As a physician who left clinical medicine because of burnout and as a writer, I’m drawn to stories of physicians whose professional and personal lives have improved after reasoned interventions. So my ears jumped to attention earlier this month when a colleague at a summit on physician burnout described the positive results his practice had achieved in reducing burnout. Read Pierce, MD, is interim director of the Hospital Medicine Group (HMG) and is the associate director of the Institute for Healthcare Quality, Safety and Efficiency at the University of Colorado.
Leaders in HMG, a hospital-based internist group that includes 85 physicians, physician assistants, and nurse practitioners, conducted a detailed survey three years ago as the first step in an effort to better understand the existing culture at work. The survey gathered information from frontline clinicians on engagement, satisfaction, burnout, mentorship, safety culture, and other topics. Results indicated that 45 percent of clinicians were experiencing some degree of burnout. Initially, leaders were unsure how to respond to the results, but they made a firm commitment to action, in part based on frustration with prior institutional surveys in which similar challenges were identified but little definitive change followed.
Pierce told me that the group sifted through the data and brainstormed on possible interventions. Over time, they chose 13 (an interesting number!) to take on. Here are three of them:
1. Incubating joy. The practice developed an “HMG Incubator,” a group headed by three physicians that focused on identifying ways to increase joy and sustainability at work. Pierce told me that the group initially assumed their work would be primarily about removing things, specifically the daily frustrations and barriers that heighten stress levels. Instead, they uncovered a hunger for “what’s missing” — like camaraderie, quiet time, and regular access to healthy food. Rather than choosing to be free of their pager for 30 minutes of catch up time, clinicians elected to focus on redesigning their workspaces. They created a low-cost program to make healthy food available in their common workspace (avoiding the walk to and from the cafeteria made healthy snacking doable). They are currently working on ways to provide both quiet space and social space, so people can more easily rejuvenate during the day and also know where to find colleagues when they need to talk.
2. Positive mentoring. HMG did away with the typical talk-with-the-boss evaluations once a year, which historically focused on comparison with peers and “what you didn’t do.” Instead, the group built an ongoing mentorship program. Mentors help clinicians identify their areas of professional passion and invest in growing relevant skills. Now, the typical conversation is focused on what strengths people bring to the table, what gets them excited, and how the group can help each person do more of that type of work, at work. According to Pierce, this shift has increased the sense of support and also made it easier for leaders to look for opportunities to pass along to individuals, based on the unique passions of the clinicians in the group.
3. Redesigning work processes based on core values. The group also revamped troublesome work processes. For example, the scheduling system for clinical shifts had been a growing source of friction for the physicians. There was ongoing tension between wanting a set clinical schedule well in advance yet also needing flexibility to meet other professional and personal obligations. Moreover, physicians often felt “disrespected” when the final schedule was released — left with the sense that schedule preferences were not taken into account fairly across the group. About 18 months ago, the group decided to change the process — and to base the redesign on the core values of the group, which include respect, collaboration, work-life balance, and ongoing improvement. A work group interviewed all the clinicians in HMG about the scheduling process. They specifically focused on how the schedule could better represent the values of the group. They drafted a set of guidelines for scheduling that includes a transparent method for building a schedule that is more equitable in balancing individual preferences and the groups’ needs in terms of creating a schedule well ahead of time.
Were these interventions effective? Pierce told me that in the course of three years, the burnout rate in the practice has dropped from 45 percent to the low 30s. Turnover has decreased by 50 percent. Reported psychological safety has doubled, and more than 90 percent of people now report a strong sense of collaboration with peers. I think many physician practices would love to achieve such improvement, and many physicians would be thrilled to work in a practice so committed to their professional and personal well-being.
As for this writer hungry for hopeful stories about physicians, I’m excited to hear that hospitals and practices that are beginning to get it: Clinicians need better places to work to do the kind of healing we ask them to do — and that every patient deserves.