WK3Assgn Hampton M - week 3 assignment PDF

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National Healthcare Issue/Stressor

Mary Hampton 9/11/20 Walden University NURS – 6053 Interprofessional Organizational and Systems Leadership Dr. Bernadette M. Pollard National Healthcare Issue/Stressor

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National Healthcare Issue/Stressor National Healthcare Issue/Stressor Health care provider work life is a national healthcare issue that impacts many aspects of an organization. With patient experience and satisfaction at the forefront of the health care industry, the work life of health care providers is not often taken into consideration. This needs to change. Physicians and other members of the health care workforce report widespread burnout and dissatisfaction (Bodenheimer & Sinsky, 2014). A great opportunity is being missed by overlooking this aspect of the Quadruple Aim. The purpose of this paper is to address the importance of health care provider work life and the impact that is has on the organization. Each year, this organization requires all employees to participate in an “Employee Engagement Survey”. This is an attempt to gain input from the employees and institute a change based off of the information collected. However, based on the results of the survey from 20152019, there are still areas that have yet to be addressed. I identified three issues that were common among many health care providers of this organization: not feeling supported by management, feeling overwhelmed on a daily basis, pay is not competitive. These three issues were the most recurrent issues from 2015-2019. For the last four years, health care providers at this organization feel unsupported, overwhelmed, and undervalued. Small initiatives have been made to attempt to address these employee concerns; however, they continue to dominate the employee engagement survey for four years in a row. I feel that if measures aren’t taken to improve the work life of the health care providers of this organization, they will seek employment elsewhere. The average staff turnover rate at this facility over the last five years is 27%.

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National Healthcare Issue/Stressor All measures of the Quadruple Aim are intertwined with one another and each measure impacts each other measure. Cost impacts access, which affects patient experience, that impacts health care professional’s work life, and so on and so forth. Patient satisfaction is much lower in institutions where many nurses feel burned out and dissatisfied with their work conditions than in other institutions (Mchugh, et al., 2011). Also, there is a shortage of primary care providers in the United States. This puts increased pressure on existing providers to see more patients in less time, which negatively affects patient experience and population health by limiting access to health care. Physician and care team burnout may contribute to overuse of resources and thereby increased costs of care (Kushnir et al., 2013). A cross-sectional study of electronic survey data collected in May 2016 from 10,627 healthcare workers across 440 work settings within seven entities of a large academic health system on the east coast of the USA found that healthcare professionals commonly subjugate personal needs for their work and these sacrifices can make maintaining healthy work-life integration (WLI) challenging (Schwartz et al., 2018). The health system in which this survey was conducted is now focusing on improving teamwork, safety, and burnout by targeting WLI behaviors with the intended result being a change in culture. Improving WLI is likely to improve healthcare worker’s quality of life, organizational outcomes and, ultimately, quality of care for patients (Schwartz et al., 2018). Professional burnout is characterized by loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment and is associated with early retirement, alcohol use, and suicidal ideation. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim (Bodenheimer

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National Healthcare Issue/Stressor & Sinsky, 2014). In this article, the authors identified several ways to address the issue of poor employee work life that include: 

Implementing team documentation to allow other members of the health care team other than the physician to assist with order entry.

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Expand nursing roles to assume responsibility of patient care under physician written standing orders

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Ensure that new staff members are trained well

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Remove unnecessary work from the practice.

By utilizing the strategies identified in the previous two articles that I summarized, this organization has the potential to improve the work life of health care providers that it employs, combat burnout, and become much closer to attaining the Quadruple Aim. Negative potential impacts from implementing the aforementioned changes include increased liability for nursing staff for entering physician’s orders and higher initial financial burden for additional staff training during onboarding. Summary Addressing and improving the issue of poor health care provider work life in this organization will positively impact every facet of the organization and result in better patient satisfaction scores, improved quality of care, and better patient outcomes. All off these positive changes would come to fruition by taking into consideration the suggestions made by employees on the annual “Employee Engagement” survey. I believe that if changes are made to improve

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National Healthcare Issue/Stressor health care worker work life, the common issues of: not feeling supported by management, feeling overwhelmed on a daily basis, and low pay would potentially no longer be an issue for the first time in five years. Competing Needs Impacting Poor Health Care Provider Work Life When EHRs were first introduced, they were touted as a way to streamline workflows and reduce the clerical burden on physicians. In this respect, however, EHRs have had the opposite effect of creating more work (Reith, 2018). In a retrospective cohort study of 142 physicians it was noted that Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (Arndt et al., 2017). This organization currently has a policy in place for Health Information Management (HIM) that addresses the use of a scribe for physician EHR documentation. If a scribe were to be utilized in the Emergency Department (ED) and physician’s documentation suite it would alleviate some of the burden of the EHR on the physicians. Also, nursing staff has access to enter physician’s orders into the EHR, however, under the current organizational policy, a written verbal order form must be completed prior to the nurse entering the order. I feel that this is redundant and increases the workload on both the physician and nurse. If this policy were amended to allow nursing staff to enter orders without using a paper form first, this could assist in reducing time spent in the EHR for physicians. Ethical considerations for amending this policy are the potential for dishonesty by both the physician and nursing staff. A nurse would have the

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National Healthcare Issue/Stressor potential to order things without the physician’s knowledge. Also, the physician would have the ability to deny giving permission for the nurse to enter an order. Health care providers are constantly asked to “do more with less”. This results in increased workloads and higher nurse to patient ratios that contribute to poor health care provider work life. Burnout and poor health care provider work life are associated with increased adverse patient outcomes and decreased patient satisfaction. The finding that burnout and poor wellbeing are both associated with poorer patient safety has significant implications for policymakers and management teams within healthcare settings (Hall et al., 2016). This organization currently has a policy in place with department-specific staffing ratios. However, though the policy exists, it is not adhered to. For example, per the existing policy, staffing ratios for the least acute floor (Med-Surg) are not to exceed 6:1 but it is not uncommon for the actual ratio to be 7:1 or even 8:1. The policy that is currently in place is a corporate policy that is supposed to be adhered to by all facilities within the organization. This facility has hired 450 staff members since January 2020. This indicates a high turnover. Understaffing is a large issue at this facility. Focus needs to be shifted from gaining employees to retaining employees. By adhering to this policy with lower nurse to patient ratios, health care provider work life is improved. This will improve staff retention and improve patient outcomes and satisfaction. No ethical concerns exist with this policy.

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National Healthcare Issue/Stressor

References

Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. The Annals of Family Medicine, 15(5), 419–426. https://doi.org/10.1370/afm.2121

Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine, 12(6), 573-576. doi:10.1370/afm.1713

Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare Staff Wellbeing, Burnout, and Patient Safety: A Systematic Review. Plos One, 11(7). https://doi.org/10.1371/journal.pone.0159015

Kushnir, T., Greenberg, D., Madjar, N., Hadari, I., Yermiahu, Y., & Bachner, Y. G. (2013). Is burnout associated with referral rates among primary care physicians in community clinics? Family Practice, 31(1), 44-50. doi:10.1093/fampra/cmt060

Mchugh, M. D., Kutney-Lee, A., Cimiotti, J. P., Sloane, D. M., & Aiken, L. H. (2011). Nurses’ Widespread Job Dissatisfaction, Burnout, And Frustration With Health Benefits Signal Problems For Patient Care. Health Affairs, 30(2), 202-210. doi:10.1377/hlthaff.2010.0100

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National Healthcare Issue/Stressor Reith, T. P. (2018). Burnout in United States Healthcare Professionals: A Narrative Review. Cureus. doi:10.7759/cureus.3681

Schwartz, S. P., Adair, K. C., Bae, J., Rehder, K. J., Shanafelt, T. D., Profit, J., & Sexton, J. B. (2018). Work-life balance behaviours cluster in work settings and relate to burnout and safety culture: A cross-sectional survey analysis. BMJ Quality & Safety, 28(2), 142-150. doi:10.1136/bmjqs-2018-007933...