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Creating Joy in Medicine™ in Baltimore, MD: A Case Study

Johns Hopkins Medicine (JHM) is an academic health center located in Baltimore, MD, that employs more than 40,000 full-time faculty and staff and has more than 900,000 outpatient visits annually. Like others across the country, the center faces the pressures of learning to use electronic health records (EHR) systems, reimbursement challenges and new reporting requirements. Recognizing the negative impact this ever-changing healthcare environment could have on its faculty and staff, JHM leadership decided to be intentional about cultivating joy so that clinicians are cared for and have the support they need to thrive.

JHM identified concrete strategies that would make their practice environment supportive, nurture careers, protect work-life balance and most importantly, help all members of the care team retain fulfillment in their work. Several efforts described here have been underway for years under the auspices of the Office for Faculty Development, the Clinical Practice Association, Human Resources and other groups throughout JHM. To centralize and accelerate this work, JHM recently established a Joy in Medicine Task Force that will focus on identifying the main barriers to professional enjoyment and outlining strategies to preserve and enhance joy. The Joy in Medicine Task Force will produce a white paper assessing the current environment at JHM, reviewing peer institutions and issuing specific recommendations for improving satisfaction. The task force has broad representation of volunteers from the organization's six hospitals, physician practices and nursing community. The five workgroups within the task force focus on support for academic and clinical success, EHR workflow, culture and work-life balance, regulatory training and clinical operations.

Although JHM conducted an annual employee engagement survey and used the results to develop interventions long before the Joy in Medicine Task Force was formed, they understood that “joy” and the repercussions of losing joy in practice may not be fully measured with this method. Their first step to gauge how staff felt was simply to ask them. To generate the blueprint for all the work around “joy,” they needed feedback. Ongoing polling of teams, meeting with various groups and most importantly, listening, led to a better understanding of what the organization can do to support clinicians, make their work more rewarding and help them achieve their professional goals. They recently introduced departmental reviews to give faculty members a confidential forum to comment on their work climate and provide feedback about how the organization can help to better facilitate their work. They also developed a new survey based on a validated burnout survey with additional questions tailored to the JHM practice environment. This new survey does not replace the engagement survey but will be administered to faculty, clinicians and nurses to specifically measure job satisfaction.

With the help of these surveys, the task force and feedback from clinicians, JHM identified the following programs and resources to improve the practice environment and keep clinicians engaged:

  • A new awards program to recognize and honor excellent clinicians and care teams

  • A clearly outlined path to promotion for clinically focused faculty

  • Small-group leadership programs that not only provide career development but also forge strong bonds among the graduates in each cohort

  • A Research Council that is wholly focused on identifying and decreasing barriers to scientific productivity across the enterprise

  • Methods to improve processes, such as a project addressing perioperative throughput and hiring outside consultants to advise on operational efficiency. They built a command center at the flagship hospital, which co-locates teams and equips them with real-time data so that they can more effectively communicate with each other to improve patient flow and reduce wait times

  • Continuing education courses, such as “Thrive After Go-Live” for community physicians using EPIC to address EHR pain points and “Economics of Clinical Operations,” which aims to educate clinicians about practical finances, funds flow and new payment models

  • A program aimed explicitly at buffering against burnout called “Finding Joy and Cultivating Joy at Work”

  • A mindfulness-based stress reduction workshop open to all faculty, which proved so popular that one course was filled in under an hour after registration opened

  • A speaker series that invites experts in the areas of humanism in current-day medicine and professional satisfaction and burnout

  • Emphasis on improving culture by creating a supportive work environment that respects and promotes work-life balance for physicians

  • Above all, JHM recognizes that clinicians derive fulfillment from their relationships with patients—getting to know them, partnering on their care plans and watching their health improve. They have introduced scribes in some specialties and are soliciting more strategies for freeing up time for clinicians to spend on direct patient care - recommendations that will be included in the task force's white paper.

JHM also identified the need to provide its medical trainees with a similarly supportive work environment. Medical residents work long hours at the edge of their abilities, in a setting that makes it hard to call on their social support system, making the risk of depression very real. To mitigate this, JHM added introspective and restorative elements to the residency program and encouraged trainees to embrace self-care strategies. For example, the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center now cover the annual cost of a membership for every resident to the fitness center on their respective campus. In addition, the School of Medicine hired an Assistant Dean for Graduate Medical Education who will devote half of her effort to wellness initiatives for residents and fellows. JHM realizes these earlier interventions are needed—and may lay the groundwork for resiliency over one's career.

Dr. Paul Rothman, Dean/CEO for JHM, says “It's hard to imagine a more critical issue for health care leaders than combatting burnout and attrition, because our people truly are our most precious asset—the heart and soul of our institutions. Moreover, study after study shows that happier care providers are better care providers, so this is not just a human resources issue. It's about quality of care and doing what's best for our patients.”

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