Studer Community Institute

'Health care is a team sport'

April 20, 2015
/ Shannon Nickinson
/ training-development

Studer Group Medical Director Dr. Jay Kaplan is the president-elect of the American College of Emergency Physicians. A New Orleans native and honors graduate of Harvard Medical School, Kaplan will begin his year-long term in October. Kaplan joined the Studer Group in 2001, the year the health care consulting firm was founded by Quint Studer. A nationally recognized speaker, consultant and facilitator, Kaplan’s work with the Studer Group takes him around the country, coaching hospital and physician leaders, medical groups, emergency departments, and individual physicians on the importance of teamwork in the ER between doctors and nurses. A resident of Northern California, Kaplan was in Pensacola recently and sat down with Pensacola Today to discuss the current challenges facing emergency medicine, as well as the improvements made over the past decade. Question: You’re President-elect of the American College of Emergency Physicians. When you assume office in October what will be among your top goals? Answer: Among my top goals are to continue to bring high quality compassionate care to patients in emergency departments; to ensure access to medical care; and to ensure emergency physicians and nurses have the tools they need to care for their patients. Q: How has the emergency room changed over the past 20 years? A: When I first started practicing medicine 36 years ago, one of my goals was to change the ER experience. And what I mean is that it would be seen by patients not just as a place you go for life-threatening trauma, but rather as a place where you could have superb physicians diagnose you in an expeditious way, and have you feel cared for as well. I think we have clearly moved in that direction. If you look at some of the data many emergency departments have implemented processes whereby patients are seen more quickly, and we are getting to where the quality of care for patients is getting better and better.

Q: When traveling around the U.S. speaking to health care providers, what are the concerns you hear most from ER doctors?

A: I hear a lot from physicians about burnout. Surveys have shown that burnout by physicians has gone up since their last report in 2013. And now 50 percent of physicians are reporting burnout. Burnout as characterized by one of three things: 1) Emotional exhaustion; 2) loss of work fulfillment; and 3) negativity and cynicism. I call that “loss of connection” why they went into medicine in the first place. And the other big issue, is that physicians are practicing much more defensive medicine because they are afraid of getting sued. There’s a huge cost to that. If we could develop some medical liability reform, what we call safe harbors that would provide physicians with some greater level of protection, I think that would be helpful. Q: What do you hear from hospital administrators about the challenges of providing health care in today’s cost-pressured environment? A: I do think, with declining reimbursements, that there have been some huge pressures on hospitals to allocate their resources more carefully. Sometimes that means taking away staff, or not building more space in which to see patients. And we know patients continue to stream into ER, with rates to ER visits rising much faster that population growth. And with the Affordable Care Act, many more patients have insurance. But because that insurance is at a Medicaid Insurance level, they can't find doctors to care for them. Q: What have been among the most important innovations, both clinically and technologically, in the ER over the past couple of decades? A: I think one of the big innovations is how quickly we see patients. Many places have created an immediate bedding policy. So, patients are asked one or two questions out front and then are immediately taken to the back and given a bed. The sooner they see the doctor, the better. Another big innovation in ER is our access to electronic health records. That innovation has given ER physicians immediate access to patient information that they didn’t have before.

Q: What have you found matters most to ER patients when measuring their satisfaction with the care provided.

A: What matters most to emergency department patients is: Were you cared for as a person, and were you kept informed about the process of your care and were there any delays? I think there’s very good evidence that if patients rate you high on how well they were kept informed in the care process, and any delays that occurred, they’re going to rate you high on everything else. Q: You're described as having a “tactical and directed” approach toward improved outcomes. Can you explain that strategy? A: Einstein was correct in saying the best definition of insanity is to keep doing the same thing over and over and expect different result. You hear from a number of critics these days that doctors need to work on their people skills. Doctors need to listen more. Doctors have no time. And, so, when I talk with physicians, I try to persuade them to use very simple tactics that can make a difference in the patient experience. I tell them to sit down at patient’s bedside. There’s good evidence that people’s perceptions of their experience in the ER greatly improve when you sit by their bedside than when you stand. I tell them it is important to use words your patients can understand. So forget the medical jargon. And, at the end of the patient encounter, don’t ask, “Do you have any questions?” which is what most doctors will say. Rather, do an affirmative ask: “What questions to you have for me?” What our patients really want is to be felt like we care about them. Our first job when we see patients is to relate to them. Next part of it, is to do our task, and to give them good care and they feel good about themselves. Q: In your talks to health care providers, you stress the importance of teamwork and physician leadership in creating change in health care. Are you seeing more leadership and teamwork these days, or is that still an uphill battle? A: I tell doctors all the time that health care is a team sport. And so doctors need to constantly strive to be good team players, because we’re used to giving orders and to directing the team. Q: Why did you decide to become doctor? A: Watching my dad, who was a doctor. He was an internist in New Orleans. I used to watch him going on house calls and I saw how patients adored him. And I knew at a young age that I wanted to be a doctor. At one time, as I grew older, I thought I wanted to become a teacher. But a professor persuaded me to become a doctor. He told me that as a doctor you can teach, and you can care for patients. You can do it all. And I’ve never been disappointed with my decision to become a physician. Q: You’re a practicing physician and do a great dealing of traveling around the country with the Studer Group. When you take a break from your busy schedule what do you enjoy doing with your leisure time? A: I live in northern California, so it depends on the season. But first of all it’s spending time with my wife and my family. I have three daughters in their 20s. I like spending time with them. I like to hike. And during winter I like to ski. And I like to write poetry.

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'Health care is a team sport'

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