“It is important that physicians not bear the inherent stresses of their lives in isolation, that doctors see their colleagues as caring, and that they perceive a “safety net” in moments of distress.”1
In 2020, the effects of the viral pandemic were inflicted not just on the general populace, but also specifically on the physicians and nurses dedicated to (caring) for (them). This quote might have been lifted from a New York City or Seattle newspaper. However, it wasn’t this pandemic that Nichol Baird, MD, and her coauthors had in mind when they wrote about this idea of physicians supporting physicians in 1995.2 In their article, they specifically advocated for the creation of hospital based physician wellbeing committees, to focus on “normal,” rather than only responding to distress and impairment.
Similarly, in 2009, Jodie Eckleberry-Hunt, PhD, et al, wrote about moving beyond the pathological focus on burnout to proactively having a conversation about what makes a physician well. They defined wellness as “a dynamic and ongoing process involving self-awareness and healthy choices resulting in a successful, balanced lifestyle.”3 As the American Medical Association notes, “at a time of dynamic change in medicine, improving the experience of the caregivers is essential, and is dependent on recognizing the costs of burnout and the value of a fulfilled professional workforce.”4
We have seen that many of the shortcomings of our healthcare system have been laid bare during this pandemic. Making a commitment to physician wellbeing will help bridge one gap. By helping physicians achieve fulfillment at work, balance, and a sense of wellbeing, we can build what the AMA calls the ‘organizational foundation for Joy in Medicine.’ In doing this we can help achieve the “Fourth Aim” of wellbeing of medical staff, consistent with the obligation of MHS to protect patients, ensure quality of care, and support medical staff functioning.
In other words, without the Fourth Aim there can be no sustained achievements in the other three areas we seek to improve: patient experience, patient health, and cost. The Institute for Healthcare Improvement, the originator of the Triple Aim, recognizes that “raising joy in work is a key strategy in the pursuit of the Triple Aim.”5 This makes developing a committee a crucial step for a hospital or health system, as well as an opportunity to differentiate itself.
To begin making an impact, an organization must effectively address physician wellbeing.6 Creating a wellbeing committee is a concrete first step an organization can take to foster a culture of clinician wellness.7 An organizational commitment to physician well-being typically begins with recognition of the physician as a precious resource by the executive leadership team.8 According to the American College of Physicians, addressing physician wellbeing sends a powerful, culture changing message:
we acknowledge this work is stressful
we acknowledge that burnout is an issue and we want to help you avoid it
we are providing this training because we care about you too … not just the patients
we can talk about stress and burnout rather than treating the subjects as taboo
it is OK to ask for help and support2
Dike Drummond, physician, coach, and author, describes the failure to address physician burnout as “an industry wide blind spot.”9 Failing to address workplace stress and physician burnout proactively can result in lower patient satisfaction and quality scores, higher error rates and malpractice risk, disruptive physician behavior, and higher than normal physician and staff turnover and associated costs.10 Therefore, clinician wellbeing is necessary for sustainably enhancing patient safety, and important for recruiting and retaining physicians as well.11
According to the ACP, many factors contribute to stress and burnout in the medical workplace including: Increasing internal and external complexity, greater pressure and accountability, lack of work/life balance, loss of autonomy and control, rising number of malpractice suits.12 Additionally, hospital systems face unique challenges on each campus and within each unique entity within the organization. At times these separate entities can be too compartmentalized, siloed, to their detriment. However by establishing a wellbeing committee at each campus or organization – or a physician champion at the smaller entities – and sharing ideas and resources, health systems can achieve economies of scale, capitalizing on shared lectures or speakers, and making use of virtual and tele-conference platforms to shrink distances, and educate physicians on dealing with stress, life-balance, and other issues.
The Mayo Clinic Department of Medicine in Rochester, Minnesota, created their Program on Physician Well-Being in June 2007. The mission of the program is to promote physician well-being through research, education, and development of individual and organizational well-being initiatives that optimize physician satisfaction and performance. The multi-disciplinary endeavor aims to improve the work lives of physicians, cultivate an environment where physicians flourish, and in turn improve the care they provide to patients.
Similarly, at Stanford, the guiding principle of the wellness committee – the Committee for Professional Satisfaction and Support – has been that the professional satisfaction of physicians and other caregivers is inextricably linked to quality, safety and patient-centeredness. Their vision is to:
“Create a practice environment that supports optimal physician wellness
and professional satisfaction by ensuring the organization’s leadership,
goals, structures and systems facilitate a healthy professional work-life.”13
Three domains of physician well-being have been identified: efficiency of practice, culture of wellness and personal resiliency.14 A healthy, balanced workforce of physicians reduces burnout, reduces medical errors, reduces disruptive behavior, and is vital to a large diverse organization such as MHS. By proactively addressing each domain, instead of being merely reactive, we can increase awareness and reduce stressors, potentially addressing (or preventing) problems before they rise to the level of reportability. By strengthening the culture, a hospital creates a location where physicians want to work and serve, we reduce turnover and create lasting relationships with loyal, engaged physicians. This translates into greater consistency within departments and on committees, and reduces turnover for the facility and its contract groups, which reduces costs.
Dr. Baird’s group identified three primary objectives for their wellbeing committee. The first function is to raise awareness and educate physicians. Such efforts might include sponsoring an awareness campaign, hosting wellness seminars, or CME programs. Research shows that learning certain skills can increase a physician’s sense of self efficacy and lower burn-out levels.
The second function, alleviating distress, is partially accomplished through the first, but also by creating or promoting preventive programs, and generally fostering a culture of wellbeing. Mindfulness training for example, supporting and working with other efforts such as hospital Critical Incident Stress Management teams, peer groups, and physician coaches. All will further aid the development of a sense of community and support.
The third function is advocating for efficiency in the workplace. The committee accomplishes this by identifying existing and emerging workplace needs or concerns, and making recommendations to those who can exact change in our organization. Not only does this reduce stress and potentially reduce triggers for disruptive behavior, it also creates an engine for efficiency of operations and practice that benefits the entire hospital.
The AMA also recommends looking at system interactions involved in physician wellness – individual, the organization and the culture.15 Specifically, the AMA notes that attempts should be made to address issues causing and fueling physician burnout, including time constraints, technology and regulations, at the system-level.16 This is very similar to the process outlined by Stanford as The Reciprocal Domains of Physician Well-Being.17 Similarly, while at the Mayo Clinic, Tait Shanafelt, MD and John Noseworthy, MD, identified and outlined nine organizational strategies to promote physician engagement and reduce burnout, many or all of which could successfully be implemented at any hospital.18
The optimal structure and size of the physician wellbeing committee has not been described. The ACP recommends inviting clinicians – physicians and advanced practitioners – from various departments with a mix of in terms of age, years worked at institution and gender, so all voices are represented. Dr. Baird’s committee, for example, was composed of physicians and two psychologists. Others also recommend inviting various professionals with specific expertise to serve on the committee, such as counselors, nutritionists, and clergy members, in order to better implement and execute the first and second functions of the committee.
In their paper “Physician Well-Being,” published by the New England Journal of Medicine, the authors conclude that “the quality and safety of patient care, and indeed the very vitality of our health care systems, depend heavily on high-functioning physicians.”19 Furthermore, that “professionally fulfilled physicians are better equipped not only to practice…clinical care, but also to lead the effort to identify and implement much needed improvements to our systems of care.” They also note that “physicians who feel supported by their organizations tend to contribute more to improvement efforts that increase the efficiency of their practice.” In this way, physician well-being efforts not only benefit the individual physician, they benefit the patient, and in turn, support the institution.
June 1, 2020
1. Baird N, Fish JS, Dworkind M, Steinert Y. Physician, heal thyself. Developing a hospital-based physician well-being committee. Can Fam Physician. 1995;41:259‐263.
2. Baird N, Fish JS, Dworkind M, Steinert Y. Physician, heal thyself. Developing a hospital-based physician well-being committee. Can Fam Physician. 1995;41:259‐263.
3. Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. J Grad Med Educ. 2009;1(2):225‐230. doi:10.4300/JGME-D-09-00026.1
4. Sinsky C, Shanafelt T, Murphy ML, et al. Creating the Organizational Foundation for Joy in Medicine™. Creating the Organizational Foundation for Joy in Medicine™ | Professional Well-being | AMA STEPS Forward | AMA Ed Hub. https://edhub.ama-assn.org/steps-forward/module/2702510. Published September 7, 2017. Accessed May 15, 2020.
5. Feeley D. The Triple Aim or the Quadruple Aim? Four Points to Help Set Your Strategy. Institute for Healthcare Improvement. http://www.ihi.org/communities/blogs/the-triple-aim-or-the-quadruple-aim-four-points-to-help-set-your-strategy. Published November 17, 2017. Accessed June 2, 2020.
6. Berg S. Physician burnout: The pledge your organization should make now. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-pledge-your-organization-should-make-now. Published June 12, 2019. Accessed May 2, 2020.
7. How to Create a Clinician Wellness Committee. ACP. https://www.acponline.org/practice-resources/physician-well-being-and-professional-fulfillment/how-to-create-a-clinician-wellness-committee. Accessed May 2, 2020.
8. How to Create a Clinician Wellness Committee. ACP. https://www.acponline.org/practice-resources/physician-well-being-and-professional-fulfillment/how-to-create-a-clinician-wellness-committee. Accessed May 2, 2020.
9. Drummond D. Physician Burnout – 7 ways your Physician Wellness Committee will FAIL. Stop Physician Burnout Tools, Coaching, Training – Physician Wellness Program Design and Implementation – The Happy MD. http://www.thehappymd.com/blog/physician-burnout-7-ways-physician-wellness-committees-fail. Accessed June 2, 2020.
10. Drummond D. Burnout Basics. In: Stop Physician Burnout: What to Do When Working Harder Isn’t Working. Collinsville, MS, MS: Heritage Press Publications, LLC; 2014:15.
11. How to Create a Clinician Wellness Committee. ACP. https://www.acponline.org/practice-resources/physician-well-being-and-professional-fulfillment/how-to-create-a-clinician-wellness-committee. Accessed May 2, 2020.
12. How to Create a Clinician Wellness Committee. ACP. https://www.acponline.org/practice-resources/physician-well-being-and-professional-fulfillment/how-to-create-a-clinician-wellness-committee. Accessed May 2, 2020.
13. Wellness Committee. WellMD. Stanford Medicine. https://wellmd.stanford.edu/center1/committee.html. Accessed May 23, 2020.
14. Sinsky C, Shanafelt T, Murphy ML, et al. Creating the Organizational Foundation for Joy in Medicine™. Creating the Organizational Foundation for Joy in Medicine™ | Professional Well-being | AMA STEPS Forward | AMA Ed Hub. https://edhub.ama-assn.org/steps-forward/module/2702510. Published September 7, 2017. Accessed May 15, 2020.
15. Berg S. Physician burnout: The pledge your organization should make now. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-pledge-your-organization-should-make-now. Published June 12, 2019. Accessed May 2, 2020.
16. Berg S. Physician burnout: The pledge your organization should make now. American Medical Association. https://www.ama-assn.org/practice-management/physician-health/physician-burnout-pledge-your-organization-should-make-now. Published June 12, 2019. Accessed May 2, 2020.
17. Bohman, B., et al. “Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness, and Personal Resilience.” New England Journal of Medicine: Catalyst, April 26, 2017. Accessed May 2, 2020.
18. 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
19. Bohman, B., et al. “Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness, and Personal Resilience.” New England Journal of Medicine: Catalyst, April 26, 2017. Accessed May 2, 2020.