THE CARE INTERVENTION SUBCOMMITTEE’S HIGH-PERFORMING PRACTICE STUDY IDENTIFIED SIX KEY ATTRIBUTES OF PRACTICES THAT WERE HIGH-PERFORMERS ON ED AND INPATIENT UTILIZATION. DE-BURDENING PHYSICIANS FROM ROUTINE TASKS THAT CAN BE BETTER AND MORE APPROPRIATELY PERFORMED BY TEAMMATES IN ADMINISTRATIVE AND CLINICAL ROLES WHO ARE WORKING AT THE TOP OF THEIR LICENSES ALLOWS PHYSICIANS TO FOCUS ON CLINICAL DECISION MAKING AND CARE FOR COMPLEX PATIENTS.
According to Shipman and Sinsky, numerous opportunities exist in primary care to substantially expand workforce capacity and improve clinician and patient experience. These opportunities can be grouped into the following categories: teamwork, work flow, technology and policies.
Teamwork: Other staff members could perform tasks that physicians spend on patient care activities outside of patient visits. For example, beyond their roles as flow managers and scribes, team members can help meet patients’ clinical needs more effectively and comprehensively with less use of the physician’s time. For example, medical assistants and nurses can be trained, within limits, to provide routine preventive counseling and to “close” the visit with any additional patient education requirements and verifying patient understanding of their overall care plan.
Work Flow: Redesigning the clinical work flow has the potential to improve clinician experience through the identification of redundant efforts, improving the physical layout of a practice and other factors. Primary care practices that have designed new clinical spaces, for instance, have placed physicians not in private offices but side by side with the rest of the primary care team in “flow stations.” This arrangement facilitates real-time communication and reduces the downtime that can occur when team members cannot locate one another in order to request assistance or
Technology: In time and with feedback from clinicians, the EHR user interface could be improved to reduce the cognitive burden of information input and retrieval, thereby reducing the time required to complete tasks in the electronic record. In addition to the EHR, other technologies (such as email, patient portals and home monitoring devices) may be used to digitally transfer patients’ health data to clinicians, in order to offer physicians a growing range of methods to reduce the need for face-to-face visits with some patients.
Policies: A reexamination of policies at the institutional, state and federal levels could lessen clinician burden in practices. For instance, varied state licensing body interpretations and limitations on non-clinician activities limit the ability to develop and uniformly implement standardized national protocols that might allow non-physician care team members to order routine laboratory studies, such as a fasting cholesterol level, under established protocols. Scope-of practice regulations could be standardized to allow all team members to consistently function at the level appropriate to their training and skills mirror to acknowledge the current state and work for improvement.
From “Reducing Administrative Burden: Refocusing on Patient-Centric Care TMF Health Quality
Institute, R. Kohl, et. al.