Tackling clinician burnout comes down to one simple word, according to Derek Feeley: Joy. The CEO of the Institute for Healthcare Improvement said that organizations and clinicians have to come together to figure out how to reconnect to the mission of healthcare and, in doing so, find the joy that first drew them to the profession. The IHI has launched some new programs around this effort. Feeley also believes that its recent merger with the National Patient Safety Foundation will allow the organizations to move from a whack-a-mole approach to more creative thought leadership on how to improve patient care. Feeley spoke with Modern Healthcare reporter Maria Castellucci at an IHI meeting late last year. The following is an edited transcript.
Modern Healthcare: In your keynote at the IHI annual meeting, you talked about the importance of partnerships—between clinicians and with patients. What inspired that? What are you seeing across the industry?
Derek Feeley: We've been thinking a lot about two big challenges. The first is burnout with physicians, nurses, other clinicians and allied health professionals. Sixty percent of physicians are thinking of leaving their job. It's shocking.
One of the benefits of our merger with the National Patient Safety Foundation is that they had begun to undertake a patient opinion poll. They were asking patients what concerned them about patient safety. We expected to see some of the data that came back, but some of what came back from patients took us by surprise. In a survey that was largely about safety, harm and error, many wanted to tell us that they didn't feel heard, that they felt disrespected, that communication occurred in a way that was unclear or unhelpful to them.
When we put those two pieces of data alongside each other—levels of patient experience that were less than optimal and staff burnout that was troubling—we started to ask ourselves: "Well, could we tackle these two things simultaneously in an integrated way? Are there a set of things that we could do that would help us to leverage both higher levels of patient engagement and higher levels of staff engagement?"
Our first question was: Are these two things correlated? In terms of the evidence base, it's actually pretty strong. Where you see high levels of staff engagement, you also tend to see high levels of patient experience. When you see high levels of patient experience, you also tend to see high levels of staff engagement.
When we started the study, part of the answer lay in connection to purpose. What brings people into healthcare in the first place? Well, it's the care. The second is this idea of true partnership. So, could we create a set of conditions that enabled clinicians to feel connected to that purpose and patients to feel empathy and compassion? And the third is power. Could we redistribute power through our system in a way that helped patients to feel more part of the team, more engaged in their care, to leverage some of those things?
MH: Do you think that's getting lost because of burnout?
Feeley: I think burnout is a feature of something else. People aren't choosing to be burned out, but I do think that the priorities that many organizations are feeling now just are not conducive to the flip side of burnout, which is joy. Joy is not found in the financials of healthcare. It's not found in payment systems or regulations or measurement. It's found in other things. It's found in caring and camaraderie and teamwork and sense of purpose and meaning.
What we need to do if we want to tackle burnout is create joy, and in order to do that, we need to change the focus. What really matters in healthcare right now, if we're going to create joy, has to be back to how do we improve care for patients, how do we create an environment where people feel a connection to purpose, how do we create a situation where they feel that their work is important?
I talk about this because people need to think they do meaningful work—I understand why I'm supposed to do what I'm doing. I feel engaged. It touches me emotionally as well as rationally.
Is it comprehensible?—I understand why I'm supposed to do this. This is connected to something that's strategic for our organization and important for us to do.
Then, is it manageable?—I can cope with this. I have the wherewithal to do it. I have the resources to do it. I have the tools to be able to do it.
If we can just make our clinical teams' lives more meaningful, comprehensible and manageable, that would go a long way to securing joy in work.
MH: We've seen a lot of political uncertainty with access to care. Do you think that's distracted the industry from the agenda of quality improvement?
Feeley: Somewhat. It's tempting to think about healthcare providers in a generic way, but actually, they are quite a heterogeneous group. And so, have some been distracted? Yes. But you also see people who are refocusing on quality improvement.
The environment is the environment. There's very little that providers can do about the politics and I can't see a situation where the pressures around cost are going to disappear anytime soon.
I think what we are starting to see is that people are accepting there are some things in their operating environment that they just can't change and they are focusing instead on the things they can change.
We can still do a lot more than we're currently doing around improving quality, understanding patients' needs, engaging patients in their care, redesigning care to provide for people with long-term conditions rather than acute episodes. What we are encouraging people to do is to focus on those things. Let's focus on the stuff we can really change. And my sense is there are still a significant number of organizations that would like to do just that.
MH: Can you talk a little bit about how the merger with NPSF is going?
Feeley: It was a great opportunity for us. IHI has been active in the patient safety field for 30-plus years. We're out in the field working with organizations all around the world on patient safety. We had gotten so engaged in the doing of patient safety that we had scarce capacity to do the thinking about patient safety.
NPSF CEO Dr. Tejal Gandhi describes this as seeing patient safety as whack-a-mole. You see a problem, and you solve the problem. If there's another problem, we'll solve that problem too. And so it's a series of projects. We came to the conclusion that in order to make real progress, we're going to have to change to building a more systematic approach to safety, to really create learning systems. And so what the merger has given us is the thought leadership of NPSF and the Lucian Leape Institute, which sits inside NPSF. Our theory is if we can marry that with the implementation ability of IHI, it ought to be a real win-win for the field.
The second thing we can do with the merger is speak with one voice, which raises our impact.
The third thing we're now able to do is integrate our programs so there's that mix from the customers' point of view that makes more sense. There's no competition for people's time and energy, but rather a set of carefully designed, well-constructed training initiatives and opportunities for people to learn about patient safety.
MH: Looking ahead, is there a patient safety issue, a quality improvement issue, that you hope gets more attention, something that you're particularly worried about?
Feeley: There are many. I could pick a few.
On patient safety, we are really interested in cross-continuum safety. Most of the safety work—and this is not just a U.S. issue—is still largely in the hospital sector. We want patients to be safe wherever they are. And so, for example, we're doing some work right now on safety in the home. There are also opportunities for safety in continuing care and in nursing facilities.
Two other things I would identify as priorities for IHI, one we talked a little bit about already, which is joy in work. If we can't make progress with raising people's joy in work, it's going to be harder for us to do almost everything else we do, because all of our work is done through the efforts and energies of point-of-care clinicians. And we need them to be engaged and we need them to feel positive about their work.
Another thing I would highlight is equity. We have some prototype work underway now with a handful of volunteer healthcare systems in a program we call Pursuing Equity. This is really trying to figure out what healthcare systems can do. There are many challenges around disparities and inequality that are driven by the social determinants of health, but there are some very straightforward things healthcare systems can do to make an impact. Having equity as a strategic priority for your healthcare organization stated upfront—you're highly unlikely to do anything about it if you don't say this is a priority for us—means doing things around your hiring procedures to make sure those are diverse and inclusive and equitable, doing things around your supply chain to make sure you touch parts of the economy in your community that represent that community.
And one more—we really want to reach more people. IHI has a number of modalities for doing that, including our Open School, which has been incredibly successful getting students, hundreds of thousands of students from all over the world, trained in quality improvement, and yet it's still just the tip of the iceberg. There are still far too many clinicians and student clinicians who are not exposed to quality improvement as part of their training or continuing development, and we would like to change that.
