What does it take?
by Martina Schulte, MD
Featured in the July-August 2019 Colorado Medicine Colorado Medicine.
Leading national health care organizations have put forth frameworks for creating healthier work environments for physicians through developing engagement and fostering joy.1,2,3 I summarize the common and recurring elements for wellbeing programs below, but I want to start with what some might call a “soft ingredient,” one I see as vital to any successful effort: creating a workplace where each physician feels truly known and valued.
I draw from my professional experience as a coach specializing in burnout in physicians, nurses, advanced practice practitioners and others. Most of those who reach out to work with me are at or near the end of their rope. Some are ready to leave their physician job the day I first meet with them. Others want to figure out how to make their work and personal life sustainable because neither feels that way to them in their current form.
One of the first things I do with physicians is ask them to spend time thinking, talking and defining their values. To do that, I ask them to recall peak or positively important work or personal experiences. Experiences are often “peak” because they are times of fully living our values and are also times when we feel a sense of mastery.
In talking through these times, people define their own values, in their own words, connected to lived experiences. There is one desire that surfaces for everyone – to be valued.
Sometimes people relay stories of a particular period at a job. In talking about the peak time and what made it so, they often describe the people they worked with, feeling supported and respected by their boss, working on initiatives or projects that excited them, and express being truly seen and feeling valued for what they did.
Conversely, when people first seek me out to discuss making a change in their work, the most common issue is not being valued in their job.
I relay these coaching moments to drive home the point that any wellbeing program has to begin with understanding the fundamental need to be valued that even, and perhaps especially, physicians have. As more of us work in employed situations, it is even more important to pay attention to this need and driver of disconnection.
My belief and zealous opinion that real physician wellbeing has to authentically begin with a healthy work environment was recently boosted by a short piece in JAMA Internal Medicine.5 The authors found physicians in an academic medical center who felt valued for their work were more satisfied. It seems an obvious conclusion, but the fact that it has to be studied and proven is interesting. Investing in social capital and demonstrating value and respect for employee staff, be they physicians or all our other health care colleagues, need to form the foundation for a physician wellbeing program. While not explicitly stated in the engagement or wellbeing frameworks currently available in the medical literature, creating a healthy workplace where physicians are engaged, listened to, respected and supported are implicit parts of each of them.
Studying three frameworks for physician wellbeing in the workplace – from the Mayo Clinic, the Institute for Healthcare Improvement, and AMA Steps Forward – common themes emerge. Creating environments where physicians are well and can thrive include these key elements.
Acknowledge and assess the problem
The AMA recommends an annual wellness survey. Other organizations have a physician wellness indicator. The IHI says start with the question, “What matters to you?”
Develop and use an effective process for making target workplace interventions
This component is specifically directed at workplace processes and inefficiencies: identifying the impediments to joy in work in the local context. This includes, but is not limited to, workflow redesign, staffing, workplace chaos and electronic health record use.
Commit to systems work to making change
Addressing local issues (above) is essential, but so is organizational commitment to addressing real workplace change.
Invest in social capital to create truly supportive and safe working environments.
Align meaning and values
Having a work environment where one can regularly live one’s values and connect with one’s meaning greatly enhance satisfaction
Develop it and leverage it to improve the work experience. Industries outside of health care, and now even in health care, recognize that leadership matters in workplace culture; in fact, leaders often dictate workplace culture. Leadership impacts satisfaction, burnout, turnover, and the general sense of being valued and heard.
Promote workplace flexibility and autonomy
To build sustainable physician lives, the ability to make decisions over one’s work experience and responsibilities is essential.
Promote healthy self-care
While this should not be the only component of workplace wellbeing programs, it has a place as part of them. Making self-care easier and normal are ways organizations can support self-care.
While these ideas come from national organizations addressing burnout, here in Colorado, practices and organizations are developing their own physician wellbeing programs. As Jeff Moody, MD, notes in his article on page 13, you must start somewhere and do something. Few programs start in a comprehensive way. Most begin with one or two steps and build over time. Every well-done effort provides help and adds to the scaffolding for the next step or two. Beginning with understanding the issue and making first steps is vital!
- 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.
- Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI Framework for Improving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017.
- AMA Steps Forward: https://edhub.ama-assn.org/steps-forward/pages/professional-well-being
- Shanafelt TD, Gorringe G, Menaker R, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432-440.
- Simpkin AL, Chang Y, Yu L, Campbell EG, Armstrong K, Walensky RP. Assessment of job satisfaction and feeling valued in academic medicine [published online May 6, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2019.0377.