Reducing pajama time and work outside of work (WOW)

. 33 MIN READ

AMA STEPS Forward® podcast

Reducing Pajama Time and Work Outside of Work (WOW)

Aug 17, 2022

In this episode of the AMA STEPS Forward® podcast, Melissa Reily, MD, and Melissa Wolf, MD, co-directors of physician wellness at Bozeman Health, discuss how to reduce pajama time and work outside of work (WOW) at both the individual and organization-wide level so you can have “more great days.” 

Learn more about the AMA Joy in Medicine™ Health System Recognition Program and access the “Getting Rid of Stupid Stuff” toolkit.

Speakers

  • Melissa Reily, MD, co-director of physician wellness, Bozeman Health
  • Melissa Wolf, MD, co-director of physician wellness, Bozeman Health

Host

  • Kevin Hopkins, MD, family medicine physician, primary care medical director, Cleveland Clinic; senior physician advisor for practice transformation, American Medical Association

Listen to the episode on the go on Apple Podcasts, Spotify, or anywhere podcasts are available.

Introduction: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.

Dr. Hopkins: Hello, thank you for joining us. My name's Kevin Hopkins. I'm a family physician at Cleveland Clinic. I'm also the primary care medical director for Cleveland Clinic's population health Institute, Cleveland Clinic Community Care. I also have the opportunity to serve as a senior physician advisor for the practice transformation initiative work through the American Medical Association, the AMA. Today we're speaking with Dr. Melissa Reily and Dr. Melissa Wolf of Bozeman Health in Montana about how to reduce pajama time and work outside of work organization-wide.

Thank you both for joining us today. Let's start by both of you telling the listeners a little bit about yourself and your background. Let's start with Dr. Reily.

Dr. Reily: Thank you, Dr. Hopkins. My name is Melissa Reily and I am a rheumatologist here at Bozeman Health. I've been here for about 10 years and I also serve as the system co-director of physician wellness here with Dr. Wolf.

Dr. Hopkins: Awesome. Thank you, Melissa. And our other Melissa, Dr. Melissa Wolf. Can you tell us a little bit about your background?

Dr. Wolf: Thanks for having me. I'm Melissa Wolf. I'm an OB-GYN physician. I've been at Bozeman Health since 2008 and I have several roles in the hospital, including medical director of the family birth center and co-director of physician wellness with Dr. Reily for Bozeman Health. I'll add a brief story here. We became friends a few years ago at a time when we were both experiencing some degree of burnout for ourselves and we set out to improve our own experience and, in doing so, decided to try and reach out to our friends and colleagues. So we drafted a proposal for a wellness program, pitched it to our very supportive and progressive executive team, and since 2019 we have been the co-directors for physician and provider wellness at Bozeman Health.

Dr. Hopkins: Thank you, Dr. Wolf for that background. It actually leads nicely into something I wanted to ask the two of you about before we get into the specifics of your most recent work at Bozeman. I wanted to bring up the fact that Bozeman Health was one of the recipients of the AMA's 2021 Joy In Medicine Health System Recognition Program—the only health system in the entirety of Montana to be recognized. As wellness leaders within your organization, and really having started this from grassroots as far as wellness initiatives within your health system, what does that mean to you both that your health system was recognized for, as you said, Melissa Wolf, the progressive leadership that you have within this space in your organization?

Dr. Wolf: Yes. Thanks. A joint medicine award is so important and specifically important to us because it acknowledges the critical issue of physician burnout and simultaneously acknowledges the work being done to address it, including initiatives such as what we're going to speak about today, but we were really honored to receive this recognition and absolutely thrilled to lead the way for health systems in Montana.

Dr. Hopkins: Dr. Reily, anything you'd like to add about that?

Dr. Reily: Well, like you mentioned, Dr. Hopkins, we sort of grew our program from a grassroots position, and really grew out of the personal experience and our commitment to helping our colleagues have a better experience at work and in our careers. And so it meant a lot to be recognized for that work formally, and also to know that we were on the right track, according to experts in this area, and following best practices to ensure that we have the right programs in place to continue to make Bozeman Health a place where physician and care team well-being is made a priority.

Dr. Hopkins: Awesome. That's work that we can all get behind and support because of its true value, not just to individual caregivers but to health systems and ultimately to patients also.

So from what I understand, the latest initiative that you're working on at Bozeman is helping providers reduce pajama time and work outside of work, or WOW, as it's sometimes called. Can you describe for me what exactly is WOW—work outside of work—and how is it measured?

Dr. Reily: Yes, I can answer that. Work outside of work, or WOW, is considered to be all of the work that physicians do within the EHR that occurs outside of scheduled patient time. As we all experience, this work flows over into personal time and evenings and after the kids go to bed, 4 a.m., et cetera. And we've both experienced, Dr. Wolf and I, Saturday nights on the EHR instead of with our personal lives. And it's well established that the amount of time that we spend in this work outside of work correlates highly with the experience of burnout among physicians and care providers.

Work outside of work can be measured by various formulas, but it should take into account the scheduled patient hours and unscheduled days, and any time that we're in the EHR outside of a patient’s scheduled visit. So this includes days off and also time during the workday, which are outside of those scheduled time parameters. If for example patients are scheduled to see you on a Wednesday from 8 to 5, that work outside of work is going to be any work done before 8, between noon and 1, and after 5, and then as well on unscheduled days so that we're taking into account the work hours for physicians as well.

Dr. Hopkins: Okay. So, it really does measure the time done outside of the typical postmarks for a typical workday, which seems valuable to know, right? And how exactly is that measured? Is it data we can get in some sort of automated process from EHR systems? Is it something that people have to track manually? How do we get that type of information?

Dr. Reily: Fortunately, at Bozeman Health we have been working closely with our CMIO and we use Epic. And so, there is something from the APP and this signal data does measure the time spent on the EHR outside of scheduled time. Now we did have to work with our CMIO to make sure that we were correcting it for the actual patient care times. As you can imagine, some physicians may have a half day of interaction and we don't want to be measuring that on a standard 7-to-7 basis or 8-to-5 basis if the physician is only seeing patients that day from 8 to noon. We want to capture the time that they were in the EHR after noon, as well. So working with our CMIO, we used a common calculator that the AMA provided to us to correct for scheduled time, so we really were capturing time truly spent in the EHR outside of face-to-face time with patients.

Dr. Hopkins: Okay, and thinking about how some people do refer to this as pajama time, and I know I've seen graphs and charts, and I use some in slides in some of the presentations that I do that show a significant number of EHR users logging in to their system on weeknights after say 9 or 10 p.m., maybe after kids go to bed, something like that, and then also on weekends. Saturday evening seems to be a popular time. And I've heard people say, you know, Saturday nights, it's date night―it sort of belongs to the EHR in some practices. Is that typical in your experience or at least within your health system? Has that been kind of a typical experience?

Dr. Reily: Yes. I think you hit the nail on the head there, describing what it's like for physicians in our organization and likely physicians across the nation. We first recognized that it was important to implement reducing pajama time and reducing work outside of work within our wellness program—our system-wide wellness program―just in speaking to colleagues and thinking of our own experience, certainly all of us basically admitted to date night, as you described it, with our EHR instead of with our families. And in speaking with colleagues, it's more than just a silly, oh, date night with the EHR. Really it impacts actually our personal relationships, our personal health, our ability to connect with people in our lives and with our patients. And the more time we noticed ourselves and others spending on this medical work outside of work, whether it be EHR, chart review, documentation, phone calls, prescriptions, whatever, the toll that that takes on our personal lives then adding to the isolation that comes along with that is really significant. And so, we realized that working on this for ourselves was really too little too late and that we really needed an organization-wide initiative.

Dr. Hopkins: How and when did you recognize that something needed to change, that this needed to be—you needed to engage this type of initiative, this has had to be a priority for your health system? I heard you say, Dr. Wolf, you figured it out in part through some of the wellness work that you've started to do. And certainly some anecdotal evidence and examples, I'm sure that you were getting from individuals and not to cheapen anything from our neurosurgery colleagues, but it doesn't take a brain surgeon to figure out that we need to spend less time doing work outside of work, right? So was there any specific data or survey information that you looked to or was it really just individual anecdotals that you were hearing from people time and time again? You hear the same thing enough times and you know it needs to become a priority. How and when did you recognize and decide that this really needs to be a priority and initiatives need to come out of it?

Dr. Wolf: Yeah. Great question. So, certainly began with our colleagues and our conversations with them, and also in participating with the AMA, honestly doing our burnout surveys, which we've done—now I think we're in our fourth iteration of annual, approximately annual surveys. And then in applying for the Joy in Medicine, putting our application together for that really, I think, specifically led us to understand how important a component this is in the just general wellness initiatives and how important it is to have a very systematic way to measure what is the time spent and then have a systems-wide approach to addressing it. So specifics would be the combination of the burnout survey information and also just in applying for that, working through the application for the Joy in Medicine award.

Dr. Hopkins: And Dr. Reily, what did it take as far as engaging your health system leadership to convince them that this needed to be a priority as well?

Dr. Reily: Well, like Dr. Wolf mentioned, we are fortunate. We have a very supportive executive team and health board in this space of wellness work. And actually even before we came up with sort of some initiatives and strategies for reducing pajama time, our chief executive of operations invited us to meet with her. We are transitioning our Epic system to our own organizational Epic system version. They asked us in recognizing the importance of care team well-being in relationship to the EHR use. They asked Dr. Wolf and I to be part of the Epic steering committee and serve on some care team groups in building the new Epic program.

So from the start we were actually invited, which is nice. We didn't have to ask permission or try to place importance on this. It was already recognized that this would be important, possibly given some of the work that we've been doing for the last five or six years at Bozeman Health, bringing physician and care team well-being to the center of many conversations. So for us, we were fortunate that it has been a priority already. And then it's been kind of up to us to use our energy to sort of create and using some of the knowledge from other people who have gone before us and nationally in this space, kind of create some initiatives that might help reduce pajama time on an organizational level.

Dr. Hopkins: That's terrific. Because I know that hasn't always been the case, right? It's becoming less and less unusual, but it's been unusual historically to have organizations so concerned about that, that they find the right leaders to do the work, to engage and to lead some transition around how can we make this better for everybody. Recognizing the fact, I think, Dr. Wolf—I think you said it earlier about the impact on caregiver well-being upon our families, our relationships, friendships, certainly it affects health care systems and ultimately affects patients, too. So as if we needed more evidence why this is important, can both of you, or either of you, get into a little bit more in-depth about why reducing pajama time or work-after-work is so important?

Dr. Reily: Well, I think it really impacts, as I mentioned before, the amount of time that we spend interfacing with computers instead of interfacing with people is really something that I've noticed over my time in health care—certainly for the past 20 years, I'm progressively spending more and more time with the computer instead of with people, whether it be patients or family or even during the pandemic, certainly, we all spent much more time on Zoom interfacing with computers compared to, you know, people even just in hallways or in meetings. And for sure, this has impacted my ability to connect with my family. Oftentimes by the time I get home at night, partner has already been to bed or once I do get home, he and I may have a quick dinner, and then he'd like to go and do something fun, you know, go out for a walk or a jog, or go hiking or something. And then I say, “Well, no, no, I have to attend to this.” And even Saturdays, right? Sometimes Saturdays all day, I'm sitting at my workstation, at my computer instead of going hiking or going to a party or whatever it may be. And so that isolation certainly, I feel, is the most critical factor because that piece of being isolated as a human is really just detrimental to ourselves and also to our relationships and … I'm previously divorced, and certainly that absolutely led to—some of the breakdown there was just the amount of time I had to spend with my computer instead of with my spouse at the time.

Dr. Hopkins: Yeah. That's the stark reality for a lot of us is that technology, as wonderful as it can be, in the right circumstance, it can actually interfere—get in the way of our human relationships and when it comes down to it, would I rather snuggle on the couch with my laptop, getting my charts closed or would I rather snuggle with my 11-year-old on the couch? I mean, my 11-year-old's going to win almost every time. And yet I also hate having things hang over my head, stuff I've got to get done. So we feel that sense of pressure and a time pressure associated with it. So let's pivot a little bit and then talk about what strategies have been included in this initiative at Bozeman Health, as far as your efforts to reduce pajama time and work after work. What strategies have you included and how did you prioritize those?

Dr. Reily: Yeah, so I can answer that, Dr. Hopkins. The most challenging aspect of this, initially, was really trying to formulate how we could come up with some plans or programs that would really reach the whole organization. As I learned more about reducing inbox time and teamwork for orders and things like that, I could see how it was benefiting me and my clinic. But rolling that out to the whole organization is probably the most challenging aspect of coming up with programs to really try to reduce our work outside of work.

So in meeting with some people from the AMA and talking to other people who have been doing wellness work, we came up with sort of three different initiatives that would help with this effort. And so one of the first things we have done is we formed small practice improvement groups, which we have coined a “more great days” group because we're trying to have more great days where we feel like when we leave work we have completed the majority of our work, that our teams worked efficiently, that we provided great care and we would like to have more great days.

So over the past year we've been leading these small practice improvement groups in which we invite physicians and APCs to join us for eight weeks, during which we meet four times. And we've been really fortunate and honored to have people like yourself join us from the AMA to provide expertise. For each individual to identify one small pebble in the shoe, one very small part of the day that leads to micro-cuts in the well-being of our day. For people to choose one pebble that they would like to remove, and that can be removed in a short period of time, over eight weeks.

Another leader from internal medicine at our organization who's very passionate about physician well-being, he and I developed a curriculum to follow so that we follow the same routine every eight-week session. And we utilize the AMA STEPS Forward® modules a great deal to help educate people about best practices that can be implemented to reduce our inbox, to bundle prescriptions, to handle MyChart messaging, things like that so that people do not have to reinvent the wheel when they're thinking about cutting out inefficient time during their day.

But the AMA has done a vast amount of work in this space, and these modules are available to us to take advantage of and to learn from. And so we have been holding these small group meetings and they've been quite successful, I think, as we've gone along in time. We're currently in our third group of the eight-week session. We typically have five to ten physicians and APCs participating at a time. And it's a great conversation, and it also empowers our colleagues to recognize that there are things that they can change about their day and really lead to more great days. So that's one of the strategies that we have been employing.

Another strategy, which is highly recommended also in the Joy in Medicine program is to query our physician and APC colleagues about the quote “stupid stuff” that we all are required to participate in through the EHR. Various clicks that are wasteful, procedures in the EHR that are wasteful.

And for example, in our system, if I add on a lab I get an alert that I've added on a lab, which I have to click on before I can actually see the lab results itself. So things like that, that are very small, but throughout the day, there are multiple examples of these useless and wasteful clicks and we're working with our CMIO to gather―so Dr. Wolf and I have been attending different division meetings and then querying our colleagues about their top three stupid things that they would like to see removed from the EHR. And we're working with our CMIO to report these to him, and whatever he can work on removing immediately is done. And there are some other things that require longer processes to try to remove or change in the EHR. So the small groups and querying our colleagues are two of the initiatives.

And then the third is that Dr. Wolf and I are gathering very small, quick tricks that help save time. So as we're transitioning to a new Epic system in our organization, this has been one of the advantages of that is that there's a lot of training. So power users, super users, there's all these courses that we can do. And there are a lot of quick tricks supplied there that we can then convey to our colleagues, various meetings and the AMA STEPS Forward® modules also provide a lot of quick wins in the inbox.

So at various meetings I have talked to people about better management of the MyChart messages, how to handle result notes much more efficiently, bundling prescriptions, pre-visit planning, pre-visit labs, things that I have learned about and have really helped reduce my work outside of work.

So through those three different approaches we are trying to reduce work outside of work. And we have an initiative to reduce the work outside of work by 25% over 10 months. We have that signal data for all of our APCs and physicians, the start of these sort of three different approaches. And we'll gather that data at the end and what we would really like to see is true movement in the time that our specialty clinics and our primary care clinics are spending outside of scheduled patient time.

Dr. Hopkins: So I heard the small practice improvement groups, those more great days groups, which, thank you, I’ve been privileged to be a small part of. The GROSS work—getting rid of stupid stuff. And then the quick tips and tricks for EHR users and then making sure that people know about those things. How far into the 10 months are you right now, as far as trying to reduce the work after work by 25%?

Dr. Reily: We are about halfway through. So we are five months into it.

Dr. Hopkins: And how do you—obviously, you're going to measure at the end, right? And pair that signal data. Do you feel like you're making progress and how would you define and how do you plan to measure success? Obviously, the 25% reduction is the key metric there. Anything you're looking at as intermediate markers or process metrics—how do you know that you're making progress?

Dr. Reily: Well, yes. So in addition to gathering that data toward the end, there is a lot of other data also available in the signal data set that we can analyze, such as how well our teams are working together to place orders, what the time is actually in prescriptions, in phone messaging, things like that. But another way that Dr. Wolf and I like to measure success, also by what we are hearing and conversations and participation. And so I've been very pleased and grateful to see such participation in these small groups. So people are starting to hear about it and I've really had no trouble. Actually have had some groups that are even a little larger than we intended join us. So I see that as a great sign of success that people are volunteering their time to improve their lives and improve the experience of their teams.

I have had people send me emails and just saying that "Hey, I already started using that quick tip that you mentioned last week in our small group, and I got out of work today on time, and my notes were done and I just really appreciate that.” So those are also measurements of success for us. Engagement in our programs, and then also just hearing what people are experiencing and hearing people share at these small groups, quick tips for one another, to me that's a sign of progress and movement.

Dr. Hopkins: That's great because we all know when it comes to change management or sometimes even continuous improvement, it can be very difficult to engage some people because everybody's at times overwhelmed and feels like they've got enough to do. But it sounds like thinking about those small groups, small practice improvement groups, even just the name of it—more great days―like that's something that gives hope to people that it can be better, right? And do you think that that's part of why it's engaging people? Because it gives hope and it can give them a little bit of power and control over how their day runs?

Dr. Wolf: I think it's definitely more tangible than something like say a quote resiliency program, you know, to say, if you participate in these small groups or use these quick tips, you're going to have more great days as a physician. And that's really what we all signed up to do, right? Is to practice medicine and take care of patients, and to do so in a way that's sustainable and meaningful. And so Dr. Reily came up with the more great days and it's really outstanding.

Dr. Hopkins: Most people really appreciate some degree of instant gratification or at least quick brief interval gratification, right? I mean, we change somebody's blood pressure medicine or their diabetic medicine, we want to see improvements in the numbers. We measure metrics. We’re a metrics-driven business and industry. At the same time we're a relationship-based industry. And so it can be difficult to bring those two things together in a way that makes sense. As far as the getting rid of stupid stuff initiative and trying to save clicks and things that don't make sense in the EHR—we probably all have experienced relative to that, too. I do some of the same things over and over again. I think boy, this is really dumb. Have you had any success stories in that, in trying to get rid of some of those unnecessary things?

Dr. Reily: In our organization, as far as the kind of GROSS list of the most common stupid stuff. Fortunately we have already removed a lot of those things. So we have single sign-on, we have double large computer screens, a lot of those kinds of things. We're still working on—I am trying to think of a specific example. And I know there are some, as far as getting rid of a couple of clicks, I would say though that the success in that space that has already occurred are in conversations like we had this morning in our small groups where some participants pointed out some very obvious click saves that are right there in front of our faces and we were actually not even aware of it. So we are working on working with our CMIO with some specific requests at a more systems level, like getting rid of duplicate colonoscopy reports.

When I first started doing these small groups, I was learning from some people who've written some of these modules and there's an excellent module about bundling prescriptions on STEPS Forward®. What this means is that we refill all prescriptions at a patient's visit for the maximum amount of time, with a maximum amount of refills that are allowed and we get all of those prescriptions on the same schedule. So it was not uncommon for me to have close to a hundred prescriptions to sign in my inbox at any given time. And once my team started bundling those, so that all prescriptions were refilled at the same time with the maximum amount of allowed refills, we reduced our prescriptions. I measured it in my nurse's inbox over the course of about three or four months. And it went down I believe it was 65-70%, the number of prescription refills coming to them, which then, of course, reduced that work coming to me. So that was a huge win of just simply following and learning about that concept through the STEPS Forward® module.

Dr. Hopkins: In being able to take part in the present cohort of that group, more great days and in the most recent previous one, I've gotten to hear some of the projects that your team has identified and working on as far as removing that pebble in the shoe that annoys and distracts us throughout the course of the day. Dr. Reily, could you share virtually the story of—there was somebody that needed a printer?

Dr. Reily: So in one of our first groups, we had a physician in internal medicine who really thought that the amount of time that he had spent walking back and forth to the printer to get his after-visit summary and bringing it back to the patient and that amount of time wasted was enormous for him. And it had not occurred to him that maybe he could just ask for printers in every room, but that was basically his project. So we encouraged people to choose a pebble and the pebble in his shoe was all of this time spent walking back and forth to the printer. So his solution was to actually just simply ask for a printer, but it was helpful that he calculated before and after. So he calculated the number of steps, how long it took him every time he walked, how much time that added up to over the course of a year, and then the equal amount of dollars that he has to be paid for that amount of time that he's walking.

And I don't remember exactly the specifics, but I think it was something like $10,000 or something for the time he was spending walking back and forth to the printer. So once he got a printer for each of his exam rooms, not only was he able to report to us the miles that he saved and the amount of money that the organization saved in paying his salary, but also he came up with it the longevity score or the reduced burnout scale for him personally. And he estimated that those two printers added two years of career to him because he was going to burn out in two years instead of right now. So that was just a fun kind of anecdote to his story, but it was great. We really encourage our participants to have before and after data. And it can be measured in time, money, but even in things like joy scale for that position. So that was a great story.

Dr. Hopkins: Those are some terrific examples. And sometimes the answer is right in front of us, as you said earlier, that sometimes it's as simple as just asking, and yet I can understand why people don't do it, right? Because we have a hard time removing the blinders and thinking about our limiting assumptions. Well, there's no way I'd be able to get a printer in each exam room because the budget is, you know, whatever it is, and I know that's not possible, so I'm not even going to ask. Or, well nobody else has that, so I'm sure if I ask I'm going to be told no. And so sometimes it's just as simple as removing those potential limiting assumptions and just asking a question, and sometimes we get an answer that maybe we weren't expecting but is the right answer. So that's great. Thank you for sharing those examples.

What are some things, maybe, that the two of you have learned as you've gone through this process of identifying the need to reduce work after work and some of the pebbles in the shoe, some of the things that cause us stress and strife, and if they were better or different might lead to less rates of burnout and more longevity, those types of things? What are some things that you've learned along that path that might help others that are looking to start the same type of projects or initiatives and want to bring others along with them?

Dr. Wolf: I think we've learned a few things. One is certainly that there is value in asking individual providers what they're spending their time on outside of work, and then, as in that story you just described, empowering those individuals to make improvements themselves or to work within their immediate teams. And having a tactic or a strategy to really help those people identify what it is that's troubling them and giving them the tools to fix it themselves, as opposed to them expecting that nothing will change unless a system changes. So there's a lot of value in working with the individual providers.

And then we've also learned that if we show them a way to make the change, people do participate because I think we were worried initially, well, we've got all these tactics, but nobody's going to take the time to do it. But once we started showing that―"Hey, look, we do have some really logistical, simple tactics"―we see more and more participation.

And then also understanding the value of really taking an organization-wide approach. So there's an individual approach that's required and also an organization-wide approach. If our organization is not on board in supporting us, telling an individual to fix a printer is great, but that doesn't help everyone else. And so we really feel that it's been so important, and we've been so fortunate that our organization has really taken this concept seriously and really does understand that something like EHR inefficiencies really do impact the physicians, really do impact the care that we can provide to patients. It really does impact our relationships, and they've been able to prioritize these projects and allocate the resources to tackle these things. And that that is really impactful to the organization and to patient care. So really just an approach that's both individualized and systems-based is required. And I think that those have been our biggest lessons.

Dr. Hopkins: Thanks, Dr. Wolf. Those are great and I agree. It seems like you've got to address both the individual and the system things. A lot of individuals are sort of sitting back, I believe, waiting for the system to come rescue them. And system changes take longer to put in place, to plan up, to dream up, to operationalize. And so it's important, I think, for us to know that there are some things we can do as individuals to at least move the needle a little bit and get the ball rolling in the right direction for some, if not everyone in the system. Dr. Reily, what about you? What are some things you learned going through this process?

Dr. Reily: Thank you, Dr. Wolf, for those points because it's excellent. It's so important that our organization is forming this and thinking about ways that we can help everyone with these changes. You know, you don't really know what you don't know and I've been in the same organization since I completed fellowship, and in fellowship, I never really gave any thought to system processes or procedures. And so when I found myself overwhelmed by the EHR and how much time I’m spending outside of work, it's really hard to think about what is even wrong here and where would I even start to make any changes. And that's where the AMA STEPS Forward® modules have been so helpful. I just started going through those, and I've gone through a lot of them and just thinking about how they apply to my situation and how my team could make changes.

And I think another important key aspect of making these changes is that we need to involve our entire team. So it seems to be a very inclusive approach where you involve your clinic manager, nurse manager, nursing team in saying, “Here's a problem I've identified, and what are your perspectives in terms of the process that is happening now and where we need to go?” And then also using these STEPS Forward® modules as kind of data to say "Hey, this is actually the best way to do this.” And then doing little pilot projects in which I showed that not only did my life improve, but my nurses inbox, their prescriptions fell by 65% in the course of a couple of months. That's really data that everyone likes. And so that helps really move these projects forward on a kind of a micro level, just in my own personal experience every day. So, if you don't know where to start, I would really encourage looking at the STEPS Forward® modules and that will really help you identify what is wrong and how to fix it.

Dr. Hopkins: This has been a really enlightening conversation. So thank you for sharing what your experience has been at Bozeman Health. I'm grateful to Dr. Melissa Reily and Dr. Melissa Wolf for joining us today. It's been a great pleasure speaking with both of you. And I look forward to hearing about your success of reducing work after work within this 10-month time period. Thank you both for your time, energy and your passion around making things better for everyone.

Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.


Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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