For years, The Permanente Medical Group (TPMG) has surveyed its 10,000 physicians to better understand what affects their well-being. That long history of measurement has given the sprawling medical group valuable insight into how physicians are feeling, the day-to-day challenges they face and the broader barriers to well-being affecting physicians nationwide.
But what has helped make TPMG a national leader in physician well-being extends beyond conducting surveys. Its leaders understand that collecting data is only the beginning. The real test is what they do with what their physicians say—and whether those doctors can see and feel a difference in their daily work as a result.
In fact, TPMG leaders know that physician surveys have the potential to backfire if doctors repeatedly provide feedback but don’t see leadership responding by taking meaningful action to address challenges.
“Survey fatigue is an important pitfall to be aware of as a leadership team,” said Ellie Farahabadi, MD, an internist and associate executive director overseeing physician wellness, human resources, physician recruitment and physician education and development.
“It’s critical as leaders to commit to making changes based on direct physician feedback because if you keep doing surveys without taking action, physicians will get tired of filling out surveys and this can actually lead to disengagement.” Dr. Farahabadi added.
That’s why TPMG leaders are transparent about their efforts, communicating what they’re doing in response to physician feedback and continuing to measure whether those changes are truly making a difference in doctors’ lives.
This intentional practice of listening, acting and then measuring again has helped TPMG consistently earn Gold-level recognition in the AMA’s Joy in Medicine® Health System Recognition Program. The Joy in Medicine Program empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.
The Permanente Medical Group is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
From feedback to action
Over the years, TPMG’s physician survey data has helped leaders identify some of the most significant barriers to physician well-being at TPMG. These metrics also allow the system to measure the progress of its well-being initiatives, while also bringing to the surface feedback from physicians about where the system should focus its energy.
Listening to—and acting upon—this physician feedback has been the driving force of TPMG’s success in this space.
For instance, TPMG heard loud and clear from its doctors that administrative burden, workload and practice inefficiencies were significant barriers to well-being. As a result, the system prioritized these issues as some of the biggest opportunities for initiatives to make tangible improvements in physicians’ day-to-day work.
“While we have done a significant amount of work in these areas over the years, it can be hard to move the needle,” said Amanjot Sethi, MD, a urologist and director of wellness operations at TPMG. “It’s an ongoing process of continuous improvement.”
One of these initiatives is TPMG’s Desktop Medicine program, which was designed to address the overwhelming number of secure messages physicians receive about issues that do not actually require physician input, such as questions about lab hours and standard refills.
“These types of messages bog down physician’s day-to-day work,” Dr. Sethi explained.
The program centered on automation that sends these messages to a pool where pharmacists and medical assistants can review and triage them before reaching the physicians.
But even after the program launched, the work wasn’t over.
“The program went through a number of iterations based on data, physician feedback and physician pain points,” Dr. Sethi said. “Our exceptional Desktop Medicine leadership team used those data points to help evolve the program to what it has become today.”
Since its launch, the Desktop Medicine program has reduced the volume of secure messages sent directly to physicians by 30% to 40%.
“They iterated along the way to get the program to a place where it was as useful as possible for physicians, and to ensure the technology would support people rather than have it turn into yet one more pain point,” Dr. Sethi said.
Measuring whether solutions make a difference
This type of iteration is par for the course in TPMG’s continuous improvement culture. Rather than simply implementing a technology or launching an initiative and moving on to the next problem, TPMG incorporates thoughtful measurements along the way to ensure that efforts aimed at improving physician well-being are actually working—and not inadvertently adding new challenges or barriers.
For instance, TPMG’s Technology Team has rolled out an ambient augmented intelligence (AI) technology to all physicians for clinical notetaking, with the goal of reducing charting time. Currently, physician adoption is 60% to 70%, with many reporting the technology has been a gamechanger.
Still, TPMG is doing a deep dive into the data to quantify that feedback and better understand the technology’s impact, how to increase adoption and continue improving it moving forward.
“We need to evaluate technologies like this to understand whether—or how—they actually improve the physician experience,” Dr. Sethi said. “So, we’re constantly gathering physician feedback and looking at objective data points from our EHR to see how much time physicians are now spending on documentation, in their inbox and working after hours.”
At the same time, TPMG evaluates all of these initiatives through the lens of clinical care and patient-physician relationships. Reducing the time physicians spend in the EHR matters, but leaders also want to understand how this makes a positive impact on physicians’ everyday work.
“We want to know whether these initiatives help doctors feel more present with their patients,” Dr. Sethi said. “The ultimate question is whether or not the tools help physicians spend meaningful time doing meaningful work and connecting to the purpose that brought them to this field in the first place—and less of that time on avoidable administrative burdens or documentation burden.”
In fact, TPMG’s survey specifically asks physicians to respond to the statement: “I am able to spend time caring for my patients without being overburdened by clerical tasks.”
That question helps bring the process full circle. Leaders can identify a problem through physician feedback, work with physicians to implement a solution and then continue gathering both subjective and objective data to determine whether physicians are feeling and seeing a difference.
“Ultimately, we want to be attentive to the tools that provide support, as well any unintended consequences,” Dr. Sethi explained. “A tool that saves time in one area but creates work elsewhere or impacts the quality of patient care you’re able to deliver is something we need to keep track of.”
A feedback-friendly environment
Just as TPMG leaders understand the value of physician feedback, they also recognize getting actionable feedback depends on creating an environment where physicians believe their voices are heard and acted upon.
That takes intentional effort from leaders at every level. Specifically, TPMG’s well-being leaders are keenly aware that one of the challenges of a robust and consistent measurement strategy is the risk of survey fatigue among respondents.
Currently, TPMG conducts annual physician surveys, and it has more recently started introducing shorter pulse surveys with highly targeted questions. Leaders regularly adjust survey timing and communications to ensure physicians continue to see value in participating.
This starts with allowing enough time for well-being leaders, department chiefs and physicians themselves to analyze the data, identify priorities and take visible steps to address the feedback before asking physicians to weigh in again.
“You have to figure out the fine line of how much time is enough to take actionable steps so physicians can feel the impact before you measure again,” said Dr. Farahabadi. “Otherwise, physicians will be wondering what happened with their responses from the last survey”
Along the same lines, closing the feedback loop is critical. And that communication must go beyond simply reporting out numbers.
“We go back to the physicians and say we heard you, and these are the areas that we’re doing well in, these are opportunities for improvement and these issues are where we’re going to have our work cut out for us in the upcoming weeks, months and years,” said Dr. Farahabadi.
Those transparent conversations happen both systemwide and at the department level.
“We ask our chiefs to discuss their data and to brainstorm with physicians about interventions that can help us make progress in the areas that are our lowest scores,” said Dr. Farahabadi. “Some can be addressed at the department level, some at the medical center level, and some at the regional level. It’s critical that all leaders are committed to reviewing results and taking action so that progress can be made.”
That process gives physicians an opportunity to see where their feedback goes after they submit their survey responses. It also gives them a role in shaping what happens next, particularly when challenges and potential solutions vary by department or specialty.
Improving the feedback loop
TPMG’s continuous improvement approach does not stop with the initiatives that come out of its physician surveys. Leaders are also evaluating the measurement strategy itself.
The medical group is currently working with its Division of Research to conduct an internal assessment of its customized physician survey to validate that it is capturing an accurate view of doctors’ real experiences.
“Our measurement strategy has been well received both internally and externally, so we knew it was important to do this study—and the results are promising so far,” Dr. Sethi said.
That willingness to evaluate the survey itself reflects the same philosophy TPMG brings to its broader well-being strategy that combines measuring, listening, acting, evaluating and continuing to improve.
Ultimately, TPMG leaders understand that a physician well-being survey is only as valuable as what happens after the survey results are in. While the numbers can show where physicians are struggling and opportunities for improvement, the data alone cannot reduce overflowing inboxes or give physicians more time with patients.
That impact requires turning feedback into visible action and evaluating its everyday impact. This process has helped TPMG use its physician surveys to truly improve physician well-being, while also showing physicians how powerful their voices can be in driving change.
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