Targeting Provider Wellness and Efficiency with the Arch Collaborative

Our participation in the Arch Collaborative survey came on the heels of UW Health’s participation in the Stanford Wellness Academic Consortium. In the fall of 2017, we administered the Stanford wellness survey. Not surprisingly, a lot of the data and comments within that survey alluded to providers’ frustrations with the EHR. As this data and commentary were being digested by our organization and as action plans were being developed, Taylor came to UGM and provided information about the opportunity to participate in the Arch Collaborative.

I had been aware of the Collaborative prior to his presentation, but the timing had not been right. With the organizational focus on wellness that was generated by the Stanford survey, I recognized that we had an opportunity to seize the momentum and encourage our organization to participate in the Collaborative as a means of generating new and deeper knowledge about the overall satisfaction of our clinicians with the EHR and how that may or may not relate to wellness. It was particularly serendipitous that I was sitting next to our chief clinical officer during Taylor’s presentation. I shared my thoughts about the linkage, and he immediately agreed with our participating as an Arch Collaborative member. 

A Push for Wellness

As is true for many organizations, UW Health is making a very concerted, strategic effort to focus on provider wellness. As part of that, we established a provider wellness committee with representation from each of our clinical departments. The committee helps to identify initiatives that may improve the three areas of Stanford’s WellMD Professional Fulfillment Model—Culture of Wellness, Efficiency of Practice, and Provider Resilience. As part of the efficiency of practice domain, I was asked to come in and lead the group for four months to identify initiatives that would help improve EHR satisfaction.

In that forum, I shared the Arch Collaborative findings with respect to the impact of training, optimization, and shared ownership. I led the committee through brainstorming exercises on what we could do to improve training, better optimize the tools, and improve shared ownership. Once we finished brainstorming, we went through a prioritization exercise and ultimately voted on which issues to tackle first.  

Four Initiatives for Improvement

Four initiatives came out of those meetings and are currently in various stages of progress. The first and most important initiative is to expand our physician informatics team to have representation from each of our clinical departments. This is a significant expansion of my team and has been a huge focus of mine over the last couple of months. I am obtaining all the administrative approvals and securing financial resources; it is not an insignificant financial undertaking to provide salary support for physicians across the various clinical departments so that they can participate on the team. Thankfully, the health system has been extremely supportive and recognizes that creating shared ownership in this way is the most foundational of the initiatives.

The second initiative is to develop mechanisms to create protected or secured time for training for all our providers. This goal is a bit on the back burner right now, but it is an identified priority and something that we hope to tackle in the future.

The third initiative is to expand our at-the-elbow support to our inpatient, ED, and operative areas. We have very robust at-the-elbow support in our clinics but have not really had the same support for our providers in those other areas. We currently have an active proposal submitted to achieve this goal.

The fourth and final initiative is to put together a specialty optimization team similar to what other organizations have done as presented at the Arch Collaborative meetings. This team is being formed to go into the clinics and take a rapid improvement approach to optimizing tools.

Taking a Closer Look at Roles

One thing that surprised me was how well we were performing overall as an organization. We surveyed almost all our clinical users: physicians, residents, APPs, nurses, medical assistants, unit clerks, and other licensed clinical professionals both inpatient and outpatient. Overall, we were at about the eightieth percentile among all organizations for net EHR satisfaction. 

But when that data was broken down into roles, we saw clear differentiation in satisfaction between our nurses and other ancillary staff members and our physicians and advanced practice providers. When we broke down that data even further, it was very clear that the dissatisfaction largely resided in our faculty providers versus our residents and advanced practice providers. That was very compelling data for us to share at the organizational level because it helped us really make the case for where we needed to target our intervention. And we were able to justify the fact that we needed to be doing something different with respect to our faculty providers versus our other clinical roles.

Improving Visibility of the Informatics Team

When we take our next survey, I am not expecting to make a ton of headway with training and optimization because those are still very much a work in progress. But I do hope that we will see changes in the shared-ownership aspects with the transparency of the data and with the concerted effort to expand the informatics team and improve the visibility of my team throughout the organization.

We have done a fair number of things to boost that visibility and shared ownership. For example, UW Health now holds onboarding events every fall for any faculty members that have joined the organization in the last year. We set up a booth at that onboarding event where we introduce our team and the support people in the new faculty members’ clinics. We also provide them with individualized information about the specific people in their clinic who they can call. The goal is to let new people know who we are, what we do, and how they can get help when they need it.

All these efforts are aimed at improving shared ownership. Moving forward, I am hoping that people are starting to realize that we are earnest about wanting to truly create collaboration between the clinicians and the informatics team to improve the tools.

Do It

Participating in the Arch Collaborative and learning from our peer organizations has been a tremendously valuable experience. Seeing how we compare to other organizations has helped to bring EHR-satisfaction data forward to our leadership. It really helps our leaders understand the importance of continuing to work on EHR satisfaction for our providers and how it relates to other things in the domain of provider wellness.

If your organization is even considering participating in the Arch Collaborative, my advice is to do it. If your organization is potentially struggling with identifying resources and initiatives that can help improve EHR satisfaction, having data to show where you stand as an organization and what other organizations are doing to move the needle can be really powerful. An evidence-based approach to tackling this big problem is also valuable. Being a participant in the Collaborative effort helps to carry that message.

Shannon Dean is an Associate Professor of Pediatrics and CMIO at UW Health.

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