Improving the Work Life of our Workforce Jim Rawson, MD, FACR jrawson@augusta.edu @Jim_Rawson_MD P.L., J. Luther and Ada Warren Professor Chair, Radiology and Imaging Medical College of Georgia Hull College of Business
Triple to Quadruple AIM • Bodenheimer and Sinsky proposed adding 4 th aim • Improving the work life of health care providers, including clinicians and staff Ann Fam Med 2014;12:573-576 .
Baldrige Performance Excellence • Malcolm Baldrige National Quality Award (MBNQA) is presented annually by the President of the United States • 7 Categories-one is workforce • 17 Item requirements-3 are workforce related
Workforce environment and engagement • Safety • Abuse • Employee Satisfaction/Engagement • Stress/Burnout • Mindfullness/Resilience • Joy at work
Employee Safety • Healthcare had 575,000 injuries (2014) • Manufacturing had 440,500 injuries (2014) • Construction had 196,300 injuries (2014) • U.S. Bureau of Labor Statistics, 2015
“…more hazardous to work in a hospital than in construction or manufacturing” https://www.osha.gov/dsg/hospitals/documents/1.1_ Data_highlights_508.pdf
Safety and Cost • Cost of injured employee • Personnel budget as percent of operating expenses • Absenteeism • Working at less than full capacity or capability
Hospital Worker Safety • Spectrum Health, Michigan • 2,000 Reported injuries • 4,700 Lost Days • 10,700 Restricted Days • 31% due to patient handling Danielle Larson-Jaramillo, SHS 2017
ROI on Safety • Direct costs of injuries • Indirect costs are 4-20 x Direct Costs • https://www.osha.gov/dcsp/smallbusiness/safetypays/in dex.html
Workplace Abuse • Workplace violence • Bullying • Discrimination • Physical Abuse • Sexual Harassment
Incidence and Cost of Nurse Workplace Violence by hospital patients/vistors • N=762 RN surveyed about workplace violence in past year • Verbal abuse by patients, 54.2% • Physical abuse by patients, 29.9%; • Verbal abuse by visitors, 32.9%; • Physical abuse by visitors, 3.5% • Annual workplace violence charges for the 2.1% of nurses reporting injuries were $94,156 (Retrospective database review) Speroni J Emerg Nurs 2014;40:218-28
Cost of ONE disruptive physician • 400 bed hospital • $1 million annually • Based on staff turn-over, medication errors and procedural errors Rawson JV, Thomson N, Sostre G, Deitte L, The Cost of Disruptive and Unprofessional Behaviors in Health Care, Academic Radiology 20 (9) 1074-1076
Cost of staff turnover? • 1.5-2x salary of employee • Staff retention vs staff recruitment Porath C, Pearson C. The cost of bad behavior. New York: Penguin Group, 2009
Just Culture vs Culture of Blame • Just Culture is not a blameless culture • Human error-console • At-risk behavior-coach • Reckless behavior-punish
Employee Satisfaction and Engagement
Gallup Employee Engagement 2014 http://www.gallup.com/poll/181289/majority- employees-not-engaged-despite-gains-2014.aspx
Employee engagement = key driver of patient satisfaction • 12 core employee engagement items • Five show a consistently strong relationship to inpatient satisfaction http://www.gallup.com/poll/8650/engagement- unlocks-patient-satisfaction-potential.aspx
Employee engagement • I have the materials and equipment to do my job right. • At work, I have the opportunity to do what I do best every day. • The mission or purpose of my organization makes me feel my job is important. • My associates or fellow employees are committed to doing quality work. • This last year, I have had opportunities at work to learn and grow. http://www.gallup.com/poll/8650/engagement- unlocks-patient-satisfaction-potential.aspx
Burnout • Stress: over-engagement • Burnout: disengagement
Physician • >50% physicians at least 1 symptom of burnout • <30% general population at least 1 symptom of burnout • 10% increase in prevalence of burnout in US physicians between 2011 and 2014 while prevalence in general population was stable Mayo Clin Proc. 2015;90(12):1600-1613
Burnout
Burnout in Medical Students • 1354 of 2566 medical students surveyed had burnout • 52.8% had burnout JAMA . 2010;304:1173 – 1180.
Mindfulness • Opposite of mindlessness “ Paying attention; On purpose, in the present moment, and non-judgmentally .” Jon Kabat Zinn
Resilience
Joy in Work
What gets measured… • Gets managed • Employee injuries • Absenteeism • Employee satisfaction • Employee engagement
Summary • People are our greatest asset • Opportunities to improve workplace environment on many dimensions • Linked to lower cost, improved quality, improved patient satisfaction
Thank you jrawson@augusta.edu @Jim_Rawson_MD
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