Discovering a Remedy for Physician Work Stress--Making the Case for Team-Based Care and Physician Leadership in Group PracticeLee Jacobs, MD, Associate Editor, Health Systems Perm J 2003 Winter; 7(1):2-5 https://doi.org/10.7812/TPP/15-190Is your medical practice stressful? Too much to do with too little time? Spending a significant part of your day doing non-doctor work? Are you feeling that you have no influence over your work life? Ready for a different approach? Remedy: A major solution for physician work stress is found in the linkage of the imperative that all physicians need to be leaders, regardless of job title, with the concept that the most effective work unit is a team rather than an individual. I'll make my case for this approach to physician well-being by addressing root causes of work-life stress. I. Prescription For Stress Reduction--The Case For Health Care Teams Regularly Doing Nonphysician Tasks The nature of the medical profession is inherently stressful--being responsible for the health of people tends to do that. Although physicians in group and solo practices may incur a significant amount of practice stress, the stressors are somewhat different for each practice setting. Although group practice has successfully managed the intensity of being on call, the frustrations of office management, and, to an extent, economic security, group practice physicians probably have a set of stressors that is not a factor in solo practice. Specifically, solo practitioners typically have surrounded themselves with an office staff (team) who have a strong sense of influence and loyalty and are trained to focus on relieving the physician of all tasks that could be undertaken by another member of the office team. Is there a lesson here? Only when group practices are organized as teams can innovations be tried to free up doctors to doctor so they are not encumbered with time-consuming activities that can be done by another team member. It takes the dynamics of a strong team to make changes in the scope of responsibilities of all team members; it does not occur just by asking. Practicing in Isolation However, there is one additional significant source of practice stress that neither group practice nor solo practitioners have solved. This is the pressure felt by an individual physician when s/he alone needs to see an entire schedule of patients, regardless of the extent of health complaints or timeliness of the patient for the visit. A review of the literature (see Annotated Bibliography) reinforces what we probably intuitively know that people working alone are more stressed than those working as part of a team. Here is a specific illustration: If a practitioner (physician, NP, or PA) is behind in seeing their patients, an empowered staff member assesses the situation and may move the chart of a waiting patient to another practitioner who is on schedule. While you might think of many reasons why this shouldn't work, this type of team support is being done regularly on KP health care teams in regions throughout the country. Granted, it takes well-trained, empowered team members, and strongly interdependent physicians, but it works. You want the evidence? I suggest reading "Successful Practices in the Physician Work Environment: We Work Together" in the Fall issue of The Permanente Journal,1 in which the authors, Karen Tallman, PhD, with Jill Steinbruegge, MD, and Michelle Hatzis, PhD, discuss interviews with physicians from several KP primary care heath care teams around the KP Program. Teams that had high patient satisfaction and high People Pulse scores ("I feel supported ..."; "I have influence ...") addressed the daily stresses of busy practice by building on the dynamics of solid teams and by leveraging the members of their health care teams to take the pressure off individual physicians. While there is much work to be done in this area, it is clear to me that a highly functional team alleviates a significant amount of the pressure from practitioners who feel responsible for their scheduled patients. Influence Over Practice There is convincing evidence that individuals who feel that they have a high level of influence over their work are more satisfied than those who feel that external forces determine their work environment. This is affirmed by the worksite employment survey of KP (the People Pulse), which repeatedly has identified the level of influence as a primary driver to satisfaction. Individuals working on a high-performing team have a much greater likelihood of developing a sense of influence over their practice. An isolated practitioner is less likely to feel that s/he has influence as opposed to a team member who is actively involved with the team in addressing issues impacting the work environment. Conclusion: Remedy for Stress--High-Performing Interdependent Teams The stages of team development are depicted in Figure 1. Phase 1 includes teams that are geographically together and episodically having meetings but the practitioners are still practicing in isolation. Phase 3 includes teams with a clear focus on patient care and service, which are organized to be totally interdependent. No question--this journey is worth taking. As demonstrated in Tallman's work, teams in Phase 3 feel in more control of their practice and overall have a much higher sense of professional well-being. In conclusion, it is my premise that our stress in busy practice settings is best dealt with by using team-based care models. But hold on, there is one fundamental requirement before physicians and staff can set off on this journey. II. Prerequisite For The Team Solution To Stress--The Case For Physician Leadership Figure 1 demonstrates three important factors that create a state of readiness necessary before teams can be organized and successfully developed. First, the teams must have practitioner staffing at the levels determined by the organization. Second, no team will make this journey unless an effective physician team leader is at the helm. Third, what is most often ignored in team development is the necessity of having all physicians on board as strong informal leaders. As readers of The Permanente Journal are aware every issue since Summer 2000 has included a section titled Physicians as Leaders. This is no exception, and on page 68, Dr Philip Tuso shares six universal and timeless characteristics of great leaders. He feels that these characteristics, if mastered, will help you to become a more effective leader. Why all this hype? Why is it important to you or me if the physicians on our teams are strong informal leaders? Answer: If you believe we can diminish our daily job stress by being part of a high-performing, interdependent team, then all physicians on the team must be seen as leaders by the team. I'm not aware of a successful team comprised of physicians who are isolationists and individualists, uninvolved in team activities. Success just won't happen without all physicians on the team modeling high quality patient care and service and team member interpersonal relationshipsie, they are leaders! The Physicians as Leaders section in this issue will define for you what this type of leadership looks like. III. Summary--Steps To Consider in Diminishing Stress in Your Daily Practice The journey in developing successful teams starts at the grassroots level by physicians, other practitioners, nurses, and other staff members who want to improve the quality of their work lives while enhancing the patient's care experience. Organizational leadership is needed to support and encourage, but it is front-line people who will make it work. Here are specific prerequisites, as summarized in Figure 1:
I hope you find this helpful and that you now have a reason to pull out your past Permanente Journal articles on Physicians as Leaders and the Tallman article on the results of the physician interviews. This is one man's opinion, and, as always, we welcome yours! Team Structure and the Impact on Job Stress
Disclosure StatementThe author(s) have no conflicts of interest to disclose. References1. Tallman K, Steinbruegge J, Hatzis M. Successful practices in the physician work environment: we work together. Perm J 2002 Summer;6(4):39-42. |
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