June 2019 Update: Well-Being Program Actively Addressing Workplace Stress
The Well-Being of our physicians, providers, nurses, and all employees is an important topic of discussion for the UNC School of Medicine and UNC Health Care System, and is the primary focus of the System-Wide Well-Being Program.
In early June, an article published in the New York Times by Dr. Danielle Ofri, a noted physician and author at New York University, highlighted the personal sacrifices health care professionals make to ensure their patients continue to receive high-quality care in spite of ever-increasing workplace demands and administrative burdens.
Dr. Ofri poignantly describes the growing pressures on physicians and nurses to see more patients each day as well as the extensive time spent documenting in the EHR. The combination results in many providers being forced to engage in “pajama time” (time spent completing EHR tasks in the evenings or other off- hours).
In addition, these administrative burdens creep-in to academic time, which decreases research productivity and time spent teaching. These significant administrative burdens cause burnout and distress for the provider and potentially worse outcomes for patients.
UNC has taken a serious stance against physician burnout that began with formally adopting the Quadruple Aim in 2016 and the subsequent creation in July 2018 of the System-Wide Well-Being Program. An initial first step of this program has been to measure the stress of our workforce to identify the areas that are most distressed and develop targeted interventions.
Over the past year, we have invited all faculty, employees and learners across the School of Medicine and Health System to sign up for the Well-Being Index to track their workplace stress levels. We have begun to prepare reports and disseminate the information to leadership, which is informing intervention efforts.
Please see below for a detailed account of the interventions and initiatives underway to address physician, provider and employee stress and burnout.
Identifying and providing resources to providers with high rates of after-hours Epic@UNC use (pajama time)
As of Monday, June 10, we are working with ISD to develop a new initiative focused on identifying and providing resources to clinic providers with a higher than average time spent in Epic@UNC after scheduled clinic hours. These resources will include a number of different elements (at-the-elbow coaching and consults for EMR personalization and optimization, assessment of work-flow related issues, clinic staffing and scheduling, etc.). We welcome your suggestions on additional resources that we can provide.
Distribution of Well-Being Index (WBI) data to leadership to promote awareness, facilitate increase in resources, and guide decisions that may impact well-being
The Well-Being Program team members are gathering data, measuring indicators of stress, and distributing reports to leadership so that we can identify the areas that are most stressed and aggressively follow up in real time with appropriate interventions to those who need it.
Human Factors Engineering Care Re-Design projects
The Division of Health Care Engineering (DHE) is leading an innovative program using a human factors engineering approach to identify work-related processes that can lead to frustration and contribute to burnout.
Their 2018 work with the Hospitalists at UNC Medical Center and UNC REX was highly successful and is now expanding to include Cardiology and Oncology at UNC Medical Center and REX while follow-through on action items from the hospitalist pilots continue.
Improvements in Laboratory Services at UNC Medical Center
During the care redesign project with the UNC Medical Center hospitalist group, we learned that certain processes involving laboratory services required change to improve efficiency and decrease frustrations. This is being actively addressed with the following improvements now in place:
- “Timed” Priority Lab Orders in Epic@UNC for Inpatients
- Beginning April 15, a limited set of laboratory tests were orderable in Epic with a “Timed” Priority for inpatients
- This did not require changes by Providers in ordering laboratory tests and had no effect on whether an order is “Lab Collect” or “Unit Collect”
- Lab worked with the Epic@UNC Beaker and Orders teams to build limits on laboratory orders that were given a “Timed” Priority
- Lab worked with Pharmacy and Physician/Nursing leadership to agree on the set of laboratory tests with a “Timed” Priority to be collected by Phlebotomy Services
- Phlebotomy Staffing
- Three Phlebotomy Coordinators were approved for hire to facilitate deployment of Phlebotomists during peak draw times,
- Morning Draw coordinator has been working for ~ 1 month and this has led to earlier completion of Morning Draw and better draw times in the afternoon.
- Two of 3 hired and one more will be starting at the end of the month to cover mornings, evenings and weekend shifts.
- Phlebotomy Morning Draw Workflow Changes
- Beginning April 29 Phlebotomy instituted a new workflow for the Morning Draw
- An Epic@UNC report is run just after 0300 showing all laboratory orders in the system at that time
- Phlebotomy supervisory staff use this report to assign patients for phlebotomists to collect on a Morning Draw “first sweep”
- Phlebotomists then go to the floors to draw only these patients
- “Lab Collect” orders put in after the 0300 Epic report is run are drawn by Phlebotomy only after the Morning Draw “first sweep” is completed (except for Blood Cultures, which Phlebotomy continues to collect within 1 hour of Order/Start Time)
Ongoing partnerships and enhancements with ISD
To support the system-wide Well-Being initiative, ISD has established a strong, collaborative partnership with the integrated Well-Being Program. ISD has strategically aligned teams to prioritize well-being and efficiency of practice:
- More than 350 providers have received personalized coaching consults through a successful collaboration with ISD, PQI and FP to successfully surpass the ISD FY19 Provider Well-Being Organization Goal
- Well-Being and Efficiency was a project objective for the Epic@UNC Upgrade in April 2019. ISD has resolved ~1000 incidents and incident volumes are well below the previous upgrade. Going forward, Epic’s new quarterly update process allows for a shorter wait time for new and exciting features
- Support of data-driven insight: Teams are working to leverage Epic’s Signal provider efficiency data, Epic@UNC Slicer Dicer and Arch Collaborative Survey Results for powerful and actionable data exploration
- ISD plans to continue to participate and contribute to the system-wide Well-Being initiatives. We are working alongside other system well-being teams to plan for future initiatives that can have a positive impact on well-being.
UNC Faculty Physicians Embedded Epic@UNC Professionals
The Embedded Epic@UNC Professionals (EEPs) are currently providing at-the-elbow support across UNC Medical Center for providers and clinicians to improve efficiency and decrease time in Epic@UNC through customized training, workflow development, and specialty specific projects.
The EEP program is actively working to expand to embed EEPs in every specialty at the UNC Medical Center in an effort to help increase provider satisfaction and decrease burnout.
Team-Based Care and Documentation
In an effort to better serve our patients and care teams, UNC is developing a Patient Centered Care Model, with rollout planned over the next two years. This model improves workflows from scheduling to patient care and post-visit care.
Providers working in clinic will be assigned increased clinical support staff who are trained in team documentation and addressing quality measures. By creating systems to allow staff to work at the top of their licenses, our physicians will spend far less time after hours completing their clinic documentation. Furthermore, while they are taking care of patients, they will be able to shift from computer time to greater interaction with patients.
Physicians working in this model report increased satisfaction with their job, a return to joy in practice, and far less time spent finishing their clinic documentation late into the evening.
Emotional Support Program
The Integrated Emotional Support Program connects healthcare professionals with emotional support resources, with a specialized focus on providing resources after adverse patient events, and unexpected patient outcomes.
The program has also started a new initiative focused on workplace safety to proactively reach out to faculty and staff who have been verbally or physically assaulted by patients and visitors.
Available resources include:
- The Employee Assistance Program provides free visits to counselors in the community as well as workshops on topics related to well-being.
- The Critical Incident Stress Management Team provides trained group-focused and individual support to health care professionals experiencing critical incident-related stress after a traumatic event.
- UNC’s Peer Support Program provides one on one support after events related to patient care or interactions.
- The Taking Care of Our Own Program is designed to address burnout syndrome and other mental health concerns in attending and resident physicians and is a highly utilized program.
If you would like to learn more, contact the Integrated Emotional Support Program Coordinator, Jenny Tauber, by phone at 919.966.5479 or by email at Jennifer_Tauber@med.unc.edu.
Expansion of School of Medicine Wellness Committee to include representatives from all Departments
This year, the School of Medicine has launched a new Well-Being Committee to liaise with and complement the System-Wide Well-Being Programs efforts and ensure representation across all SOM Clinical and Basic science departments.
The Committee, chaired by Dr. Tim Farrell, Professor of Surgery, will support efforts to communicate effective interventions, disseminate well-being metrics, and champion a culture of well-being across the School of Medicine.
The School of Medicine Well-Being Committee is formalizing an organizational structure comprised of three sub-committees – research faculty, clinical faculty, and scholarship, chaired by Drs. Ilona Jaspers, Deanna Sasaki-Adams, and Susie Martinelli, respectively - and an executive committee.
The aim is to have 100% representation from each of the School of Medicine’s departments to ensure efforts are responsive to the well-being needs of the faculty at large and complementary to efforts at the system level. To find out who from your department is involved, or to volunteer, please contact Lauren Westervelt (firstname.lastname@example.org).
A toolkit of best practices that can be tailored as appropriate to meet the specific needs of individual teams at each entity is currently under development.
If you would like to be a participant in this effort by contributing ideas and disseminating information to help adopt and share best practices across the system to enhance work culture and relations, contact the Well-Being team today!
Share your ideas and feedback
In summary, the complexity of health care delivery requires ongoing vigilance of the Well-Being of all physicians, nurses, and staff involved in delivering patient care and performing our other vital missions of research and teaching.
The System Well-Being Program is committed to working together to make things better. Please email us with questions or suggestions at WellBeing@unchealth.unc.edu.