Below are a few applications in which the improvement of processes and the development of soft skills must occur together to create lasting change. This is not a comprehensive list. Other scenarios may involve the patient experience and service excellence; huddles and other continuous improvement processes; leadership and staff development; transformation and other organizational change initiatives; the culture of patient safety in a high-reliability organization; and more.

Diversity and InclusionDiversity / Inclusion

Diversity includes differences in race, cultural background, gender, religion, age, sexual orientation, nationality, education, socio-economic status, and other factors. Healthcare providers face the challenge of creating delivery systems and cultures that are inclusive of these differences. Studies have shown serious treatment inequalities; degraded clinical and service outcomes; differences between care teams and the populations they serve; and conflict and inefficiencies on the care team when diversity is not managed.

Potential Process Work — Data collection to define the problem, updating policies and hiring practices, offering language services, implementing conflict resolution workflows, improving access to specific groups, and so on.

Potential Soft Skill and Behavior-Change Interventions — Cultural competency training (how to interact with others from different cultures), empathy, communication skills, dealing conflict/ unfairness, situational ethics, and so on.

Inclusion is fundamentally about respect for other people. Practicing this is central to good leadership as well as strong business and clinical outcomes.

Patient EngagementChronic Conditions / Patient Engagement

Chronic conditions from arthritis and Alzheimer’s to diabetes, cancer, congestive heart failure, obesity, and COPD make up most of the cost and misery in healthcare today. Called "lifestyle conditions," these health problems are, in many cases, affected by avoidable behaviors such as smoking, eating, lack of activity, alcohol consumption, and other health related habits. Successfully treating chronic conditions requires reworking provider services and helping patients achieve sustained behavior changes.

Potential Process Work — Implementing screens and evidence-based care practices associated with chronic conditions, providing health coaching services, nutritional services, referral to community services (e.g. smoking cessation), measuring and tuning interventions to the patient’s level of change activation, implementing population health and so on.

Potential Soft-Skill and Behavior-Change Interventions — Motivational interviewing, share decision-making, disease-specific self-management program for patients, a wide variety of phone apps that providers might recommend, change groups such as the Diabetes Prevention Programs supported by the CDC and so on.

Dealing with chronic conditions requires a persistent community-wide effort. PHA’s online kCards communities support and provide a low-cost, persistent intervention for many of the soft-skill and behavior-change challenges associated with chronic diseases.

Stress and ResilienceStress and Burnout / Resilience

Stress, burnout and suicide rates among physicians and other healthcare providers are reaching alarming levels. One report claims that nearly two-thirds of U.S. physicians are burned out, depressed, or experiencing a combination of both.  This is not only a disaster for providers' work life quality, it can lead to medical mistakes, patient safety issues, and lower quality of care for patients. It also creates problems for practice management and workforce scheduling given the turnover, absenteeism, and reduced productivity it causes.

This problem begins in medical school and requires a multi-dimensional response. According to the study's lead author and Mayo Clinic researcher Dr. Liselotte Dyrbye, "We need to sort of figure out ways to nurture empathy and to help trainees build their social support. But ultimately, the problem with burnout isn't because the medical student, or resident or physicians in practice is somehow defective in personal coping strategies—it is ultimately coming from the work and the learning environment, and that's really where attention should be focused in terms of strategies." (Modern Healthcare, Sept. 2018).

Potential Process Work — Design and implementation a wellness program, removing variation, defects, and inefficiencies in care processes that put unnecessary burden on providers; improved empanelment, scheduling and no-show management, more efficient means of completing clinical documentation and so on.

Potential Soft-Skill and Behavior-Change Interventions — Resilience, emotional intelligence, mindfulness, sleep, nutrition, social/peer support group and so on.

Stress and burnout are symptoms of deep and systemic problems in our healthcare system. Addressing them calls for approaches that combine leadership, process improvement, soft skill development, and wide-spread behavior changes.