Latest / Becker’s Healthcare Podcast / Physician Burnout, AI Tools and Physician Leadership with Dr. Phillip Chang

Transcript

Physician Burnout, AI Tools and Physician Leadership with Dr. Phillip Chang · Becker’s Healthcare Podcast

• 0:00
  - Hello. This is Francesca Matthews with the Becker's
• 0:02
  - Clinical Leadership Podcast.
• 0:04
  - I'm thrilled to be joined today by doctor
• 0:06
  - Philip Chang, chief medical and qual quality officer
• 0:09
  - with CommonSpirit Health. Doctor Chang, thank you so
• 0:11
  - much for being here today.
• 0:13
  - Happy to be here.
• 0:14
  - Right.
• 0:15
  - We can, we could start off here by
• 0:17
  - jumping into
• 0:18
  - a very important topic. It's discussed a lot,
• 0:20
  - but it's always great to get a real
• 0:22
  - physician leader perspective.
• 0:24
  - Where do you see physician burnout standing, and
• 0:27
  - what's actually changed with regards to position burnout?
• 0:31
  - Yeah. So I think, you know, I think
• 0:33
  - the data would show that it gotten quite
• 0:35
  - quite a bit worse, gotten worse and worse
• 0:38
  - towards COVID, and it sort of peaked
• 0:41
  - around COVID, and it's sort of understandable. And
• 0:43
  - I think
• 0:44
  - nationally,
• 0:46
  - we're seeing some
• 0:48
  - relief
• 0:49
  - of overall physician burnout. This is data from
• 0:52
  - AMA and other sources.
• 0:54
  - And, I I think partly because of the
• 0:56
  - efforts that we've all put in around this
• 0:58
  - particular topic. That said, I wanna stress that
• 1:00
  - physician burnout,
• 1:02
  - it is still higher than the non health
• 1:06
  - care,
• 1:06
  - you know, professionals,
• 1:08
  - per now median. So we're still quite at
• 1:10
  - risk, but we are doing better. And one
• 1:13
  - of the things that
• 1:14
  - actually, a number of things that we've very
• 1:16
  - we've been very deliberate at CommEspire,
• 1:19
  - to tackle these issues because these are serious
• 1:21
  - issues, not just not to mention, you know,
• 1:24
  - it's a physician's well-being, it affects their work,
• 1:27
  - it affects their family life.
• 1:29
  - Sometimes it it directly impacts mental health, etcetera.
• 1:31
  - So we've been very deliberate in working on
• 1:33
  - this. There is a vice president of provider
• 1:36
  - wellness, physician well-being,
• 1:38
  - who is in my department.
• 1:40
  - And we we view this sort of as
• 1:42
  - a almost a pyramid and a tier approach.
• 1:44
  - Right? So at the very bottom,
• 1:46
  - we've been very, very intentional
• 1:48
  - to
• 1:49
  - digest and provide
• 1:51
  - evidence based care
• 1:53
  - and set these standards. So, clinical standards,
• 1:57
  - that is based on evidence,
• 1:59
  - we view that as
• 2:01
  - fundamental
• 2:02
  - to physician wellness and well-being.
• 2:04
  - Because once there's a standard, there is understanding
• 2:07
  - that this is a these are the right
• 2:09
  - approaches
• 2:10
  - to take care of patients, and and and
• 2:12
  - I and evidence has shown that that that
• 2:14
  - helps with burnout.
• 2:16
  - And we layer on top of it, and
• 2:19
  - and, you know,
• 2:20
  - this is work that's been ongoing for years.
• 2:22
  - So I'm taking,
• 2:24
  - helping taking over. So credit to my predecessors
• 2:26
  - who've done a lot of work on,
• 2:28
  - peer support. So whenever the physician is having
• 2:31
  - a bad time, having a bad day, had
• 2:33
  - a bad outcome,
• 2:34
  - we have
• 2:36
  - trained position leaders and supporters
• 2:39
  - who will reach out or who can be
• 2:41
  - reached out to.
• 2:42
  - And then and then to layer further on
• 2:44
  - top of that, we have a commensality
• 2:46
  - program. So it's a guided conversation through
• 2:50
  - sharing the meal together, and this is based
• 2:51
  - on some of the research,
• 2:53
  - that's come out of Mayo Clinic and later
• 2:55
  - Stanford. So so, you know, obviously, we follow
• 2:57
  - the evidence,
• 2:58
  - including how to address,
• 3:00
  - physician burnout.
• 3:02
  - So I think I think other health care
• 3:04
  - systems probably like us, we've all been much
• 3:07
  - more intentional. And, again, a lot of credit
• 3:10
  - to to some of the pioneers,
• 3:12
  - in this field,
• 3:13
  - such as doctor Tay Sheidenfeld,
• 3:16
  - now at Stanford, who who really
• 3:19
  - brought this to light and and helped many
• 3:22
  - of us understand that, yes, this is something
• 3:25
  - we can actively work on and and actively
• 3:27
  - improve upon. And we're seeing very similar results.
• 3:30
  - So we don't just, for instance,
• 3:32
  - commensality.
• 3:33
  - We don't just provide,
• 3:34
  - you know, a meal
• 3:36
  - or reimburse a dinner. We take surveys before
• 3:39
  - and after. We we take it a very
• 3:41
  - we take a very analytical approach
• 3:44
  - to how we do all this, and we
• 3:45
  - are seeing results.
• 3:47
  - So so that's that's good. You know?
• 3:51
  - We we we believe that we contribute to
• 3:52
  - the national landscape
• 3:54
  - in terms of helping,
• 3:56
  - to decrease physician burnout and increase the physician
• 3:59
  - wellness.
• 4:00
  - Mhmm. Mhmm. Absolutely.
• 4:02
  - And all that's really resonating with things I've
• 4:04
  - heard, just in other systems and sort of
• 4:06
  - that that network approach and supporting physicians.
• 4:09
  - One thing I'm curious about, just a kind
• 4:10
  - of a follow-up here, something I've heard a
• 4:13
  - lot in speaking with physician leaders is there
• 4:15
  - being a difference between
• 4:17
  - burnout and moral injury
• 4:19
  - Yes. As it relates to just
• 4:22
  - the things that make, you know, being a
• 4:24
  - physician more difficult. I guess I'm wondering if
• 4:26
  - you see a similar,
• 4:28
  - difference between those two things and how you
• 4:30
  - kind of reconcile that.
• 4:32
  - Yeah. So so I think burnout is sort
• 4:36
  - of low I don't wanna say low level,
• 4:38
  - but it's it's in the background. Right? It's
• 4:39
  - always there. But whenever there are specific events
• 4:43
  - that as a signal to us
• 4:46
  - that our physician feel like they're put in
• 4:49
  - a put in a position and feel more
• 4:51
  - injury,
• 4:52
  - meaning that
• 4:54
  - the situation of the systems
• 4:56
  - is is tasked is asking them to do
• 4:58
  - things that's against their moral fiber,
• 5:01
  - we absolutely step in. And we're, you know,
• 5:03
  - we're we're fortunate that we're in a mission
• 5:06
  - focused faith based organization
• 5:08
  - that always puts patients first.
• 5:11
  - So anytime I hear more injury,
• 5:14
  - we really, really get on top of it
• 5:16
  - and and resolve it. And we have all
• 5:18
  - different kinds of mechanisms to help with the
• 5:20
  - patients
• 5:21
  - from operations
• 5:23
  - to mission
• 5:24
  - to the sort of the MyChart, the medical
• 5:27
  - staff, and the quality department to ensure that
• 5:30
  - our physicians do not feel that.
• 5:33
  - Mhmm. Absolutely. And I know that, one tool
• 5:37
  - that many
• 5:38
  - organizations have,
• 5:40
  - deployed to
• 5:41
  - take some administrative burden off positions is rolling
• 5:44
  - out different AI tools. So I'm curious what
• 5:47
  - AI scribes and documentation tools have done for
• 5:50
  - the workday at your organization.
• 5:52
  - Yeah. We we're systematically rolling this out right
• 5:55
  - now with, with a goal to to be
• 5:57
  - in every,
• 5:59
  - employee physician's hands
• 6:01
  - in in the very near future, and that's
• 6:03
  - being worked on right now. The physicians who
• 6:05
  - are experiencing it
• 6:07
  - is, for many of them, it's it's like
• 6:10
  - being parched in the desert and and getting
• 6:13
  - some relief with a nice cold glass of
• 6:15
  - water.
• 6:16
  - It's become part of life. One of the
• 6:19
  - things that we're very, very intentional
• 6:21
  - about at CommSphere is that
• 6:23
  - we don't
• 6:25
  - burden the physicians
• 6:26
  - because now they have a tool, and they
• 6:28
  - can all of a sudden say, see a
• 6:30
  - couple more patients a day. So we're very
• 6:32
  - intentional
• 6:34
  - to not
• 6:35
  - let that happen, and it's very tempting. Right?
• 6:37
  - Because because now you've got a tool that
• 6:39
  - helps you produce your notes much faster and
• 6:42
  - it's much more efficient, etcetera, etcetera. And then
• 6:44
  - the second thing we're very intentional about
• 6:47
  - is to make sure that that we don't
• 6:49
  - take
• 6:50
  - the AI. We still have a physician in
• 6:52
  - the back double checking that everything is documented
• 6:55
  - correctly.
• 6:56
  - And and I also you know, since we're
• 6:58
  - talking about AI, we we we also are
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  - very aware
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  - that
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  - AI,
• 7:05
  - supportive scribing technology,
• 7:08
  - it it's really just a start.
• 7:10
  - At CommonSpirit, we have our own, and I
• 7:12
  - think Becker has been
• 7:14
  - has featured it in the past. We have
• 7:16
  - our own, AI engine
• 7:18
  - that's inside the firewall called called Insightly.
• 7:20
  - And Insightly allows us to
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  - do more things
• 7:25
  - than just,
• 7:27
  - you know, scribing
• 7:28
  - a note.
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  - So,
• 7:31
  - I was rounding in California
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  - recently, and and some of our CMOs are
• 7:36
  - using
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  - our own AI tool to,
• 7:40
  - identify opportunities
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  - for length of say. You know? And and
• 7:43
  - I'm just hearing more and more people,
• 7:46
  - you know, because we have this tool available
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  - to all common spirit,
• 7:51
  - our physicians and nurses, I'm sure, and operators,
• 7:54
  - administrators are all sort of thinking and working
• 7:57
  - on tools to to do this. And our
• 7:59
  - IT team have been tremendous in
• 8:02
  - coming to us and say, hey. If you
• 8:04
  - have some ideas, a problem you wanna tackle,
• 8:07
  - quality,
• 8:08
  - patient safety, etcetera,
• 8:10
  - we can build an AI agent, a robot,
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  - a bot so that we can accomplish these
• 8:15
  - goals. So it's very, very exciting what's happening
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  - right now in this space.
• 8:20
  - Mhmm. Mhmm. Absolutely. Yeah. And great to hear
• 8:22
  - that collaborative effort there. Just pivoting a little
• 8:26
  - bit to to to talk about different, employment
• 8:28
  - dynamics.
• 8:29
  - Independent practice and
• 8:31
  - employee practice is something that we write about
• 8:33
  - a lot here at Becker's as medicine shifts
• 8:35
  - around. I'm curious,
• 8:37
  - how are employed and independent practice dynamics playing
• 8:39
  - out in your market?
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  - Yeah. So I think I I would I
• 8:43
  - would broadly sum it up as we work
• 8:45
  - very nicely together.
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  - We know that we
• 8:49
  - don't employ everybody.
• 8:51
  - We employ a large number of physicians,
• 8:54
  - particularly in the primary care space because we
• 8:56
  - wanna be able to serve
• 8:58
  - our community, and serving our community is
• 9:02
  - obviously not just the acute care of the
• 9:04
  - hospital setting. Right? Really, where we can reach
• 9:06
  - out are all of our ambulatory settings. So
• 9:09
  - and the prevention aspect of health care, the
• 9:12
  - wellness side of health care as opposed to
• 9:14
  - the critical care or the acute care side
• 9:16
  - of things.
• 9:17
  - But I do think that, you know, be
• 9:19
  - it ambulatory
• 9:20
  - and and independent physicians or typically we're talking
• 9:23
  - about acute care setting,
• 9:24
  - we apply the same standard, quality standard for
• 9:28
  - employee and independent physicians.
• 9:30
  - They have the same access
• 9:32
  - to technology
• 9:34
  - inside the firewall. They have the same access
• 9:36
  - to
• 9:37
  - evidence based
• 9:38
  - guidelines
• 9:39
  - that we provide, and,
• 9:42
  - we give independent physicians
• 9:45
  - same opportunity
• 9:46
  - for
• 9:47
  - leadership development and training, etcetera. So we
• 9:51
  - we certainly view them as great partners, and
• 9:54
  - we know we
• 9:56
  - together, you know, the blend
• 9:58
  - of acute care in the acute care setting,
• 10:00
  - the operation
• 10:02
  - side, the nurse side,
• 10:03
  - the employee physicians, and the independent physicians. We're
• 10:06
  - all just working towards the same goal, which
• 10:08
  - is to deliver the best possible patient outcome.
• 10:12
  - Mhmm. Mhmm. Absolutely.
• 10:14
  - What's another pivot here to to some more
• 10:16
  - leadership questions? But, I'm curious, what's the hardest
• 10:19
  - part of going from peer to boss as
• 10:22
  - chief medical quality officer?
• 10:24
  - So first of all, I'm not anybody's boss.
• 10:27
  - I think that's a that's a mislabel.
• 10:30
  - I do I do
• 10:31
  - know what you mean, though, and I think,
• 10:34
  - you know, some of us physicians, when you
• 10:36
  - when we go through the journey, many of
• 10:38
  - us started
• 10:39
  - by being
• 10:41
  - very inquisitive,
• 10:42
  - right, or
• 10:44
  - sometimes
• 10:46
  - almost rebellious, if you will, in the structure.
• 10:49
  - And I think when you transition to
• 10:52
  - maybe more administrative,
• 10:54
  - and those of us who do transition to
• 10:56
  - to be on both sides, right, practicing physician
• 10:59
  - and
• 11:00
  - be on the operational administrative side,
• 11:03
  - we play a couple roles. Like, the first
• 11:04
  - role is,
• 11:06
  - in some ways, we're a translator.
• 11:08
  - You know? I I'm translating what the administrators
• 11:11
  - are saying to the
• 11:13
  - at large, and I'm translating what the physician
• 11:16
  - is reflecting back. I'm the messenger and I'm
• 11:19
  - the translator. Right? So so we always have
• 11:21
  - to be ears on the ground and understanding
• 11:23
  - how things work and, more importantly, how things
• 11:26
  - don't work and maybe how things could be
• 11:28
  - better. So, again,
• 11:30
  - accomplishing the same goal.
• 11:32
  - I think another role is sort of appreciating
• 11:36
  - how
• 11:37
  - things work at different speeds,
• 11:41
  - and understanding that
• 11:43
  - as we are
• 11:45
  - helping to be the right
• 11:47
  - stewardship of our resources,
• 11:49
  - that
• 11:50
  - things sometimes things don't happen right away. Right?
• 11:53
  - So so one of the things that
• 11:55
  - as, you know, my background is trauma surgery.
• 11:58
  - So
• 11:59
  - when I'm facing the patients
• 12:01
  - and however complicated it is and however multidisciplinary
• 12:05
  - it is, in the end,
• 12:07
  - we have to make the decision and make
• 12:09
  - that and take responsibility and accountability for those
• 12:12
  - clinical decisions with the patient's interests at heart.
• 12:16
  - When you
• 12:17
  - are thinking about a hospital as an organism
• 12:20
  - or a health care setting as an organism,
• 12:23
  - things get much more complicated
• 12:25
  - and tend to go a little
• 12:27
  - slower. And, and and I think sometimes they
• 12:29
  - can be misgivings
• 12:31
  - in in that sense.
• 12:32
  - So
• 12:33
  - my my friends joke, oh, now you're the
• 12:35
  - new boss. What's it like? I said, well,
• 12:37
  - making decisions are slower
• 12:39
  - and seeing results
• 12:41
  - is much, much slower,
• 12:43
  - and it's not for everybody.
• 12:45
  - Mhmm. Mhmm. For sure.
• 12:47
  - We kinda talked about there just, you know,
• 12:50
  - what's different going from
• 12:51
  - what perhaps, physicians get wrong about the quote,
• 12:54
  - unquote bots, but I'm curious,
• 12:56
  - what does the c suite get wrong about
• 12:58
  - physicians?
• 13:00
  - You know, look, I mean, I think, you
• 13:01
  - know, we we think about engagement, right, and
• 13:04
  - engagement and alignment.
• 13:06
  - And we have, at Commisperity, for the most
• 13:08
  - part, really
• 13:10
  - great, benchmark in engagement and alignment scores.
• 13:14
  - So
• 13:15
  - by and large, I think our physician body
• 13:18
  - and leadership or administration
• 13:20
  - are aligned. And and the reason we have
• 13:23
  - the square alignment is because we
• 13:25
  - we have a mission. Right? And this is
• 13:27
  - very clearly stated and everybody knows when you
• 13:30
  - work for CommonSpirit at at CommonSpirit,
• 13:33
  - our main mission is to serve the patient
• 13:35
  - population and the community. Right? And and I
• 13:39
  - think that's sort of the but your question
• 13:41
  - was, what does the administration or c suite
• 13:44
  - get wrong about physicians? I you know, I
• 13:46
  - I think they understand. I think each side
• 13:48
  - understands that we have a shared mission and
• 13:51
  - shared goal of taking care taking the best
• 13:53
  - possible care of our patients, making sure they're
• 13:56
  - safe.
• 13:57
  - I do think that
• 14:00
  - sometimes, particularly at large organizations
• 14:02
  - like particularly in large organizations like ours,
• 14:06
  - you do sometimes see that, you know,
• 14:10
  - one hospital
• 14:11
  - medicine doctor is is one line on a
• 14:14
  - spreadsheet. Right? And then and then sometimes,
• 14:17
  - they're showed up that, you know, they're they're
• 14:19
  - listed on a spreadsheet, and and there's misconception
• 14:23
  - that they're viewed as interchangeable
• 14:25
  - parts. But there's a lot of nuances in
• 14:28
  - it. Now this is not my area of,
• 14:31
  - responsibility.
• 14:32
  - My partner, chief of physician enterprise, this is
• 14:35
  - her area of expertise, but but I do
• 14:37
  - notice that we have physician leaders
• 14:40
  - who help, again, translate some of that information
• 14:42
  - and help manage
• 14:44
  - that physician relationship.
• 14:46
  - So I guess what I'm saying is we
• 14:48
  - don't view physicians as interchangeable parts. We understand
• 14:51
  - there are nuances
• 14:53
  - behind every
• 14:55
  - MDDO
• 14:56
  - and APP.
• 14:58
  - Absolutely.
• 14:59
  - Well, on that note, that is all I
• 15:01
  - have for you today, doctor Chang. Thank you
• 15:02
  - so much for being here today. Okay. Thanks
• 15:05
  - so much. Enjoyed it. Absolutely. It's been a
• 15:07
  - pleasure speaking with you, and I look forward
• 15:08
  - to connecting with you again in the future.
• 15:10
  - You bet.