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Learn how COlleagues Meeting to Promote And Sustain Satisfaction (COMPASS) groups build a sense of community to reduce burnout and distress felt by isolated physicians.
In 2007, the Mayo Clinic Department of Medicine created the Program on Physician Well-Being (PPWB) to better understand the entire spectrum of personal, professional, and organizational factors that influence physician well-being. This effort was led by Tait Shanafelt, MD, Lotte Dyrbye, MD, and Colin West, MD, PhD. The program spanned across disciplines, including medicine, psychology, and health science research. In the first few years, the focus of the PPWB was on establishing the epidemiology of burnout and distress. Based on institutional and national survey studies, it became evident that burnout is highly prevalent among physicians across all specialties. The drivers vary from practice to practice, but include excessive workload, inadequate support at work, work-home conflicts, loss of control, and diminished meaning and purpose from work.
The PPWB's research on the epidemiology of stress and burnout made it clear that they had to address these problems, but they weren't sure what would work best. Therefore, they decided to conduct randomized trials of interventions designed to reduce distress and promote well-being. One of the ideas tested was to hold small, organizationally supported physician group meetings oriented around topics reflecting common stressful physician experiences. This initiative was called COlleagues Meeting to Promote And Sustain Satisfaction, or COMPASS.
COMPASS groups build on a sense of shared community as one of the great virtues of physician-hood. Mutual support from colleagues to deal with the challenges of their field has long helped physicians manage the stress related to practicing medicine and derive meaning from their work. Increased expectations about productivity and other changes to practice over the last several decades have decreased the time physicians must interact with colleagues and have eroded personal connections to colleagues. The goal of the COMPASS group meetings is to encourage collegiality, shared experience, connectedness, mutual support, and meaning in work, thereby promoting well-being and reducing burnout and distress.
COMPASS groups consist of 6 to 10 physicians, with 1 group leader responsible for organizing hour-long meetings twice per month over a 6-month period. Each group is asked to meet in a relatively private setting (eg, a restaurant near campus or a reserved meeting room) rather than a public space where interruptions are likely. Group leaders are provided with 3 to 4 discussion topics or specific questions for each session. Examples include:
Think about one of your most satisfying days at work over the last month. What made this day so professionally satisfying? Share with your colleagues.
Brainstorm ways to promote collegiality in your hallway or work unit.
Choose 1 stressor that you can control, come up with 2 concrete ways you can reduce it, and commit to trying 1 approach within the next week.
The first 15 minutes of each meeting are dedicated to semi-structured discussion involving a check-in and a dialogue about 1 of the assigned topics for the session as selected by the group. The remainder of the time can be used for additional discussion or socializing and building relationships with colleagues.
Internal studies found measurable benefits from participation in the COMPASS group meetings, including reduced burnout, increased well-being, improved meaning from work, reduced social isolation, and improved job satisfaction. Due to the success of these early studies, Mayo Clinic leadership continues to support this program with funding derived from clinical sources within each hosting department.
As of July 2017, nearly 1500 physicians and scientists have signed up to participate in a COMPASS group, representing 40% of eligible individuals across all Mayo Clinic sites. At the end of the first 6-month period, more than 95% of group leaders reported that the groups were valuable and that they planned to continue meeting.
Although this program has been successful, lessons were learned during implementation that may prove helpful for other institutions and practices considering a similar effort.
Administrative support is required. Although groups are responsible for their own scheduling, sometimes they need assistance to keep track of members and maintain a point of contact should issues arise. To support this task, an internal website was built with links to contact information, lists of discussion topics, and other guidance for participants. The program also has a dedicated support staff member with a small amount of institutionally directed time for this role.
Anticipate the needs of group members who want to participate beyond 6 months. Many groups expressed interest in extending their enrollment beyond the initial 12-session period. Discussion topics are available to support roughly 3 rounds of the program. Beyond that, groups may need to repeat topics as additional content is developed.
Be flexible with group assignments. Some individuals will only participate if their close colleagues also sign up, whereas others will only participate in groups outside of their clinical circles. Flexibility in group assignments is critical to respect these wishes and provide each participant with the optimal setting for maximal benefit.
Identify a suitable mechanism to protect time and resources. Reimbursement through existing institutional mechanisms such as a corporate travel card is much less resource-intensive than processing thousands of one-off receipts for payment. According to participants, the most challenging aspect of the COMPASS groups is making the time to engage meaningfully with their colleagues. This challenge speaks to the importance of efforts to prioritize opportunities for physicians to engage together as a community.
Mayo Clinic leadership, the PPWB, and COMPASS participants have spread the word about the effort. This opportunity for community-building is presented to all new staff during their orientation process. Many physicians have joined in the second wave of groups based on word-of-mouth from members of earlier groups—even as finding time to meet proves challenging, groups find value in the program and have continued to enroll.
There is no single solution to the physician burnout crisis. However, each additional evidence-based tool added to the menu of interventions an organization can provide increases the chance that every physician will benefit in some way. Ultimately, the hope is that patients will receive care from physicians who find joy, purpose, and meaning in their work.
The Mayo Clinic Program on Physician Well-Being was established to conduct and promote innovative research focused on physician well-being. Research led by the team has established that physician burnout threatens the quality of patient care, patient satisfaction, access to care, and physicians' lives.
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