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JC Physician blog – News for M.D.s from M.D.s at The Joint Commission

Written by and for physicians, the biweekly JC Physician blog discusses health care issues of interest to doctors as well as other topics that may touch on ethics, the environment and current affairs.

NOTE: Physicians are encouraged to submit guest blogs for the JC Physician blog. Those interested should contact Social Media Specialist Sean Ostruszka.


A peek behind the curtain

Feb 24, 2015 | Comments (0) | 773 Views

Logan-MerrandaMerranda Logan, M.D.
Nephrology Fellow at the Brigham and Women’s/Massachusetts General Hospital Combined Nephrology Program
Patient Safety and Quality Improvement Fellow at Harvard Medical School.
Visiting Fellow at The Joint Commission

It’s one thing to “know” an organization. It’s another to understand it.

In December, 2014 I took a sabbatical from my position at the Edward P. Lawrence Center for Quality and Safety at the Massachusetts General Hospital to work for two weeks as a Physician Fellow at The Joint Commission.

My comprehensive experience  reinforced the importance of the patient safety principles, change management techniques and quality improvement project design skills that I utilize in my current roles at Harvard Medical School and the Massachusetts General Hospital. As part of the Joint Commission fellowship, I completed Robust Process Improvement training and was immediately able to apply practical new tools to my current projects.

A goal during my fellowship was to learn how The Joint Commission develops standards. I was not disappointed, as it was fascinating to learn how detailed, evidence-based and collaborative the Joint Commission’s process for standard development is, all to ensure that every standard is meaningful and relevant. At the Massachusetts General Hospital, we want to be proactive toward The Joint Commission’s regulatory standards. An example is our development of an Interdisciplinary Patient Tracer program to assess care delivery and compliance. After learning about how the Joint Commission’s standards are developed, I’m even more proud of our program.

With two of my main goals completed, another highlight was the opportunity to learn more about high reliability organizations and the application of high reliability principles to the health care setting. Prior to attending medical school, I spent my undergraduate summers interning in the Quality Assurance division of a pharmaceutical manufacturing company. That’s a place where Lean Six Sigma projects were abundant and high reliability was everyday practice. The Joint Commission truly believes zero patient harm is a tangible goal, and transforming healthcare to meet that goal must be a priority.

I cannot sufficiently emphasize how transformative my fellowship experience at The Joint Commission was, and I look forward to continued collaborations. I recommend that all pioneers and leaders in Quality and Safety take full advantage of the incredible array of invaluable resources developed by the Joint Commission as they make their journey towards effectively transforming health care delivery.

The Impact of Physician Burnout

Jan 28, 2015 | Comments (1) | 1635 Views

Alan H. Rosenstein M.D., M.B.A.,Michael R. Privitera M.D., M.S.    

Whether we don’t talk about it or don’t realize it, physician burnout is real.

Physician_Blog_Jan_15Recent studies have shown that nearly 50 percent of physicians report increasing levels of stress and burnout. And those are just the physicians who realize they’re actually getting burnt out or are willing to admit it. Both the realization and the admitting are as much of a problem as the burnout itself.

As physicians, our focus is always on the patients first. That’s a good thing, unless we are losing control due to stress. Increasing amounts of stress can negatively affect thoughts and attitudes, while building frustration, anger and resentment. In more extreme cases this can lead to impaired judgment, communication gaps or performance liabilities. All of these can affect the patient-physician relationship or the treatment the patient receives.

However, with so much focus on patients, it’s easy to not even realize how stressed you are, and even if you do, you’re supposed to suppress it. That’s the profession, or at least the old thinking of it.

Yet, we’ve all experienced extreme levels of stress; some to the point of burnout.

Many probably remember when the rollout of electronic records began. Many organizations, including ours, saw numerous physicians come and go because they couldn’t handle the added stress. We took people out on disability for being burnt out. I’ll even admit that when electronic records began being implemented at my hospital I felt like I was walking on Mars; too stressed to even know what planet I was on.

So how do we fix a problem physicians may or may not realize they have or want to talk about?

The best approach is for the organization to recognize the downstream consequences and provide support services. These programs will help physicians gain a better understanding of the pressures and consequences of today’s health care environment, and provide appropriate operational and emotional support to help them better adjust. 

Of course, there will still be physician reluctance to admit that they are under stress, as they may feel doing so would mean they’re weak. When physicians do talk about stress, it’s either in a colloquial sense – “everybody’s burnt out” – our just amongst each other; not to leadership. This situation makes it imperative for organizations not to rely on the physician to seek out help but to pro-actively offer support services in a confidential, constructive manner.

We are finally beginning to see some organizations take notice and put into place programs designed to help physicians. Recognizing that many of the attitudes and behaviors that contribute to under-recognition of stress develop during medical school, there are a number of grants available to help redesign training programs to focus on personal and business issues as well as core studies. For physicians already in practice, many organizations have developed new initiatives. Whether it’s conducting a “cultural fit” assessment during the hiring process, providing comprehensive onboarding services at the time of employment or provide coaching or counseling support services, there is no shortage of options.
What we need to recognize is that physicians and other health care workers are a precious resource, and no resource survives for long under intense stress.

Inspiring Change

Nov 12, 2014 | Comments (0) | 1487 Views

edupree4-14By Erin DuPree, M.D., FACOG
Chief Medical Officer and Vice President
The Joint Commission Center for Transforming Healthcare

“People change what they do less because they are given analysis that shifts their thinking, than because they are shown a truth that influences their feelings.”
– John Kotter, The Heart of Change

The health care industry is changing rapidly. With that change comes ever-increasing challenges: payment changes, government mandates, public reporting, technology costs, and informing and engaging patients. The impact to physicians is enormous. Even though physicians find great pride and satisfaction in caring for people, burnout is a real concern.

That got me thinking about how physicians can LEAD change instead of being the recipients of change.

The delivery of health care requires skills that no one learns in medical school: finance, accounting, team building, regulations, information technology, operations, quality improvement – all requiring new knowledge and skills. 

After all, we lead patients through changes every day.  In my OB-GYN practice, I led patients through the various stages of preventing a pregnancy, planning for a pregnancy, the actual pregnancy, and the inevitable changes after the new baby arrived.

Yet, as physician leaders, we are usually reacting to change -- the latest regulation, the flavor of the month from the CEO, or a new nursing leader in a key service line. 

As Kotter’s quote indicates, change requires touching people – their feelings and their hearts. In order to lead change we have to get in touch with our own hearts and invite others to do the same. This was basically the LAST thing I was taught in medical school! Avoiding emotions and learning the nuts and bolts of complex diseases was all that mattered. 

As physician leaders, leading change requires inspiring those around us. One of the best ways to do that is to make it personal -- tell a story, look for the resisters and listen to their concerns. Paint a vision of the future. We do this every day when we care for patients. We listen and we tell stories. We know what health and successful treatment looks like. We can lead patients in dealing with the unexpected changes because, usually, we have seen it hundreds, if not thousands, of times before. We can share the vision of success with them. If we can lead change with our patients, we can lead change in the hospitals, offices and systems in which we work. 

As I went through the fourth (or was it the fifth?) round of electronic medical record (EMR) implementations, I shared stories with those around me of my frustrations with the implementation that impacted my patients and my practice, yet ultimately was successful. The stories resonated and inspired those around me; it gave them the confidence that they, too, could get through the massive changes associated with an EMR implementation.

It’s time to get in touch with your heart, your stories, and inspire those around you: being a physician leader is as much about being a human being as it is about being a doctor. This is how to lead change.

Envisioning a safety culture - The perspective of one psychiatric hospital

Oct 29, 2014 | Comments (0) | 1785 Views

Anne_BauerBy Anne C. Bauer, M.D.
Field Director, Accreditation and Certification Operations

To me, it’s one of the most moving and inspiring, parts of surveying an accredited psychiatric hospital.

As the last day rolls around and the leadership session begins invariably the subject of high reliability in health care comes up. That topic usually spawns talk of how staff and leadership envision a safety culture at their facility. As a surveyor and field director, I have had the privilege to witness many of these conversations, and they rarely fail to move me.

During this time, staff are usually incredibly honest about having more to achieve, but, of course, they are eager to share what they are doing consistent with their particular vision of a safe health care environment.

At a recent leadership session, several board members attended, and they started the conversation by sharing their visions of a board which is very active in establishing and maintaining a safety culture at their psychiatric hospital. One board member joked about having seen more types of toilet paper holders than he could imagine as they searched for the one that presented the least risk to the patients. Another board member described his pride that their board had been through the building many, many times and knew the facility inside and out. Involving front-line staff in changes to the physical environment is often cited, as it was in this session, when the example of installing a door alarm to decrease elopement of patients was discussed. The first proposed location for the alarm was ruled out by the staff because they wouldn’t be able to hear it. So the plan went back to the drawing board.

A psychologist from the Partial Hospital Program also talked about his vision of a safety culture where they would implement a best practice for following up with patients during the high-risk period after discharge from their program.

Staff from human resources often talk, as they did during this session, of changes in the new hires. In addition to credentials, they look for people with a passion about safety and quality of care, and who seek a stimulating “learning environment” in which to work.

Safety culture, as they see it, is a place where everyone has something to learn, from the doctors to the housekeeping staff.

This particular hospital emphasized that they saw the “recovery culture” in behavioral health care as consistent with high-reliability health care and safety culture because it emphasizes viewing treatment from the patient’s perspective.

“The patients will teach us,” they told us. “The old thinking was program-centric. Now we are person-centric.”

As I said, it’s quotes like these that always make for the best endings of surveys.

The Tragedy of Physician Suicide

Oct 08, 2014 | Comments (0) | 2130 Views

By Paul Ziaya, M.D.
Field Director
The Joint Commission

It was an alarming read, to say the least.

In early September, an op-ed by Dr. Pranay Sinha, titled “Why Do Doctors Commit Suicide?,” appeared in The New York Times. The author spoke to the tragedy that is suicide, specifically about new physicians as they negotiate the difficulties of residency education. The statistics alone were worth the read – nearly 10 percent of fourth-year medical students and first-year residents reported having suicidal thoughts in the prior two weeks.

Residency is a very stressful time. We all remember that.

So despite the nationally implemented reduction in weekly hours for residents and programs implemented to assist with coping, suicide remains a risk. For physicians in general, there may be as many as 400 completed physician suicides each year in the United States. This is a worldwide issue and, as Dr. Louise Andrew noted in her Medscape article, “Physician Suicide,” “Depression is at least as common in the medical profession as in the general population, affecting an estimated 12 percent of males and 18 percent of females. Depression is even more common in medical students and residents, with 15-30 percent of them screening positive for depressive symptoms.”

The factors that may lead to suicide are many and, perhaps related to physician knowledge of and access to medications, physicians have a higher rate of completing an attempted suicide than in the general population.

Depression is difficult enough to recognize in others, but even when physicians recognize depressive symptoms in themselves, the majority fail to seek help; why is a complicated question. Perhaps it’s due to concerns about the potential effect on their careers or the sense that they are supposed to be the healers, not those needing healing.

Joint Commission standard MS.11.01.01 is specifically written to encourage medical staffs to identify and manage matters of individual health in ourselves and our colleagues. Separate from actions taken for disciplinary purposes, it focuses on education of physicians to recognize issues in others and also encourages self-referral in an effort to result in confidential diagnosis, treatment and rehabilitation to “retain and to regain optimal professional functioning that is consistent with protection of patients.”

Physicians, despite all their knowledge, are like everyone else in their risk for depression and suicide. Yet they have trouble getting effective treatment. While resources exist to help, we must continue to remove the stigma and other barriers associated with getting the needed assistance. That perceived stigma is thought of as a dangerous thing to a career or a physician, but we all must remember it pales in comparison to the depression itself.

Yes, The New York Times piece was alarming. Hopefully it’s an alarming reminder that despite efforts over more than a decade to recognize and improve the factors that may affect the rate of suicide in physicians, there still remains much to be done, and we as medical staff leaders and colleagues have an important role to play.


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