Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.
Christine Sinsky, MD: Well, hello. It's my pleasure today to be speaking with Dr Tait Shanafelt, chief wellness officer at Stanford Medicine. Dr Shanafelt is also the associate dean at the Stanford School of Medicine and the director of the Stanford WellMD Center. We are very pleased to have Dr Shanafelt as an author of four of our STEPS Forward® modules. So, Tait, thanks so much for taking the time to share your wisdom with us.
Tait D. Shanafelt, MD: Thanks, Chris. Great to be with you today.
Dr Sinsky: A few years ago, you became the first CWO at a health care organization in the country. As you think back on your early days and your early months, what advice can you now give to newly minted CWOs? What are some of the first things a CWO might consider doing in this newly established position?
Dr Shanafelt: It's an important question of what are some of the first things that CWOs should do. And I think it's always tempting to just jump in and start doing things and making change. But prior to that, I think some of the most important early steps are to make sure you've defined sort of the scope that you are responsible for and the charge your organization has given you. A second piece is really to take enough time to diagnose your organization and develop some organizational intelligence about, you know, why your organization is committed to this, how decisions are made and by who in the organization is a really important initial step. We need to then, you know, sort of in a related sense, define the current state as well as the desired future state, that often if not already done, does involve collecting some baseline assessments of where things are getting a lot of input from the physicians in the organization, and then to use sort of that assessment of current state and, and then where you're desiring to go to develop a system-level strategy of how you're going to get there.
For most of us, there just are so many things that could be done, many of which are worthwhile, but you will not be able to do them all. And so, the strategy really helps you hone down on the critical few, that you have prioritized as the most important to address the needs for the organization now. And it can, I think help you avoid, you know, one of the other, you know, challenges of sort of just taking on too much, too fast. I think one of the other things that's easy to miss is developing a really robust communication infrastructure, which involves both listening and disseminating information and messaging. And then thinking about how are you going to measure progress? If the initiatives we do implement, and as we execute on our strategy, if we're successful, how are we going to measure our progress toward that ideal future state? So, I think those are maybe some early things to reflect on before just diving in.
Dr Sinsky: What advice, what wisdom do you have around some of the common pitfalls and how one might be prepared for them?
Dr Shanafelt: I think one of the first would be failing to develop a strategy and often kind of say, you know, confusing a collection of tactics as being a strategy, rather than having a very clear sense of where the organization is, where it needs to go. And what are the very specific and limited number of initiatives that are going to help in that regard? I think a second is taking too narrow a focus on personal resilience, because it's easier. You know, it's much simpler to create courses, initiative resources for individuals than it is to try to bite off structural change, improving the efficiency of the practice environment, really evaluating what things in our culture or our, our leadership behaviors as an organization need to change. And beginning to try to advance those things is much more difficult, but we are not chief personal resilience officers.
And so, I think, you know, making sure that that's one important component, but really doing the difficult work and the more challenging work around the practice environment, the culture and our leadership. I think another piece is focusing too heavily, only on the organization-wide level factors, rather than the work-unit-specific factors. And when we're doing that it's sort of tempting again, to just only focus on these broad initiatives that sort of, I guess, would be viewed as raising all boats, but oftentimes those are not the highest priority aspect to be addressed for any of the individual units. And so, we come across as maybe being out of touch with the greatest issue for each unit individually, and those individual work unit factors oftentimes are things that can change faster. And so, I think we need to have that attention to both the broad and the targeted opportunities and building out a process that will systematically engage all units in those unit-level factors. Even as we're biting off and trying to move the broader ones, takes thought and attention and structure to advance. So, I think those are some of the key things. The last one maybe just I'll mention is picking the wrong metrics for progress. And I think it's easy to confuse measures of organizational progress with measures of progress for your team and your office.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA's STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward® can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.
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