Battling burnout
Hospitals are starting to employ chief wellness officers to help overwhelmed physicians
THE QUESTION of how to reduce clinician burnout is being answered by some providers by appointing a chief wellness officer. Supporters of this new role, which can be found at about a dozen health systems across the U.S., argue that the burnout issue demands attention from someone in a C-suite level position. Burnout can be found among roughly 44% of doctors nationally, according to recent estimates, and a growing body of evidence shows it can harm quality of care, patient experience scores and the bottom line through higher turnover.
“The problem is so significant and it has so many negative effects to the health system that it has to have C-suite level attention,” said Dr. Darrell Kirch, CEO of the Association of American Medical Colleges. “There is a business case on the part of the CEO to really pay attention to the problem.”
Additionally, chief wellness officers and researchers say there is now enough evidence and insight into what causes burnout and possible solutions that providers can meaningfully tackle the issue.
“We know that there are a whole variety of local things that leaders can implement to help reduce the work stress and improve efficiency,” said Dr. Liselotte Dyrbye, a researcher of burnout and physician well-being at Mayo Clinic who co-developed the Well-Being Index, a tool marketed to healthcare organizations as a way to measure burnout among clinical staff.
But even as wellness gains a seat in the C-suite, not all CEOs or boards are convinced burnout is enough of a problem that such a position is warranted, said Greg
Button, president of global healthcare services at consultancy Korn Ferry.
“The CEOs and the boards of these institutions probably could use some more education on the severity of what’s going on, not only around burnout but health and wellness overall and how important it is, and how it correlates to workforce engagement and ultimately the financial performance,” Button said, adding, “If you don’t understand the issue, it’s probably just pushed aside.”
Some CEOs will argue they have “higher demands,” particularly pressure from the board to perform well financially amid shrinking margins, he said. This likely explains why the healthcare industry hasn’t seen chief wellness officers until recently even though other sectors have had them for a while. More common solutions from providers have been to establish wellness committees or a physician leader like the chief medical officer to take on the problem. Ascension, Sutter Health and Trinity
Health are among the big players taking such approaches.
To burn out is human?
Regardless of the approach taken, leaders who decline to acknowledge burnout as a serious problem may be fighting a losing battle as national efforts around the topic continue to gain momentum.
Kirch likens the buzz around burnout to the quality movement that started 20 years ago when the Institute of Medicine published To Err is Human. He said the landmark report kicked off a conversation about safety issues at hospitals and eventually led to the quality improvement agenda in force today.
“I believe 20 years from now every major health system will have a chief wellness officer focused on the well-being of the clinicians and staff just like everyone has a chief quality officer,” he said.
But in order to succeed in such a newly established and unfamiliar role, chief wellness officers need to be able to fundamentally change an organization, so they must be allocated appropriate resources and influence, said Dr. Victor Dzau, president of the National Academy of Medicine. In 2017, the academy formed the Action Collaborative on Physician Well-Being and Resilience, a nationwide effort with more than 60 organizations that researches the causes and solutions to burnout.
“You have to empower the individual by giving the person the authority and the ability to do things,” and that would include any needed financial and personnel resources, Dzau said. “The chief wellness officer should be a big part of the organization. You get a budget and you get empowerment.”
If the chief wellness officer isn’t afforded such resources, the role can easily alienate the clinical staff, Kirch said. “If the chief wellness officer is a ceremonial position or window-dressing, it will worsen the burnout. The clinicians will conclude that the organization actually doesn’t care about their well-being,” he said.
In fact, chief wellness officers say they are met with skepticism from their institutions’ clinicians.
Dr. Jonathan Ripp, chief wellness officer at the Icahn School of Medicine at Mount Sinai since March, said the reaction from physician faculty about his role has been a “mixed bag.” Some are excited to see the health system has appointed someone to address burnout, while others question how much of an impact he can make. Burned-out physicians are usually disillusioned with their work, finding they lack control in their environment or they’re being asked to do more with less time. Doctors question if those feelings can actually be changed as CEOs and boards focus on profits.
“Some people are a little skeptical, and I can understand why. There are a lot of big factors at work that have led to this situation,” he said. “It’s incumbent upon me to convince them” that a CWO can effect change.
There also needs to be an understanding from the CEO, board members and wellness officers that change won’t happen immediately, Button at Korn Ferry said.
“These things are going to take time, so it’s not about having this massive team; it’s about having informal influence,” he said.
Agents for change
Although Kirch and others predict chief wellness officers will one day be a core part of the C-suite team, right now those in the role are a small group with lofty goals.
Research from the National Academy of Medicine shows that burnout is mainly caused by policies of an organization that are outside of an individual clinician’s control. For instance, a bureaucratic environment focused on producing revenue can leave a physician with a lost sense of autonomy or satisfaction.
Given that, chief wellness officers work with all departments in the system to identify opportunities for changes in practice.
Take for instance, the ongoing work by Ripp at Mount Sinai. Ripp calls himself a “change agent” because he has to “insert” himself into every facet of the organization.
“So much of the work is engaging with the big drivers that really impact the way in which clinicians are practicing,” he said.
Ripp said he works primarily with the health information technology, patient experience and practice transformation teams. He hasn’t made many changes yet because he was waiting until the wellness survey of the physician faculty was complete. It just concluded at the end of January, and about half of Mount Sinai’s 4,000 clinical faculty completed it.
The results will offer him insight into where the biggest opportunities for improvement are.
Burnout evaluation
Dyrbye at Mayo Clinic said an essential first step for chief wellness officers is to assess the burnout and stress levels within their organizations because that will guide where solutions should be directed.
For example, at UAB Medicine in Birmingham, Ala., Chief Wellness Officer Dr. David Rogers said he’s actively working with the leaders of advanced-practice providers because the preliminary results from a well-being survey show that group appears to suffer from burnout at higher levels than the physician faculty.
Rogers, who has been in his role since January 2018, said managers greatly influence burnout levels. “If your immediate leader is really positive and effective, that can make a huge difference.”
At UC Davis Health, Chief Wellness Officer Dr. Peter Yellowlees said he’s taken a three-pronged approach to tackling burnout. One approach involves breaking down stereotypes that prevent physicians from seeking help as well as ways for them to practice self-care.
“A major part of my job is getting people to understand that promoting self-care and looking out for yourself is a good thing and helps your patients,” he said.
At the moment, he’s working on selecting a “well-being champion” for each department who will promote positive health choices and collaborative, supportive environments.
A psychiatrist who has treated physicians for most of his career, Yellowlees also encourages all 1,800 physicians at the Sacramento, Calif.-based system to take an anonymous survey that assesses risk for depression and anxiety. Since the tool launched in 2014, 84 physicians who were referred to a therapist or psychiatrist sought treatment.
The other two approaches are looking at ways to improve efficiency in the EHR and to increase virtual visits offered because that gives providers more flexibility (See story, above).
Chief wellness officers also offer resiliency training, but it’s not a big part of their agenda. Resiliency training has been criticized for putting the onus on physicians to deal with their own burnout.
“The last thing we want to do is give people the idea that they just need to become more resilient,” Ripp at Mount Sinai said. “Promoting resilience is not the entire solution here; it’s an element.”