workload, quality, burnout: improving the lives of ... · burnout • increasing job satisfaction...

Workload, Quality, Burnout: Improving the Lives of Patients and Providers through Interprofessional Practice Susan J. Corbridge, PhD, APRN, FAANPAssociate Dean for Practice & Community Partnerships, College of NursingClinical Associate Professor, College of Nursing and Division of Pulmonary, Critical Care, Sleep & Allergy MedicineUniversity of Illinois at Chicagosjsmith@uic.edu

OBJECTIVES

• Review the evidence of interprofessional teams on workload, burnout & quality of care.

• Provide two examples from our institution of interprofessional team modeling.

• Recommend strategies for implementing interprofessional team-based models.

WORKLOAD

• Interprofessional teams decrease workload 1

• Interprofessional practice frees up time for other medical services (better use of one’s skillset) 1

• Shared knowledge of and investment in the patient 2

– Patients needing unscheduled visits, etc.– Patient with new problem; need for collaboration

1Chomienne M-H et al. 2011. J of Eval in Clini Prac, 17; 282-287.2 Sinsky et al. 2013. Annals of Fam Med. 11(3) 272 – 278.

BURNOUT• Increasing job satisfaction decreases burnout

• Relationships are important at all career levels to increased job satisfaction 1

• Collegial relationships, learning from each other and development of mutual respect and trust increase satisfaction 1

• Sharing clinical care among a team & having a high functioning team improves professional satisfaction 2

1Ahmed N et al. 2012. Acad Med. 87(11):1616-1621.2 Sinsky et al. 2013. Annals of Fam Med. 11(3) 272 – 278.

QUALITY• Improved patient outcomes

– Earlier diagnosis 1– Patient quality-of-life scores improved 1– Increased provider knowledge 1– Patient satisfaction and willingness to work with

other professionals entering in the practice (trust relationship) 1

– Decreased ICU mortality 2– Decreased rates of ventilator-associated

pneumonia 3• “Seat at the table” by nurses; more “buy in”

1Chomienne M-H et al. 2010. J of Eval in Clini Prac, 17; 282-287.2Kim M et al.2010. Arch Intern Med, Feb 22;170(4):369-76.3Costa D et al. 2016. Am J of Infection Control, 44(10), 1181-1183.

One Model of an Interprofessional, Team-based Sub-specialty Clinic

A Second Model of an Interprofessional, Team-based Primary Care Clinic (Federally Qualified Health Center):

• Nurse Managed Clinic• Humboldt Park, Chicago’s West Side• One of Chicago’s most disadvantaged communities• Department of Corrections partnership• High need for primary care and mental health services

Behavioral Health Care Manager

Psychiatric Consultant

Patient

Medical Assistant

DAST-10

PHQ-9

AUDIT-C

GAD-7

Primary Care Provider

Collaborative Care Model

RECOMMENDED STRATEGIES

• Individualize an approach to meet specific needs• Strive for a horizontal model • Recognize unique expertise of team members • Leverage diversity for stronger teams• Advocate top-of-license practice• Recognize billing and system constraints• Include administration when appropriate • Acknowledge that words matter• Partner with academic institutions• Address documentation requirements and malpractice

through policy

ADDITIONAL REFERENCES• Corbridge, S., Tiffen, J., Carlucci, M., & Zar, F. (2013).

Implementation of an Interprofessional Clinical Education Model. Nurse Educator, 38(6), 261-264. http://dx.doi.org/10.1097/01.NNE.0000435271.40151.23

• Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. (2012). Collaborative Care for People with Depression and Anxiety. Cochrane Review. http://doi: 10.1002/14651858.CD006525.pub2

• Institute for Healthcare Improvement (2018). http://www.ihi.org/

• Waljee, J., Chopra V., & Saint S. (2018). Mentoring Millennials. Journal of the American Medical Association. Apr 17;319(15):1547-1548