Focusing on the patients’ needs is also a key component
of Scripps’ Value by Design concept. It’s intentional, says
Keswani, who explains there two basic principles to Value
by Design: continuous improvement and respect for people.
“Respect for people means respect for self,” he says.
“Respect your nurse, your team, your patient more than
As far as standardizing work processes and exam rooms,
hard data on whether it is decreasing wait times has not
been studied yet. Geary says the patient satisfaction scores
are good; in fact, the patient satisfaction score was 91.8% in
April 2014 and increased to 93.1% in November 2014, but
it’s hard to tie a direct line to patient satisfaction from just
two initiatives. For physicians, she says, the standardization
is working well.
“Anecdotally, it has been successful, but continues to be a
work in progress,” she says.
Debating the art and
science of medicine
While many health system leaders believe that reducing
variability in patient outcomes will improve quality, some
physicians are raising the issue of whether standardization
removes the art from medicine.
“Right now, it’s 80% art and 20% sci-
ence,” says Gueramy. “It will switch,
Geary looks at the issue in a differ-
ent way. She says that standardizing
work processes doesn’t interfere with
physicians’ human touch. Instead, it
can make them more efficient, giving
them more time to spend on matters
that affect patients.
“Some of the things we do as phy-
sicians are not things that need to
be done by a physician,” says Geary.
“For example, mail and forms. I’d be
sitting at my desk at 5: 30, filling out
a form that needs the clinic address,
the patient’s address, or a note. That’s
paperwork I don’t need to do. If we
could take away those inefficient
operational details from the physi-
cians’ responsibilities, I think that’s
Those small details, together, can
create inefficiency that adds to a doc-
tor’s workload without improving
patient care or satisfaction.
Brenner, the independent physician who is now employed,
says he is much happier letting someone else take over the
regulatory and administrative burden he dealt with for more
than two decades.
His workload is lighter. Instead of working 80 hours a week,
he now works 60 hours a week. He’s paid twice as much in Texas
as he was in California, and he has a better work-life balance.
“It’s beyond the fact that they’re paying me more,” says
Brenner. “I worked crazy hours, and this is an opportunity
for my wife and me to spend time together.”
A new focus on balancing physicians’ personal and profes-
sional life is not a bad thing, says Pryor, who encourages phy-
sicians to take time for themselves, away from the hospital
and/or physician office.
“Most of us who have been here a long time have a lot of
scars,” he says. “I was laughing the other day that an 80-hour
workweek used to be a minimum, not a maximum, but we’re
giving them permission to have more work-life balance, more
rest, and to get away.”
Jacqueline Fellows is senior editor for physicians and
service lines for HealthLeaders Media. She may be contacted
HealthLeaders n March 2015 27
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