EY Study: Lack of autonomy and patient safety driving clinicians to sound the alarm for new care delivery models

EY Global Voices in Health Care Study 2023 finds clinicians are calling for models that allow them to put patients first without sacrificing their own quality of life.

Clinician respondents cited lack of control or autonomy (cited in 42% of responses), burden (38%), and concerns for patient safety and moral injury (27%) as the top factors for why they would leave the profession. Clinician respondents also expressed the need for more time per patient to feel like they are practicing medicine safely, caring for patients, and realizing their purpose.

The EY study, based on more than 100 in-depth interviews conducted with patient–facing clinicians(including physicians and nurses) and health system executives in 11 different countries, including the US, Australia, Canada, Germany, and the UK, aims to understand the pain points for front-line clinicians, what is driving workforce shortages around the world and how health systems should shift care delivery models to better attract and retain health care workers.

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The study also found care delivery models of today rest on the idea that clinicians will continue to work as they have for generations – across long hours, often unpaid for charting and mentoring time and for training new doctors and nurses. Meanwhile, healthcare workers interviewed have been raised on the idea that work-life balance is important. Often mission-driven, they want to see better outcomes and experiences for their patients, and for themselves.

“The EY Global Voices in Health Care Study 2023 finds that care delivery models are not working for today’s clinicians, and probably won’t work for tomorrow’s. However, we have already seen the tremendous costs of not having resilient workforce strategies. We need to hear our clinicians. For example, when health systems improve workflows to save time, are they using it to optimize the patient-clinician experience, or adding more patients?” says Aloha McBride, EY Global Health Leader.

Workforces in crisis

As they were confronting a crush of extremely ill patients, financial challenges, and skyrocketing labor costs, health system executives tended to focus on pay in their response to the shortages (39% cited this approach), making sure clinicians were practicing at the top of what their license enabled (33%), education pipeline initiatives (33%) and wellness benefits (22%). However, when asked how health systems need to change in the future, the top changes cited by clinicians were: more preventative care, better staffing ratios, and better flexibility.

Perhaps reflecting their poor experience with digital health tools, better use of technology was cited by 15% of clinician interviewees as having the potential to improve the system, compared to 47% of health executives who identify technology as a key part of fixing the health delivery model. Of the clinicians interviewed, many expressed dissatisfaction with the effectiveness of some newly introduced digital tools, such as siloed apps or platforms that require multiple logs per patient. Many clinicians expressed potential in the usefulness of new digital tools, praising examples such as artificial intelligence (AI),bedside tablet PCs, and voice dictation software but stated tools must be designed for the reality of how they work to be beneficial.

Too much data, very few insights

According to the EY study, none of the clinicians interviewed said they have access to analytic insights about their patient pool. Only 26% of health system executives surveyed say they are using data analytics insights to create patient care pathways and just 30% say they are using analytics for workforce planning and management. Clinicians expressed frustration at having access to too much data at times, unable to decipher actionable insights for what they need, through lack of tooling.

Potential of virtual care and task burden

The study reveals a large proportion of clinicians (88%) interviewed see potential in virtual and remote methods, with more than half (53%) citing primary and chronic disease as the top area patients are benefitting, followed by rural areas and the elderly (16%).

When discussing ways to relieve the burden of tasks, 85% of physicians saw an opportunity to hand off tasks to other roles, such as assistants, nurses or clerks, both for transferring care tasks to other team members and reducing administrative burden. However, only half of nurses saw the potential to transfer tasks to others. In many interviews, physicians and nurses voiced that when they have tasks taken off their plate, they say it doesn’t lead to more time with their patients.

“Health organizations can address continuing workforce challenges by advancing hybrid care models that seamlessly integrate remote and in-patient care to relieve care demand, expand preventative care and improve patient and clinician experience. Data insights can help drive this shift to a new care model that works for the clinicians of today and tomorrow,” McBride says.