Consumer demand is shaking up traditional industries more than ever. From Lyft to Airbnb, expectations for fast, convenient, and affordable options are allowing industry newcomers to grow and obtain significant market share across various market segments.
Healthcare is no different and arguably has more at stake in meeting patient demand, as financial incentives are tied to patient satisfaction and outcomes. Patients want the same affordable, easily accessible, and personalized options they have come to enjoy in other facets of their lives. However, the healthcare industry is struggling to keep up with these growing demands. According to a recent study, nurses spend 73% of their day on documentation and administrative tasks. Instead of conducting repetitive tasks with little value for patients, nurses can drive better outcomes by dedicating their specialized expertise to patient care. Understanding this, how can healthcare leaders address this challenge head-on by empowering their nursing staff to work at the top of their licenses?
Why Front-Line Healthcare Providers Need Workflow Automation
With growing documentation requirements, the administrative burden on nurses has ballooned over the last decade. Today’s nursing school graduates abide by this rule: “If it wasn’t charted, it didn’t happen.” By performing repetitive, potentially duplicative work, nurses must allocate significant time to tasks removed from direct care, leading to higher burnout rates.
Since provider engagement is an important strategy to drive better patient outcomes, addressing these challenges means more than hiring additional staff – requiring leaders to find smart ways of scaling processes and maximizing the resources at hand. By bringing automation into everyday processes, nurses can focus their expertise and specialized skillsets on care delivery.
How Automation Optimizes Experiences
To identify where automation technology can be valuable, it is essential to first understand what it means to automate. According to the International Society of Automation, automation is the creation and application of technology to monitor and control the production and delivery of products. Automation has been used in various industries to meet changing consumer demands. For example, retail companies understood they needed to tailor online shopping experiences to an individual shopper’s preferences. Personal shoppers enhance the in-store experience by recommending clothing items according to the client’s taste and style – creating an experience tailored to the individual. To create a personalized shopping experience for online shoppers, retail companies leverage automated technology that recommends items based on past purchases and recent page views. The success of online shopping may be attributed to the personalized experiences and instant gratification consumers receive. Similarly, automated technology can accelerate innovation in healthcare delivery by streamlining repetitive processes such that interactions can be tailored to the individual.
By leveraging automation in clinical workflows, hospitals and health systems can more effectively engage with patients without adding additional administrative burdens for front-line providers. Clinical workflows can be automated with enhanced clinical decision support, care management task assignment, appointment reminders, and post-discharge follow up outreach.
In the example of post-discharge follow up, hospitals can automate the initial outreach call or text to assess recovery status for all patients within a target population. The automated outreach triages those individuals who indicate concerns, empowering clinicians to engage patients with targeted and meaningful information. This contrasts sharply with traditional outreach methods, in which nurses become increasingly frustrated with unsuccessful attempts to reach patients with manual outreach processes.
Automated workflows ensure that staff not only have more meaningful conversations, but patients are connected to the resources they need more quickly. This reduces the likelihood of adverse events, such as avoidable readmissions.
How Workflow Automation is Accelerating the Healthcare of Tomorrow
By implementing the right technology that reduces repetitive work, hospitals and health systems will experience healthcare’s Quadruple Aim of improved patient outcomes, enhanced patient experiences, increased staff satisfaction, and lowered cost of care. To maximize labor efficiency ROI, leading healthcare organizations are leveraging automated technology to reallocate valuable nursing resources to direct patient care. When providers work at the top of their licenses, healthcare organizations are better equipped to face the growing challenges presented by the ongoing evolution of the industry.
To learn more about how automation is changing the healthcare industry, we invite you to check out these resources:
In the era of value-based care, nurses are assuming expanding roles by leading the front lines of healthcare delivery and coordinating care as patients transition into population health and community-based settings. According to a Gallup study, nurse engagement is the most important predictor of mortality and complication variation across hospitals. Since the level of nursing engagement is strongly correlated with healthcare quality, nurse retention is a top priority that extends beyond the domain of the human resources department to impact the organization-wide mission of delivering outstanding patient care. As such, leading healthcare organizations are proactively leveraging evidence-based practices to retain nurses and thus, advance patient quality and safety.
Nurse turnover is an important and widely-used indicator of the quality of healthcare working environments. In a multi-state, 10-year longitudinal panel study of new nurses, 17.9% of nurses left within the first year of starting their first job and 60% of nurses left within eight years of starting their first job. The low retention rate of newly licensed nurses is concerning, as each nurse who leaves costs the organization up to 1.3 times their salary to replace. More importantly, this affects the quality of patient care. If we hope to better engage our nurses, we must proactively understand and act upon the predictors of turnover. According to a survey conducted by the New England Journal of Medicine, drivers of nurse burnout include compassion fatigue, moral distress, and work environment issues such as psychological safety and hostility.
As the industry continues to shift towards value-based care models, healthcare leaders are increasingly focused on outcomes. The risk of focusing on outcomes is that we neglect the underlying variables that drive the results. As such, healthcare leaders should strive to ensure that nurses understand the metrics that value-based care environments are evaluated on and how their work directly impacts the results – as well as seek their feedback on how to better improve these outcomes on an ongoing basis. For example, HCAHPS scores are important because they measure the critical essentials of healing. If communication with healthcare providers or quietness of hospital environment is compromised, this can lead to loss of control and induce a “fight or flight” response – draining the precious healing resources of the already-compromised individual. Nurses can give patients their best chance to heal by incorporating these essentials of healing into the patient’s plan of care.
To address the underlying issues impacting nurse retention and engagement, leaders should look to accomplish the following:
Accomplishing these goals requires time, action, and feedback. However, these evidence-based interventions do not require huge investments and there are many ways leaders can take steps in the right direction.
Develop an Environment of Psychological Safety
As the cornerstone of the Institute for Healthcare Improvement’s Framework for Safe, Reliable, and Effective Care, psychological safety is characterized by the following qualities: anyone can ask questions without looking stupid, anyone can ask for feedback without looking incompetent, anyone can be respectfully critical without appearing negative, and anyone can suggest innovative ideas without being perceived as disruptive. In a study conducted at Google, teams characterized by psychological safety achieved better results due to fostering a learning culture. In contrast, environments with poor psychological safety can reduce motivation, disrupt working memory, and cause distraction – leading to increased likelihood of medical errors and other adverse events.
In healthcare, lives are at stake. In these high-pressure environments, nurses frequently meet patients on the worst days of their lives. The emotional and physical stress of patient care may lead to disruptive behaviors from other members of the healthcare team. When faced with uncivil behavior, nurses need to feel supported by peers and managers that will advocate for them.
As a leader, what can you do to create a culture that is psychologically safe? First, leadership inclusiveness is an indicator of psychological safety. Leaders have the responsibility to set the tone for their teams. To understand the perceptions of psychological safety on their units, leaders should gather direct feedback from their nurses: Can team members take risks by sharing ideas and suggestions without feeling insecure or embarrassed? Do team members feel supported, or do they feel as if other team members try to undermine them deliberately?
After asking these questions, it is time to act. Leaders should model behaviors that increase psychological safety in their teams, such as recognizing the value of divergent perspectives and praising another team member’s contribution in front of others. During leadership or executive rounding, senior leaders can build a culture of trust when they encourage staff to share concerns without fear of negative repercussions. As an added value, when healthcare providers feel comfortable discussing near-misses, this can drive quality improvement initiatives to address breakdowns in processes and ultimately, enhance patient safety.
Integrate Opportunities for Meaningful Recognition into Leaders’ Workflows
Healthcare professionals are often trained to focus on what is “wrong”, but it is important to make the time to reflect and celebrate everything that is “right”. Lack of recognition for work performance is one of the biggest threats to nursing satisfaction. As such, the recognition of nurses when they demonstrate excellence in patient care should be embedded into the culture of every unit, not just a once-a-year event during Nurses Week.
Meaningful recognition involves genuine acknowledgement of the contributions of the individual nurse and how his or her actions make a difference in the lives of others. Creating a process that allows patients, families, and colleagues to recognize extraordinary actions in real-time is important to strengthen perceptions of self-confidence and esteem, hope, and resilience. There is nothing more rewarding for a nurse than to receive meaningful recognition from patients and families – even if the individual believes “I was just doing my job.” This feedback validates the importance of the work that nurses do – driving greater visibility into the mastery of skill required of the nursing profession.
Build a Culture of Continuously Seeking and Acting Upon Feedback
It should be clear to nurses that their opinions matter. Healthcare leaders should listen for underlying causes or themes when nurses share suggestions for improvement. When nurses perceive that their voices are heard, research demonstrates that this leads to increased staff satisfaction and improved patient safety. Responding to feedback quickly is key. Leaders should be held accountable for acting upon the feedback they receive. When leaders include nurses in the design and implementation of their ideas, they are more likely to continue to participate in the continuous feedback loop. When nurses feel like their ideas are validated, hope abounds: there is optimism that the status quo can and will change for the better, leading to enhanced staff empowerment and investment.
By developing strong practice environments that address key drivers of nurse retention and engagement, healthcare leaders can build a culture of resilience to better meet the demands of today’s continually-evolving healthcare landscape. As your team continues to seek improvements in patient outcomes and experiences, it is critical to empower your nurses. When leaders develop evidence-based processes that improve nurse engagement and retention, organizations save significant costs on hiring and training new nursing staff – and more importantly, reap immense benefits for staff, patients, and their family members.
To learn more about how to build a highly-engaged nursing team, I recommend these resources:
As CipherHealth’s Chief Nursing Officer, Lisa Romano, MSN, RN brings more than 25 years of experience in clinical practice, healthcare IT strategy, and healthcare operations to her current role. Prior to previous CNO roles, Lisa spent 19 years as a nurse and hospital administrator at Lehigh Valley Hospital and Health Network in Allentown, PA, where she was responsible for all patient flow and transfer center operations as well as numerous quality and patient satisfaction initiatives. Lisa is passionate about improving the health of patients across the healthcare continuum.
Every flight starts with the standard three-minute safety demonstration, complete with seatbelt and life vest props. During the demonstration, flight attendants inform passengers that in the event of a sudden decrease in air cabin pressure, oxygen masks will drop from the ceiling. Flight attendants explicitly instruct passengers to put their own oxygen masks on first, prior to assisting others. These safety instructions provide an important lesson for all individuals in helping professions: in order to help others, you need to take care of yourself first.
In my experience, most healthcare professionals pursue healthcare as a career to help others. To provide the highest quality of patient care, we must also care for ourselves and our peers. Attaining joy in our work is necessary to ensure optimal patient outcomes.
Prioritize Self-Care to Achieve the Quadruple Aim
In 2007, the Institute for Healthcare Improvement (IHI) developed the Triple Aim framework to support healthcare organizations in navigating the shift from reactive healthcare to the proactive improvement of health for individuals and populations. Since then, the Triple Aim has been expanded into the Quadruple Aim, as many healthcare organizations have identified restoring joy in the workplace as a prerequisite to enhance the experience of care for individuals, improve the health of populations, and reduce the per capita cost of healthcare. In fact, the President of the IHI recently shared, “Staff are much more likely to be enthusiastic and positive about securing the best outcomes for patients when they feel supported, empowered, and respected.”
According to a recent Discussion Paper published by the National Academy of Medicine, burnout is characterized by “…a high degree of emotional exhaustion and high depersonalization, and a low sense of personal accomplishment from work.” Due to significant changes in how care is provided, documented, and reimbursed, the evolving healthcare environment is a major contributor to burnout. Healthcare professionals experiencing burnout adopt attitudes that lead to lack of engagement and loss of connection at work. They may feel that patients are asking unreasonable requests, team members do not listen to their concerns, and their place of employment does not care about their experiences. As such, the National Academy of Medicine identifies burnout among healthcare professionals as a threat to safe, high-quality patient care.
Leverage Proven Strategies to Reduce Burnout
As healthcare professionals, what can we do to ensure that we feel supported, empowered, and respected? As current and future healthcare leaders, how can we take better care of ourselves and our colleagues as part of our organizational commitment to the Quadruple Aim?
The Green Cross Academy of Traumatology developed Standards of Self-Care Guidelines in recognition that only those that first care for themselves can provide the highest quality of care for others. As an ethical principle, the Academy maintains, “…the duty to perform as a helper cannot be fulfilled if there is not, at the same time, a duty to self care.”
The University of Buffalo School of Social Work provides a number of resources for self-care, including a Self-Care Starter Kit developed by Lisa Butler, PhD. Although there is no one-size-fits-all approach to self-care, important elements include managing and reducing stress, taking care of physical health, honoring emotional and spiritual needs, nurturing relationships, and finding balance in personal and work life. According to Butler, “…each person needs to identify what they value and need as part of day-to-day life (maintenance self-care), and also identify the strategies they can employ if and when they face a crisis along the way (emergency self-care).” For some, this may mean that we need to seek, find, and remember appreciation from our supervisors and clients. For others, it may mean physically exercising regularly, enjoying the outdoors, and engaging in self-reflection.
As healthcare leaders, take the opportunity to conduct proactive rounds on front-line staff at all levels of the organization. Both formal and informal check-ins are a great way to ensure that your team members connect to their day-to-day work and have the adequate resources to take care of themselves and their patients. Recognizing the achievements of your colleagues can go a long way towards reinforcing what is important and boosting morale.
To achieve the Quadruple Aim, staff must perform at their very best every day. By developing self-care strategies that include expressing and experiencing gratitude, healthcare professionals can become more proactive in the prevention of burnout. As we celebrate Patient Experience Week, take a moment to review your own self-care plan. For your own well-being and that of your patients, you will be grateful that you paused, took a breath, and reflected upon your role in providing the best possible experiences for all patients.
To learn more about how healthcare organizations can improve the patient experience across the continuum of care, we recommend these resources:
As the Senior Vice President of Client Success, Barb Davis, MHA, brings over 30 years of experience in healthcare quality and patient safety to her current role at CipherHealth. Barb led efforts at SCL Health to improve patient outcomes through the “Reconnect to Why” strategy, which was designed to help healthcare professionals articulate the relationship between the patient experience and their own experiences.