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Creating Joy in Medicine™ in Salt Lake City, UT: A Case Study

STEPS in Practice

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University of Utah Health (UUH) is a large academic medical center that relies on more than 1,400 physicians to staff their integrated health system. UUH recognizes that prioritizing the health of their workforce is vital

In the winter of 2016, in response to increasing rates of burnout at the national level reported in the literature and lay press and a perceived need to address this issue at the system level, the chief executive officer (CEO) of UUH asked for a concerted effort to address the needs of faculty across the institution and to develop reportable metrics around wellness. This effort began with the addition of a Chief Wellness Officer, who expanded existing efforts and helped initiate many new wellness-specific programs, including the establishment of a Resiliency Center with the help of a multidisciplinary committee. This work not only focused on the needs of UUH faculty, but also took a thoughtful look at how the organization supports staff and medical trainee well-being. Under the direction of its Graduate Medical Education (GME) office, a multidisciplinary GME Wellness Committee was convened in 2015 to outline a GME-specific wellness program. A Director of GME Wellness was hired in the spring of 2016.

UUH initiated a multifaceted assessment of the current state of burnout among their faculty to guide the new wellness program creation. UUH partnered with the American Medical Association (AMA)-American College of Physicians (ACP) Wellness Pilot for data analysis and guidance. UUH conducted the AMA's Mini-Z survey with additional questions geared toward understanding the needs of academic faculty, such as:

  • Hours of direct outpatient or inpatient care

  • Average number of patients seen in a four-hour shift

  • Average daily census

  • Feeling of support/appreciation by peers, patients, families and/or immediate supervisor

  • The three main sources of dissatisfaction with practicing medicine

  • Ratings of clinical support from medical assistants and nurses

The Mini-Z data was collected along with a needs assessment of possible programmatic targets. This data was also complemented by additional surveys to gain an understanding of burnout challenges as they relate specifically to the institution. The Diversity Engagement Survey (developed by the Association of American Medical Colleges; AAMC) is disseminated by the UUH Office of Health Equity and Inclusion every two years to faculty, staff and students in the health sciences. This survey is conducted to understand how diverse groups engage with the institution. Additional information was gathered from the StandPoint Faculty Engagement Survey (formerly known as Faculty Forward). Faculty Forward is run by Human Resources and is used to diagnose areas of faculty engagement and effectiveness of faculty-related institutional policies and practices in the domains of engagement.

The AMA analyzed the-Mini-Z data and the findings were combined with in-house analysis of unique questions and additional surveys to yield benchmark data for UUH. The Chief Wellness Officer and one of the faculty co-directors of the Resiliency Center then met individually with leadership from each of the departments within the School of Medicine to identify areas of strength and opportunities for improvement. Each department, both clinical and non-clinical, selected one or more wellness champions to develop projects to meet identified departmental wellness priorities, using specific and relevant metrics. Metrics included patient satisfaction, number of patients being served, electronic health record (EHR) efficiency and provider engagement. A range of projects focused on topics such as personal wellness and resilience and advanced models of teamwork facilitation, clinic flow, EHR use and flexibility of hours. Quarterly meetings with the Chief Wellness Officer and co-director of the Resiliency Center are held with the wellness champions to assist them in their project development and implementation. The last meeting of 2017 will be a poster session where projects will be shared to encourage future collaboration in wellness initiatives.

Simultaneously, UUH began cataloging existing programs that were already addressing faculty and staff wellbeing, looking for synergies and opportunities for collaboration. Among these programs, the Office of Wellness and Integrative Health and the Office of Health Equity and Inclusion collaborate on a weekly Community Read. The Community Read is similar to a book club or a journal club focused on a specific topic or area. The focus of the winter 2017 semester's readings was the science of wellness and exploring the relationship between inclusion and wellness and wellness and quality. UUH believes that an inclusive environment leads to a well environment and a well environment leads to quality.

As momentum continued to build around wellness and burnout prevention at UUH in 2016, a group was formed to specifically discuss provider resilience. Initially sparked by a conversation between risk management and health system senior leadership regarding concerns around providers dealing with poor outcomes, the group's target quickly expanded to include all faculty and staff. It was this group that developed the new Resiliency Center in 2017. This Center was created to bring together the extensive wellness programs already in existence, build novel resources, and create a hub that serves as a crucible for innovative ideas. The Center coordinates closely with undergraduate medical education (UME) and GME wellness efforts, including hosting joint wellness champion meetings, mindfulness training, and a peer-to-peer counseling program. The Resiliency Center is helping providers become more resilient by encouraging innovation, helping focus energy, maximize impact and avoid duplication of effort across organizational wellness initiatives.

UUH wellness efforts have been strengthened by senior leadership support including from the Senior VP's Office and the Office for Health Equity and Inclusion. A clear case was made that resiliency and wellness efforts were likely to advance operational goals, such as provider/staff engagement, patient satisfaction, patient safety, operational efficiency and productivity. Wellness initiatives at UUH also benefit from access to existing resources, the collaborative nature of The University of Utah and use of the American Medical Association-American College of Physicians Wellness Pilot for data analysis and benchmarking.

Over the next year, UUH will continue to look for ways to collaborate with existing programs in the further development of the Resiliency Center and expand the number of wellness champions to include additional faculty and staff. Additionally, they plan to complete an annual follow-up burnout survey using the Mini-Z instrument. UUH knows they must make the wellbeing of people in their system a permanent operational goal.

Where CME credit is designated, the activity is part of the American Medical Association's accredited CME program. The AMA is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
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