Please, Higher-Ups, We Know What to Do. Let Us Do It.

What's the best way to motivate and inspire members of our teams to do more?

In a world where we're all stressed out, all burned out, all quite a bit overwhelmed to say the least, how do we move forward on initiatives, ideas, and new projects that are designed to make the lives of our patients and our providers better?

Volunteers Can't Fill the Void

Unfortunately, the way things stand now, asking for volunteers is just not going to cut it. As we look at our fractured and misaligned healthcare system, over and over we see places where a big difference could be made. Better ways to communicate results to patients, better ways to build communication and collaboration between providers. Better ways to manage and enhance population health, better ways to build registries, better ways to reach all of our communities, better ways to ensure that all patients get all they need. Better ways to overcome inequities, better ways to ensure that no one is falling through the cracks.

But having a good idea is a long way from turning it into a reality. Unfortunately, over and over again, we've seen that someone wants to know what the business plan looks like; someone wants to know what the bottom line is. If I'm going to pull a provider from one or two practice sessions a week to build a new model of mental healthcare at our under-resourced practice, then what happens to the relative value units (RVUs) that that provider used to make during those sessions? Who's going to pay for that?

If we assign one person to be in charge of closing gaps in breast cancer screening or colon cancer screening, or a vaccine champion for the flu, pneumonia, shingles, and COVID-19, that's a lot of percentages of clinical full time equivalents (FTEs) that somehow need accounting for. If we're going to advocate with the vendors of our electronic health record to help create a better system for us to work in and for our patients to live in, if we're going to work with people smarter than us about this stuff to develop new technology tools and new ways to provide video visits and telehealth, then someone's got to support that salary.

More Than Low-Hanging Fruit

Over the past few years, whenever some initiative has come up at our practice, the idea of just asking someone to step up and take it on without taking away some other responsibilities from them just no longer seems palatable. And can you blame people for not wanting to do it? People are working their butts off, churning through office visits in a packed schedule, answering portal messages and emails and phone calls, trying to find specialists to take care of our patients, trying to track down outside medical records, filling out forms and dealing with insurance companies demanding prior authorizations, and spending countless after-work hours at home closing their charts, writing their notes, following up with their patients.

It's gotten really hard, really tough, to ask them to do more. Of course, some folks take an idea and run with it, throw some extra hours at it, trying to develop an innovative way to transform care. Just recently, one of our ambulatory chief residents and one of the nurse practitioners who is a certified diabetes educator at our practice, rethought and restructured the workflow for getting point-of-care hemoglobin A1c tests done for diabetic patients. This transformed workflow has made it far easier to get the right data we need at the start of the office visit, to change and improve the care of our diabetic patients who have had trouble reaching their goals.

Unfortunately, not everything can be such low-hanging fruit. More often things require a lot of heavy lifting, going through the sometimes laborious process of quality improvement, mapping out the pain points and barriers to change, getting input from multiple parties, doing multiple iterations of Plan-Do-Study-Act (PDSA) cycles. This takes time, energy, and human capital.

More and more we've seen that continuing with the status quo just is not going to cut it. Too many people are suffering -- both our patients who are trying to navigate this crazy system and the providers who are trying to deliver the best care possible. For us to continue to be a wellspring of innovation, we're definitely going to need a lot more support, a lot more recognition that this is the kind of place where ideas are born that can change things for the better.

If you give us free rein, we will be the ones who will say, "This is a way to do things better. Listen to us, listen to our patients, and let us do the right thing."

Without Change, Breakdown

I know that going up the chain of command they're going to look at the business plans for these things, the return on investment, and say, "It just doesn't make sense; we can't afford to pay for this. Just keep doing what you're doing; keep churning out those RVUs."

But those of us on the front lines doing this day in and day out know that the system is going to break if some (many) things don't change. So listen to us, listen to the primary care providers, listen to all of the patients, staff, doctors, nurses, and everyone else who says, "This can't be right. There has got to be a better way." Trust us, we can make it better. We know that it doesn't look like it's going to make you a lot of money, but in the end, is that really what we're in this for?

The old expression "an ounce of prevention is worth a pound of cure" seems fitting here, if not a little corny. Investing and letting us build a system that makes sure everybody has all of their healthcare maintenance up-to-date, all of their vaccines done, all of their screenings, that all of their chronic illnesses are managed as best as possible, will prevent those downstream costs of serious complications that cost so many of our patients, and our society, so much.

So let us roll with this stuff, and we'll show you where we can take you.

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