In partnership with IntelliGuard Intelligent Inventory Solutions
IntelliGuard Intelligent Inventory Solutions develops disruptive technology that doesn’t disrupt clinical workflows. We aim to increase the level of patient care through innovative systems that solve problems in and out of the Operating Room (OR.) In doing so, we are committed to resolving medication inventory management challenges that may affect patient care. Through this commitment, we’ve worked toward holding space for the difficult conversations surrounding everything from mental health issues and burnout to the diversion - or stealing - of controlled substances in acute care facilities. The next iteration of this effort is in the following conversation between two pediatric anesthesia providers, Dr. Gaconnet, the Division Head of Pediatric Anesthesiology at the Naval Medical Center in San Diego, and Dr. Ness, the Chief of Anesthesiology at Rady Children’s Hospital.
The need for these conversations is hard to ignore. In starting this discussion, Dr. Gaconnet was able to provide a bit of context around what physicians face in their pursuit of minimizing burnout in the workplace, especially during the COVID-19 pandemic, “If you say you are being treated for a mental health issue, you are automatically flagged as a problem by the medical board. The message is clear, don’t tell anyone, don’t get treated, it’s not a good thing to be addressing your mental health in a reasonable way.”
Dr. Cory Gaconnet serves as the Division Head of Pediatric Anesthesiology and the Director of the Bioskills and Simulation Training Center at Naval Medical Center San Diego and is an Assistant Professor at the Uniformed Services University where he plays a significant role in medical education at his affiliated hospitals. His medical training combined with more than 13 years of leadership experience within healthcare uniquely positions him to bridge the gap between effective healthcare business and quality-based clinical care.
Dr. Daniel Ness has been with Rady Children’s hospital for over 20 years and currently serves as their Chief of Anesthesiology. In this role, Dr. Ness strives to champion innovative solutions for physicians and improve patient care.
How has the COVID-19 pandemic impacted clinical care?
GC: I think the biggest underlying issue has to do with fear. In my practice in the hospital, I never thought I’d experience the fear that I would go to work and do my job and care for people and also risk my life to do it, especially at the beginning of the pandemic. It’s really difficult because we’re usually on the other side of it. We see our patients' fear before they go into surgery, and we’re used to alleviating that fear for them. We have the tools to provide the best care possible. But now when we go in and give that life-saving care, the risk that is involved with intubating is extremely scary. Is this the time I will get COVID and give it to my family? The other form of fear, believe it or not, is the fear that we can’t help these people.
It’s an incredible thing to be a physician and commit yourself to heal people and to then come across a disease process where we had no idea what the path of physiology was and we had nothing to treat it with and all the things that we had relied on, trusting that intubating will make someone better, was now replaced by a fear of inadequacy. If you want to break a doctor, give them that fear and have them carry that day in and day out.
DN: Initially the fear of the unknown was driving everything. It was to the point where people were concerned about what people look back on now and view as silly and not important. But at the time, it was scary. We were learning about the virus and the prognosis and course of the disease in little bits as more studies would come out and more bits of information would appear. Things were changing, so people were having a difficult time keeping up and trying to figure out what mattered.
Reflecting on the past year and a half, can you walk us through the progression of how COVID impacted you and your teams? From a clinical, workflow, mental health, and burnout perspective?
CG: You can imagine it’s this vicious cycle. You saw it a lot in the news when physicians would be interviewed, in walkouts, in animosity between administration and physicians trying to make decisions about patient care. I’ve never seen that in my career until the pandemic came about. I feel like it’s more a reflection of where people were and where they continue to be. You’re seeing the extremes of personalities.
In my practice caring for pediatrics and their families, I see that when people are pushed to the extremes of their personalities and all of their coping mechanisms are broken down, you see lashing out and anger. Usually, a level of decorum is maintained, but I think COVID has broken down the expectation among physicians that is usually there.
DN: See on the other hand I’ve really seen teams come together. Previously, infection control was seen as a department that was trying to force themselves onto others and really impacted our workflows. Now, infection control has become our best friend. We want their input. I see that people's patterns of behavior have changed. There are better practices going on now, so it’s been nice to see some of the positive that’s coming out of this.
What is the difference between burnout and mental health, to you?
DN: The way I think of it is burnout is an acute situation that can lead to decreased mental health. I think that if you recognize the symptoms of burnout in others and yourself and you can take action to remove yourself from the situation or refresh the energy, you could in theory avert that from progressing into a mental health problem.
The whole great resignation that we’re seeing in society as a whole, I think we’re seeing that because of burnout. I worry that it's leading to a great depression.
CG: We’re all susceptible to it. Once you reach the point where your normal resilience is so challenged, where you are no longer feeling the sense of gratification from your professional activities, you’re no longer contributing or producing at the level you would normally contribute or produce at, that is then going towards the mental health spiral. It starts with a feeling of being overwhelmed.
Unfortunately, referring specifically to anesthesiologists, we’re at risk, from the sheer nature of the stress of the occupation, for mental health issues already. You could imagine that you have someone who is normally able to cope with the stressors of dealing with anesthesia care, when those resources are removed, you’re really opening the floodgates for diversion. I’ve certainly had periods of feeling burnout.
What piece do you think technology and innovation play in preventing diversion?
CG: Poor mental health and the inability to receive certain treatment combined with occupational stressors lead people down a path of trying to escape. It’s not one day someone decides they’re going to try fentanyl. It’s little by little to where they are so broken down they’re looking for relief and they find that in opiates or other substances. There’s not just one solution. We need to engineer safeguards to try to keep people from having access to this escape that they need in order to live their normal lives.
We need to normalize (as physicians) that if you’re not feeling your best that it’s ok to need a day to recharge. All I can hope is that little by little we change the culture (of the hospital).
DN: Until the whole culture shifts more - I see it happening some in our profession with our younger colleagues valuing work-life balance earlier in their careers - I think yoga and meditation and what exists now is a band-aid on a gaping wound. I think the Family Medical Leave Act provided some respite for some people, so there are ways that government programs can assist in providing some baseline mental health coverage but it’s going to take some time.
Consider if/how IntelliGuard may have helped with Controlled Substance management, reconciliation, diversion, and/or state/federal regulatory audits.
DN: I think there is a lot that healthcare is trying to do to prevent diversion. Whether it’s lowering the amount of narcotics they are prescribing after injuries and surgeries to the systems we put in place in hospitals to monitor controlled substances usage, I think that combined with all of the metrics you can look at when tracking controlled substances it’s really helpful.
With machine learning (like IntelliGuard) you can look at the big picture and the data and see if there are any outliers or discrepancies to figure out what might be an issue and what’s not. I’m hopeful that that technology and the culture shift can narrow the chance of addiction in the hospital.
CG: I am a big advocate of the use of technology to improve the workflow and lower the stress of work. I feel that more and more going into the operating room, between our automated charting requirements, our dosing requirements, and the data we’re being fed, the technology that we’re using in the operating room needs to facilitate the focus on patient care and also not be an annoyance.
If you go into the operating room and there are ways to limit those things that I feel are distractors from my patient care, that’s going to make my day a little easier. That’s why I enjoy the IntelliGuard product because it realized that I’m not a storekeeper. Barcode technology expects me to scan my medication while my back is turned to my patient. It’s ludicrous. Between all the restrictions and regulations, I’m about doing the right process and there’s good behind what I’m doing.