Are Hospital Workflows Harming Physician Well-Being?

Webinar

Featuring

Medical Home Network
Sharp Index

Description

Suppose new legislation bans using EMRs forever, effective tomorrow. In this fictional universe, would the challenge of clinician burnout be solved?


Probably not. The problem goes deeper than technology, and the solutions go deeper than software.


Dr. Jay Bhatt, Principal of JDB Strategies and former Chief Medical Officer for the American Hospital Association, focuses on fixing the riff between clinicians and administration.


Dr. Bhatt is a powerful advocate and voice for clinician well-being, and he can speak extensively on coordinating the work and language of clinicians and leadership.


Joining this conversation, long-time friend of the show, Janae Sharp (founder, Sharp Index) discusses data-driven efforts and initiatives to solve these problems.


Dr. Bhatt and Janae’s work has a lasting impact on healthcare, and we’re honored to have them join this discussion.

Jay Bhatt

Dr. Jay Bhatt

Chief Clinical Product Officer & Medical Director
Medical Home Network

Medical Home Network logo
Janae Sharp

Janae Sharp

Founder
Sharp Index 

Sharp Index
Chris Hemphill

Chris Hemphill

VP, Applied AI & Growth
Actium Health

Actium Health
Terry Tuznik

Terry Tuznik

VP Clinical Solutions
Actium Health

Actium Health
1

Transcript

Chris Hemphill: All right everybody. Hello healthcare, hello LinkedIn and hello YouTube. Hello whatever avenue you’re coming from. We’re live and we’re extremely eager to have this conversation with you today. One thing that we like to emphasize is that, when it comes to things like physician burnout, clinician wellbeing, every issue that we’ve touched on on this show is an ongoing conversation. When somebody comes in and promises to transform healthcare, my next question is well you can transform, but by what percent? What’s the incremental progress that you can bring to the table? You can’t do everything in one day, or you can’t completely turn around a three plus trillion dollar system, but whatever input, we love the audience that we have here, the mix between people on the IT side, the patient engagement side, the strategy side, because it allows us to, for some time in the week, take all the barriers down. We invite conversation, questions, stories, have an active conversation with this panel that we’ve brought together today. This panel, you’re right here with us and we’re excited to be talking with you about this subject. We’ve had Janae Sharp on before who heads up the Sharp Index, which is a big data collection effort and rewards effort to help organizations understand what to do to address challenges around physician wellbeing and physician burnout. Terry Tuznik, she’s a wonderful co-host. The title is about physician wellbeing, but there’s a broader conversation and future conversation to be had about other aspects of the clinical sphere. Terry, along with bringing the informatics background that she has at SymphonyRM and working within health systems, also has a nursing background as well and she’s also serving on the front lines right now assisting with vaccine delivery, so a welcome addition to the board. New to this panel is Dr. Jay Bhatt. He’s been a fantastic advocate for physician wellbeing. He’s been fantastic at getting the conversation out there and helping to reframe it in an area where we’re looking at going towards physician wellbeing rather than specifically avoiding the problem of physician burnout. There’s different modes of thinking, there’s a broad organizational context that he brings to the table as well. He was formally the chief medical officer of the American Hospital Association and what that helps with is getting a broad administrative and clinical experience that helps to look at physician burnout and wellbeing with empathy towards the challenges that administrators have as well as the challenges towards clinicians have. Nobody on this table, nobody on this call has it easy. I just wanted to welcome everybody to this conversation, invite you to take part in it, share stories, share ideas, share thoughts. I’d love to see that going down in the comments. Dr. Jay, since you’re new, would you like to say a few words introduction and what brought you here today? Dr. Jay Bhatt: Sure. Thanks Chris, really appreciate you having me on. I’m just grateful to have this conversation and glad to be with my wonderful colleagues, Terry and Janae, who are doing just incredible work. This is an issue that’s an ongoing issue. Over the last several years we’ve paid significant attention to it and we’ve made some progress with burnout rates dropping below 50% for the first time. Part of that was concentrated work and effort around the issue and a collective kind of call to action among physicians and other clinicians involved in the delivery system, but I’m concerned that progress is under siege because of the rapid pace of change and uncertainty that we’ve had to endure over the last year plus and will continue to endure. We can certainly talk more about that, but for someone who experienced, my own attack on wellness and burnout and mental health challenges during residency training, this is very personal for me. I’ve really committed because of what I see, how it impacts patients and patient safety and patient’s health, but also how it impacts our colleagues and their lives and how that impacts the team. This has really become an important area of work. We did a lot of work on this during my time at the American Hospital Association. Now I see patients in an underserved community on the south side of Chicago a couple of days a week and I work for Medicaid ACO in a Medicaid managed health plan trying to deliver the best health we can to vulnerable populations and redesign care. Often I’m on ABC as a medical contributor. Chris Hemphill: Thank you for sharing that. We have an agenda that covers some aspects of physician wellbeing, but you brought up a really powerful point, which is stress that you endured under the residency program. I’m curious if you’d feel comfortable talking about any kinds of issues that you observed early on that are kind of fueling the advocacy that you’re bringing to the table today. Dr. Jay Bhatt: I think that when we think about … part of this discussion about reframing the language, I think that’s really important. Physician burnout is well defined in the literature, emotional exhaustion, depersonalization, decreased feelings of personal accomplishment, those are the feelings I had in my residency training. I think that transiently we may feel this, but it’s the sustained feelings of those that really can become dangerous. The question is what does it mean for a physician to be well? That has some data behind it, some of it’s very personal, some of it I think largely system, we work in a system that’s configured to not advance wellness. We’ve gotten better over the last four years and I really applaud the field for that, but I think the notion of physician wellness in my mind is living your best life of fulfillment and … living your best life and having fulfillment and accomplishment. For me, which is not different than I think what we’ve experienced in COVID, I was in the ICU as a resident early on in my training and the fifth patient had died that month. It wasn’t things that we could have done significantly differently to prevent that, these were very sick, unfortunately and had challenges. Each one chips away at your mental health and stress points. Could I have done something differently? Could I have done something better? Could I have made a difference for that patient’s family? There may not be a mom or a grandmother that’s there at your dinner table or a celebratory event. I mean I think COVID-19 has shown us the same. It’s impacted our clinician community and our workforce in a tremendous way. There’s this … we’ve seen in the literature the notion of moral injury, the trauma that each patient’s experience may impact those that care for them. Under the conditions that we have where we’re putting families at risk, colleagues at risk for exposure, extended hours, lack of supplies, confronting a death toll that thankfully is going in a better direction, but there are names and families behind those numbers of people that we’ve lost. It also is connected to people that have cared for them. I think we’re going to see increased anxiety, depression, trauma and burnout and other mental health issues. The thing that made a difference for me that I wish I had done earlier is ask for help. I think we’re conditioned as physicians that we can do this, we can work in extreme circumstances and challenging circumstances in pajamas late into the night to take care of patients and document. I think that we come to an unrealistic condition. I think asking for help, particularly for those folks going through experiences now, is critically important and we’ve got to support our physician and clinician community, all clinicians to ask for help. I think that can go a long way and then support each other in that process. Chris Hemphill: Thank you for sharing that. That does branch off into conversation points, things that people see that have a deep impact at an early age, early into their careers. Thank you for sharing that. I want to address something and then lead into the next point, which is I saw a comment in the feed focused on creating a decentralized healthcare internet. I’d like to make sure that we all understand here that this is not a good platform for self promotional efforts. If there’s any kind of advertisement or links or anything like that you’d like to share, we’re having a very deeply personal conversation here and if there’s any kind of advertising type promotion posts we’d ask that you not share those at this time. We don’t use this as an opportunity to talk about our products and services, we use it as an opportunity to talk about the issues at hand. I would appreciate not including marketing type messages within this, but I do invite you to have a good conversation. Go ahead? Janae Sharp: I was just thinking about … yeah, links are fun, drop them all on every single thing we post, just drop the same link over and over. There’s always that one guy, right? No offense to their product, I’m sure it’s great. I was thinking about what Jay was saying with asking for help and how that impacted me personally, because I remember in residency we talk a lot about burnout, we talk about mental health, but do we really talk about it? Every time we’re off camera … we’re having these very authentic conversations and saying how important mental health is, then you go off camera and you don’t really want to be like, “How are you really doing?” “Well I have a pretty severe depression and I can’t handle it.” You’re like, “Okay, I don’t want to talk to you,” or you don’t want to be the physician that can’t hack it. No-one wants to be the person that can’t hack it. I remember in residency training the conversations are important to have, but there are a lot of people who are saying, “Okay, but you’re just doing that for the touchy-feely bit and it doesn’t actually help me with my real life.” In my personal experience through medical school I saw that from the other side, from the side of a spouse of someone in school. It was like losing someone that you love. It was having someone, like Jay was saying, you’re disconnected. I think we’ve all experienced that in some point in our life when we have less of a connection with people that we care about, or less of a connection with what we’re doing. We say ask for help, but we, I mean I did ask for help, I was like, “This is not okay.” A lot of people would push back, they’d be like, “Well this is what you can expect.” We not only need to ask for help, we need to be able to manage expectations. We can’t tell people just ask for help. Okay, just ask for help. Well they might have asked for help. There is not always help available, especially in mental health. We don’t actually have the infrastructure to support people’s mental health needs, but also, when you do ask for help, you don’t really get help. You get a lot of people being like, “Okay, well you’ll be fine, just figure it out.” Dr. Jay Bhatt: Yeah. I think it’s so variable, Janae, right? It’s different everywhere. I was fortunate enough to have an incredible program director and colleagues and friends and people that supported me, but if there’s not an infrastructure for wellbeing, both formal and informal, then I think folks are left in a really tough place. Janae Sharp: I really … oh sorry, this is something I care about a lot. In mental health we always tell people to ask for help, but it’s not enough. We can’t expect the person who’s depressed or burned out, we can’t put the pressure back on them. If you’re depressed, the last thing you need is more work. I love the idea of asking for help, I think there’s so much hope there, but from a larger perspective, if we have to expect people to ask for help we’ve already failed them. Terry Tuznik: Yeah. Janae Sharp: This is a ranting topic for me it turns out. Terry Tuznik: No, Janae. I totally agree with you. I think it’s both getting through the stigma of it’s okay to ask for help and having clearly checks and balances to check on people and having the infrastructure in place to help them. I have a daughter who’s a nursing student and she said she saw some really traumatic things, especially around some of the COVID cases that she’s worked with. She’s like, “Well the school says ask for help, but when I did they said that’s good, are you okay?” There was no plan or structure to help her. We have to help our clinicians. We have to check on them and we have to have something in place to actually help. Dr. Jay Bhatt: You have to create a culture of wellbeing from the very senior levels of the organization, throughout the organization and that’s sustainable. Janae Sharp: Oh that’s a great point with sustainability, especially during COVID. At the beginning I spoke with Bridget Duffy and she was saying physicians are going to step up, they’re going to give it their best effort, they’re going to perform well in the pandemic, but now it’s been a long time. How sustainable is all of this? Can we keep going? Chris Hemphill: I want to dig into that then. There’s kind of an underlying question, we’re talking about the concept of wellness and wellbeing, but we’re also marrying it with the new reality, okay there was progress and then COVID happened and put demands on people that pushed them beyond their physical limits and capabilities. It also caused them to have to interact in new ways and new modalities. I’m curious, Dr. Jay, if there was a single definition of wellness and … physician wellness and wellbeing that we could all agree upon, how would you describe that? Then how would you describe how COVID-19 has had an impact? Dr. Jay Bhatt: I would say, to your point about progress, burnout rates dropped below 50% for the first time since 2011. That’s a pretty remarkable pace of change from the mid-50s and going at a good trajectory now. There isn’t, I think, a great definition in the literature about wellness, but this is a conversation that we had at the National Academy on clinician resilience and wellbeing action collaborative about what does it mean to have wellness. I think there’s a lot of different ways people may describe it, but I would say for me I’d define it as having, being able to live your best life with a sense of fulfillment, with professional and personal fulfillment. If being well means having a balance between work and personal life a physician may not achieve this, but I think that’s just one part of it. I think wellness is working in a system that has a culture of wellbeing that is sustainable, like we just talked about. I’ve seen, through some of the programs we’ve done, incredible transformations people have had. Part of what was holding them back was aligning with stories that were just that, they were stories that developed from programming and default settings when they were six to 16 to 20 and carried that through their time. For me, I would say that my achievement model was work hard. If I don’t succeed, work even harder. At some point that doesn’t work. It flies in the face of wellness too. We spent a lot of time in our physician leadership experience in partnership with OneTeam Leadership in Novant helping groups of 20 physicians explore this. We had nurses as well, we had a couple of CEOs. I think out of that came this shared idea that physician wellness is about living your best life, both professionally and personally and showing up in your A game more often than your B game. Chris Hemphill: That leads me to another question about living your best life. It sounds like one person’s best is a very different definition than another, so it sounds like there’s a personal understanding that should be taken into account too when we’re accounting for wellbeing. Dr. Jay Bhatt: Yeah. I mean it could be the opposite, right? If we’re defining burnout as a state of exhaustion emotionally, depersonalization, decreased feelings of accomplishment, then wellness is really feeling joy, feeling personally connected, feeling part of a team, feeling accomplishment and fulfillment, feeling that you’re supported in the organizations you work in and feeling like you have an electronic health record system that doesn’t create so much challenge to your ability to be well. Janae Sharp: Oh sorry. I was thinking about how at the Sharp Index we’ve started measuring like a love metric. What are the things that really matter? Just asking people, measuring it is different. Like Jay was saying, there isn’t a standardized measure, but the importance of getting input about how people feel and how people perceive their life is matters. Dr. Jay Bhatt: Yeah. I would say that some people define … I think the other conversation we’ve had about defining it is that physician wellness is having a quality of life. There’s still work to be done, I think, to get to a common kind of definition and shared understanding around this. Terry Tuznik: I wanted to circle back to something we had talked about before we went life. Jay, you mentioned some of the stressors from COVID around our interactions over Zoom. I found that really fascinating. Could you go into that for this audience? Chris Hemphill: That actually relates to a question that came in from Shontae Ramsey, hey Shontae, about feelings about virtual delivery. I think this would be a good opportunity to expand on that. Dr. Jay Bhatt: Yeah. I think it’s a critically important point. I think my view is that as humans we’re not trained to do the level of telemedicine, virtual health and Zoom, pick your platform, in the way that we’ve done it for the last year and likely for the foreseeable future. I think humans are just not trained to do that at the amount of time that we’re asked to do that. Virtual meetings have skyrocketed. Even for those clinicians that are administrative and front line, the administrative piece has become now all Zoom or video platform, Teams, Google Meets, whatever you pick. There’s a peer reviewed article that came out, it was the first one to systematically deconstruct Zoom fatigue from a psychological perspective. It was published in the journal Technology, Mind, and Behavior just this past week. Professor Jeremy Bailenson examined the psychological consequences of spending hours per day on Zoom and other popular video chat platforms and identified four consequences of prolonged video chats that contribute to fatigue. Excessive amounts of close up eye contact is highly intense. That is not normally how we engage, right? Even seeing yourself during video chats constantly in real time is fatiguing. Video chats dramatically reduce our usual mobility, so that has an impact on health with mobility and physical activity. The cognitive load is much higher in video chats. You bring those together and that has an impact. They’ve got a Zoom exhaustion fatigue scale, a 15 item questionnaire. It’s actually a very interesting study to look at. They looked at about 500 participants over five separate studies. Chris Hemphill: That would be interesting to look at. I might have to ask you for a link to that after the show and drop it in the comments. I’m curious, well first of all I wanted to address the increased virtualization, there’s some good and bad. We started this web series as a result of this kind of inability to go out and meet in person, so we’ll be keeping that even after the vaccine’s distributed, we want to keep meeting with you on a weekly basis, but then meet you in person once it’s safe. One thing I wanted to get to, Dr. Jay, is just going to the workflow concept and perhaps if there are things that, well challenges that have happened this year as a result of COVID-19 that might have been preventable or addressable through workflows. I’m just curious, with the things that have impacted burnout and wellbeing over the past year, are there roles that workflows and addressing physician workflows, are there various opportunities that hospitals or administrators might have missed? What can people start doing or focusing on, regarding workflows and the recent challenges? Dr. Jay Bhatt: Janae will, I think, have thoughts on this as well. I mean I think the way that we talked about establishing a program for hospitals and health systems had seven key steps in the wellbeing playbook that was launched in 2019 and actually just, the American Hospital Association just launched a revised edition, 2.0. It was based on creating infrastructure for wellbeing, engaging your team, measuring wellbeing, designing interventions, implementing programs, evaluating program impact and a sustainable culture. Now with COVID the issue on workflows is that, because we were just thrown into trying to make things happen, trying to transition quickly, trying to meet the needs, the significant needs that the American public had, it was hard to step back and say, “Well let’s engage with intention around how do we create workflows that minimize, that support wellness and wellbeing and minimize frustration and fragmentation.” For organizations that might have a chief wellness officer, they could bring that person into activation, or someone else that has responsibility for that, but if you don’t have capacity in the organization around this and a strategy, then it’s left to chance. I think that’s partly what happened, both from electronic medical record workflows to virtual telehealth workflows. I think folks evolved over time and got better at it. When there was space after a bit of time, or if there was someone particularly attuned to it, you could have identified, “Well here’s how we construct the workflow,” it’s the filter of wellbeing. That should always be a standard filter by which we think about workflows and operationalizing them. Let make the right thing to do the easy thing to do. Chris Hemphill: In the answer Jay referenced the potential work, or ideas that you might have on the subject, so Janae, I just wanted to get your thoughts on that question too. Janae Sharp: On the workflow? I have a lot of thoughts. I did talk to people when they were setting up workflow planning when we first heard about it over a year ago. They were at the hospitals meeting with people. Workflow is so important. You had to educate all of the public. What do we do now? Every time people have a cold, do they go in? Then how do they get tests? We didn’t have tests in the beginning. Certainly now it’s more organized and I also know that state by state there’s a lot of variation to general guidelines, try to triage people outside of the ER, try to get people more help. Education is huge, I mean there’s still large groups that kind of don’t believe in it. With COVID we’ve seen a lot of the damage that misinformation can do and that, when there’s no established protocol and workflow, the chaos that ensues is disastrous. It’s also been financially difficult for hospitals since the overall financial plan with … I think most of them have recovered actually, but the abrupt change was something that was not expected. I have a lot of friends who have done the telemedicine workflows. I talked to, Mental Health Center Denver rolled out fully remote care in a mental health facility in a week. That’s huge. There would be some patients that get lost. I have tons of feelings about workflow, so I’ll get distracted, but teaching people new workflow in terms of physicians is super important. Some health systems would measure physician’s mental health, say, “How are you feeling? Are you feeling safe at work?” We talked to some people about developing those. Do you have these symptoms? For clinicians, do you have these symptoms? Are you feeling safe? Do you have testing access? That type of check in on your physicians, clinicians, your nurses, all of your front line healthcare workers made a huge difference, both in preventing the spread and in ensuring that people felt safe. Anyway, I’ll stop talking about workflow, because I would talk about it all day. Dr. Jay Bhatt: I think what was … they’re great examples and I think we should lift up those ones that have worked. I’ve been really impressed at some of the innovation that has happened around workflow and redeploying resources and reorganizing them to meet the needs of teammates and the workflows that need to be put in place. I think the other thing is people had a shared purpose in this moment and came together around that. I think about leadership is enabling shared purpose in the face of uncertainty. I think those that were able to do that and taking responsibility and accountability for it could be successful. I think that the question is what are we going to not turn back because of the progress that we’ve made through this and the learning we’ve had? Both from a regulatory and policy perspective there are things that have enabled the innovation and the workflows that have contributed to positive wellbeing. Chris Hemphill: I love it. I love that, because … well, here’s what I don’t love, that we’re close to time and we’ll have to wrap the question up, the conversation up, but there’s a point that you brought up in your response that really corresponds with somebody who’s been sitting with this presentation for 30 minutes or so, what are some examples, we have the problem defined, what are some examples of things that we can do to execute or think about as I’m presenting to my peers or leadership? That part was where you said the idea of holding up organizations or groups that have taken good approaches to workflow, or taken good approaches and done it well. It’s a question I want to ask you, Jay and then to Janae because she’s recently done the Sharp Index 2020 awards, but Jay, is there potentially a case study or a particular organization that you can think of that really did a great job at addressing it? Dr. Jay Bhatt: I think that there have been a number of them. Novant Health is one I would point to in Charlotte. They’ve really made an investment from the CEO about physician and nurse wellness. I think over the last three, four years, they’ve built capacity around it so it actually came to bear in this moment. Geisinger and Avera Health, which is rural, has created spaces for community and peer-to-peer support and wellbeing coaches that have, I think, helped redesign the physical environment and the workflow to re-humanize the practice of medicine and increase interactions. Different ways that people are organizing video visits and administrative meetings by how they’re creating energy and space to allow folks to process and be in a good place. Minnesota Hospital Association has done really interesting work around looking at data and following that data out over time to understand where their opportunities and what interventions can go forward. I’ll drop the link into the chat. It has links to case studies that you could share as well. I think when we think about what are the important things to consider and remember as things that have worked, you start with, I think, the issue of leadership and having strong leadership and support. Honestly it can come from anywhere. It doesn’t have to be the top of leadership, but it could be the informal leadership people have and they advance and move forward. I think the other is matching strategy to culture, thinking about critical shifts in behavior. Let’s celebrate the existing culture, the strengths in it, things that work. Measure and monitor the evolution. I think you can’t improve what you don’t measure. I think a lot about this notion that aims create systems and systems create results. You’ve got to have an aim. Move this by this, move an issue by a percentage by 2020, so let’s reduce burnout by 10% in two years and then work towards that. That’s really important and having a team. I’ll stop there. Chris Hemphill: Aims create systems and systems create results. I’m stealing that. I’m writing it down. Terry Tuznik: Yeah, that was a good one. Dr. Jay Bhatt: I give credit to Dennis Wagner, my colleague at CMS where we worked together on a lot of quality initiatives, who really drove that home for me in a meaningful way. Chris Hemphill: Excellent. Good to know and thank you for offering up the links to the case study. I think you might have sent it in our chat, so I’ll drop that in the LinkedIn for everybody to share it and research. At the same time Janae, with your recent 2020 Sharp Index awards, I just wanted to hear your thoughts as far as case studies or things that people should be looking to and thinking about. Janae Sharp: Oh yeah. We got to give a lot of awards, which was amazing, because trophies. Also it was really encouraging to see the work that people had done. Some of the most interesting things, we had a ton of categories. Some of the most interesting things were the technologies that did really well were largely technologies that made technology disappear. Balsera Communications did super well with a hands-free communication device. The winner, another winner was Saykara, who just got acquired by Nuance Health. It’s not a transcription, it’s like an assistant that helps with virtual notes, so you’re reducing the time that physicians have to spend in the EHR. There are so many interesting things that happened there. Nuance Health during COVID was feeding front line workers. We think a lot about metrics and how to award things and a lot of the progress that was made was not necessarily within these traditional healthcare metrics that we’re so in love with. Those aren’t always the metrics that actually matter to humans. The other thing we saw when we were looking at all of these healthcare nominations and people who have done great work, there are a lot of programs and there are a lot of health systems who are working, some of them are really out-of-the-box. Our winner for the health system program was Park View Health and theirs was really unique. People could personalize what type of support they wanted. I just thought it was fascinating to see how important it is, but also it’s still such a huge problem. Two years ago when I spoke with healthcare CEOs and with healthcare leaders, a lot of them didn’t have physician wellbeing or burnout on their roadmap for the year. They’re like, “Well that’s not actually part of our strategy,” meaning their budget for this year. This year I just spoke to an organization and it was on there. The thing that was lacking was co-creating with physicians to personalize it. They want to do well, they want to have overall reduction, but they are not necessarily going to do it the most efficient way if they’re not co-creating with front line providers and physicians. That was just a thought that struck me. We’ve come very far in that people understand that it’s important, but we haven’t gotten to the point yet where we’re willing to do it the easiest way, which is to ask people. Dr. Jay Bhatt: I think Janae makes a really good, important point about different technologies. I think, imagine a future not too far away where there’s not a keyboard in the room. It’s ambient technology and voice that translates, so you’re focused on really the humanity and compassion of caring for people, because that’s what we should be doing and then having help and technology to support and document. That being said, I also think we have to put a filter on technology, because caring for people is very human. It’s not algorithms that explicitly get used, you’ve got to put those algorithms through a filter and test them so that they don’t perpetuate the bias. That’s, I think, an important piece. Technology is a great enabler, but we’ve just got to be thoughtful. Chris Hemphill: Those are excellent points and honestly, when listening to and talking to people at different technology firms, including even Epic, even large vendors, people that are developing these tools, they don’t want to be part of the problem and perpetuate the challenges with those systems, but there clearly, since the problem is not 100% solved, there needs to be questioning, exploration on what initiatives work, what initiatives get adopted, how they get adopted and really I think that’s kind of a subset of the overall workflow conversation. Great future subject to explore. One person who’s nodding her head vigorously is Terry Tuznik. She’s written papers on this very subject. I’m going to go round-robin and just kind of ask if there’s anything that you’d like the audience to take away from. Since we were kind of on that technology note and Terry wrote the book on it, I’m curious- Terry Tuznik: No, I have seen so many things change. Dear Lord it was the early ’90s when I first got involved with healthcare IT outside of being at the hospital and actually being a vendor. I have seen physician involvement and some of the workflows to a good extent, but not where it needs to be. I mean I think we really need to involve in the design and implementation of technologies physicians, because they’re the people who are using these. Chris was referring to a very early one, I wrote my master’s thesis actually in the early ’90s, it was about provider burnout related information technology, because you could see at that point in time that disruption into the workflow, especially with the early technologies, we were not providing enough value for the disruption that we were causing. We had to always be mindful of that. This has been a great conversation. I think around the topic of clinician burnout in general, especially around COVID, I think as we’re now a year into this, we have to be mindful not to get fatigued as leaders and executives. We still have clinicians who need help and support and we have to not forget that, despite the fact that we’re now a year into this pandemic. That’s kind of my close on that, Chris. Chris Hemphill: Janae, your close, anything that you’d like for people to take away as they look to … like Dr. Jay said, it doesn’t have to be a fully top-down initiative, so your thoughts on what any individual contributor could do. Janae Sharp: Yeah. I think everybody can add to their voice, especially as we have social media, we have ways that people can contribute there. I always think about what Terry was saying, even a year in we still need help. We’re about to launch a fund for childcare for physician moms. As we get further in, we’ll need new people to come and have ideas of how to help people, because a lot of those people might be burned out that have been working hard. I think there’s a huge opportunity there. I hope people remember that we need new ideas and we need people who have energy to come and help. That’s it. Chris Hemphill: Did I miss the audio here? Janae Sharp: Maybe. No, I don’t know. Chris Hemphill: Oh okay, sorry. Terry Tuznik: We’re still on. Chris Hemphill: Okay. Good, good. Janae Sharp: I’m making faces and trying really hard not to touch my hair or drink water and I’m dying. Chris Hemphill: Dr. Jay, your final thoughts? Dr. Jay Bhatt: Sure. One, thank you for this conversation. I think it continues to be a really critical one to reimagine health and healthcare in America and to really put our teams, our clinicians in the best position to have the best personal and professional life they can so that they can be there to not only be well, but be well so they can lead well and care well. I think that there are really important steps we need to continue to push forward on the EMR front. I think that there can be a real groundswell about how to … we’re seeing some of this in different parts of the country, different organizations about common structures, common formats, re-engineering that tool to be one that supports us taking care in the best way we know how and doing the things that bring us joy in terms of patients. I’d say just take, have an assessment of yourself, where you are at personally and professionally. What are the things that matter to you? What’s one thing you could change next week? Make small changes in behavior and habit, but reflecting on what are those things that keep you from doing the best you can and what are achievement models that may not be relevant for the moment, today and into the future? Chris Hemphill: Thank you for sharing those thoughts. I really appreciate you coming in and being frank and transparent about what’s brought you here and witnessing traumatic events early on into your residency and then taking that and turning that into advocacy and turning that into actionable steps that people have been able to learn from over the years and people can take away from this call right now. To continue this conversation, we’re always thinking about what the next step is. One part of the health system that … honestly I don’t think there’s enough conversation on this arm of the health system, but it’s the physician outreach and physician liaison teams that are often very much getting feedback from physicians on EMR processes, workflow and things like that. I think that there needs to be more of a voice for that side of the healthcare spectrum. We’re going to be interviewing on March 19th, in the next couple of weeks … no, it’s March 12th, on March 12th we’re going to have Chris Barlow from Barlow/McCarthy. There’s an opportunity to continue the conversation because her role is to train these teams and lead those teams from a national level at many different health systems. One thing that we want to bring up is different areas where there can be a voice of physician feedback into the administrative loop to better improve decisions. Everybody thank you for staying on a little bit over with us, spending a little bit more of your Friday than you might have initially planned. Again, it’s about breaking down those silos and we’re here across organizations, across roles, across departments and we love seeing the questions and knowledge that you guys are sharing. Next week we also have a conversation about that, breaking down silos with Edward Marx, who is currently the chief digital officer at Tech Mahindra for their health and life sciences vertical. What the exposure is there, breaking down silos, we’re breaking down silos across industries too because Tech Mahindra is a conglomerate that covers multiple industries and those learnings for digital experiences and digital transformation across these other industries, across big brands become learning for digital transformations within healthcare. We’ll talk about the possible, we’re not going to say, “Hey, here’s Uber, why aren’t you like Uber?” But instead outline practice steps to digital transformation and breaking down silos between departments. Again, thank you everybody for being here with us and sharing with us. We look forward to seeing you next week. Janae Sharp: Thanks Chris. Dr. Jay Bhatt: Thank you. Chris Hemphill: Thank you.

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