Stop health care’s great resignation [PODCAST]

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“As the next COVID-19 variant hits our country, I feel a renewed sense of urgency. We need to move faster to invest in an infrastructure that protects our nation’s health care workforce before we lose more nurses, doctors, and other care team members. Every day they risk their own safety for ours and our loved ones. It is time to reimagine safety and take action to make lasting change. That means investing in new policies, processes, resources, and solutions that ease the burden of team members and safeguard their physical, emotional, and psychological wellbeing. It means coming together as a nation and recognizing that health care is an essential infrastructure and that the people who work in health care are national assets and that their safety and wellbeing matters. We cannot afford to lose another nurse, physician, or frontline care team member.”

Bridget Duffy is an internal medicine physician and health care executive.

She shares her story and discusses her KevinMD article, “End the trauma, stop health care’s great resignation, and protect care teams now.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Bridget Duffy. She is an internal medicine physician and health care executive. She wrote the KevinMD article “End the trauma, stop health care’s great resignation, and protect care teams now.” Bridget, welcome to the show.

Bridget Duffy: Thank you.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Bridget Duffy: Well, my path in medicine has not been very normal or typical, but I had a wake-up call early in my career. In the last month of my residency in internal medicine in Minnesota, I was up on call at night and was rounding the next morning in the ICU. A patient had been there 30 days, and I sat down only because I was tired, and I watched as every specialist came into the room and dealt with the machine that dealt with the defective body part. And in my sleep-deprived state, I had this aha moment that my patient wasn’t diseased and fragmented, but the system was. There was nobody there integrating all the information and then sharing that and communicating with the family. I was trying to get in and around early, before the family arrived.

So I came home that night in my scrubs, exhausted, and on the top of my mail was a picture of this man and an article about him and his vision to create the most healing hospital in the world. I cold-called him. His name was Earl Bakken. He invented the pacemaker and founded a little company called Medtronic. Had I known he was a billionaire, I probably wouldn’t have called. Anyhow, I said, “I want to help you build the most healing hospital in America.” And I was on a 25-year journey with him to do just that, and that’s been my commitment and passion the last 25 years of my career.

Kevin Pho: So tell me some of the major challenges that you faced during your 25-year health care executive career, and how you overcame some of those challenges.

Bridget Duffy: Well, when you’re not a normal nine-to-five doctor and you just don’t go into practice, you’re faced with all sorts of adversity. And when you’re one of very few people who actually cared about humanizing the patient experience before the government mandated that we measure it, publicly report it, and tie reimbursement to it, you end up with a lot of arrows in your back. I often thought I should wake up with a Kevlar vest on.

And in one of my key roles, I’ll never forget day one. A gentleman who headed up the performance management improvement office, who did the Lean Six Sigma, looked at me and said, “Dr. Duffy, do you have a bicycle helmet?” And I said, “Sure.” He goes, “You might want to bring it to work.” And I go, “Why?” “Because every day you’re going to get up and you’re going to run your head into the wall trying to make change happen in health care. You’re going to wish you had a helmet on.” So that was early in my career. I figured out how to get the work done smarter, with less trauma, but it’s not easy when you’re pushing against the status quo in health care and trying to make it better for doctors and nurses and patients on the front lines.

Kevin Pho: So tell me some of the things that you do to move that needle in health care, because, like you said, there’s so much inertia in health care. It’s such a monolithic entity, where the status quo is so powerful. So in your role, in terms of what you do, what are some ways that you can move that needle in health care when so many others have failed doing that?

Bridget Duffy: Well, I think there is nothing good about the pandemic, except that it put a spotlight on how broken the system is and how antiquated the technology is. And never in my career did I witness fear in the eyes of my colleagues, and despair. And we asked them to run into the fire, and then another surge came and we said, “Run into the fire again.” And I think the pandemic unearthed, or laid witness to, the trauma that had been there before the pandemic, and put a sense of urgency on it for us as a nation to do more, because we are in a crisis right now, and it’s global, because of the mass exodus of people from the profession of medicine, nursing, and frontline staff. And this will impact all of us personally. It will impact my parents, my siblings, and our children, who will not get the quality access to the quality of care that they need in health care.

So from my perspective, I’m hopeful right now, because we’ve hit bottom and there’s no way but up, and there’s an openness to change and an urgency to accelerate innovation. Health care is historically so slow. We just hold on to the status quo in health care, and we do the things we’ve always done. Nurses will no longer stand for that. So I’m witnessing now small coalitions of people coming together to make change happen quickly, and that was really the impetus of the article that I wrote for you: We need to just do something urgently now and remove the preventable trauma in health care. And I’m witnessing it being done across the country.

Kevin Pho: So let’s talk more about that. Your article is titled “End the trauma, stop health care’s great resignation, and protect care teams now.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Bridget Duffy: Absolutely. A little bit of the background is, when the pandemic hit, in the first wave, I, like probably every other physician, nurse, or somebody in health care, just ran into it and said, “What can I do to help my colleagues?” I mean, it was like never before in my life. I used to walk out the door early in my career and turn around to my husband and say, “Please pray that I don’t harm anyone.” The Hippocratic oath is “First, do no harm.” Never in my career did I think I would walk out the door and pray that I didn’t get ill or take the infection home to my family.

And so when this hit, I said to myself, “What more can I do as a physician? What more can my team do at my company, Vocera, because we are focused on helping and protecting nurses and doctors?” And so we got our leadership team together, and I said, “What if we got the nation’s top CEOs and their teams together and right now defined what safety means for the nation, so that never again are we ill-equipped, with inadequate PPE, protective equipment, in the trenches?” I come from a military family, with five brothers. Never would we have sent a warrior into battle without the equipment and the ability to communicate with their comrades, and we did this to our people here in health care.

And I said, “Well, I remember reading when the Business Roundtable pulled together Fortune 500 CEOs, and they wrote the guiding principles for a company beyond shareholder value, and it included things like employee well-being and diversity, equity, and inclusion, and then they got other CEOs to sign it.” I said, “What if we did that?” So early, in the first month of the pandemic, I picked up the phone and called 10 CEOs from institutions, Cleveland Clinic, Intermountain, and Hackensack, and within 30 seconds the CEOs said, “I’m in.”

So we launched the CEO Coalition with the intent of doing three things. Number one, making psychological and emotional safety as important as physical safety. Workplace violence was rising. Second, we wanted to protect their physical safety because of the elevation of the violence in the trenches. And third, two of the CEOs said, one, Andrea Walsh of HealthPartners in Minnesota, and Susan Ehrlich. Susan Ehrlich said to me, “Bridget” (she runs SF General), “when you work at a safety-net institution, you just assume you will be assaulted in your career.” I said, “This is not OK.” And Andrea Walsh said, “Bridget, my people are not safe unless they are free from racial injustice or bias of any type.” So we made health justice the third pillar.

This was in the middle of the civil and social unrest. In San Francisco, the attack on Asians in my community, and on Asian physicians and nurses in the trenches, was appalling. And so we set out on a mission to create a movement to really change the definition of safety for our nation’s health care system. We got the 10 CEOs to sign it. We put out a call to action for other CEOs to sign it. Many have signed it. My dream is that President Biden has this group to the White House, that this is signed by all CEOs in the country, and that this doesn’t just sit on a shelf, that we rapidly come up with, and we already have, new clinical and process standards under each of those three pillars, so that we can rapidly, in the next 30, 60, 90 days, make change happen to stop the trauma and the mass exodus from the profession.

Kevin Pho: So give us some examples of some of these exact changes that you would like to see enacted, whether in a clinical setting or in a process setting, if this were to move forward.

Bridget Duffy: Well, I think there are process issues, there are technology issues, and there are cultural issues. And overnight, we’re working in a collaborative way with the National Academy of Medicine and with the Office of the Surgeon General, rapidly doing listening tours of the front line. And we already have a checklist of the five things the national task force for well-being has come up with, like the five things to remove, and we can give your listeners access to that list.

But number one, it’s like, stop the stupid stuff. It’s that basic, the rules for rules’ sake that are keeping people away from the bedside. It’s stopping the issues linked to just coding. It’s helping people with the electronic medical record, providing scribes, using voice-activated technology so that we are not data entry clerks. I mean, the electronic medical record caused trauma before the pandemic. It’s just caused extraordinary trauma now with the pandemic and has really stripped and destroyed the relationship between doctors and patients.

And then third, from a family perspective, never in my career did I think we would strip loved ones away from each other in a parking lot or have older parents and grandparents die alone. So it’s deploying new technologies that actually create human connections, or voice-activated, hands-free ways for when you’re in your PPE. The greatest risk of infection for a nurse or doctor is taking on or off their PPE. So it’s using creative technologies like the Alexa for health care from Amazon, utilizing ways for people to stay connected as a team when you’re in large COVID wards in health care. So many technology improvements we’re witnessing, many process improvements, and many things around culture, which is probably the most important: The rules for rules’ sake have to go away.

Kevin Pho: So we talked earlier about the inertia in health care and how the status quo is so powerful in preventing any change. So tell me a success story. Tell me how this initiative that you’re talking about has moved the needle.

Bridget Duffy: Well, I think what’s happened is the CEOs have dedicated people to taking this on. In one institution, there’s a SWAT team that daily maps the number of hassles versus joy in a clinician’s life and rapidly removes the hassles and amplifies the joy, and then scales that around the hospital. So I think you’re seeing now people being anointed or appointed into positions of authority and accountability to actually take the work on, and they are giving them the resources to do it. My comrade Kelly Hancock, who’s a nursing leader at Cleveland Clinic, was appointed the chief caregiver well-being officer.

I mean, never in my career. Being the nation’s first chief experience officer in health care, you know, people said, “Well, why do we need that?” And I said, “Well, shame on us that we waited till the government mandated we measure patient satisfaction.” And after I spent time in my first 30 days on that job, I came back to the boardroom and said, “We can’t focus on patient experience until we focus on staff experience.”

So I’m optimistic today, in the middle of the pandemic, seeing people appointed in this role, reporting to the CEO, who are addressing the systems issues. These are not broken people, as in my father dragging me to Dr. Deming. These are systems issues that we have witnessed and left alone for the last 50 years, that now, because of the pandemic, we need to come together as a nation and rapidly fix. And I’m hopeful because these CEOs in this movement have given the authority and accountability to team members to lead that effort.

Kevin Pho: So I completely agree that a lot of the issues are indeed system issues, and too often the blame is placed on individual clinicians or members of the health care team. So if I’m listening to this podcast as an individual physician or health care professional, what are some things that we can do to help fix the process, as you’re describing?

Bridget Duffy: Well, I think one of the lessons I learned early in my career is that I thought health care was data-driven and results-driven, and it’s really a hierarchical profession where it’s power- and relationship-driven. And so for me personally, what I learned was how do you get people in the foxhole with you to lead the innovation, and where is the power base in the institution to get the work done? So first, go get some enlightened leaders on your team. And I think it’s the power of small coalitions coming together within an institution and actually speaking up and doing the work. You don’t have to ask for permission anymore. My MO is covert with integrity. This is how I get work done. You no longer have to suffer or blame, “They won’t let me do it.” I always say to people, “Who’s ‘they’?” In administration, I think administration is now on board and really is looking for leaders who want to step up and take this on to get the work done.

I will say the work of this coalition is also driving and shaping. Our ultimate goal is to shape policy and reimbursement and have a voice in Washington, D.C., on the Hill, so that these things do not continue to happen to people in the trenches going forward. So that’s our ultimate goal through the work. But I think individual nurses, physicians, and frontline staff can actually stand up and take this on and do the work. There’s a way to do it by rapidly mapping not just gaps in efficiency or quality, but mapping gaps in the human experience. So within one day on your unit, you can say, “What are the 10 things that are impeding the humanity of medicine, and what do we need to take out, and what can we put back in?” So it’s just rapid prototyping of human-centered design that doesn’t cost a lot of money and doesn’t need FTEs to do, and we can’t afford not to do it.

Kevin Pho: We’re talking to Bridget Duffy. She’s an internal medicine physician and a health care executive, and she wrote the KevinMD article “End the trauma, stop health care’s great resignation, and protect care teams now.” Bridget, what are some of the immediate next steps or work that still needs to be done, for both your coalition and the initiative that you’re describing?

Bridget Duffy: Well, I think we need to really create a campaign and awareness around it. And so I would like to put out a call to have every CEO be open to signing this and putting their heft behind working at the intersection of physical safety, psychological safety, and health justice, helping us destigmatize it. So it’s creating a campaign, raising awareness and visibility. So our hope is that we will have this presence with the surgeon general in Washington, D.C.

I think number two is raising awareness in your own community, letting your philanthropists and people that support your institutions, making them aware of this. And I think third, we need to work with other partners outside health care. There’s a great opportunity to take on destigmatizing and giving people access to the behavioral health support they need. We do not need more meditation tapes or teaching people how to sit in lotus position. We need people to come in and fix the systems issues and remove the preventable trauma from the system. And let’s find other partners outside of health care that have been able to do that in their industry, and let’s go faster together and not take no for an answer.

Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?

Bridget Duffy: I think the profession of medicine and nursing is the most noble profession, and it distresses me to have people not recommend the career to their kids. So I think it’s our time right now to stand up and do something, because we cannot afford to lose another doctor or nurse or frontline staff from this work. And I have hope that we can get this done and make change happen.

Kevin Pho: And how can people find out more about the coalition?

Bridget Duffy: CEOcoalition.com, or they can ping me directly through my LinkedIn or Twitter, and I’d be happy to get them on board working with us.

Kevin Pho: Bridget, thank you so much for sharing your time and insight, and thanks again for being on the show.

Bridget Duffy: Thank you so much.

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