Conversation Starters
From the ACGME Symposium on Physician Well-Being, I went back to work with some good ideas as a burning platform to make change in my own institution. I reached back out to one of the friends I’d had dinner with at the symposium because she had experience initiating programs for promoting a culture of well-being in health care organizations. She was kind enough to share a draft proposal of what she thought would be a start.
Unfortunately, the time was not right. The institution was not ready then to have an outside consultant and the cost too was prohibitive. After my initial disappointment, I decided to work on my own. I solicited support from kindred partners in the chief nursing officer along with a faculty member in the department of medicine who had expressed interest and was well versed in research methodology.
I started having conversations with the university and hospital leadership. I referred to the recent ACGME mandates to emphasize the urgency. I created a talking sheet with facts. I knew I had to speak the language of the stakeholders. I worked hard on my elevator pitch for when I spoke to the hospital leaders, focusing my conversations to show that physician burnout (or lack of well-being) has an impact on patient care, safety, quality, satisfaction and finances. The focus of conversations with the undergraduate and graduate medical education leadership were educational needs, learner well-being, and the need for a culture of well-being to maintain an optimal clinical and learning environment.
Accreditation needs were germane to both. The conversations always ended with the tragic and moral imperatives, my voice growing stronger and loaded with emotion when I shared this need and the story of our colleague who had died by suicide. I tried initially to remain professional—as in emotionally detached—but it was not possible. After a few attempts, I stopped trying to hide my anger and heartbreak and spoke from my heart.
My urgency to do something to promote a culture of care that supported authentic relationships was both a blessing and a curse. It was the catalyst that energized me, but the inertia I felt was often frustrating and crippling. It felt like the leadership’s general attitude was one of denial. Yes, of course all this is going on in other organizations, but it’s not our problem. It’s somebody else’s problem. We are okay. This attitude I realized later on was not unique to us. I had to practice my own teachings: be kind to yourself and trust. But it was not easy!
Data Talks
The university was an easier sell than the hospital because they could more quickly buy into the importance of investing in the well-being of students and residents. However, the need for well-being of the faculty physicians was a harder sell. The hospital leadership wanted to see the data to prove the problem was real. It was another harsh reminder that data does speak! My colleague from the department of medicine was immensely helpful. Though none of us had protected time or resources, we were committed to take some action to create awareness around this epidemic of physician burnout that we were facing in our institutions. After an extensive review of the literature and with my colleague’s help, we came up with a proposal and got approval from our Institutional Review Board. We surveyed all the physicians and residents employed in the hospital and university.
The survey was administered in the late summer and we had our results by early autumn. Our numbers mirrored the national means, showing higher rates of burnout in women compared to their male counterparts, and in residents more than faculty. We also had data for individual departments. We indeed had a problem comparable to the national data at our institution! Armed with the results, I had more conversations with the different stakeholders. I began to get traction from a few people who also believed something needed to be done.
Encouraged by these allied colleagues, I created a wellness memo outlining a need for creating a task force with representation from each department and the hospital leadership. I met individually with the dean of the university, the chief executive officer, chief medical officer, and chief nursing officer of our affiliate hospital to get their buy-in. With their approval, the March 2017 wellness memo was addressed to colleagues, residents, fellows, and students of the University of Tennessee College of Medicine—Chattanooga.
The memo outlined our specific goals and aims to (1) understand and promote physician and trainee engagement and well-being, (2) provide resources for physicians and trainees that help them promote their own well-being, (3) discover personal and organizational approaches to prevent and address physician and trainee distress, and (4) create a workplace culture that is energy replenishing.
In May 2017 we facilitated a one-day offsite organizational retreat with members of the Well-Being Task Force and two leaders who were experienced advocates for physician well-being, one from Vanderbilt and the other from the ACGME. Nearly fifty leaders from all areas of the hospital and university convened at the Chattanoogan Hotel to explore how we would transform our organization to promote well-being. People who didn’t often work together were mixed into groups: hospital leaders, university leaders, department heads, nurse managers, residents, medical students. We asked them to imagine that our affiliate hospital had been voted the best place to work for the third or fourth time and a reporter was interviewing them, wanting to know what is so good about it. Armed with flip charts and pens, people dove into the thought exercise. After lunch, we asked, “What needs to happen now in the next four years?” We unpacked the challenges of the previous four years and discussed how we might overcome the barriers to well-being. It became clear we must improve communication, trust, and transparency, increase physician engagement, as well as define and align the often-conflicting missions of clinical care and education.
The ideas generated that day and a shared sense of vision and imperative for change eventually led to the establishment of well-being initiatives. Based on the needs identified during the retreat, the task force met regularly every two to three months. We identified the areas for interventions at each program level and overall as an organization. We looked for the low-hanging fruit such as ways to improve day to day efficiency of work and also personal well-being, such as gym access, yoga classes, reflective sessions, or social events. We could begin to work on these offerings as a department and hospital.
Later, and together with the university, we would look at tougher issues that would require culture change. It wasn’t yet safe to discuss issues that can stigmatize physicians, such as mental health and substance abuse. In an article in the New England Journal of Medicine, one physician describes this hurdle:
“On my own recovery journey, I have often felt branded, tarnished, and broken in a system that still embroiders a scarlet letter on the chest of anyone with a mental health condition. A system of hoops and barriers detours suffering people away from the help they desperately need—costing some of them their lives.”
[To be continued…]
