4

Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work

Prevent and reduce the unnecessary burdens that stem from laws, regulations, policies, and standards placed on health workers.

“Reduce the regulatory burden which makes health workers feel like data entry people.” - Frontline Health Worker¹

Health workers are faced with time-consuming tasks that detract from time spent with patients or promoting health, and they are often not empowered to take back their time (Sinsky et al., 2020). Though standards are essential to providing safe, high-quality care, the constellation of organizational, state, and federal policies have created administrative requirements that multiply over the course of a health worker’s day. Depending on the clarity of guidance from government agencies, overly conservative interpretation of regulations at the organizational level can result in a less safe environment for patient care, as health workers lose time and cognitive bandwidth for clinical care while addressing multiplying administrative requirements throughout their daily work (Definitive Healthcare and Vocera, 2019; Padden, 2019).

There have been many advocacy efforts to address nonessential policy barriers, but change was incremental until the federal government and many states removed barriers to care to respond to

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¹ For background on this quote and those in other chapters, visit the NAM’s Clinician Burnout Crisis in the Era of COVID-19: Insights from the Frontlines of Care webpage at: https://nam.edu/initiatives/clinician-resilience-and-well-being/clinician-burnout-crisis-in-the-era-of-covid-19/.

the COVID-19 public health emergency. This demonstrated that strategies to decrease health worker workload, which contributes to burnout, can be rapidly implemented on a wide scale. As a result of Centers for Medicare & Medicaid Services’ emergency declaration blanket waivers, certain limitations to hiring out-of-state providers were lifted, documentation and reporting requirements were suspended or eliminated, and practice restrictions were modified—so that the health system could emphasize taking care of patients (CMS, 2020). To prepare for potential future emergencies, as COVID-19 becomes a more predictable and manageable threat, it will be important to understand the benefits that these flexibilities have had on the delivery of care and the health workforce, whether they should be sustained, and whether additional measures are needed. Fundamentally, health workers recognize what works in their local environments to execute a team-based model of care that meets patient needs and is positively linked to health worker well-being. A key way to maximize teamwork and efficiency in providing patient care is to fully leverage the training and education of all care team members (Smith et al., 2018). Organizational leaders should empower health workers to share their views, uncover barriers to team-based care, and work together with additional stakeholders such as funders and regulators to design a system that better serves the population and the health workforce.

Goal 4.5.	Interstate practice is simplified and virtual services are easy for health workers and patients to use.
Actors		Academic Institutions, Clinical Training Programs, and Accreditation Bodies
		Federal, State, and Local Governments
		Health Information Technology (IT) Companies
		Health Systems
		Health Workers
		Insurers and Payers
Actions	4.5.A. Expand telehealth and virtual care for subsets of patients where such care has been shown to be safe and effective.
	4.5.B. Permanently remove certain licensure requirements to allow out-of-state health workers to perform telehealth services, and include telehealth credentialing and licensure within interstate compacts so that it is not an additional burden.
	4.5.C. Develop compensation models that facilitate asynchronous and continuous electronic messaging between the patient and the health care team.

NOTE: The list of actors in this table is not exhaustive. Many of the actors named in this table will need to plan and coordinate their actions with each other as part of a systems approach to health workforce well-being.

RELATED RESOURCES^{2 1}

Conduct Workplace Assessment

• Tool: NASA Task Load Index (Agency for Healthcare Research and Quality)

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² For additional resources, visit the NAM’s Resource Compendium for Health Care Worker Well-Being webpage at: https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/.

Enhance Workplace Efficiency

• Guide: Saving Time Playbook (American Medical Association)
• Calculator/Guide: Team Documentation: Improve Efficiency of EHR Documentation (Sinsky, 2014)
• Guide: Lean Health Care: Eliminate Waste and Spend Mre Time with Patients (Sinsky, 2015)

Examine Policies and Practices

• Guide: Debunking Regulatory Myths (American Medical Association)
• Guide: Getting Rid of Stupid Stuff: Reduce the Unnecessary Daily Burdens for Clinicians (Ashton, 2019)
• Framework: Putting Patients First by Reducing Administrative Tasks in Health Care (Erickson et al., 2017)
• Policy Considerations: Practice and Policy Reset Post-COVID-19: Reversion, Transition, or Transformation? (Sinsky and Linzer, 2020)
• Policy Action Items: 25x5 Symposium to Reduce Documentation Burden on U.S. Clinicians by 75% by 2025 Summary Report (Rossetti et al., 2021)
• Initiative: Occupational Therapy Licensure Compact (American Occupational Therapy Association)