After recently purchasing a mid-size rear-wheel drive car, I was worried about the car’s ability to handle the ice and snow during the brutal Chicago winters. I decided to seek advice on improving my new car’s safety from a friend who races cars as a hobby.
His response? “Son, I have just one word for you…tires. No matter how that car moves, it will do so through the small patches–where the rubber meets the road.”
My car’s safety and performance characteristics ultimately manifested via four small areas–my tires. Therefore, having the right kind of rubber for my tires was the best thing I could do to achieve my safety objective.
Where the Rubber Meets the Road in Healthcare
All the regulations, organizational structures, policies, procedures, and personnel involved in the healthcare system ultimately impact the interaction of the physician and the patient in the treatment room. The healthcare system makes up the vehicle’s machinery, and where the physician meets the patient (over 1 billion times per year) is where the rubber meets the road. This intersection drives critical results for the patient, the community, and the population.
It is here where the bureaucratic process meets the healing process–and dramatically impacts the attitude and behavior of the physician. Therefore, it’s essential to consider this intersection when making decisions that could impact the physician-patient interaction in the treatment room.
What is Negatively Impacting This Intersection?
To illustrate my above conclusion, I’ll provide you with a few examples. For instance, with increasing government regulation, such as meaningful use, we are seeing…
- Significantly decreased “Facetime” between the doctor and the patient.
- Increased “screen time” between the doctor and the EHR.
These outcomes have hurt patient care. In the same sense, institutional efforts to increase effectiveness have, to date, focused primarily on physician productivity–not the promotion of treatment effectiveness. This “top-down” approach to managing healthcare has taken its toll on physician engagement, leading to burnout rates deemed a “national healthcare crisis.”
According to Medscape LifeStyle Report 2017, “burnout rates for all physician respondents have been trending up since 2013, the first year that Medscape asked about it when the overall rate was 40%. This year, it is 51%, over a 25% increase in just four years.” The fatigue, decrease in effectiveness, and cynicism typical of burnout have had an insidious and profound effect on patient care.
Literature has shown that wounds heal faster if the patient experiences kindness and empathy from providers. However, the depersonalized physician has difficulty delivering these qualities.
As another example, studies have shown that one-third of new prescriptions are not filled, and a lack of trust and empathy are major contributing factors. If a physician can genuinely connect with the patient, they are more likely to fill the prescription, take the medication, and follow through with what is in their best interest.
From there, they get better, and population costs will go down.
Coaching’s Role in Improving Our Healthcare System?
Coaching can improve healthcare delivery by addressing this issue at multiple levels.
The most obvious is coaching at the physician level. Improving physician engagement through the coaching of physicians has been shown to reduce the rates of burnout significantly.
Physician leader coaching also has a positive effect on overall physician engagement. It has been shown that how a physician supervisor leads plays a significant role in increasing physician engagement. Most importantly, coaching can help the physician leader turn systemic “vicious cycles” that fuel physician burnout into “virtuous cycles” that promote physician fulfillment.
In summary, adopting the healthcare “vehicle” design to promote physician engagement requires more attention to how it impacts the individual physician and their relationship with their patient.
Remember, this is “where the healthcare rubber meets the road.” An engaged and fulfilled physician will deliver more effective care and support the healthcare system in getting where it needs to go, improving population health and decreasing population costs.
