P2A045: Improving Clinician Well-being by Enhancing the Care Team

Background: Children’s Primary Care Medical Group (CPGM) is a 164 clinician, physician-owned pediatric practice serving patients at 28 sites throughout San Diego and Riverside counties. A recent increase in CPCMG’s burnout rate (from 35% to 52%), thought related to an increased workload from a post covid viral resurgence, staffing shortages, and high in-basket patient messages, highlighted the importance of organizational drivers of burnout and confirmation of a Team Based Care approach.

Methods: Leadership of CPCMG and its management team (RCPMS) previously started a Care Team Re-design initiative to improve efficiency of practice. Each area of focus has clinician and administrative leads who direct clinician/staff committees. The dyads report monthly to the CPCMG and RCPMS CEOs, followed by a meeting with all participants in which the dyads leaders can report, review progress, and collaborate.

CPCMG’s CMO and RCPMS Director of Nursing are focused on improving the integrity and efficiency of the well child check workflow, from scheduling, to performance of the visit, to after visit follow-up. This group conducted clinician, staff and patient surveys. Initial action items included implementation of strategic scheduling with expansion of time allowed for certain visit types, optimizing completion of the patient entered questionnaires, and developing consistent scripting for the staff/clinicians at each contact point with patients.

The CPCMG CMIO and RCPMS IT Director developed a risk stratification model to identify the spectrum of patient complexity. This process enables robust care coordination for higher need patients and ability to identify when added time and resources are needed for visits during team huddles.

The CPCMG Director of Marketing and RCPMS Director of Business Development are working on scripted communication with patients and families, to better understand the specific expectations at each level of service. The inaugural step was the establishment of a written compact between the care teams and patients.

The CPCMG Director of Clinician Wellness and Director of Population Health teamed up with RCPMS Directors of Operations and Human Resources to develop the “ideal care team.” The first step focused on an InBasket remote care coordination pilot in which all patient portal messages are routed first to a pool staffed by nurses and medical assistants instead of the clinician, and a “refer-in” option to nurse care coordination for more complex patients.

Results: 1. Despite staffing shortages, progress is possible when the medical group and management service organization collaborate.
2. Progress is gradual and incremental, requiring measurement and frequent feedback. Pivoting based on emerging challenges is essential.

Conclusion: Future action will include the development of more robust metrics to decide success including the incorporation of EMR metrics in the care coordination pilot. Most critically, CPCMG management will continue to track and assess the effect on clinician burnout through periodic well-being assessments.