better American people. Health literacy, education, social development and so many more areas shape resilience, better behaviors, and better outcomes.
If you want to avoid crippling isolation and compromises of our economy and schools - it takes a very health literate population.
Sadly so much overspent on military, health care, prisons, and debt defeat these investments
People investments and investments in the people that innovate with each student, patient, or client - are blown away at all levels.
So this is about American burnout. Until we stop burning out Americans we will continue to burn out our serving human infrastructure (teachers, nurses, public servants). We have also burned out our physical infrastructure. The spiritual infrastructure is being stretched and exhausted in these and other ways.
Nations are about their people, their servants, and their beliefs. With deficits in these areas - you can bet those with not so lofty goals will manipulate and worse.