Novel Metrics for Improving Professional Fulfillment

Ideas and Opinions21 November 2017Novel Metrics for Improving Professional FulfillmentYumi T. DiAngi, MD, Tzielan C. Lee, MD, Christine A. Sinsky, MD, Bryan D. Bohman, MD, and Christopher D. Sharp, MDYumi T. DiAngi, MDFrom Stanford University School of Medicine, Stanford Health Care, and Stanford Children's Health, Palo Alto, California; American Medical Association, Chicago, Illinois; and University HealthCare Alliance, Newark, California., Tzielan C. Lee, MDFrom Stanford University School of Medicine, Stanford Health Care, and Stanford Children's Health, Palo Alto, California; American Medical Association, Chicago, Illinois; and University HealthCare Alliance, Newark, California., Christine A. Sinsky, MDFrom Stanford University School of Medicine, Stanford Health Care, and Stanford Children's Health, Palo Alto, California; American Medical Association, Chicago, Illinois; and University HealthCare Alliance, Newark, California., Bryan D. Bohman, MDFrom Stanford University School of Medicine, Stanford Health Care, and Stanford Children's Health, Palo Alto, California; American Medical Association, Chicago, Illinois; and University HealthCare Alliance, Newark, California., and Christopher D. Sharp, MDFrom Stanford University School of Medicine, Stanford Health Care, and Stanford Children's Health, Palo Alto, California; American Medical Association, Chicago, Illinois; and University HealthCare Alliance, Newark, California.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-0658 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Measurement abounds. Indeed, many ambulatory care providers feel besieged by the financial, quality, and service metrics that pervade their professional lives. Relatively new to this landscape are measurements from the electronic health record (EHR), which include practice efficiency scores that create a window on the clinician's workflow. In this article, we propose a set of EHR-related metrics that provide further insight into the clinician experience.The EHR, which was intended to improve patient care, has had the ironic and unintended consequence of impairing practice efficiency, largely because of poor design, a focus on regulatory reporting, and the burden placed on ...References1. Shanafelt TD, Dyrbye LN, Sinsky C, Hasan O, Satele D, Sloan J, et al. Relationship between clerical burden and characteristics of the electronic environment with physician burnout and professional satisfaction. Mayo Clin Proc. 2016;91:836-48. PMID: 27313121 doi:10.1016/j.mayocp.2016.05.007 CrossrefMedlineGoogle Scholar2. DiAngi YT, Longhurst CA, Payne TH. aming the EHR (electronic health record)—there is hope. J Fam Med. 2016;3. PMID: 27830215 MedlineGoogle Scholar3. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374:1714-21. PMID: 19914516 doi:10.1016/S0140-6736(09)61424-0 CrossrefMedlineGoogle Scholar4. Rucci A, Kim S, Quinn R. The employee customer-profit chain at Sears. Harv Bus Rev. 1998;76:82-97. Google Scholar5. Hong Y, Liao H, Hu J, Jiang K. Missing link in the service profit chain: a meta-analytic review of the antecedents, consequences, and moderators of service climate. J Appl Psychol. 2013;98:237-67. PMID: 23458337 doi:10.1037/a0031666 CrossrefMedlineGoogle Scholar6. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13. PMID: 26653297 doi:10.1016/j.mayocp.2015.08.023 CrossrefMedlineGoogle Scholar7. Arndt B, Beasley J, Temte J, Tuan W, Gilchrist V. Work after work: evidence from PCP utilization of an EHR system Abstract. Presented at North American Primary Care Research Group Annual Meeting, Cancun, Mexico,. 24–28 October 2015. Google Scholar8. Tai-Seale M, Olson CW, Li J, Chan AS, Morikawa C, Durbin M, et al. Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine. Health Aff (Millwood). 2017;36:655-62. PMID: 28373331 doi:10.1377/hlthaff.2016.0811 CrossrefMedlineGoogle Scholar9. Swensen S, Shanafelt T, Mohta N. Leadership Survey: Why Physician Burnout Is Endemic, and How Health Care Must Respond. NEJM Catalyst. 8 December 2016. Accessed at http://catalyst.nejm.org/physician-burnout-endemic-healthcare-respond on 13 July 2017. Google Scholar10. Schutte L. What You Don't Know Can Cost You: Building a Business Case for Recruitment and Retention Best Practice. Journal of the Association of Staff Physician Recruiters. 2012. Accessed at www.aspr.org/?696 on 13 July 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Stanford University School of Medicine, Stanford Health Care, and Stanford Children's Health, Palo Alto, California; American Medical Association, Chicago, Illinois; and University HealthCare Alliance, Newark, California.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0658.Corresponding Author: Yumi T. DiAngi, MD, Stanford University, 4100 Bohannon Drive, MC 5522, Menlo Park, CA 94025; e-mail, email protectedcom.Current Author Addresses: Dr. DiAngi: Stanford University, 4100 Bohannon Drive, MC 5522, Menlo Park, CA 94025.Dr. Lee: Stanford Children's Health, 700 Welch Road, Suite 114A, Palo Alto, CA 94304.Dr. Sinsky: American Medical Association, 330 North Wabash Avenue, Suite 39300, Chicago, IL 60611-5885.Dr. Bohman: Department of Anesthesiology, Stanford University, 300 Pasteur Drive, Palo Alto, CA 94305.Dr. Sharp: Stanford University, 211 Quarry Road, Palo Alto, CA 94304.Author Contributions: Conception and design: Y.T. DiAngi, T.C. Lee, C.A. Sinsky, B.D. Bohman, C.D. Sharp.Analysis and interpretation of the data: T.C. Lee.Drafting of the article: Y.T. DiAngi, T.C. Lee, C.A. Sinsky, B.D. Bohman, C.D. Sharp.Critical revision of the article for important intellectual content: Y.T. DiAngi, T.C. Lee, C.A. Sinsky, B.D. Bohman, C.D. Sharp.Final approval of the article: Y.T. DiAngi, T.C. Lee, C.A. Sinsky, B.D. Bohman, C.D. Sharp.Provision of study materials or patients: T.C. Lee.Obtaining of funding: T.C. Lee.Administrative, technical, or logistic support: T.C. Lee, C.D. Sharp.Collection and assembly of data: T.C. Lee.This article was published at Annals.org on 10 October 2017. 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