Organizational and Cultural Strategies for Physician Wellness

Educational Objectives

The goal of this program is to improve physician wellness and burnout prevention through the implementation of organizational strategies. After hearing and assimilating this program, the clinician will be better able to:

1. Utilize strategies and tactics implemented at the organizational level for addressing physician burnout.

Summary

Data on organizational interventions: meta-analyses by De Simone et al (2021) and Panagioti et al (2017) showed statistically significant improvement in burnout with organization-directed interventions; a systematic review by DeChant et al (2019) showed that organizational interventions improve physician burnout and job satisfaction and decrease stress

Business case: Shanafelt et al (2017) — demonstrated burnout as a major driver for physician turnover; decrease in productivity of burned-out physicians leads to lower quality of care and decreased patient safety and satisfaction; described 7 dimensions that drive burnout, including workload, efficiency, flexibility or control, culture and values, work-life integration, community at work, and meaning in work; organizations can often make profound changes in flexibility, control at work, scheduling, efficiency, process improvement, community at work and meaning in work even if funds are not available; addressing burnout benefits patients, physicians, health care teams, organizations, and society

Organizational strategies for improving physician well-being: Shanafelt et al (2020) suggests a carefully crafted strategy supported by appropriate tactics; evaluate, define, and understand the current situation and the desired state, using strategies to bridge the gap between current to desired state; tactics are specific initiatives or programs that advance a specific component of the strategy; once a strategy is created, optimal tactics for advancement can be determined; strategies undergo minimal changes every year, whereas tactics and specific interventions may evolve dramatically; use tailored strategies to meet unique challenges, opportunities, and goals of each organization; 4 fundamental components include foundational programs, cultural transformation, rapid iterative experimentation, and focus on sustainability and scalability

Foundational programs: interventions — assessment of well-being and driver dimensions at recurring intervals coupled with sharing the results and accountability by leadership; system-wide approaches to provide clinicians opportunities to identify and prioritize local factors that irritate them; an appropriate array of evidence-based self-care, wellness, and support offerings; offerings should promote congeniality and community at work, social events, and discussion groups

Cultural transformation: the goal is to infuse well-being into the culture; a chief wellness officer with authority and resources can drive change, advocate for wellness, develop a comprehensive plan of action at the system, organization, and culture levels with clear strategic pillars and evidence-based tactics; culture of leadership development at all levels must be emphasized with accountability for well-being metrics compared with national benchmarks; additional tactics include support of vacation, conference time, sick leave, and normalization of mental health care; Thomas et al (2018) advocated for specific tactics, including confidential mental health services during off hours, coverage to attend appointments during work hours, and proactive psychological support; tactics for cultural wellness include healthy food onsite, exercise facilities at or near work place, and leadership that tracks well-being measures; peer-led programs can make a major difference in addressing emotional needs of physicians and health care providers; reach-in services should be available for those requesting help with accessible, confidential, and affordable mental health services

Rapid iterative experimentation: especially helpful in process deficiencies; when no proven tactics exist, experiments with methods (eg, Lead, Sigma) are undertaken and, once an effective intervention is proven, it can be scaled; this helps organizations develop and pilot tactical approaches, and their optimization

Sustainable actions: design of programs with sustainability and scalability; chief wellness officers advocating for adequate infrastructure, budget, project management, and communication

Readings

Ashton M. Getting rid of stupid stuff. N Engl J Med. 2018; 379(19):1789-1791. doi:10.1056/NEJMp1809698; Brower K, Brazeau C, Kiely S, et al. The evolving role of the chief wellness officer in the management of crises by health care systems: Lessons from the COVID-19 pandemic. NEJM Catalyst. 2021; 2. 10.1056/CAT.20.0612; De Simone S, Vargas M, Servillo G. Organizational strategies to reduce physician burnout: A systematic review and meta-analysis. Aging Clin Exp Res. 2021; 33(4):883-894. doi:10.1007/s40520-019-01368-3; DeChant PF, Acs A, Rhee KB, et al. Effect of organization-directed workplace interventions on physician burnout: A systematic review. Mayo Clin Proc Innov Qual Outcomes. 2019; 3(4):384-408. Published 2019 Sep 26. doi:10.1016/j.mayocpiqo.2019.07.006; National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being. Taking action against clinician burnout: A systems approach to professional well-being. Washington(DC):National Academies Press (US); October 23, 2019; Ripp J, Shanafelt T. The health care chief wellness officer: What the role is and is not. Acad Med. 2020; 95(9):1354-1358. doi:10.1097/ACM.0000000000003433; Panagioti M, Panagopoulou E, Bower P, et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis. JAMA Intern Med. 2017; 177(2):195–205. doi:10.1001/jamainternmed.2016.7674; Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017; 92(1):129-146. doi:10.1016/j.mayocp.2016.10.004; Shanafelt T, Stolz S, Springer J, et al. A blueprint for organizational strategies to promote the well-being of health care professionals. NEJM Catalyst. 2020. 1. 10.1056/CAT.20.0266; Shapiro J, McDonald TB. supporting clinicians during COVID-19 and beyond - learning from past failures and envisioning new strategies. N Engl J Med. 2020; 383(27):e142. doi:10.1056/NEJMp2024834; Shanafelt TD, Schein E, Minor LB, et al. Healing the professional culture of medicine. Mayo Clin Proc. 2019; 94(8):1556-1566. doi:10.1016/j.mayocp.2019.03.026; Thomas LR, Ripp JA, West CP. Charter on physician well-being. JAMA. 2018; 319(15):1541-1542. doi:10.1001/jama.2018.1331.

Disclosures

For this program, members of the faculty and planning committee reported nothing relevant to disclose

Acknowledgements

Dr. Fessell was recorded exclusively for Audio Digest on October 1, 2021, using virtual teleconference software. Audio Digest thanks Dr. Fessell for his cooperation in the production of this program

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

IM691103

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.