Physician Enterprise Academic Excellence Paper Presentations
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Introduction
This document provides an executive summary of presentations focusing on crucial aspects of healthcare improvement: enhancing the patient experience during medical procedures, addressing cardiovascular disease risk factors in women with an emphasis on racial and ethnic disparities, and promoting healthcare worker well-being through contemplative medicine. The presentations, followed by a discussion, underscore an overarching theme of valuing the human spirit in healthcare across patient care and the well-being of healthcare professionals.
Improving the Cystoscopy Experience for Women: A Patient-Centered Approach to Process Improvement
Una Lee, M.D. presented a process improvement project aimed at creating an extraordinary experience for women undergoing cystoscopy, utilizing the principles of the Virginia Mason Production System (VMPS). VMPS, based on the Toyota Production System, applies manufacturing principles of efficiency, safety, and quality to healthcare, with a central focus on the patient as a priority. Key features include a patient-centered approach, lean thinking, value stream mapping, Kaizen events (continuous improvement), 5S methodology (organization and waste elimination), standardization, staff empowerment, visual tools, and a focus on safety and quality.
The project was inspired by a negative online review, highlighting the need to improve the patient experience during cystoscopy, a common urologic procedure involving the examination of the bladder with a scope. While healthcare providers may perceive cystoscopy as minimally invasive and routine, women often find it invasive, personal, and fear-inducing, desiring to be treated as individuals. This difference in perspective was a crucial starting point.
The process improvement involved extensive data collection using VMPS tools and experience-based design principles, including emotion word lists, customer debrief forms, surveys, and patient spotlights. This feedback revealed insights into patient perceptions, such as the impact of feeling well-cared for on the perception of wait times.
Based on patient feedback, several improvements were implemented using a Plan-Do-Study-Act (PDSA) cycle. A key initiative was training staff in "omo tenanasi," a Japanese concept of anticipating and thoughtfully meeting needs before they are even expressed. This involved comfort measures, addressing emotional and knowledge needs, and providing education and clear explanations to patients. Simple gestures, such as showing patients how to relax, were found to make a significant difference.
This project represents a paradigm shift towards patient-centered care, where processes are designed for and with patients, empowering them to make informed healthcare choices and leading to satisfying and extraordinary experiences. The principles of patient-centered care emphasized include aligning missions and values with patient goals, collaborative and coordinated care, accessibility, prioritizing physical comfort and emotional well-being, respecting patient and family viewpoints, and ensuring a welcoming setting with transparent information delivery. An emotion word cloud from patient feedback illustrated the wide range of feelings associated with the procedure. The overarching goal was to make every patient feel valued, cared for, and acknowledged, recognizing that patients remember how they were made to feel. The patient who provided the initial negative feedback was even involved as an author in the resulting paper, highlighting the importance of patient partnership.
Cardiovascular Disease Risk Factors in Women: Addressing Racial and Ethnic Disparities
Rachel Bond, M.D., FACC presented findings from an American Heart Association scientific statement on cardiovascular disease risk factors in women, with a particular focus on the impact of race and ethnicity. Heart disease is a leading preventable cause of death in the United States, yet significant disparities exist among racial and ethnic groups, with Black women facing the highest prevalence and mortality rates at younger ages.
Traditional risk factors alone may not fully explain these disparities. Black women exhibit a higher prevalence of hypertension globally and elevated lipoprotein little A levels, a genetically determined risk factor. They are also disproportionately affected by other traditional risk factors such as obesity, diabetes, and smoking-related diseases. Consequently, greater than one in every two Black women have heart disease, with a higher risk of mortality, especially between 35 and 54 years of age.
The presentation highlighted the critical role of non-traditional risk factors that disproportionately affect communities based on race and ethnicity. These include pregnancy-related complications (preeclampsia, gestational diabetes, premature labor), which can have long-term cardiovascular impacts. Psychosocial stressors such as discrimination and lack of social support, along with environmental exposures like lead and air pollution, and mental health conditions like depression, are also associated with higher cardiovascular disease incidence. Many of these falls under the umbrella of social determinants of health, which account for a significant portion of overall health.
The concept of the "superwoman schema" or weathering was introduced, explaining how chronic stress from stereotyping, oppression, and discrimination can impact the nervous, inflammatory, and hormonal systems, leading to increased allostatic load and premature cardiovascular health. Allostatic load refers to the cumulative burden of chronic stress and its impact on bodily systems.
The scientific statement emphasizes the importance of screening for both traditional and non-traditional risk factors, including pregnancy history, female-specific risks, and social determinants of health, at all patient visits. Culturally tailored interventions and education are crucial, along with policies ensuring equitable healthcare access. Integrating non-traditional risk factors into standard cardiovascular disease assessments and increasing the representation of Black women in clinical research are also vital. Supporting community-based initiatives and peer-led programs can further improve outcomes. CommonSpirit's efforts to screen for social determinants of health were acknowledged as a step towards treating the patient holistically. The presenter's personal experiences as a Black female in the United States and witnessing patients' experiences fueled her passion for this work.
Contemplative Medicine: A Practical Application to Well-Being 2.0
Anne Kennard, D.O., FACOG, Dip-ABLM addressed the urgent need to address healthcare worker burnout, which was at crisis levels even before the pandemic, as highlighted in the 2022 Surgeon General's Advisory. Physician burnout has significant impacts on physician retention, economic factors, and patient safety and satisfaction.
The evolution of physician well-being was discussed, moving from well-being 1.0, characterized by awareness and initial studies on the link between burnout and negative outcomes, to well-being 2.0, which emphasizes systemic changes, a sense of shared community connection, agency, and work-life integration. Agency, even amid a difficult workload, is a strong predictor of well-being.
Contemplative medicine was presented as a practical approach to achieving the qualities of well-being 2.0. Arising from hospice, palliative care, and chaplaincy, it encompasses a variety of contemplative practices within a framework of deep connection with self, colleagues, and patients. It aims to facilitate compassionate practice, generous listening, the ability to process difficult experiences, and a sense of agency and commonality. This aligns with the Stanford WMD model, which includes culture, efficiency of practice, and personal resilience.
A 12-month cohort-based experiential learning intervention in contemplative medicine was described to address the challenges of sustainably practicing medicine. The pilot study (N=34) showed statistically significant improvements in all three measures of the Maslach Burnout Inventory (emotional exhaustion, depersonalization, and personal accomplishment) in a pre-post assessment. Notably, emotional exhaustion levels decreased to pre-pandemic normative group levels after the intervention. Qualitative data indicated positive impacts on agency and community connection, key predictors of well-being.
Limitations of the pilot study include the small sample size and the length of the program. Future steps involve assessing longer-term outcomes and the applicability of abbreviated programs, particularly within graduate medical education. Local efforts at Marian Regional Medical Center, such as peer support programs and physician dinners, are grounded in the contemplative framework. While personal and cultural approaches are valuable, systems-based change remains paramount for the long-term well-being and retention of physicians. The presenter's personal connection arose from witnessing the impact of stress and the need for practical well-being solutions.
Overarching Theme and Discussion
The subsequent discussion highlighted a striking common theme across all three presentations: the value of the human spirit. Whether it is in enhancing the patient experience, addressing inequities, or supporting the healthcare workforce, acknowledging and prioritizing the human element is central. The presenters shared their personal motivations and the triggers that led to their research and improvement efforts, emphasizing the importance of personal experiences in driving meaningful change.
The discussion also touched on the integration of patient feedback into ongoing processes and the potential to inform patients about the improvements made based on their predecessors' input. Furthermore, the science of kindness, compassion, and empathy was acknowledged as underpinning the work being done. The presenters reflected on how their work has shifted their perspectives on the practice of medicine and the healthcare system overall, leading to changes in their clinical practice, teaching, and advocacy. The importance of instilling these values in future generations of healthcare professionals was also emphasized. The collective work presented underscores the potential to create extraordinary patient experiences and a more sustainable and humane healthcare environment by centering on human needs and values.
Artificial intelligence (AI) was used to transcribe the presentation’s contents and create a summary of the information contained in the presentation. This is an experimental process, and while we strive for accuracy, AI-generated content may not always be perfect and could contain errors. This summary has not been reviewed by the presenter to guarantee completeness or correctness of the content, so it should not be used for medical decision-making without reviewing the original presentation.
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