A primary care department at Permanente Medical Group in Oakland, California, was able to reduce charting time for its physicians through a few simple steps.
The health system has a survey instrument it uses to collect data on workload, wellness, the impact of clerical and administrative burden, professional development, and psychological safety. Following their data review, department chiefs asked their technology leaders to coach physicians on setting up voice dictation and creating templates to make charting easier.
Modest changes at the department level are sometimes the most impactful, said Amanjot Sethi, MD. He is a urologist who directs wellness operations for The Permanente Medical Group, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The Permanente Medical Group also has been honored by the AMA Joy in Medicine™ Health System Recognition Program. Applications for 2023 recognition are being accepted until March 17. Learn more and submit now.
In an episode of “AMA Update,” Dr. Sethi offered more details on a three-part framework his health system adopted to foster teamwork and ease physician burdens.
“It’s not enough to have a strategy”
Upon joining Permanente, Dr. Sethi was impressed with the health system’s robust infrastructure and resources to support physician wellness. Still, he saw opportunities to work smarter and not harder, “to look at our work as physicians and think about our long-term health and sustainability.”
When his mentor at Permanente offered an opportunity to work with physicians on health and wellness, “I took the ball and ran with it,” said Dr. Sethi, who eventually became its regional director for wellness.
Dr. Sethi was one of the instrumental leaders in developing Permanente’s strategy to improve joy and meaning in medicine. The aim was to track well-being with the same level of commitment as operational and care goals, he said.
The strategic framework he and his colleagues developed included these three key elements.
Practice support: The idea was to optimize systems and tools, allowing people to spend more of their time on meaningful and purpose-driven work.
Culture: What parts of culture support the concept of connecting to joy and meaning? How does the health system choose its leaders? How is it developing skills to lead in a collaborative environment? Is it offering a broader spectrum of professional development opportunities for its people across their career arc?
Personal wellness: This was about creating a diverse array of personal wellness programs to help doctors, physicians and teams prioritize their health.
It’s not enough to have a strategy, Dr. Sethi added. “You need to put goals and the strategy in motion.”
This meant ensuring that all operational leaders were using the framework to speak the same language and identify strengths and opportunities in their own domains, “whether it was their department or their medical center across the organization, and to use the strategy to drive tests of change to improve the practice environment,” said Dr. Sethi.
Undertaking a task of this scope isn't easy, he added. Dr. Sethi and his team offered support to leaders by providing them with tools and skill building to help them navigate conversations within their departments and their spheres of influence.
Leaders sought feedback from the members of their departments and worked with them to design tests of change to reduce burnout.
Small interventions, big impact
Often, the simplest things people discover within their own work unit or department make the biggest difference, said Dr. Sethi.
An orthopaedics department looking at clerical burden, for example, targeted physical therapy orders as the most impactful administrative burden. Department personnel worked together to develop new ordering templates so that their medical assistants could easily input the orders based on the type of patient being treated.
“This was a small intervention with a really tangible impact,” said Dr. Sethi.
