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Success Story: Improving Emergency Department Culture to Decrease Physician Turnover

Based on an American Medical Association news article published August 13, 2019 and Sara Berg's interview with Darren Shafer, MD, emergency physician and executive medical director for Presbyterian Medical Group, Albuquerque, NM.

Learn how feedback gathered through an annual review program fostered a culture of wellness in the emergency department (ED).

What Was the Problem?

An emergency department in Albuquerque, New Mexico, struggled with the culture of their medical group. To address this, one doctor created an annual review program to maintain a healthy emergency department culture while maximizing quality of care and physician well-being. It is a relatively simple step that has produced dramatic results.

Developing the Intervention

“We started recognizing the need to look closer at our culture,” said Darren Shafer, MD. “We realized there was quite a bit that was missing…we didn't have enough bidirectional communication.”

Prior to his current position, Dr Shafer was the program medical director for urgent and emergency services, which is where he developed an infrastructure and tried to respond to some of the issues the group was experiencing by creating the innovative program dubbed the Provider Annual Rhythm. The effort has helped cut ED team member turnover by half.

As part of the Provider Annual Rhythm, yearly strategic retreats have helped Dr Shafer capture input from the health care team to contribute to reviews, sparking friendly competition. Figure 1 illustrates the focus areas of an effective Provider Annual Rhythm program.

Figure 1. Focus Areas of a Provider Annual Rhythm program

Place priority on top frustrations

During the retreat, health professionals vote on the top challenges to focus on as identified by the provider experience survey results and friction in practice survey. From there, Dr Shafer and his team will share a weekly report to identify the status of each issue which is color coded to indicate progress.

Green tasks are those that are finished, while yellow is in process. If a problem was challenged, rejected, or they are trying to identify how to approach the situation, it would be considered red. This shifts the focus to fixing problems that cause frustrations and lead to physician burnout—it closes the feedback loop.

Feedback from team, not just leadership

Modified 360-degree evaluations, which are one part of the annual review, allowed individual team members to see how everyone perceived them.

The online survey included a handful of questions focused on various aspects of the workday, such as arriving on time, appropriate handoffs, if they would want this person to care for their family member, etc. These evaluations allow physicians to see where their “blind spots” are and where they can improve.

“It only takes about half an hour and people were really receptive and eager for feedback,” said Dr Shafer.

Share metrics with team

There had not been “any sort of formalized feedback structure” for physicians and their teams previously. The annual rhythm contains a focus on an annual review for feedback to each clinician. This includes looking at individual metrics and how each team member is performing, such as the time it takes for a patient to get a room or if a patient returns within 72 hours, resulting in hospital admission.

These metrics were initially shared in the ED without physician or team member identifiers. After a planning meeting, though, the team decided to complete six months of blinded information followed by open, unblinded metrics sharing within the group.

Identify placement

With metrics in place and unblinded data sharing, physicians and other members of the team can see who is to the right of them on the curve and who might be to the left. For those on the right of the curve, this allows physicians and their teams to identify who to pay “attention to in these different areas while they're on shift” as someone to watch for tips.

And those who were to the left of the curve could then be helped by recognizing differences in work and offering potential solutions. The team looked to help with the aim of making “their life a little bit easier at work to gain work-life balance and decrease stress while on shift,” said Dr Shafer. This helps to create collaboration, while making it a better place to work.

“Work-life balance is extremely important, and the stresses of work are hard enough. So, it's great to have a teammate who's looking out for you.”

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Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

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