HealthMarch 16, 2020

Calming the effects of chaotic clinics

By: Bana Jobe
Chaotic clinics often become that way for similar reasons. If your clinic is overwhelming, here’s how to start addressing the problem.

Every clinic is hectic from time to time, but not all of them are “chaotic.”

Chaotic clinics occur because of systemic problems. They can lead to stressful working conditions and physician burnout, as well as contribute to medical errors and threaten patient safety.

A study in the Journal for Healthcare Quality looked at how these working conditions develop and how they can be addressed.

The causes and effects of chaotic clinics

The authors of the 2017 paper reexamined their own data from the Minimizing Error, Maximizing Outcome (MEMO) Study, published in 2005. That original study explored data from 112 rural and urban primary clinics, with clinicians self-rating their practices from “calm” to “chaotic.” While the 2005 report found links between chaotic climates, provider stress and medical errors, it didn’t elaborate on what made some clinics more chaotic than others.

The 2017 secondary assessment did. Comprising 36% of the participating clinics, these clinics were more likely to:

  • Serve minority and Medicaid patients
  • Have clinical bottlenecks that disrupted patient flow, for example problems with registration, check-out, phone access, chart lookup, interpreters or pharmacies

These factors connect into the patchwork of care quality—and organizational stress may carry through to individual stress and patient safety risks. All told, the study found that physicians from chaotic clinics were less satisfied, more burned out and more likely to leave the practice within two years. Chaotic clinics also had higher rates of medical and prevention errors like not screening patients for depression.

For practice owners: What’s the cure for chaos in the clinic?

If any of these facts hits close to home for you as a practice owner, the authors suggested some tips that may help. However, they stressed that more research is needed to see how they shake out when it comes to patient safety.

1. Focus on the system, not the person

Reduce the chaos systematically, not just by helping clinicians better deal with it individually. For example, employee mindfulness exercises or individualized trainings don’t address the problem head on, but a high-level audit of IT systems, workflow barriers and other issues may. Helping individuals rather than tackling the whole toxic culture won’t lead to lasting change.

2. Remove bottlenecks

The study’s reported bottleneck areas are a good place to start addressing problems. Assess processes around check-in, pharmacy, interpreters, chart lookup, phone systems and check-out. Are there any lags that bog down patient flow, increase wait times and stress out clinicians? Would an enterprise system or protocol help or hurt? Ask staff what they think and compare the costs and benefits of new investments closely. Remember, patient safety is priceless.

3. Beware of failed attempts

The authors cautioned against short-term solutions that ultimately make the chaos worse. For example, upping compensation may make people temporarily happy, but if you’re not targeting the root of the problem, solutions like these are just bandages that cover up worsening resentment. Eventually, that bandage will fall off, and the problem could be bigger than ever.

For employed physicians: What can you do?

If you’re a physician coming to terms with the consequences of a chaotic workplace, have you considered jumping ship? More doctors are doing so, as NBC News reports. Many are grappling with whether to just leave their current clinic or to quit practicing medicine entirely.

If you do branch out, scrutinize potential employers not only for pay and benefits but also for chaos. Talk to other physicians who work there about systemic stress and ask the tough questions, including:

  • What’s the patient flow like from check-in to check-out? Are there backups that frustrate the care team?
  • Do clinicians have the information they need, or is it always a rabbit chase to find the right charts and decision-makers?
  • Is there a cultural acceptance of chaos, or are chaotic moments few and far between?

After all, even with a phenomenal salary, some things aren’t worth it. If you can sniff out chaos and ensuing burnout at the onset, it’s best to head in the opposite direction. Your own mental well-being—and that of your patients—may be at stake.

Bana Jobe
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