Quality of care threatened by frantic pace in medical practices


It’s a top-speed, rapidly changing, high-tech world — one physicians, nurses and clerical support staffers are having trouble keeping in stride with, a new study reveals.

Conducted by the Agency for Healthcare Research and Quality (AHRQ), the survey prompted 23,679 people from 934 medical offices throughout the U.S. about the trials and tribulations associated with current patient care practices. More than 70 percent of the medical professionals involved admitted they felt rushed when caring for patients, while 52 percent of all those surveyed said patient volume was extreme given the limited number of healthcare personnel in their respective offices. The overall consensus was one of exasperation — the frantic pace of medical office workflow mixed with high patient quantities is a tough concoction to swallow for health professionals who aim to provide top-notch care.

Workflow issues were reported by 51 percent of the respondents; 39 percent admitted that their offices maintain a level of disorganization more acute than it ideally should be. Little over half (51 percent) didn’t think clinic owners/managers were “investing enough resources to improve the quality of care,” and about a third of those surveyed believed their offices subscribed to the mindset that getting more work done was the paramount priority, even over quality of care.

“In many practice situations, the pace just does feel too fast,” said David Shute, MD, medical director of GreenField Health, an eight-physician primary care clinic in Portland, Ore. “It’s well understood that when humans are given too many tasks to focus on at once and there is too much time pressure, the error rates go up. This survey highlights a big problem.”

A majority of the clinics involved (75 percent) in the “2012 User Comparative Database Report: Medical Office Survey on Patient Safety Culture” were hospital or health system owned, with just under two thirds (62 percent) laying claim to fully implemented electronic health record systems. Given such results, primary care clinics shouldn’t anticipate that the evolution away from paper-chart based systems will be the miraculous cure to all their workplace woes, experts said.

“There’s no question that primary care is really feeling the push,” said Mary Pat Whaley, a Durham, N.C., practice management consultant. “It doesn’t make any difference if they are in an independent physician practice or a hospital or an integrated health system. It’s just really intense.”

Nevertheless, the survey finds that embracing electronic recordkeeping is a necessary step physicians should take to ease workflow tensions, even if it’s only the initial tread in a lengthy course toward betterment.

“Going electronic is a tool, but you have to implement it appropriately,” David L. Bronson, MD, president of the American College of Physicians told amednews.com. “You still need office systems and a protocol on how messages are handled, and a protocol on drawing blood to confirm you get the right patient. That this John Smith is the correct John Smith and get the other validations necessary to confirm that the appropriate tests are being done. You have to have those fail-safes implemented into your systems, especially when you have a busy, frenetic office.”

Physician owned practices possessed the highest positive ranking within the survey’s patient safety culture metrics — practices with one or two physicians had a better chance of scoring an “excellent” or “very good” score in overall patient safety when compared to practices with 14 doctors or more.

A measure of the importance of teamwork was rated universally high by all respondents, with 80 percent confirming their offices collaborated successfully. However, nearly half of the office staffers felt it was “difficult to voice disagreement in this office,” when asked in the AHRQ survey about their degree of comfort.

“The first thing we need to do is see our co-workers as colleagues, not as servants,” Shute said. “The minute we do that as physicians, openness goes way up and, frankly, the work stress goes down.”

Jeff Brady, MD, MPH, Center for Quality Improvement and Patient Safety at AHRQ, summed up the study and its results as such: “The survey showed that physicians, nurses, and staffers thought the fast pace and high patient volume made it difficult to provide the best care. Through the survey responses, we also observed that medical office staffers found it hard to voice their disagreement and believed their mistakes were held against them. If people find it difficult to discuss problems in an organization, it can be more challenging for the organization to improve. It’s important to foster a culture that is open to learning about problems in order to improve patient safety.” 

More statistics and information about the survey can be found at the Agency for Healthcare Research and Quality website.

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