Kathleen Wessel (Host): Medicine is more than a job. It's a calling. As healthcare grows more complex, clinicians face increasing pressures that can make it harder to focus on what matters most: caring for patients.

Welcome to AHA Bringing Value Series from the american Hospital Association. In this series, we speak with AHA business partners and learn how they support AHA hospital and health system members. I'm Kathleen Wessel, Vice President of Business Management and Operations at the American Hospital Association. Today, I'm here with Dr. Lee Benjamin, National Director of Emergency Medicine, Hospital Medicine Wellbeing at Envision, National Partners for the Practice of Medicine. Join us as we explore how health systems can better support clinicians so they focus on their calling to practice medicine and providing high-quality care. Dr. Benjamin, welcome.

Lee S. Benjamin,  MD: Thank you for having me.

Host: Let's get started, shall we? From your perspective as a physician leader, what are some of the biggest pressures clinicians are facing today that pull them away from focusing on patient care?

Lee S. Benjamin,  MD: Well, that's a great question. And if we take a step back for a moment and we remind ourselves of our why, of our purpose, of why those of us who went into healthcare and clinicians on the front lines went to the bedside, it's to take care of our patients. And when there are barriers to doing just that and we can't do what we've trained all our lives to do, what we've practiced for years to do, that purpose tends to fade. And that's when we see people starting to struggle.

So, what we're really talking about here when we're talking about it's to take care of our patients. And when there are barriers to doing just that and we can't do what we've trained all our lives to do, what we've practiced for years to do, that purpose tends to fade. And that's when we see people starting to struggle.

So, how do we help return to our purpose? How do we return to our why? How do we reinvigorate that calling and unleash our physicians, our APPs, those in the front lines to do what they've been trained to do.

So when we ask what are those pressures, there's a general understanding that the bucket that we refer to as administrative burden is really what takes us away during our clinical shifts from the bedside. And I'll give you some examples of administrative burden to help everybody understand what we're talking about. And I don't think a lot of this is too surprising, but there are things that there are solutions for that we can work together, do some collaborative problem solving, and really impact.

But when we talk about administrative burden, the first thing is the documentation requirements. And we all know that documentation is a significant ask on the behalf of our systems to our physicians and frontline providers. It's absolutely necessary for so many reasons. However, it does draw us away from that patient. Some people are bringing computers in the room and chatting with patients while they're typing. Eye contact is gone. That connection is gone. But it has to be done.

And some doctors—I was talking to one the other day—have made the specific choice not to document during their clinical shift so they could spend time with their patients and provide the experience that they want to, and they plan on going home, going to their kids' soccer game, coming home, having dinner, cleaning up, tucking the little ones in, cleaning up, putting their PJs on and going back to work. And we call that pajama time. So, these people are making the conscious choice to add two hours to their day, two hours they could be spending with their loved ones; two hours that could be spent learning the latest and greatest to actually improve care at the bedside, or to pursue a personal project, which we know invigorates everybody. But no, unfortunately, they have to go back and do that documentation just because the systems have been developed that way. It's completely inadvertent. But this is the sort of thing that really challenges our purpose and our calling and detracts from our experiences.

Host: When pajama time is a known thing and everybody just nods their head, it is a real thing that we need to contend with. Also part of that conversation, you know, burnout in healthcare has been part of our conscious for some time. And that conversation often kind of moves to engagement and wellbeing. So, in your view, how does clinician engagement actually show up in patient outcomes and operational performance of hospitals and health systems? What does that look like?

Lee S. Benjamin,  MD: Well, that's fantastic and it's becoming easier and easier to identify exactly how that shows up in the end product. But I want to take a step back again, because we have this wonderful opportunity. We've talked about burnout for a generation of clinicians. We've talked about how it's an illness almost. People use the word injury, describing moral injury, contributing to burnout. And it's great to have this conversation and shift it from burnout further down the spectrum to a state of engagement and wellbeing. But then, I ask, "Well, that seems like that should be the minimum we should ask of ourselves and our folks."

What we would rather have, what I would rather have is folks who are thriving in their workplace because we know that when clinicians are thriving, things change. Things are very different. But no one's really studying that yet. It's coming, and these conversations are shifting the conversation and moving to this.

And I think it's critically, critically important because there is no single metric. If I were the CEO, CMO of a healthcare system, the single metric I would want to know is how are my frontline clinicians, how is my nursing staff, how are my people doing? Because we know that when people are in a state of wellness, in a state of wellbeing, and dare I say, when they're thriving in the workplace, take any other metric you want from a hospital perspective, and it will improve.

So, let's talk about from a patient perspective for a moment. How about outcomes? You're more likely to survive a serious illness if your clinician taking care of you is thriving. You're going to have decreased errors made by those clinicians. You're going to have decreased hospital-acquired infections when you have clinicians, nurses, frontline folks who are in a good space, who are thriving, and there's evidence for all of this.

We also know that clinicians adhere to best practice better when they're not burnt out, when they're thriving. We know they deliver a better patient experience. Are these things that healthcare leaders care about? Absolutely. And when you start having that from the patient perspective, the health system, all of it answers itself. We know that medical-legal risk drops, clinician productivity skyrockets, cost of care declines. And importantly, we know that physician turnover. which Is a $4 billion a year tax on the US Health system—$4 billion—we know that when we have thriving clinicians, or at least not burnt out, we know that physician turnover decreases. You don't suffer that recruitment, that loss of productivity, loss of access for that specialty, So, we know, and the evidence is clear, that if we take care of our people, all the rest of those problems tend to take care of themselves.

Host: Yeah, that's great. You know, as you're talking through this, I'm thinking about like how you scale some of those things. So, how do you move from addressing individual level solutions for addressing burnout towards designing systems or cultures that truly support kind of clinicians in their practice of medicine?

Lee S. Benjamin,  MD: I think the first part of your question is the most critical. And it's based on the assumption that healthcare leaders recognize that burnout is not an individual clinician issue. We know the vast majority of the issues that influence burnout are organizational issues that need organization systems level answers. And that's the first step.

And when we talk about that, there's two parts that I think about when I think about changing organizational systems and cultures. And the first is systems. Now, for an organization to be successful, it has to be smart, it has to be efficient, it has to be innovative, it has to be novel to get that competitive advantage and be successful in what it's doing.

So ,you have to be smart. And when we say smart, there are opportunities to utilize developing technologies responsibly and with consent of patients, of course, that will help remove those systemic barriers such as documentation such as my friend's pajama time. We know that ambient charting slashes pajama time, nearly eradicates it when done responsibly and with patient consent. So, that's the sort of thing that our systems folks can think about.

How about inboxology? The study of inboxes in electronic medical records? So when that clinician gets home and they have a hundred memos from, maybe it's the lab, something that needs to be checked; maybe it's a patient question, maybe it's a scheduling question. There are systems that are looking at how to better facilitate a clinician's ability to go through that efficiently. And you could wipe out a ton of those and redistribute them or answer them in ways that don't demand the clinician's time. So, that's an example of being smart.

But also, to be successful, you've got to be healthy. I think it's been said by many leaders in industry that culture eats strategy for lunch. And I think this is that example. You've got to be well, you have to take care of your culture. And when I think about the culture, and there are organizations doing this throughout the country, I think of leadership, because no one has more influence over the day-to-day experience of our frontline clinicians than their immediate leaders.

So, I ask, what are we doing to help our leaders? Are we empowering them? Are we giving them the capabilities to provide an environment that allows for clinician thriving and that return to purpose? We know that 11% of burnout is due to leadership, immediate leadership. And we also know that those leaders who demonstrate the highest number of positive leadership behaviors, their frontline clinicians have higher levels of professional fulfillment.

Now, I will argue fulfillment is not thriving. These are two different things. We need to have that conversation. How do we move from burnout to fulfillment to thriving where it's electric and things take care of themselves? So, this is how I think about the systems and the cultures, investing in the strategies, the technologies to be smart, while also being well and influencing the culture for that healthy workplace to allow for clinicians to return to purpose.

Host: Yeah, I feel like we could spend hours on each one of those elements that you've just raised. But alas, we're wrapping up this conversation. So, given what you've just laid out for us, what are some of the actionable steps that leaders can take to better support their clinical teams so that they can focus on delivering great care?

Lee S. Benjamin,  MD: Well, it's wonderful that we're even having this discussion, and the fact that it's being had around the country. People recognize, leadership recognizes how important this is, and This is a great opportunity. Because we know by supporting our clinicians, by letting them do what they do, all of our outcomes are going to be better. So, this is our opportunity for our healthcare systems to become thriving multipliers. I think that's the term we need to think about. This is a multiplication of outcomes and positive improvement by investing in this.

So, the first and most important part is have these conversations. So when you look around the country, there are a lot of big facilities, a lot of healthcare systems that have identified their champions and put them into senior level positions to work specifically on clinician wellbeing and whether that be managing burnout, which is real, or maintaining fulfillment, which is the other side of it. And what Envision would argue is let's move toward thriving. A lot of big healthcare systems have that chief wellness officer or someone whose role is specifically to look after their medical staff, and we know what it does to all of those outcomes that we talked about earlier. So, it's most important to have that, have those conversations, identify your champions, and build a formal structure in your systems. We're not going to get anything done unless we're collaborating, we're communicating.

I was in a meeting yesterday where one of my family practice docs suggested, "Gosh. It kills me all the interruptions I get when I'm trying to order MRIs ," And I've got a radiologist in the room who says, "You know what? That slows us down too. We both want the same thing to be efficient and to do this right the first time. Get it done for the patient. Let's work on this together." And it happened completely organically. But when you start having those conversations and getting people in the room, the frontline folks know the problems and how to solve them. So, we need to empower them and resource them to look for those problems and to fix them. We've got to remove those systems boulders, such as the electronic medical record. And finally, we need to empower our leaders to develop and deliver on a thriving-based leadership model that's going to truly allow people to do what they've been trained to do and do what they do best. Let's take care of our patients at the bedside.

Host: Absolutely. I couldn't agree more. And I am so glad you were able to join me to start talking through some of these points. And Dr. Benjamin, thanks again for joining the podcast and sharing your insights with our audience. For our audience, if you'd like to learn more about Envision, please visit envisionhealth.com. This has been an AHA Bringing You Value series brought to you by the American Hospital Association. Thanks for joining us.