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WHAT IS PERC?

Physicians for Engagement, Representation and bidirectional Communication is an independent, grassroots, volunteer organization that advocates for principles of DIRECT (Diversity, Inclusion, Representation, Engagement, bidirectional Communication, and Transparency) in UCSF Health decision-making affecting frontline physicians. PERC’s mission is to make UCSF Health the best place for clinical work, a place where physicians feel empowered, effective, engaged, and valued.

WHAT ARE THE PROBLEMS?

The recently released 2022 UCSF Health Net Promoter Survey (NPS) scores described a one-year drop of 12 points from +10 to -2 in UCSF Health physician Net Promoter Scores and a sharp increase in self-reported physician burn-out from 44% in 2021 to 53% of all UCSF Health physicians. Contributing factors include:

• Opportunities to have a scribe as a member of their clinical team are limited, even though scribes can save 2 hours of documentation each day
• Physicians are asked do more without additional compensation or time preserved
• Physician voice in UCSF Health decision-making is inadequate, particularly for junior faculty and underrepresented groups
• Unilateral decision making by the Health System on decisions affecting clinical work have led to a work environment where physicians can feel unrepresented and disengaged

WHAT DOES PERC DO?

Our vision is to promote Awareness, Advocacy and Action in support of PERC’s mission to improve physician work environment at UCSF Health, increase the voice of physicians in UCSF decision-making, and understand and address the root causes of clinician burn-out. We strive to hold our UCSF Health leaders accountable to the voices of our frontline faculty by ensuring there is meaningful action aligned with faculty input and the UCSF Mission to be the best place to work and to receive care.

In short, PERC is a group of UCSF faculty physicians who want to make UCSF a better place through:

• Partnering within and engaging with our UC Health system to advocate for DIRECT principles to improve the work environment for physicians
• Enhancing trust in our leaders and promoting teamwork within our system by ensuring accountability and alignment toward common goals
• Encouraging frontline physician engagement, promoting representation and inclusion, and promoting bidirectional communication
• Advocating with UCSF Health Leadership for accountability, oversight, and iterative improvement when working toward stated goals

PERC has accomplished the following to date:

Awareness:

• regular meetings with campus and UCSF Health leaders and stakeholders to raise awareness of issues affecting frontline physicians
• biweekly open meetings with frontline physicians to hear concerns, brainstorm solutions, and prioritize efforts
• ongoing monthly meetings with key campus and UC systemwide committees to advocate for physician representation and improved physician work experience

Advocacy:

• monthly liaison with relevant campus, Academic Senate, and UC systemwide committees to build allyship and support
• active participation in symposia and guest panels on topics of physician representation and physician experience; encouragement of front line physicians to attend and speak up at UCSF Health Town Halls
• participation on the combined UCSF Health workgroup that advanced a proposal to UCSF Health to improve frontline physician engagement, representation, and communication
• PERC-initiated written proposals to UCSF Health to address current gaps in engagement, representation, transparency, and communication
• support and allyship with aligned physician advocacy groups such as the Scribe Advisory Group

Action:

• agreement by UCSF Health to
  • nominate and elect physician representatives to a Scribe Advisory Group
  • appoint a UCSF Health Taskforce on physician engagement and representation
  • annually elect physician representatives to UCSF Health committees on Finance, Strategy, and Faculty Practice starting in 2022
• participation as a permanent guest on the Clinical Affairs Committee of the Academic Senate
• creation of a PERC website hosted by the UCSF Academic Senate

HISTORY OF PERC

In the summer of 2020, UCSF Health decided to terminate the in-person scribe program that had been successfully supporting faculty with high outpatient volume and proposed to implement in its place the use of out-of-state scribes who would interact with physicians remotely. The motivation for this change was primarily financial, since remote scribes would not be subject to the California minimum wage. Upon receiving the news, affected faculty members were stunned not only by the disruptive implications of the decision itself, but also by the short time frame for implementation and especially the lack of participation of affected physicians in the decision-making process. Most faculty members had no idea that cessation of the in-person scribe contract was even being considered. Not only would there be disruption to patient care by the termination of trained, experienced scribes in lieu of lower-paid scribes who were unfamiliar with physicians’ practice patterns, but the job losses would occur mid-pandemic amongst a vulnerable population of young, often first-generation students who were aspiring to use their scribe experience toward becoming health professionals. In-person scribes were explicitly prohibited from transitioning to the remote scribe program.

Eighty-nine affected faculty members wrote a letter expressing deep concerns about the decision itself as well as the process by which the decision had been made. In response, a town hall meeting was conducted, during which various faculty advanced numerous constructive suggestions for mitigating the disruption that would be caused to patient care and to the plans of in-person scribes. UCSF Health leadership indicated that the essence of the decision could not be revisited, but subsequently UCSF Health agreed to support an extended time frame for in-person scribes to voluntarily leave their current positions. UCSF Health also agreed to form a Scribe Advisory Group (SAG) consisting of both elected faculty physicians and representatives of UCSF Health. Four faculty members were elected: Don Ng MD, Division of General Internal Medicine, Mindy Goldman MD, Division of Gynecology and Gynecologic Surgery, Alan Shindel MD, MAS, Department of Urology, and Katherine Van Loon MD, MPH, Division of Hematology/Oncology.

Many faculty were disappointed that this and other decisions at UCSF Health that affected clinician work experience were being made without the input of frontline physicians. This lack of physician agency was a prevalent issue within the organization and was identified as a key dissatisfier and contributor to physician burnout. Indeed, UCSF Health had no formal mandate to include in its decision-making processes the affected frontline physicians, particularly those from junior ranks and underrepresented minorities. Gaps were also identified in transparent, bi-directional communication between frontline physicians and UCSF Health leadership.

A group of concerned physician faculty members began to meet in July 2020, with the express goal of improving the work experience for UCSF Health physicians by advocating for elevated physician voice at all levels of UCSF Health decision-making through representation, engagement, inclusion, and bi-directional communication. Three faculty members started meeting together to strategize how to do this: Brent Kobashi MD, Katherine Van Loon MD MPH, and Patty Robertson MD. The group increased its outreach and members over the next year. This group became formally known as PERC: Physicians for Engagement, Representation, and bidirectional Communication.

As of 2022, the PERC Executive Leadership Team includes Kirsten Kangelaris MD, David Hwang MD and Patty Robertson MD. The alternates are Anna Haemel MD and Brent Kobashi MD. This is a volunteer organization, without external funding or assigned resource support. All UCSF Health physicians are invited to attend PERC meetings, which are held two to three times per month and often include an invited campus leader guest. The goals of these meetings are to promote awareness, create allyship, craft and implement strategic initiatives, and advocate for meaningful change. Many of the PERC leadership have multiple leadership roles both systemwide and on campus and represent a diversity of backgrounds and clinical practice profiles.

Please see Appendices I and II at the end of this summary for detailed documents of PERC advocacy.

WHY SHOULD I GET INVOLVED?

Do you seek a safe space to talk about problems at work with other physicians?
Do you feel alone when you ask questions about why changes in our health system are made?
Do you feel your frontline experience is not reflected in the decisions made by UCSF Health?
Are you doing more work year after year without additional compensation?
Do you feel a lack of control in your workload, schedule, and ability to obtain support for clinical work?
Do you feel an escalating burden of after-hours work and a lack of work-life balance?
Do you feel unrepresented and unheard in UCSF Health decision making?
Do you feel like your good will is taken advantage of?

As UCSF Health physicians, we believe in the shared mission of UCSF, including the delivery of exceptional patient care, but at the same time, we want to have influence, voice, and participation as stakeholders in UCSF Health decision-making affecting our clinical work. In short, we are UCSF faculty members wanting to make UCSF a better place to work and receive care.

If this resonates with you, we welcome you to join our group!

Imagine if:

• Providers were included as stakeholders in all decisions affecting clinical care
• Safe environments for authentic perspectives were fostered, feedback was readily considered and proactively acted upon
• Faculty engagement and satisfaction increased, decreasing burn-out
• UCSF Health System decision making improved because of faculty input and buy-in

Some might say that “representation at every level” will lead to “paralysis at every level.” The truth is that collaboration and transparency in decision making can build trust, create alignment, improve the quality of decisions, enhance physician experience, and yield better results for UCSF Health and our patients.

HOW DO I SIGN UP FOR PERC?

Please complete the Qualtrics survey at this link to indicate your level of interest: https://ucsf.co1.qualtrics.com/jfe/form/SV_etByJOMVTFurg34 and we will be in touch.

FAQs

What is the Net Promoter Score?
The Net Promoter Score is based on an annual spring survey of UCSF Health physicians regarding the physician work experience. The two key performance indicators are “likelihood to recommend UCSF as a place to receive clinical care” and “likelihood to recommend UCSF as a place for clinical work.” The survey also includes a modified, quick 2-point burnout survey.

How does PERC fit with the organization of UCSF?

• PERC leadership has been granted a permanent guest position on the Committee for Clinical Affairs
• PERC provides opportunities for leadership for junior faculty, such as a recent ask of PERC to provide a faculty member on the new Parking Task Force at UCSF
• Many PERC members have simultaneous leadership roles such as serving on the SOM Faculty Council, the Board of the UCSF Faculty Association, the system-wide level committees representing all UC Health campuses

Why is PERC limited to physicians and not all clinicians such as advanced practice practitioners?
This is a question that was carefully considered as PERC started. Physician faculty members do not have formal representation: the majority of the advanced practice practitioners, nurses, residents, and fellows are unionized and have a strong voice at the table. There are also specific, contractual processes that must be observed for negotiation between UCSF Health and represented clinicians. Notwithstanding, it is hoped that advocacy for issues of common concern will lead to changes that will benefit all clinicians.

What are the contributors to clinician burn-out?
Professor Christina Maslach’s research has identified three distinct aspects to clinician burnout. It is important to note that measures to address one domain do not necessarily remediate another domain; all three aspects are important.

1. Exhaustion – task overload
   1. Rapidly escalating volumes of inbox messages and “attending-only” tasks
   2. Increasing burden of documentation, shifting work to after-hours
   3. Removal/restriction of scribe support that could mitigate after-hours work
2. Reduced professional efficacy
   1. Gaps in institutional and staffing support for physicians to carry out optimal patient care
   2. Inadequate opportunities for front line physicians to engage in operational and strategic improvement, both at a practice level and throughout the organization
   3. Impaired ability of UCSF Health to drive organizational priorities and objectives due to inadequate communication and alignment with front line physicians
3. Disengagement/cynicism
   1. Actions not aligning with words - e.g., lip service
   2. Silencing discontent/disagreement/dissent
   3. Lack of input from faculty in decision making – messaging that “we need to move on, the decision has been made”
   4. Lack of representation of junior and underrepresented faculty in the UCSF Health decision-making structure
   5. Low net promoter scores for UCSF as a place of clinical work due to lack of physician engagement, institutional belonging, and physician influence in decisions that affect clinical work

Shared Space for Faculty Reflections

https://ucsfonline-my.sharepoint.com/:w:/g/personal/kristie_tappan_ucsf_edu/EfbrbREVFThFuxR_AxS_XwwBigx1etyBiD7NT0CPhX6u1w?e=yNCnYO

School of Medicine Faculty Council February 17, 2022 Meeting: A Conversation About Measuring and Improving Clinician Experience

https://senateserviceportal.ucsf.edu/senatedocs/2021-2022/SOM-FF-mtg-Feb-17-2022.mp4Anchor

APPENDIX I

1. Presentation at the Academic Senate Division Meeting
2. Executive Summary - Proposal to Increase UCSF Health- Clinician Physician Engagement and Representation
3. Faculty Scribe Letter
4. Proposal to UCSF Health from the Combined Work Group on Physician Engagement, Representation and Communication within UCSF Health
5. PERC Response to Josh Adler email 12.8.2021
6. UCSF Health Representation and Engagement Task Force Report
7. SAG letter regarding scribe expansion 2.17.2022
8. PERC response to declining Net Promoter Scores (NPS) and increasing burnout (8/1/22)

APPENDIX II

1. 2019 Faculty Climate Task Force Report
2. Organizational Chart of UCSF Health