National Academies Press: OpenBook

National Plan for Health Workforce Well-Being (2022)

Chapter: 4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work

« Previous: 3 Priority Area: Support Mental Health and Reduce Stigma
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 34
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 35
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 36
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 37
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 38
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 39
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 40
Suggested Citation:"4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work." National Academy of Medicine. 2022. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
×
Page 41

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

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., 2020b). 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 guid- ance from government agencies, overly conservative interpreta- tion 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 (Defini- tive Healthcare and Vocera, 2019; Padden, 2019). There have been many advocacy efforts to address nonessential policy barriers, but change was incremental until the federal gov- ernment and many states removed barriers to care to respond to 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/. 35

36 | National Plan for Health Workforce Well-Being 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 re- sult of Centers for Medicare & Medicaid Services’ emergency dec- laration blanket waivers, certain limitations to hiring out-of-state providers were lifted, documentation and reporting requirements were suspended or eliminated, and practice restrictions were mod- ified—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, wheth- er 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 pro- viding 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 bar- riers to team-based care, and work together with additional stake- holders such as funders and regulators to design a system that bet- ter serves the population and the health workforce. PREPUBLICATION COPY - Uncorrected Proofs

Address Compliance, Regulatory, and Policy Barriers for Daily Work | 37 Priority Area: Address compliance, regulatory, and policy barriers for daily work. Time spent on documentation is reduced to provide Goal 1 more time for meaningful professional activities and personal well-being. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Companies Actors Health Systems Health Workers Insurers and Payers 1A. Revise policies and requirements for documentation that do not contribute to quality patient care. 1B. Remove low-value tasks from processes, rather than simply automating them. 1C. Measure time spent on documentation and set goals to Actions reduce non-patient contact time. 1D. Use metrics to assess the nature and quality of workload in addition to achieving a reduction in overall time spent on administrative work. 1E. Include direct care workers in the refinement of electronic health records (EHRs) to ensure that proposed changes improve workflow. PREPUBLICATION COPY - Uncorrected Proofs

38 | National Plan for Health Workforce Well-Being Policies address hybrid, virtual, and in-person Goal 2 workflows to facilitate work-life integration and responsive patient care. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Actors Companies Health Systems Health Workers 2A. Institute paid leave and protections for health workers. 2B. Involve direct care workers in the development of hybrid workplace policies and provide training for teams to connect in-person and virtual workflows. Actions 2C. Assess how virtual and in-person workflows connect and support each other. 2D. Fund infrastructure to support effective transitions to virtual or hybrid workflows for health workers. PREPUBLICATION COPY - Uncorrected Proofs

Address Compliance, Regulatory, and Policy Barriers for Daily Work | 39 Prior authorization requirements are reimagined in a manner that places a focus on supporting quality Goal 3 patient care while also reducing unnecessary burden on health workers. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Actors Companies Health Systems Insurers and Payers 3A. Eliminate prior authorization requirements if validated clinical decision support tools are used. 3B. Reduce the volume of prior authorizations needed and increase transparency of requirements. 3C. Standardize the prior authorization process with a single workflow so that payers can respond within fixed and de- Actions fined timelines. 3D. Increase automation when appropriate and deploy health IT to ensure timely care for patients. 3E. Create rules and regulations that are general and as in- clusive as possible. If exclusions are required, ensure they are limited and as specific as possible. PREPUBLICATION COPY - Uncorrected Proofs

40 | National Plan for Health Workforce Well-Being Requirements are streamlined for health workers to Goal 4 comply with regulations and policies. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Companies Health Systems Actors Health Workers Insurers and Payers Private and Non-Profit Organizations 4A. Form a public-private task force of experts, regulators, and health workers to identify frameworks and best practices for interpreting local-level rules and guidance that minimize burden. 4B. Standardize licensure processes, prepopulate necessary documents, and standardize timelines. Actions 4C. Standardize facility and procedural credentialing with prepopulated documents, attestations, and other required paperwork. 4D. Re-evaluate mandatory learning and trainings to shorten or eliminate those that add to the administrative burden of health workers. PREPUBLICATION COPY - Uncorrected Proofs

Address Compliance, Regulatory, and Policy Barriers for Daily Work | 41 Interstate practice is simplified and virtual services are Goal 5 easy for health workers and patients to use. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Companies Actors Health Systems Health Workers Insurers and Payers 5A. Expand telehealth and virtual care for subsets of patients where such care has been shown to be safe and effective. 5B. Permanently remove certain licensure requirements to allow out-of-state health workers to perform telehealth services, and include telehealth credentialing and licensure Actions within interstate compacts so that it is not an additional burden. 5C. Develop compensation models that facilitate asynchro- nous 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 RESOURCES2 1 Conduct Workplace Assessment • Tool: NASA Task Load Index (Agency for Healthcare Research and Quality) 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/. PREPUBLICATION COPY - Uncorrected Proofs

42 | National Plan for Health Workforce Well-Being Enhance Workplace Efficiency • Guide: Saving Time Playbook (American Medical Association) • Calculator/Guide: Team Documentation: Improve Efficiency, Workflow, and Patient Care (American Medical Association) • Guide: Lean Healthcare (American Medical Association) Examine Policies and Practices • Guide: Debunking Regulatory Myths (American Medical As- sociation) • Guide: Getting Rid of Stupid Stuff (American Medical Associa- tion) • Framework: Putting Patients First by Reducing Administra- tive Tasks in Health Care (Erickson et al., 2017) • Policy Considerations: Practice and Policy Reset Post-COV- ID-19: Reversion, Transition, or Transformation? (Sinsky and Linzer, 2020) • Policy Action Items: 25 by 5 Initiative to Reduce Documenta- tion Burden on U.S. Clinicians by 75% by 2025 (Columbia Uni- versity, Vanderbilt University Medical Center, American Med- ical Informatics Association, National Library of Medicine) • Initiative: Occupational Therapy Licensure Compact (Ameri- can Occupational Therapy Association) PREPUBLICATION COPY - Uncorrected Proofs

Next: 5 Priority Area: Engage Effective Technology Tools »
National Plan for Health Workforce Well-Being Get This Book
×
Buy Paperback | $25.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

In the United States, 54% of nurses and physicians, 60% of medical students and residents, and 61% of pharmacists have symptoms of burnout. Burnout is a long-standing issue and a fundamental barrier to professional well-being. It was further exacerbated by the COVID-19 pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care. Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care.

The National Plan for Health Workforce Well-Being is intended to inspire collective action that focuses on changes needed across the health system and at the organizational level to improve the well-being of the health workforce. As a nation, we must redesign how health is delivered so that human connection is strengthened, health equity is achieved, and trust is restored. The National Plan’s vision is that patients are cared for by a health workforce that is thriving in an environment that fosters their well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity; therefore, achieving the “quintuple aim.”

Together, we can create a health system in which care is delivered joyfully and with meaning, by a committed team of all who work to advance health, in partnership with engaged patients and communities.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!