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Finding efficiency in practice: Overcoming the overwhelming

Jennifer Donahue, MD, Regional Medical Director, ProHealth Physicians

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ProHealth Physicians, part of OptumCare, is a physician-led medical group caring for more than 345,000 active patients with 350 primary and specialty care providers at 85 locations in Connecticut.

For ProHealth Physicians, improving wellness at work for our clinicians is crucial to ensuring quality care for patients. ProHealth is an organization formed by joining many small medical offices distributed throughout the state. 

From office to office and clinician to clinician, the way we approach that goal can vary. Compliance with reporting requirements and use of EHRs competes with direct patient care time. 

To treat our patients to the best of our ability and be satisfied in our work as clinicians, we must become our most efficient selves. 

Solving through shadowing

There are many solutions that maximize productivity and minimize burnout, but the best result can be seen when tailored for the individual clinician. 

When I am shadowing a colleague I ask them to go through their day as they normally would, interrupting as little as possible, to get a view of their work world. 

I take note of specific difficulties and inefficiencies and note the fixes that will gain precious time. Later, I give my colleague notes on where they are doing well and what their best opportunities are to increase efficiency.

In addition to doing the shadowing other ProHealth providers, I offer my colleagues the chance to shadow me on a clinic day. There they can see how an efficient office with highly trained support staff can make a world of difference. 

All our office workflows: planning the day in morning huddle, managing clinical notes and delegating administrative tasks are available for us to question and learn from.

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Implementing new processes

Through the process of shadowing and being shadowed, I’ve come to understand that flexibility to change is the key to evolving efficiency. 

By trying a new way to work, perhaps taking the time to teach support staff administrative tasks like entering orders and referrals, I’ve seen clinicians find the productive rhythm of their work. 

There is great benefit to reclaiming those evening “catch up” hours of personal and family time. Feeling a new mastery of their work clinicians can relax, grow and thrive in their roles as primary caregivers.

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Case study: James Ocampo, MD

For James Ocampo, MD, the demands of the electronic health record, specifically the timely completion of clinical notes, gave a sense of dread. 

“When you have five or six unsigned notes and you are still seeing patients, it gets hard to stay focused. The nagging of unfinished tasks makes seeing more patients harder and harder.”

It was a new technology that brought Dr. Ocampo back to productivity in practice. The MModal dictation program was recommended by a colleague. By adding this element to his workflow, Dr. Ocampo found himself completing clinical notes with much greater ease. 

“Within the first week, I felt a huge weight lifted.” His rate of note completion by 7 p.m. rose from 60 or 70% to 100%. 

With greater confidence that he could stay on top of documentation, Dr. Ocampo has increased the number of patients he sees, is able to relax and be present in his time at home with family, and feels a greater sense of joy and accomplishment as a primary care physician.

Conclusion

With a greater volume of more complex patients and greater oversight and regulation to comply with, clinicians are facing higher expectations than ever. Fortunately, each one of us is not an island.

Spreading the work among our team of colleagues with each working to the top of their license and responsibility has become a must.

Taking the time to recognize our challenges and, like Dr. Ocampo, try new techniques can give us the chance to adapt and excel. Just as importantly, when we make the effort to optimize our work, we can rediscover our passion for patient care.

Tips for administrative efficiency:

  • If you type it more than a few times, it should become a macro.
  • Work as a team, so when a clinician is out for more than a day the work gets done in their absence.
  • When clinician input is not needed, work flow should not require they see it.
  • Staff should pre-complete all areas of forms not requiring clinical judgement.
  • Plan! Use huddles, standing orders, and staff education so that clinical staff knows in advance which information to gather and tests or vaccines to prepare.
  • Hold staff accountable. Take the time to explain expectations to staff, and then ask them to follow through. Don’t do their work — it may feel easier in the short run, but it costs much more time in the long run.

This publication is informational and for educational purposes for practitioners only. The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice.