Production pressure is a source of stress for physicians and is a contributing factor in physician burnout. Production pressures are the “overt or covert pressures and incentives on personnel to place production, not safety, as their primary priority” (David M. Gaba, MD, et al). Unrealistic workload planning, inadequate staffing, disorganization, duplicative efforts, and delegation problems can contribute to production pressure. Although much of the responsibility for managing the risk of production pressure falls on healthcare administrators and managers, there are a variety of strategies individual providers can use to help reduce the impact of certain sources of production pressure.
Examine How You Manage and Allocate Time
Time management can be a major challenge when administrative duties, cost-effectiveness, and patient workflow pressures limit the time available to complete all the things you need—and want—to do. Exploring ways to improve time management might lessen the stress caused by a busy schedule and production pressure.
Recapturing Time: A Practical Approach to Time Management for Physicians
This article discusses how effective time management can limit physician burnout and increase personal satisfaction. It provides techniques that can help you improve time management habits and includes Covey’s Time Management Matrix, adapted for physicians.
This article discusses how improving time-management practices may lead to decreased stress, increased productivity, and improved well-being for physicians. It includes links to download slides from the “Physician Time Management” workshop.
Covey’s Time Management Matrix
The time management matrix developed by Stephen R. Covey is an effective method for organizing priorities. Use of the grid will help organize priorities by categorizing them by urgency and importance.
NORCAL Group Webinar: “Proactive Problem Solving: The A3 Method”
A3 problem solving is part of the “lean process improvement” technique developed by Toyota to remove barriers and frustrations from workflow processes. It can be used in a healthcare practice to identify issues that impact patient safety and medical liability risks, as well as facilitate solutions. This webinar presented by NORCAL Group Risk Management offers a tutorial for physicians and staff on this key aspect of lean process improvement.
Make the Most of Communication with Patients
Less time spent with patients (or a perception that less time is being spent with patients) can also add to production pressure that can result in diminished patient and physician satisfaction, less preventative care, diminished patient safety, and increased malpractice risk.
Time constraints can make effective communication challenging. However, blending time management skills with essential relationship and communication skills throughout the patient encounter can enhance quality of care while helping patients and physicians use their time together more efficiently.
Patient Efficiency Model
The Patient Efficiency Model (developed by Larry B. Mauksch, MEd, et al) is designed to enhance communication, patient satisfaction, and patient safety within the limited timeframe usually available during an office visit. Providers who struggle with production pressure may want to consider using this model or portions of it when appropriate.
- Engage in up-front, collaborative agenda-setting: On average, patients want to discuss three to six concerns per visit with a PCP. Learn from the patient which issues are the most important and urgent, then prioritize and explore the most important concerns. If necessary, postpone less important problems for another visit.
- Develop and maintain a positive relationship with the patient: For example, use direct eye contact and start an examination with a question about an event in the patient’s life or a nonmedical topic.
- Practice mindfully: Remain critically curious. Do not let your agenda overly influence the patient’s reasons for making the appointment.
- Track the topic of the visit—remain focused on a mutually agreed upon topic: For example, when the patient is scheduled to discuss noncompliance with diabetes care but starts discussing back pain, give the patient the opportunity to choose one or the other topic and suggest scheduling another appointment to discuss the other health issue at a later time.
- Empathetically acknowledge the patient’s social or emotional clues: Acknowledging patient suffering can draw out the patient’s beliefs about his or her illness and treatment preferences.
- Understand the patient’s perspective and knowledge: Ask the patient what they already know about the health issue from their own experience, research, or cultural background. This can help you focus the discussion and avoid discussing aspects of the illness with which the patient is already familiar, as well as address any misconceptions or inaccurate information they may have.
- Co-create a plan: Create an explicit agreement with the patient that includes healthcare goals, next steps, and what roles the patient, the patient’s family, and other clinicians will take in implementing the plan.
Applying these skills at the beginning of the patient encounter can help reduce production pressure by avoiding redundancy and increasing efficiency. Provide written follow-up or discharge instructions at the end of the appointment to further enhance communication and patient understanding.
Improving Communication Skills
Communicating complicated health information to patients within the time constraints of the patient encounter can be a challenge and can add to production pressure stress. The following resources offer strategies to improve physician-patient communication.
“‘The Hand on the Doorknob’: Visit Agenda Setting by Complex Patients and their Primary Care Physicians” discusses strategies for addressing time constraints during patient visits including setting agendas and helping patients prepare for their visits.
“Patient-Provider Communication Vital for Appointment Agenda-Setting” addresses the importance of appointment preparation, especially when patients have complex conditions or place increased demands on providers.
“Tips for In-Office Patient Communication” gives practical tips for improving physician-patient communication and patient satisfaction.
“Assessing Effective Physician-Patient Communication Skills: ‘Are You Listening to Me, Doc?’” discusses the importance of good communication skills for physicians (emphasizing the importance of interviewing skills) in establishing a good relationship with patients.
Additional Resources for NORCAL Group Insureds
The following resources developed by NORCAL Group Risk Management offer additional recommendations for increasing the efficiency of patient visits. NORCAL Group insureds can access them in the MyACCOUNT policyholder portal (log in above) under Risk > Risk Resources.
- Risk Management Resource: “Office Visit Communication with Patients”
- Sample Form: “Office Visit Communication Template”
Advocate for Organizational Change
Physicians and Administrators Working Together to Address Production Pressure
Organizational issues such as high expectations for physician performance, coupled with organizational realities (e.g., unrealistic workload and inadequate staffing), are another way that physicians experience production pressure. Having input into decisions made at the organizational level is one way that physicians can address production pressure in their environments and reduce this source of stress and burnout. The following resources offer strategies for physicians to consider in this area:
“Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout” (Tait D. Shanafelt, MD, and John H. Noseworthy, MD).
Physician Well-Being and Professional Fulfillment: Improving the Practice and Organizational Environment (American College of Physicians):