How will you respond to clinicians sounding the alarm on unsustainable care delivery models?

Authors
Jenny Parker

EY Oceania Health and Life Sciences Leader

Improving health services sustainability strategies. Two wonderful children. Avid walker and baker.

Leonie Costello

Partner, People Consulting, EY Australia

Nick Allen

Manager, People Consulting, EY Australia

9 minute read 16 Oct. 2023

In EY Global Voices in Health Care Study, clinicians call for models allowing them to put patients first without sacrificing quality of life.

In brief:

  • Patient safety and lack of autonomy are top reasons cited by clinicians as to why they would leave medicine, according to EY interviews.
  • Health systems should help ensure frontline clinicians gain actionable insights from the patient data they collect throughout the day, to improve outcomes.
  • By advancing digitally enabled hybrid care models, health organisations can expand preventative care and prioritise time between clinician and patient, providing more autonomy.

Care delivery models of today rest on the idea that clinicians will continue to work as they have for generations — for long hours, often on call, with inhospitable hours and demands on their time well beyond the call of duty. Meanwhile, health care workers of today have been raised on the idea that work-life balance is important. Often mission-driven, they want to see better outcomes and experience for their patients, and for themselves.

To better understand the drivers of health care workforce shortages, uncover leading practices and hear from frontline clinicians, EY conducted more than 100 in-depth interviews in 11 countries with health system executives and clinicians. The clinicians were health care workers who had daily responsibilities to care for patients, including doctors, nurses and allied health professionals. Health system executives were also interviewed.

The clinicians interviewed for EY Global Voices of Health Care Study 2023 identified in detail the top factors causing them to consider leaving the profession: lack of autonomy or control (cited in 42% of global responses), burden (38%) and moral injury and concerns about patient safety (27%). Read the full study findings (pdf).

Voices in Health Care 2023

The medical workforce in the past was willing to do exceptional hours, long working hours, much more than the standard 40-hour working week. The new generation of doctors is much more focused on work-life balance. So not only are there less doctors, the doctors that are there want to work less, so it's a double-edged sword.
Health executive, Australia
Burnout is the thing that encompasses everything. There is a combination of loss of accomplishment, a loss of gratification, a loss of control and just feeling like I don't get the joy out of my work that I used to. I feel like it's not going to get any better.
Doctor, US
Unless we build a system where less severe disease can be treated more cheaply via self-medication, hospitals cannot focus on patients who actually need treatments at hospitals.
Health executive, Japan
Unfortunately, in many cases, administrative activities have started to consume a significant part of a doctor's day, sometimes even up to 50%. This approach of burdening doctors, who are already expensive resources, with extensive administrative duties is organisational madness. The system often takes advantage of doctors' dedication to their work, adding more tasks until they reach their limits.
Doctor, Germany

A disconnect between clinician and health system perspectives

As they confront rising demand from acutely ill patients, financial challenges and skyrocketing labour costs, health system executives responses to the workforce shortages focus on improving pay (39% of global respondents cited this approach), making sure clinicians practice at the top of what their licence enabled (33%), providing education pipeline initiatives (33%) and wellness benefits (22%).

Some clinicians said in interviews they appreciated the increased focus on mindfulness and mental health, but when asked how the health system needs to change in the future, the top changes cited were: more preventative care, better staffing ratios and better flexibility.

Clinicians in several countries shared stories of not being able to get the care they believed their patients needed, and then seeing them cycle through the health system ineffectively, without addressing the root cause of disease or preventing crisis.

  • Open image description#Close image description

    This interactive graphic displays quotations from clinicians and health executives who participated in the EY Global Voices in Health Care Study 2023. Full data is below.

    Country Person Quote
    United States of America Physician “Burnout is the thing that encompasses everything. There is a combination of loss of accomplishment, a loss of gratification, a loss of control and just feeling like I don't get the joy out of my work that I used to. I feel like it's not going to get any better.”
    Australia Health executive “The medical workforce in the past was willing to do exceptional hours, long working hours, much more than standard 40-hour working weeks. The new generation of doctors is much more focused on work-life balance. So not only are there less doctors, the doctors that are there want to work less, so it's a double-edged sword.”
    Japan Health executive “Unless we build a system where less severe disease can be treated more cheaply via self-medication, hospitals cannot focus on patients who actually need treatments at hospitals.”
    Germany Physician “Unfortunately, in many cases, administrative activities have started to consume a significant part of a doctor's day, sometimes even up to 50%. This approach of burdening doctors, who are already expensive resources, with extensive administrative duties is organisational madness. The system often takes advantage of doctors' dedication to their work, adding more tasks until they reach their limits.”
    Colombia Physician “There is too much information, but we don't know how to analyse it effectively.”
    Norway Physician “We do have access to lots of data. But right now, it's a bit chaotic because they haven't really optimised it yet.”
    Brazil Health executive "We have billions of health data points generated in private and public health practice, but none of it is being used to improve the patient experience, clinical outcomes, early diagnosis and disease prevention.”

Why are we doing this?

Looking to free up time for overwhelmed nurses during the pandemic, leaders at University Hospitals in Cleveland invited 50 frontline nurses and nurse managers for a brainstorming session. Peter Pronovost, Chief Quality and Transformation Officer for University Hospitals, said the group explored what work they could stop doing and what work technology could eliminate through automation. They also looked at tasks that could be outsourced, such as having an admission nurse who focuses only on admissions, working remotely. The last question they pursued was: “What work is sacred and needs to remain at the bedside in person?”

“We asked our nurses for policies where the burden exceeds the benefit. And then we looked at how many times it happens, how many minutes it takes... We changed probably around 70 policies. But what we found is those policies are embedded in 2,000 order sets,” Dr. Pronovost said. Through this exercise, the health system was able to free up an estimated 30% of nurses’ time to focus on patients. The health system also is working with the Centers for Medicare and Medicaid Services in the US to reduce burdensome policies.

Similarly, the team found that nurses were spending 24% of their time hunting for supplies during their shift. The health system introduced an app that enabled nurses to search for the most common assets they use. “And it instantly says where the nearest one is. So it's huge that the time it took a nurse looking for supplies went from 32 minutes to 2.” 

Digital transformation will play a huge role in solving the problem, but the clinician voice is critical

Health organisations can seize on digital transformation to clear the obstacles from clinicians’ days.

“Digital is seen as a cost centre, not a value centre,” said Rachel Dunscombe, CEO of OpenEHR, who has worked extensively in creating digital clinical programs for England’s National Health Service (NHS) and elsewhere. “We really need to reframe it as being the operating model that allows more productivity while keeping our clinicians a lot happier in the work.”

In EY interviews, clinicians say they see value in some digital tools that have been introduced, especially in voice dictation software and tools that allow them to view images, scans or medical records remotely. However, they disliked siloed apps and platforms that require them to log in multiple times per patient and they asked for better surfacing of the information they need from the Electronic Health Record (EHR). Still wary and frustrated by EHRs that have them lost in multiple click drop-down boxes, clinicians were more sceptical about the role of technology in changing the care delivery model than executives.

The costs of not pursuing digital strategies that will help attract and retain clinicians is high as well, with the consequences of burnout including costly turnover, increased medico-legal risk and financial costs. Loss of workforce supply is significant, given the costs of training with government contributing more than $320 million in 2020 to support tuition and clinical training costs through the Commonwealth Grant Scheme and individual’s bearing substantial personal study and tuition cost burden as well.1

Dunscombe says health systems need to familiarise clinicians with the technology and free them to create the experience that is right for them. Another challenge to unleashing the power of health data is “the lack of tooling for the clinicians to actually interrogate the data,” she said. “One of the most powerful things we can do is allow the clinicians to understand the population.”

None of the clinicians interviewed by EY said they had access to analytic insights on their patients. Clinicians even expressed frustration with swimming in too much data at times, not being able to find what they need. In fact, a recent report by The World Bank estimated that some countries use less than 5% of health care data to improve health.2

Junior medical officer spends much of their entire time on ward rounds, typing notes and then cleaning up the notes and then ordering certain investigations based on those notes.
Clinician, Australia
There is too much information, but we don't know how to analyse it effectively.
Doctor, Colombia
We do have access to lots of data. But right now, it's a bit chaotic because they haven't really optimised it yet.
Doctor, Norway
We have billions in health data generated in private and public health practice, but none of it is being used to improve the patient experience, clinical outcomes, early diagnosis, and disease prevention.
Health executive, Brazil

Health organisations must advance towards digitally enabled hybrid care models to address continuing workforce challenges

Newer models that seamlessly integrate remote and in-patient care can help relieve care demand, expand preventative care and improve patient and clinician experience. Data insights can help identify the appropriate time, site and mode of care for patients. More effective virtual triage options and virtual primary care can help reduce the burden, while smart remote patient monitoring devices and apps can enable exception-based interventions and help create more consistent touch points with patients.

Six key actions will help executives move health systems towards digitally enabled hybrid care models:

  1. Prioritise time between clinician and patient. Health systems should support clinicians through digitally enabled care models and tools to manage their workload making time available for patients who need longer consultations or more time spent.
  2. Activate the data that clinicians are collecting throughout the day by pulling out insights about their patient population. By equipping clinicians with actionable insights, they can better improve outcomes and experience.
  3. Develop more precise and consumer-friendly communication strategies to help patients feel more seen and heard. When patients are waiting for test results or appointments, anxiety can build. Communication strategies can help assuage those worries, better manage expectations and keep them connected to the health organisation.
  4. Educate the public about what quality care looks like and their role in it. Many may still believe quality care only occurs in hospitals. How can health organisations help the public to understand what high-quality care in hybrid models looks like, and empower them to take a more active role in their care. Clinicians also indicated more needs to be done to stop the abuse of health care workers by patients and to rebuild trust.
  5. Collect real-time feedback from employees. Health organisations need a better understanding about what’s working for employees in the moment so they can drop what’s not working and remove obsolete policies or benefits that are not adding value for employees.
  6. Focus talent strategies on supporting the move towards new digitally enabled care models. As health systems shift care to preventative models and towards the home, Human Resources (HR) will need to be ready for the new roles that will be necessary to carry care through to the home, such as consumer health techs to connect home health devices. Health systems will also need to work with governments and education systems to enhance digital clinical worker skill sets and pipeline.

EY Global Voices in Health Care Study 2023

Clinicians are calling for care delivery models allowing them to put patients first without sacrificing quality of life.

 

Download pdf

Special thanks to the following individuals who contributed greatly to the EY Global Voices in Health Care Study 2023:

Crystal Yednak, EY Global Health Senior Analyst;
Aakanksha Kaul, EY Health Sciences and Wellness Analyst;
and Risha Saxena, EY Health Sciences and Wellness Analyst

  • Methodology notes

    From March through June 2023, EY conducted more than 100 in-depth interviews with clinicians and health system executives in 11 countries to better understand what is driving health care workforce shortages and how care delivery models need to shift in the future. EY also analysed government data, evaluated academic articles and conducted a comprehensive literature review on the workforce shortages in the 11 countries involved in the study.

  • Show article references#Hide article references

    1. Australian Government, Department of Health. National Medical Workforce Strategy 2021-2031
    2. The World Bank press release, “Investments in digital can accelerate improvements in health care,” Aug. 19, 2023.

Summary

The key priority arising from the EY Global Voices in Health Care Study 2023 is advancement towards digitally enabled hybrid care models. Health organisations must embrace new care delivery models to address continuing workforce challenges. Hybrid care models seamlessly integrate remote and in-patient care to relieve care demand, expand preventative care, and improve the patient and clinician experiences.

About this article

Authors
Jenny Parker

EY Oceania Health and Life Sciences Leader

Improving health services sustainability strategies. Two wonderful children. Avid walker and baker.

Leonie Costello

Partner, People Consulting, EY Australia

Nick Allen

Manager, People Consulting, EY Australia