For more than a year, healthcare heroes have put their lives on the line to fight the COVID-19 pandemic. Mental Health America surveyed 1,119 healthcare workers about their mental health and well-being, and the results were resounding: 93 percent reported stress, 86 percent reported anxiety, 77 percent reported frustration, 76 percent reported exhaustion and burnout and 75 percent said they were overwhelmed.
Clinician well-being — mentally, physically and spiritually — has never been more important. In this conversation, experts from MATTER, Accenture, Advocate Aurora Health and the American Medical Association discuss clinician well-being during the pandemic.
Learn more about MATTER events here.
Speaker 1: (00:10)
Welcome everyone to today's program on fostering clinician wellbeing. Uh, my name's Steven Collins. I'm the CEO of matter. Uh, clinician burnout has always been a thing, but it's become significantly more acute of a problem in the last 14 months as a result of the incredible strains placed on frontline healthcare professionals. During the pandemic in September mental health, America released a survey of healthcare workers and the results were, uh, discouraging to say the least 93% reported stress. 86% reported anxiety, 77% reported frustration, 76% reported exhaustion and burnout. 75% said they were overwhelmed last week. Catchum public relations firm released another survey that backs up those findings suggesting that while there is so much reason for optimism today that we will soon end our collective pandemic distress. There remains a lot of work to do to support the wellbeing of the healthcare professionals. We all rely on for so much though, today we have a terrific group of four experts from three of matters partners to walk us through the importance of clinician wellbeing and strategies to mitigate pandemic burnout.
Speaker 1: (01:29)
The Reverend Kathy bender switch is the chief spiritual officer of advocate, Aurora health, where she oversees chaplaincy clinical pastoral education, church affiliations, and faith, community relationships, and key to today's conversation, physician and team wellbeing. She has more than 30 years of experience in spiritual care and executive leadership at the national level. Dr. Mila Felder is vice chair of emergency medicine at advocate Christ medical center in Chicago's OK. Lawn neighborhood. She published an article in December in Jamma on the effects of sleep on physician wellbeing, finding ties to both burnout and medical errors. She's one of the leaders of advocate Aurora's wellbeing council and represents the system nationally on the American college of emergency physicians' wellbeing committee. Kira Capucci is a practice transformation portfolio leader, the American medical association, where she consults with health systems from around the country to promote physician will be prior to joining the AMA.
Speaker 1: (02:34)
Kira helped develop and launch the national academy of medicine's action, collaborative on clinician wellbeing and resilience consortium of more than 200 organizations committed to reducing clinician burnout and suicide and leading today's conversation is Dr. Scott CU. Scott is the health provider lead and chief clinical innovation officer at Accenture working with health systems on strategy, change management, and the transition to value based care. His background includes stints as a practicing primary care physician, an executive, an entrepreneur, and a consultant, and he's led work at some of the nation's top academic medical centers and integrated delivery networks. HIRA is going to start us off with a short presentation with some data from the AMA on caring for healthcare professionals, amid the pandemic. So Kira take it away.
Speaker 2: (03:28)
Great. Thanks for that introduction, Steven and good afternoon, everyone. Um, it's a privilege to be with you today. Um, I'm excited to share some of the work that we've been doing at the AMA over the past year, as it's related to, um, physician wellbeing, um, and clinician wellbeing overall. Um, so I'm gonna be sharing some of the data from a national survey, um, that we've been, um, sharing with health systems over the past, um, 16 months. So just a little bit of background on the survey. Um, AMAs been working with health systems for the last few years to provide burnout assessments and really serving as advisors to health systems that want to build out strategy and support for wellness and burnout. And so when COVID became our reality, um, last spring, we developed a new assessment tool so that health systems and practices could monitor the impact that COVID was having on their workforce in real time, so that they could respond in real time as well.
Speaker 2: (04:22)
So this became, what's now our coping with COVID 19 for caregivers survey. Um, this is a 20 question survey to assess things like stress, fear of exposure, self-reported anxiety or, and depression as well as burnout, but also to capture potential solutions for health systems to enact in response to their data. We opened up this survey to any organization that was interested in using it. Um, it was no cost to use it. It was not tied to AMA membership, um, and systems who did decide to participate would receive a URL, a survey URL that was specific for their organization. And then we built a dashboard, a reporting dashboard for them to see their survey responses. So the results that I'm gonna share with you in the next few minutes represent the responses we received in aggregate, um, from just over 85 organizations representing more than 200 individual hospitals or practice sites.
Speaker 2: (05:15)
Um, these data were collected from early April of last year in 2020 until the end of 2020, um, and comprise over 58,000 responses. We are to continuing to deploy the survey now. Um, but today I'll just be reviewing the 2020 data. We are currently in the process of analyzing our 2021 data. The survey itself was developed for both clinical and nonclinical staff, but distribution was at the discretion of each participating organization. So we did not dictate this. Um, but I will say on the front end that most organizations did choose to deploy the survey to both their clinical and their non-clinical staff. So just a quick look at demographics. So you can see who makes up our convenient sample. Um, the majority of our respondents were female. Um, they comprised almost 70% of our sample and the majority of respondents identified, um, as white at about 64% of our sample.
Speaker 2: (06:09)
We also asked respondents, um, for their role type cuz as I said, we deployed this to all role types, um, within healthcare. Um, so the majority of organizations did deploy it to their entire staff. Um, but about one third of our sample is comprised of physicians, um, followed by nurses. And then we have 17% of our sample representing nonclinical support staff, which we grouped all nonclinical roles, roles in. Uh, we also asked respondents for their prac their current practice setting. Um, this was a multi-select question. Um, since we know that respondents are often working in multiple settings, um, but the majority of our sample, um, are those that were hospital based, um, but not working in the ER or ICU. Um, and those that were providing non COVID care in an ambulatory setting. So 35% were ambulatory non COVID care. 35% were in a hospital based setting, not in the IER ICU.
Speaker 2: (07:00)
So this is just to say that 70% of our samples coming from individuals who were not providing care over the past year when we were collecting the I of the high level results. So I'm gonna share some of the high level results from our data. The are, these are certainly not comprehensive and I'm happy to elaborate during today's webinar. Um, this will hopefully give you a flavor of some of the trends that have emerged from our data, um, that are very similar. So to some of the trends that Steven shared, um, in his opening remarks. So firstly looking at burnout, we use the validated, uh, single item burnout measure. Um, this has been validated against the Maslow burnout inventory and ask respondents to rate their burnout based on their own definition. We characterize burnout as anything that you're seeing in the red, orange or yellow.
Speaker 2: (07:44)
So those that are beginning to burnout and have at least one symptom of burnout all the way to those that are completely burned out and may need to seek help 49% of over of all of our respondents. So the bottom line, the overall, um, respondents, uh, indicated some level of burnout. This was highest in nurses at just over 56%. We've been doing burnout assessments at the AMA prior to COVID, that was focused mostly on just physicians and in those pre COVID data around 50% of physicians were experiencing burnout in this sample from our COVID survey, it's still about 50% of physicians. So we aren't yet seeing any spikes of burnout over the past year. Um, this is also true of self-reported anxiety and depression, but that's not to suggest that it won't get worse. Um, we'll, we'll talk a little later as well, but we do know from SARS that spikes and burnout started to appear about a year after the initial threat of the outbreak were off.
Speaker 2: (08:39)
And certainly, uh, you know, even at 50%, that's half of our workforce that is experiencing burnouts with something we certainly need to be paying attention to and devoting resources to for not already doing it. Burnout was high before COVID and it remains high. We also looked at burnout, um, by practice setting. Um, so on the, the left, you'll see each of our four practice settings. Um, so ambulatory, non COVID care, ambulatory COVID care. And then our hospital based respondents, those that were in a non ER or non ICU setting. And then those that were in the ER ICU using the ER ICU as a proxy for those that were caring for COVID patients, burnout was highest in those that were in an ambulatory, uh, setting, providing COVID care as well as those that were in hospital based setting in the ER ICU. Uh, both of those categories were five percentage points higher than non EER ICU and non COVID care.
Speaker 2: (09:33)
And certainly speaks to the unique needs of people who have been, uh, doing COVID care over the past year. Um, and the needs that they may continue to have as things sort of reset in COVID cases drop and, um, healthcare kind of resets to whatever a new normal will look like. We also ask respondents about their self-reported anxiety or depression. This was not a diagnostic measure. It was self-reported. So just want something I wanna clear up on the front end and a little over one third of all respondents noted self-reported anxiety or depression moderately, or to a great extent that number jumps a lot when you include those that said that they are experiencing anxiety or depression, um, somewhat, um, this was again highest in nurses at 44% followed by clinical support staff at 43% and clinical support staff. We included medical assistants and nursing assistants.
Speaker 2: (10:23)
Um, so this is another area we'll be keeping a close, um, eye on in the coming months. Um, a lot of organizations have made mental health support services available throughout the past year, um, and are working to make those support services available long term, um, to hopefully allow these individuals to, to have resources available to them in multiple forms. Another question we asked respondents was about how valued they felt by their organization, as well as whether they felt an enhanced sense of meaning and purpose. Um, from being a part of the COVID 19 response, 46%. So less than half of all respondents felt valued by their organization. This was lowest and clinical support staff at 37% and lowest in nurses at 40%. Um, we did find in our analysis and follow up that feeling valued by your organization and feeling in an increased sense of meaning and purpose did serve as a protective factor.
Speaker 2: (11:18)
So those that were, that did feel valued by their organization were also less likely to be experiencing burnout self-reported anxiety or depression, um, as well as stress. Um, so I will say anecdotally, this was kind of the drop the mic moment for a lot of organizations we worked with. Um, I think it was shocking to a lot of organizations to see that less than half of their, um, respondents were feeling valued by their organization. Um, but the, the glass half full, um, side of that is, um, it really presented an opportunity, some low hanging fruit opportunities for organizations to think about how they were communicating with their, um, employees, how they were expressing gratitude, um, how visible leadership has, and has continued to be, um, over the last year. Um, we did work with a group who sent thank you notes, um, right after they did their survey and then res surveyed three months later. Um, and we did see this go up, um, slightly. Um, so it's not a fix all. Um, but certainly, um, if these questions, uh, were identifying some low hanging fruit opportunities, um, for re for, um, leadership within the organizations that we've worked with.
Speaker 2: (12:27)
And lastly, the last thing I'll share today, um, as part of this presentation is we asked respondents, um, to tell us how likely it was that they would reduce their clinical hours in the next 12 months or to leave their practice altogether in the next two years. Um, we know from research that people who say that they are going to leave their practice in the next two years, do leave their practice in the next two years. And so this is not only important for individual organizations to be thinking about and monitoring from a succession planning from a cost perspective, um, who they might have to replace in the next, you know, one to two years, but certainly from a, a national workforce perspective. Um, we also know from SARS that people started leaving the workforce about a year, um, after the, the outbreak initially, um, started.
Speaker 2: (13:10)
So this is something we wanted to keep a close, close eye on overall, uh, 27% of our respondents noted a moderate likely or definite chance of reducing clinical hours in the next 12 months or leaving their current practice in the next two years. So about a third of respondents are indicating that they may leave. Um, this was highest in nurses at 40%, um, followed by advanced practice providers. So your nurse practitioners and your physician assistants at 32%. Um, so we will certainly be keeping a close eye on this. And this has come up in a lot of discussions, um, with the groups that we work with when thinking are people taking early retirement, are they burned out and wanting to leave the professional together? There have been, um, some articles in the New York times about individuals who have left, um, healthcare in the last six months to a year. Um, so certainly something to be mindful of, um, but happy to discuss more during today's conversation. Um, so with that, um, that's all I have to share today from our survey and I will turn things over to Dr. CU and I look forward to the discussion,
Speaker 3: (14:09)
Hey car. Thanks. That was, uh, really great information. Um, I was wondering if you could, uh, identify maybe what some of the main sources of burnout have been in your studies, uh, and, and how that might have changed, uh, during the pandemic. And then I'll ask, um, uh, Kathy and, uh, Dr. Felder to, uh, discuss that as well.
Speaker 2: (14:35)
Yeah. Happy, happy to start. So in a pre COVID world, we know from the research that things like work overload or, um, work autonomy are main drivers of burnout, as well as time on the EHR specifically in primary care, which is a lot of where the research has focused. We know that for every one hour of patient care, um, a physician will spend two hours documenting in the EHR. So that's pretty astounding and has certainly been a major driver of burnout in a pre COVID world. Um, as well as things like team based care, where are our clinical support staff able to support physicians and documenting and follow up and order entry. And of course, that's going to vary by state as well with what's actually legal, um, and allowed for and all. And then the culture, culture of medicine, uh, that's pre COVID that's COVID, that will certainly be a theme post COVID.
Speaker 2: (15:24)
Um, you know, we have a culture in medicine that can make it hard for people to seek help that is often can be, um, seen as competitive. Um, and so we've had a lot of folks, especially in their qualitative responses, talk about that, um, how much pressure there is for them to perform, um, missing out on other things in their life, like time with family members and feeling really taken away from those other life events. Um, uh, because they're, they're drawn to this profession, uh, with COVID. A lot of it has been, especially in the early days, uh, we were seeing a lot come out around just basic needs, so making sure that food was available and that they understood how they could go home and lessen the risk that they would bring something to their families. Um, as well as visible leadership organizations who had leadership on the ground rounding very early on being transparent in their communications, uh, saw much, much better, uh, results. If that's, that's kind of a weird way, way to phrase it much lower burnout, um, than other groups, um, who didn't necessarily have active invisible leadership, um, at the start of the pandemic. So I'll pause there and would love to hear from my colleagues as well.
Speaker 3: (16:33)
Kathy, did you wanna, uh, give us your thoughts on that?
Speaker 4: (16:36)
Sure. I think all good points there, in addition to during COVID the burnout that occurred, there is fear over having the right PPE. So keeping themselves protected also, as we doubled and tripled the size of our COVID units, pulling in staff who don't normally work in ICUs or highly infectious areas. So they were facing practicing in areas that they weren't that comfortable with necessarily and needing to be trained that way. And then I've heard a lot of, uh, our physicians and clinicians talk about the fact that normally when they're treating someone who's ill, they have a sense of what the treatment plan is and how to either provide care or cure. This was such an unknown that they didn't know how to address it from day to day as protocols changed and not having family members around for support or anything, they were the emotional care providers to the patients, as well as the physicians, clinicians. So that really added to their stress as well. And I'll ask Dr. Felder to add on that
Speaker 5: (17:43)
Think the two of you really have covered, uh, the multitude of challenges. People personally were struggling with balancing the risks. They're bringing home with their function in the hospital, both administrative and clinical physicians were struggling with supporting each other while trying to provide care and to summarize it all coming home, there was a combination of fear, but also anxieties related to just personal life kids that are young, unable to go to school yet not having backup childcare because normally that was set up, but no longer available. So I think the stresses just kept changing as did our expectations of what people are to bring to work in terms of mental and physical things that had to come in with us. There was so much change every day that by itself, that amount of change I think, was a big stressor that for the first, I would say three, four months of the pandemic, we were trying to deal with just to do items as opposed to long term planning. We were just trying to deal with the daily challenges.
Speaker 3: (18:52)
Thank you. That's very helpful. Um, we've got a couple of questions already in the window, but one that I think is relevant, uh, Kara to further illuminate something in the data that did strike me as well is, um, the stress in ambulatory care, um, was fairly high and a couple people expressed some surprise over that.
Speaker 2: (19:13)
Yeah, that's a good question. So in a pre COVID world, we know that burnout is quite high in, uh, primary care. Um, it's actually probably highest in primary care, uh, mixed in with emergency medicine, depending on which data you're looking at. So it wasn't necessarily surprising for us to see that it remained high in the ambulatory setting, um, for those that were providing COVID care, especially. And I think this build off of what Reverend vendors, which was saying is that so much was unknown. I mean, we were working with offices who were just trying to figure out telehealth for the first time and you're talking new workflows, all of a sudden with not much guidance on what those workflows look like. How do you incorporate clinical support staff into those workflows? And then of course, you know, added on top of that, what, what others have mentioned, which is fear, um, of uncertainty and not sure, you know, what's going to happen next, or how do you even handle, uh, these types of cases? What do you, what do you do with your patients when they come in and they're very ill, um, and you don't know what to do next. So, um, I think it's a combination of those factors, but I would say it wasn't, it wasn't surprising to us to see that, um, ambulatory care respondents were feeling a lot of burnout and I suspect they will continue to feel a lot of burnout, uh, even without COVID because they were feeling it before mm-hmm
Speaker 3: (20:25)
. Okay. Well, that certainly makes a lot of sense. Um, uh, Reverend bender switch, do you wanna talk a little bit about, for a second about what a chief spiritual officer, uh, is doing in, uh, advocate Aurora these days?
Speaker 4: (20:39)
Sure. And please feel free to call me Kathy. Um, my, my role is very similar for those of you who are familiar with Catholic health systems and, and chief mission integration officers. Um, that's very similar to what I do. The advocate part of advocate of our is faith-based. So that is something that I continue to, uh, keep the organization true to as our faith-based relationships with our faith-based partners. Um, but I do oversee all of our spiritual care work, um, including emotional and mental health wellbeing, especially now, since COVID focusing on that for our physicians, clinicians, and team members, I also oversee all of our ethics functions. So biomedical ethics, social ethics, organizational ethics, keeping us a good corporate citizen, good corporate partner out in the communities. Um, and then also oversee the wellbeing of our environment. So I oversee environmental sustainability, so caring for our environment, our communities in that way, um, also ourselves and the generations that come after making sure that we're not doing more harm to people as we try to improve their health by, by things we put into the environment or chemicals we use. So that's,
Speaker 3: (21:50)
That's a, that's a pretty
Speaker 4: (21:50)
Broad scope of what I do
Speaker 3: (21:52)
At, I was gonna say that's a pretty comprehensive portfolio. Um, so mil, let me, uh, as we touch on some of the things that might, uh, be positive and, and have an impact here. Um, uh, one, one thing that came up that ki mentioned is culture, right? And we, we have a fairly stoic culture in many cases when it comes to physician culture, um, uh, and, and other caregivers in some cases as well, um, given that some may be a bit in denial about their proximity to burnout. Um, how do we address, how, how do you think is it's the best way to address raising awareness and giving permission for, um, asking for help?
Speaker 5: (22:43)
That's a really great question. Uh, Scott, I think that as we train through the stages of healthcare education, we teach people that story culture. And I think that we need to start there with saying a normalizing need for being human and connecting to where the reality is in our environment at advocate, Kathy has really been tremendous in helping us develop some of the tools that physicians and clinicians, uh, across spectrum are able to use their published, their shared, but more so they're socialized continuously. Initially we started with just serious of social interventions, getting group gatherings, talking through initiatives. The problem with that is that people that need these interventions the most are typically not the people that think they need them the most. And so I think that challenge that unless you approach it very early in someone's career, where they have some tools to identify where they are on the spectrum of wellbeing to burnout and depression beyond that, I think it's harder in the middle or late career to pull those people out without sounding like you're coming at them, which has a really low likelihood of being successful.
Speaker 5: (24:01)
So I think it has to be a cultural shift towards normalizing these conversations in small group meetings and large medical staff meetings and our organizationally saying, yes, your individual wellbeing is important to us. Yes, here is meditation and here is yoga. And here is all these tools that are available to you through this system. But as an organization, this is what we do to, to promote your wellbeing systematically by EMR support by doing, uh, organizational interventions, that support peer to peer work by looking at improving your CME and how you could use that for your wellbeing. I think by saying that this is normal, we all know that there were suicides already as a result of this COVID pandemic, including an emergency physician, Dr. Lauren Andreen nationally, by promoting the task forces like the new legislature that's, you know, is actively being pursued to promote the resources that go towards that very wellbeing at the very early stages of it. And by promoting the support at the later stages when people potentially, and very likely hit their barriers with the burnout, I hope I answered the question.
Speaker 3: (25:14)
No, that's, that's a great start. Uh, and, and it, so what I'm hearing you say is that it isn't just about personal resiliency or your ability to withstand stress, although we can certainly help folks address that there's the external factors like the EMR, like some of these other prompt to burning out that need to be addressed by organizations, regardless of where people think or feel they are on the continuum.
Speaker 5: (25:42)
Yes. I think that it is useless to tell people here's one more meditation tool after you're done with your work after 14 hours. I think what really works is organizations saying, we understand these are the challenges that we put in place for you with a new EMR. And here's what we're doing to address that. So you could get back to your work life integration. I think that organizations that are at the forefront of saying those things are more likely to have healthier, better task force that are less likely to leave and also options that are available to people, uh, going to part-time split, you know, split working really looking at what does this generation of physicians coming in need in order to stay successfully meaningfully in their careers long term.
Speaker 3: (26:34)
So what struck me, um, you know, in Kira's data, um, was the fact that the burnout numbers haven't changed dramatically since COVID right. Um, I am curious, uh, and Kathy, I, I think you have some insight into this, uh, in terms of the perspective on when we see the impact of Sentinel events like COVID, um, versus ongoing chronic, uh, prompts to burnout.
Speaker 4: (27:04)
Yeah, that's a good question. And as Kira said, it's like PTSD where it's not really going to hit, we realize for another year or so. So we are building all of our interventions into what I call the fabric of the organization that it's not going to go away. Once we say, oh, the numbers are down, everything's opening up, we're done. We realize that some of the heavy lift is still ahead of us. So we're building in more of the normalcy of being comfortable saying, I need some help now. Um, also looking at how we onboard our new physicians' clinicians, nurses, letting them know that we have a culture of wellbeing of taking care of themselves so they can seek assistance earlier on and not wait till they hit a brick wall. Um, so we're, we're really looking at it that way and trying to, as I say, normalize, seeking help because, you know, and this is a word that has been overused, but these are unprecedented times. Yes, physicians are tough and supposed to be able to handle a lot. That's how they're trained, but this is some we've been through something in this last year that no one has experienced before. And so to be able to name that and make it okay to say, I need to talk to someone I need help. Um, those kinds of things are things that we're putting in place for the long haul.
Speaker 3: (28:26)
Great. That that is helpful. That makes sense. Um, and, and in terms of, uh, let's, let's talk about some tangible solutions. Let's talk about what we can bring to the equation, um, perspectives on, uh, addressing the technology both from reducing negative impact, as well as maybe finding, uh, countervailing technologies that could, uh, be positive, uh, in terms of the situation. Uh, any thoughts on that, Mila.
Speaker 5: (29:03)
Um, so just to clarify your question, what can we use to counteract this?
Speaker 3: (29:11)
Yeah. And, and, and I'm not limiting it. I'm not suggesting it as limited to technology the technology cause it plays a role. Um, it, are there any interventions that you've seen, whether technological or not, um, that are beginning to have a positive impact.
Speaker 5: (29:28)
And I'm gonna say that with the disclaimer that anytime organization starts measuring the impact, and we talked about it repeatedly, it seems like first year only shows worsening impact. But the reality is that it's just better identification and shift in culture to seeing the problem and being willing to accept it. So with that, disclaimer, I think some of the things that are successful across the spectrum with the organizations are EMR interventions to improve efficiency, uh, individual site support work that address site specific needs for physicians ensuring that the resources are available. For example, within advocate, we're looking at having electronic scribe system to allow physicians to decrease their time doing the non-patient non-clinical work, but also more of social interventions. Like the one we developed here called peer to peer together as one program where we train clinicians and non-clinicians removing that isolation of as a doctor or as a neuro I'm in this camp by myself.
Speaker 5: (30:40)
So across the organization, training people to identify signs of trauma and burnout and developing a set of tools, then providing that, those tools to the ambassadors that are trained, that's building eventual and network of people, not only understanding the signs of burnout, but together as we approach to 30% of the system being trained, shifting the culture to that of acceptance. And that I think long term is what will allow us to counteract the impact because today it's COVID and tomorrow it's something else, and there's always going to be something stressing our ability to deal with change and challenge. I think the cultural shift towards what can we do together, compassionate for each other is what will sustain us in that process.
Speaker 3: (31:27)
What kind of programs are out there at the micro or the tactical level to measure risk of, uh, burnout.
Speaker 2: (31:38)
I'm happy to, to take that one. Thank you. Um, but would love colleagues to, to weigh in. Um, so, so yeah, I would say just taking a step back from that question, we are seeing people measuring burnout for the first time in waves. Um, I don't think that it is yet sort of the standard in healthcare that organizations are actually measuring using data burnout in their organizations, um, even in a pre COVID world. Um, you know, we were working with a handful of sites over the last few years that were measuring burnout with a validated tool. Um, there are only four validated tools to measure burnout. We use one of them at the AMA. We use the mini Z, uh, burnout assessment, which was developed by a physician researcher out of Hennepin healthcare in Minnesota. Um, so the silver lining of COVID from our lens, uh, is that organizations have really awoken to the need to have data and to take a good look at what's going on within their systems to say, uh, you know, we know that there's a pocket over here.
Speaker 2: (32:36)
These role types are really struggling with X, Y, and Z. These are struggling with, with, with another, um, you know, set of concerns. Um, we like to say, you know, you can't fix what you don't measure. And so even if you're not ready to measure with a survey and assessment tool, like I referred to, uh, during today's presentation, even just, you know, focus groups, getting on the ground, asking people, what do you need? Um, how can we help? And having leaders actively doing that, um, I think is the silver lining of this past year, cuz we're seeing that come in waves. Um, as I said, we've worked with over 200 hospitals or practice sites just in one year. Um, that was a 400% increase for us, um, from the year before. So we have organizations that are eager now to have the data and to start understanding it, um, and hopefully, uh, to put resources behind that work. Um, but I would love for, I don't know if, uh, Kathy, you have anything else to add or Dr. Felder.
Speaker 4: (33:31)
Sure. And then I'll ask Dr. Felder to weigh in as well. Uh, we're trying to do, to measure, um, our wellbeing council is very sensitive to the fact that people can be over surveyed or over measured too. So we're working with colleagues and other disciplines to get questions or measurements into other surveys, like our culture of safety survey, which will be coming out in the next month or so we'll have a couple questions in it targeted at, at burnout or wellbeing because we realize we can't provide the very safest care if our care providers aren't in a place of wellbeing. So connecting it to other things that way, again, building it into the culture of the organization, finding ways to insert questions or measurements into other surveys that already exist. Neil.
Speaker 5: (34:18)
Yes. I agree with, uh, really this burden of asking too many survey questions spreading across, adding more to the stress that people are challenged with. The problem is that we want to gather data that's specific enough to drive interventions and you could only do it at the organizational or even system site level yet nationally, we need to continue to gather data as far as what's the direction we are headed in as a healthcare as a system. You know? And so the challenge of that is I believe that there are many different surveys like wellbeing index is a good example where I love my little app on the phone that reminds me every three months or however I often I ask it to remind me it's time to retake the survey and it measures where I am compared to my own metrics and those of similar providers across the country, without tools like that.
Speaker 5: (35:14)
Nationally, we may be moving as an organization in certain direction, but we're not in isolation. We're not gonna be successful in isolation. And so I think developing national tools and that's where I'm really excited about this Lauren and brain regulation, because if past there is going to be funding for developing tools like that, that hopefully we could then share nationally and identify not just at the system level. And I agree with Kathy, our engagement service are a great way to start getting there because you wanna have metrics. You want to see that you're moving in the direction and you're sustaining that movement. So I think my answer is as Stanford pie of wellbeing would put it, it's the individual at the center of what the system and the entire country nationally, culturally is doing to get from where we are to where we wanna go.
Speaker 3: (36:06)
I think that's a really great point you raised and it, and it highlights a question in my mind, which is, um, when you think about measurement, right, you can measure an aggregate or you can measure and you can measure at the individual level and increasingly in medicine, as we can, as we can collect data at the individual level. And we try to drive more precision and personalization and medical care, right? The same question could be raised here, which starts to run us into, I don't know if I'd call it moral jeopardy, but certainly a hazard around individuals being identified, right? Not necessarily raising their own hands, but, um, being identified as being at risk. And if we're identifying them being at risk, then we have to start addressing issues of shame or career impact or other things that can be brought into the discussion. Kathy, I I'd be interested in hearing your perspective on that balance between, uh, addressing the individuals at risk versus, um, just developing programs, driven by aggregate understanding of burnout levels.
Speaker 4: (37:12)
And I think it's a both end, um, one thing that we put in place at the beginning of COVID, we were planning to do it anyway, but COVID just speeded it up. Um, was a twenty four seven chaplain call line where we have a chaplain staffing, a phone twenty four seven, um, you can call in anonymously, say I'm struggling with this. Um, and then that person can be referred to EAP or behavioral health or something as well, or provide other venues, but trying, we also have drop in virtual support sessions where people can drop in and say, I'm really struggling with this today. Those can be done either individually or in group where they can address the individual in a more of an anonymous or safer fashion. Um, but then also finding ways to get that person the additional help or assistance they need. And that's why we're trying to build this cadre of peer to peer support providers too, that can help people know what the next step is. Um, so hopefully addressing some of the issues as they come up earlier on what rather than waiting until they get to be very serious. But we, we do struggle with, you know, physician's reticence about what does this mean for my licensure and all of that saying that I needed to seek help. And that's where I think we all need to take a strong, um, physician advocacy in changing some of the regulations that, that make it okay to seek assistance when we're struggling again, especially given all that we've been through in the last year.
Speaker 3: (38:46)
Do you foresee a self-service or self-assessment, uh, function, uh, arising in response to this that people could use, um, to, to assess for themselves their level of risk and then potential pathways forward from there?
Speaker 4: (39:05)
Yes. I think that that would be something that would be very helpful and we have, um, done some things with it. Like we have a, a checklist, a personal checklist people can, can go through and say, this is how I'm feeling today. And this is how I'm going to deal with the stressors and so on. Uh, but to do something that's more, again, part of, of the normal part of the organization where everyone does this and it's, there's nothing strange about it. I think that could be very valuable.
Speaker 2: (39:33)
And I'll just add when we do mini Z burnout assessments and the mini Z is a very brief tool. It's 10 questions along with 11th open ended question. Um, at the end of that survey, respondents can see what their total score was on the mini Z, cuz it's scored across two subscales and how they compared nationally to AMA data. And then it points them to resources that was really important for us to build in so that it wasn't just, Hey, take a survey and then walk away. We're not gonna talk about it again, but Hey, here's, here's how you performed on the survey and here's, uh, some, you know, resources based on, um, what you provided to us in the survey.
Speaker 3: (40:08)
That's great to add
Speaker 5: (40:09)
On to that,
Speaker 3: (40:10)
Given the data, uh, situation and the fact that, you know, we could help, we can collect data and aggregate. We could collect data at the individual level or in self-service tools, but unless leadership is focused on this issue and continually expresses as, as Mila pointed out willingness and readiness to, uh, assist, um, it it's, it's just gonna be another source of frustration for, for folks, right. Uh, and potentially source of alienations. So, um, who do you see as a leading institutions, um, aside from yourself and, um, what do you think they're getting right in regards to this?
Speaker 5: (40:54)
I, I, I'm gonna jump on this one. I think that nationally there has been a wealth of literature and groups looking at it from different angles nursing American hospital association, Stanford has an outstanding task force, uh, for physician wellbeing, that's been publishing and that's how we publish the sleep literature. I think what's lacking and academy national academy of medicine is trying to do that, is getting all of these separate task forces with AMA being one of them to work together, to contribute rather than to pull apart and have separate pieces developed separately. I think that, uh, I really loved our ability when we had it to be part of the wellbeing consortium with Stanford, because what really delivers is an integrated work that looks at the entirety of what clinicians experience is like. And it's really difficult to do without putting together multiple sets of minds in different clinical settings, outpatient and inpatient, or even non-clinical settings and how that impacts the clinician.
Speaker 5: (42:04)
So I think organizationally the success of those individual workforces, AMA Stanford wellbeing, consortium, national academy of medicine, just to name a few, and there are many, many more at the level of organizations for professional or non-professional clinical, uh, people, I think it's going to be in United uniting that work and really getting support nationally to say, okay, we're gonna normalize wellbeing at the level of behavioral health by pushing forward support for clinicians at the state level. So they're not afraid to ask for help. We're going to do this nationally for us to shift the culture individually and at the institutional level, I think without it, it's unlikely to be successful long term.
Speaker 3: (42:55)
That's helpful. Thanks. Um, Kira Cathy, any further thoughts on that?
Speaker 2: (43:01)
I would just add to it. Um, I, I, I used to work at the national academy of medicine and was part of the launch of the action collaborative. And our goal certainly was to bring these groups together nationally so that no one was working in silos. And I think that the action collaborative overall has been very successful in that they're going into their fifth year now, um, which I think is, is good to see from afar. We at the AMA participate as an organization in the collaborative. And I think that we didn't have everyone sitting at the same table agreeing on things like burnout is a systems issue. We have a systems problem here and we need to be working together to solve it. Um, I think if we weren't doing that, um, we would be much further behind than we even are. Now, the only thing I would add, and this isn't necessarily related directly to the question you asked, but I think is important.
Speaker 2: (43:44)
Nonetheless, is the need for more research into what works at a practice level or a hospital level. And from an intervention perspective, um, we are funding some practice, what we call practice science research, research grants, um, that look at interventions. Um, but I think we need more of that. We have a lot of data from primary care about what works in primary care when it comes to team based care, training up your MAs, um, EHR optimization projects, but we have much less when it comes to hospital based care. Um, what works, how teams should be structured, how do you have, how do you give people autonomy in that setting? Um, so I think, I think we just need a lot more research in that space, uh, specifically as well.
Speaker 4: (44:26)
I would agree with that. And one very basic comment I would make is I think we still are challenged to come up with a working definition of burnout. I noticed in your AMA survey, people identified burnout the way they identified it for themselves. So it's hard to know how to address it if everyone is defining it differently. Um, so, so figuring out what exactly the needs are and then figuring out how to meet them. And we've been, we've been working at that by having clinicians involved in the conversations about what would make your life easier. How can we address that? Some have said, this is what I need you to do for me. Others have said, I have this great idea that I would like to help the system launch. And so we've been open to that as well. It's, it's very, you know, a personal thing as to whether I need to be fed or whether I can help feed others at the moment, uh, based on how burned out I'm feeling. Um, the other thing that has really helped us is our CEO does a every other week, uh, broadcast for the entire organization where he continues to name that your wellbeing is important to us, to me as the CEO. And so we're putting things into place and it's going to be long term. Um, and that is something that is, has really helped us move this along and, and let people know that we're serious about it.
Speaker 3: (45:45)
Well, we, that that's helpful. Thank you. You know, we know that, um, when, when folks reach the point where they need behavioral health support, we also know that the system out there is already pretty, it's pretty difficult to get that support in many cases, uh, in the public realm. Um, do you guys, have you guys devoted specific resources at advocate Aurora around this, or, um, has this been managed largely through the EAP program model?
Speaker 4: (46:18)
No, it, I mean, we do have a, a robust EAP program, but we have added behavioral health providers, uh, in our behavioral health system and have put in place, um, an express lane, if you will, for our own clinicians and providers, that when they call, they can get an appointment within 48 hours as opposed to three weeks, um, kind of thing, again, showing that we are taking this very seriously and, and want to care for our, our own staff as well.
Speaker 3: (46:49)
Got it. We haven't talked too much about, um, and I know we, we discussed resiliency briefly when we, when we all met the first time a little bit. Um, but we haven't really touched on the self care resiliency piece of this, and we don't wanna overemphasize that because there's a lot more to it, of course, in terms of burnout, but, um, what, what are the, what are the resources that, uh, you guys have found to have high uptake in terms of improving personal resiliency?
Speaker 5: (47:24)
I think that I'm gonna start this one and pass it to Kathy and Kira. I think that what we've found is it really is dependent on what's going on during this COVID time when people were isolated, because of just inability to be in the same physical space with others, creating conversation surrounding some connection point book clubs, uh, art Institute of Chicago created some really wonderful events for us putting together women physicians organizing people around narrative medicine works because by pulling people into something they already are passionate about, they see a network that they could rely on. And with that, there are conversations that you could have related to what they're going through, but uniting them in a way of dealing with it that really have helped as we emerge now from truly, uh, being secluded with COVID for many, especially in ambulatory care, I think it will evolve in more of in person conversations in person events, in really integrating the gratitude moments into what we do, because we know that that really elevates immediately one's wellbeing. And so using what we already know, but integrating it into what the time is asking for and really promoting, learning about change, dealing with change as a component of our norm as we move forward with, because I think that for many years we were afraid of change and now we are trying to embrace it, but there's a certain amount of learning and cultural shift that goes into it. So integrating it in all we do in our different wellbeing events, I think is really important, Kathy,
Speaker 4: (49:09)
I agree very much with the, the change culture and helping people feel comfortable with it, as well as the collaboration culture of getting out of being just a lone ranger, so to speak and feeling free, talking to others, um, at some of the very basic levels around resilience during COVID, we were very aware of the need for providing healthy food options and having them available 24 7 to our care providers, as well as creating sleep rooms and saying, yes, you will take a half an hour break and go sleep. Uh, you know, you need to do that cause we care about you as we come out of COVID, we're looking at things like, um, we've had requests from our physicians, could the cafeterias make available so that I can order meals to go when I'm done working and pick them up and take them home, um, rather than needing to worry about going home and cooking meals. Um, when, when we didn't have kids in school and childcare was an issue, we provided a financial reimbursement for childcare to our physicians and team members who needed it so that they didn't have to worry as much about dealing with childcare issues. So finding ways to meet those very basic needs, that stress me out so much that I can't bring my whole self to work every day. Um, finding ways to address those. And some of those we will look at how do we continue that beyond COVID as well to make lives a little easier.
Speaker 3: (50:34)
Great. You add there, Cara,
Speaker 2: (50:38)
I echo everything my colleagues have shared, and I would just say this is less self care, um, resiliency related, but again, just coming back to peer support and the importance of peer support and what we've seen in our data, I would say almost every organization that we've worked with has instituted some kind of formal or informal peer support program. Um, and we've seen in the qualitative data, how important that's been to respondents. Um, I will just say there, if, if you can't yet put a formal or even informal program in place at your organization, there are resources out there to point people to peer support like programs. Um, one specifically, which I can add to the chat, um, is called peer RX med. Um, one of our colleagues, Dr. Mark ALD from the Carion clinic in Virginia has developed this and essentially just asks you to give yourself a buddy pair up with somebody and he writes and sends out prompts for discussion. It can be a simple, I wanna get a weekly text prompt so that I can check in with my, you know, battle buddy, um, or something, you know, more frequent if that's what you're looking for. So I'll put that in the chat, but I do think peer support has been throughout and will continue to be really important for organizations to consider,
Speaker 1: (51:45)
Uh, that are, uh, GI given the time. Uh, it seems like a perfect place to, uh, start to wrap things up. Um, so thank you so much, Kathy and ne and Kira and Scott for sharing your perspectives and for what is really a very important, uh, conversation. Thank you everyone, uh, for joining us, thank you again to our, uh, panelists and I hope you enjoy the rest of your day.
Speaker 6: (52:11)
Speaker 2: (52:13)