Article Figures & Data
Tables
On-Site Visits Site Specialty Setting No. of Physicians In-person visits Ambulatory Practice of the Future GIMa Urban 2 Brigham and Woman’s Hospital GIM Urban 7 Cleveland Clinic Strongsville FMb Suburban 103 Clinica Family Health Services FM Rural 46 Clinic Ole FM Rural 15 Fairview Rosemont Clinic GIM/FM Urban 2 Group Health Olympia FM Urban 36 Harvard Vanguard Medford GIM Suburban 14 La Clinica de la Raza FM Urban 16a Martin’s Point-Evergreen Woods GIM Rural 4a Mayo Red Cedar FM Rural 13 Medical Associates Clinic GIM Urban 115 Mercy Clinics East FM Urban 7 Multnomah County Health Department IM Urban 40 Newport News Family Practice FM Urban 5 Quincy, Office of the Future FM Rural 2 Sebastopol Community Health Centers FM Rural 8a Southcentral Foundation FM Urban 115 ThedaCare-Oshkosh FM Urban 5. University of Utah-Redstone IM Rural 5 West Los Angeles VA IM Urban 12a Virtual visits Allina-Cambridge FM/IM Rural North Shore Physicians Group FM/GIM Urban 200 -
FM=family medicine; GIM=general internal medicine; IM=internal medicine; VA=Veterans Affairs.
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↵a Includes physicians, physician assistants, nurse practitioners.
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Problem Innovation Unplanned visits with overfull agendas Previsit planning
Preappointment laboratory testsInadequate support to meet the patient demand for care Sharing the carea
Expanded nurse or medical assistant rooming protocol
Standing orders
Extended responsibility for health coaching, care coordination, and integrated behavioral health to nonphysician members of the team
Team responsibility for panel managementGreat amounts of time spent documenting and complying with administrative and regulatory requirements Scribing
Assistant order entry
Standardized prescription renewalComputerized technology that pushes more work to the physician In-box management
Verbal messagingTeams that function poorly and complicate rather than simplify the work Improving team communication through
Co-location
Huddles
Regular team meetings
Improving team functioning
Systems planning
Work flow mapping-
↵a These roles require 2- or 3-to-1 clinical support per physician.
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Additional Files
Supplemental Appendixes 1-3
Supplemental Appendix 1. Study Sites; Supplemental Appendix 2. Site Visit Guide; Supplemental Appendix 3. Future Research Agenda
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file, 3 pages, 143 KB
- Supplemental data: Appendix 2 - PDF file, 2 pages, 172 KB
- Supplemental data: Appendix 3 - PDF file, 3 pages, 143 KB
The Article in Brief
In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices
Christine A. Sinsky , and colleagues
Background As American physicians spend more time on large volumes of clerical work that does not utilize their training, they face burnout, which in turn threatens patient care. In this study, researchers gather innovations they believe can facilitate joy in practice and reduce physician burnout.
What This Study Found A shift from a physician-centric model of work distribution and responsibility to a shared-care model with higher levels of clinical support per physician and frequent forums for communication can result in high-functioning teams, improved professional satisfaction, and, potentially, greater joy in practice. Site visits to 23 high-performing family practices revealed 5 key innovations: (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) shared clinical care among a team with expanded protocols, standing orders, and panel management; (3) shared clerical tasks with collaborative documentation, nonphysician order entry, and streamlined prescription management; (4) improved communication by verbal messaging and in-box management; and (5) improved team functioning through co-location, team meetings, and work flow mapping.
Implications
- These innovations, the authors assert, can address barriers to the healing relationship between physician and patient, take advantage of the resources of the health care team, and improve care for patients, thereby enhancing physician joy in practice.
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