Sutter Health’s approach to innovation and physician burnout

Digital health has arrived and health systems find themselves on a new playing field. Leaders know they need to adopt digital solutions to stay in the game, but knowing this and doing it are two very different things. What's the game plan? And how do you keep score?

AVIA leads a network of health systems that have teamed up to meet this challenge head on. They range from small and nimble community hospitals, to leading academic medical centers, to large integrated delivery networks. Together, AVIA and its members are creating the playbook for digital and strategic success. AVIA network member Sutter Health, a not-for-profit health system serving patients and families in more than 100 Northern California cities and towns, has stepped up to the plate. Sutter Health created a rigorous process for translating innovation into clinical practice called "4-REAL." Their leaders recently put the model to the test by taking on the issue of physician burnout. They took a big swing and hit a home run. Read more to discover their winning strategy.

4: In less than 4 sentences, describe the specific problem you are solving for

The first step in Sutter Health's process refers to the "elevator pitch." A well-crafted elevator pitch delivers a succinct and compelling description of the specific problem and why it is pressing for your organization. Questions this pitch should answer include: What is the burning issue that you are solving for your patients, staff or bottom line? And how will this impact clinical or business metrics? If you cannot crystallize the message, either reframe the message or move on; the project may not be compelling enough to pursue.

Sutter Health executed this expertly when they crafted a powerful pitch for improving physician workload. Their physicians were staying 2-3 hours per day post-clinic typing notes. Medicine was becoming more about documentation rather than patient care, focused on screens and not patients. This challenge isn't exclusive to Sutter Health; work-related burnout among U.S. physicians has reached a critical level. According to a Medscape survey in 2015, between 40-55% of physicians experienced burnout. Sutter Health prioritized solving these pressing issues, eliminating redundant tasks and refocusing medicine back on human connections.

R: Tying your innovation to RETURN on investment

The next step is to define the value of the innovation or program through clinical, operational or financial results. For example, does this solution help us perform better in our jobs as caregivers? Can we gain workflow efficiencies or brand reputation improvements? Can we save costs or increase revenues? To define success metrics, understand who and what your solution can impact. Consider all potential stakeholders, including patients, physicians, staff, legal, compliance, marketing and venture.

Sutter Health focused squarely on the results when they selected Augmedix. This solution uses cutting-edge smartglass technology to connect physicians with a remote team of scribes. Physicians wear the smartglasses, which contain a camera while conducting patient exams. The remote scribe acts as an extension of the care team, accessing patient information and transcribing rich patient notes in real time. Offloading this burden offers several benefits that Sutter Health translated into meaningful success metrics:

Clinical: Improve quality of patient visit notes - more accurate, thorough and timely documentation. Enhance patient experience, making them feel understood and cared for by their physician.
Operational: Reduce physicians' time spent on administrative tasks, allowing them to devote more time to what they love: caring for patients and getting home to see their families. Happy physicians equal happy patients.
Financial: Increase clinical productivity and patient access by maximizing physician's time. Improve brand reputation as an innovative organization that seeks solutions to benefit both our patients and physicians.

E: Life EXPERIENCE matters

Sutter Health knows that innovation isn't just about technology; it's also about people. That's why the next step in their process is to evaluate the solution team. Looking beyond education and professional expertise, consider these three components when evaluating a team:

Depth of healthcare knowledge: Healthcare delivery is complex and new technologies, or approaches can meet resistance. Does this team have a thoughtful approach to the clinical workflow and the individuals who are delivering it?
Grit and resilience: It is inevitable that an early company will morph and evolve as its business takes shape. Will the team be able to handle unforeseen problems that may arise, sticking it out through the tough times or pivoting when needed?
Partner capability: Both sides need to be mutually interested and invested in making the experience seamless and effective. Can the solution team be a collaborative partner and not just a vendor?

Augmedix understood that healthcare and provider organizations are complicated. To be successful, they have approached every implementation as a minimally viable product (MVP) from the customer's eyes. While the goal has remained the same – to save physician time – each system has expressed specific needs. This awareness and flexibility have helped build the right workflow and supporting infrastructure to achieve any health system's goals.

Flexibility and a healthy dose of resiliency are critical to successfully managing a partnership and unforeseen issues. Augmedix had both qualities in spades, which came in handy when Sutter Health hit a technical roadblock that prevented live streaming. They didn't fret, they got creative, building a full mock-up of Sutter Health's digital environment in their office to troubleshoot and find a solution.

This dedication to quality proved to Sutter Health that they had found a true partner in Augmedix. Not only did they share a similar work ethic, but also a mission for the work. "Our obsession with quality directly correlates with our mission of re-humanizing healthcare by focusing physicians' attention back on patients," said Pelu Tran, co-founder and president for Augmedix. "For remote scribing to be effective, acceptance from the physician and the patient was an imperative."

A: Organizational ALIGNMENT

To rally an organization, Sutter Health recommends a compelling story that inspires the team's hearts and minds to carry the torch forward. This critical step includes knowing your individual stakeholder's influence, risk appetite and strategic mindset to enlist the right champions. Overcome the naysayers with incentives that are mutually aligned.

Dr. Albert Chan, Sutter Health's vice president and chief of digital patient experience, understands the value of assembling the right team. He believes that "it takes a village to give birth to the living organism that is clinical translation. Having the right team with an all-hands-on-deck attitude is imperative."

Sutter Health's village includes leaders, providers, staff and patients, who all recognized the problem of physician burnout and desired a solution. While Augmedix's vision to "re-humanize healthcare" resonated well with Sutter Health leaders, there were still technology concerns around data security, patient privacy, technical stability and provider and patient adoption.

Committed to solving these issues, leadership from both organizations set the tone for collaboration: everyone is a leader and a problem solver. Working together, Sutter Health and Augmedix addressed each concern in a stepwise approach. For example, remote scribing started in San Francisco and then later migrated to India after security or privacy concerns were mitigated.

L: LIVING at Scale

The world is full of implementations that stay in project mode. We all suffer from "pilot-itis." Sutter Health advises aiming for scale from the start, using rapid pilots to manage risk and fix the technical and operational kinks. If you cannot imagine scale, do not bother to pilot.

Sutter Health had scale in mind from the start of the Augmedix implementation. They intentionally enlisted a diverse set of 10 physicians, ranging in technical savviness and productivity, to inform project success and provide insight. All physicians came from the same department, so there was a shared set of experiences and ideas for improvement.

Before the pilot started, Sutter Health wanted to ensure all participating physicians had skin in the game. Healthcare costs are significant and cannot afford to increase further. For physicians to receive the benefit of Augmedix, the economics needed to make sense. Each physician signed an agreement laying out clear program and participation expectations to achieve end goals.

The pilot focused on metrics that matter: patient acceptance and productivity improvements. The results of the pilot showed 96% patient acceptance and substantial physician productivity efficiencies of almost 2 hours saved per physician per day. These savings translated into improved patient access and increased satisfaction from both physicians and patients. The most impactful response for Sutter Health are the positive responses from their physicians, including "You've brought the joy of medicine back into my life" and "You've allowed me to see my family again, thank you."

"Our goal was to improve the clinical care experience both for patients and providers. With Augmedix as a partner, we have had a win-win for all our key stakeholders," said Dr. Chan. Sutter Health used their "4-REAL" process to scale Augmedix to over 100 physicians with plans to reach an additional 100 in 2017.

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