Health systems are finding ways to address three domains of physician well-being: a culture of wellness, efficiency of practice, and personal resilience.
Coming to grips with the fact that more than half of all physicians suffer at least one symptom of burnout, health system leaders are beginning to focus on how to address the epidemic.
Physician burnout is defined as one or more of these conditions: emotional exhaustion, depersonalization, or feelings of low achievement. Historically, physicians affected by burnout have been left to their own devices, but that is changing, says Colin P. West, MD, PhD, co-director of the Mayo Clinic Department of Medicine’s Physician Well-Being Program. Research conducted by him and others has revealed many systemic factors outside a physician’s control—excessive workloads, administrative burdens, regulatory-reporting demands, and other issues—that contribute to burnout.
Drawing on that research, physician leaders at the Stanford WellMD Center devised a three-part framework (see the sidebar) to help organizations think about burnout mitigation strategies. Organizations that embrace the framework seek to promote:
- A culture of wellness
- Efficiency of practice
- Personal resilience
Leaders from three organizations shared their strategies for achieving these components.
Take Away the Taboo
“I’m talking about it constantly,” says Amy Sullivan, PsyD, director of behavioral health at the Mellen Center for MS Treatment and Research in the Neurological Institute at Cleveland Clinic.
Sullivan (pictured at right) chairs the institute’s physician-engagement team, which meets monthly to devise ways to address burnout among physicians and all other providers. Appointed in early 2017, the team includes physicians, advanced practice providers, nurses, researchers, and administrators.
“Anything that comes under the mental health realm has some sort of stigma attached to it,” Sullivan says. “So I’m just going to keep talking about it until people get comfortable with it.”
She writes a monthly blog post to educate her colleagues about burnout topics and, in partnership with the institute’s chairman, co-hosts “engagement dinners,” at which about 20 physicians at a time gather to share concerns and suggest ideas for reducing burnout drivers. Her physician-engagement team, in conjunction with two departments, recently hosted grand rounds, a forum, and a reception for two experts in the field of resiliency, self-care, and burnout.
By eliminating any taboo associated with burnout, Sullivan, a clinical health psychologist, creates opportunities to help. “Some departments have asked for consultation around this,” she says. “So I’ve met with teams of people to talk about their concerns.”
In those sessions, she listens closely to understand what team members are saying and looks for opportunities to implement small changes that might make a significant difference for that particular work unit. For example, members of one team expressed frustration that required work meetings were scheduled at 7 a.m., over their lunch break, or at 5 p.m. She suggested to their leader that meetings be scheduled in a 30-minute slot during the workday.
“That was very meaningful to that team,” she says. “Listening to your teammates is probably the most important thing that you can give them.”
Video interview: The Consequences of Physician Burnout
In the past four years, some 700 physicians, nurse practitioners, and physician assistants employed by Novant Health have taken three days of their own time to participate in a leadership development program. But this type of leadership is not about job promotion or taking on more responsibilities.
“We want to develop their leadership skills, starting with the leadership of their own life, and help them build a foundation of personal resiliency to help with all the changes and the trauma and the intensity of the healthcare environment,” says Tom Jenike, MD, senior vice president and chief human experience officer of Novant Health.
The program began in 2013 after Jenike (pictured at right) sought help from an executive coach to address his concern that he might be suffering from burnout. That effort was so reenergizing to him that he sought and received support from Novant Health’s CEO to develop an intensive three-day program to provide the same experience to others.
Through this program, a cohort of 15 to 20 participants convenes at a hotel for three days of in-depth conversation. Jenike and the executive coach facilitate discussions, which acknowledge the pressures, challenges, and constant change that physicians are dealing with. “But we aren’t focused on trying to make things go away that aren’t going to go away,” Jenike says. “We focus on, ‘What is my internal reaction to those external forces that is creating a set of professional and personal outcomes for me?’”
The goal is to guide participants as they step back from their daily work routine to reflect on how they are spending their lives. Special focus is given to the importance of relationships, both personal and professional.
“Understanding my own patterns of thinking, patterns of behaving, and patterns of feeling is foundational to helping build resilience and wellness and decreasing burnout,” Jenike says. “This program focuses on the participant’s entire life rather than just the professional life.”
Jenike points to Press Ganey physician engagement scores to show how the program is changing the culture across the Novant Health system: Physicians who have participated in the program are in the 97th percentile nationally in terms of engagement.
Build Community in the Workplace
Physicians in all practice types—from huge health systems to solo offices—are at risk of experiencing loneliness and isolation, fueled perhaps by the relentless demands and fast pace of their work. Mayo Clinic encourages its physicians and scientists to make community-building a priority, and the organization will pick up the dinner tab to make it happen.
In the past two years, more than 1,500 Mayo physicians and scientists have participated in COMPASS (Colleagues Meeting to Promote And Sustain Satisfaction) groups designed to build community at work. They sign up in groups of six or seven and commit to meeting for a meal together every other week for six months.
Participants devote part of each meeting to a question—for example, why did you become a physician?—that sparks discussion about the virtues and challenges of their professional lives. Mayo pays for the meals, a small financial outlay that communicates a big message.
“This shows physicians that the organization cares enough about this issue that they are actually going to put some skin the game,” West (pictured at right) says. “They’re not just telling me, ‘Hey, you need to make sure that you’re exercising enough.’ There is an organizational commitment to establishing an environment that is conducive to physicians’ well-being.”
The COMPASS program was rolled out to all Mayo physicians and scientists—nearly 3,700 professionals—after two randomized trials. The first trial assigned some physicians to meet with a small group of colleagues to discuss “physicianhood” topics during one hour of protected time every other week; the second trial examined small-group discussions that took place on the physicians’ own time with Mayo paying for a meal. In both trials, participants experienced an improvement in “meaning of work” measures and decreased burnout.
A program assessment in early 2016 found that 95 percent of participants thought COMPASS gatherings were worthwhile.
“Getting 95 percent of physicians to agree on just about anything is tricky, so we viewed that favorably,” West says. “Our Board of Governors agreed, and they said, ‘Yes, this will continue.’”
Lola Butcher writes about healthcare business and policy topics for several HFMA publications.
Interviewed for this article: Tom Jenike, MD, senior vice president and chief human experience officer, Novant Health, Charlotte; Amy Sullivan, PsyD, director of behavioral medicine, Mellen Center for MS Treatment and Research, Cleveland Clinic, Cleveland; Colin P. West, MD, PhD, co-director, Program on Physician Well-being, Mayo Clinic.