How Will This Toolkit Help Me?
This toolkit will help individuals develop and succeed in the chief wellness officer (CWO) position at their health care organization by providing a step-by-step guide for defining the scope, building a team, identifying resources, developing a strategy, establishing partnerships, setting performance metrics, and avoiding common pitfalls.
Leading organizations are creating a new C-level executive position called the chief wellness officer (CWO) to systematically improve well-being among physicians and other health care professionals. Once the organization has established the position and chosen a CWO, the CWO must implement specific and effective strategies for change. For individuals wanting to learn how to lay the foundation for such a position at their organization, visit the STEPS Forward® toolkit, Establishing a Chief Wellness Officer Position. For new CWOs, this toolkit is designed for you, outlining a step-by-step approach to executing and succeeding in your new role.
Nine STEPS for Leading Change as a New Chief Wellness Officer (CWO)
Clearly Define Your Scope and Charge
Study and Understand Your Organization
Build Your Team
Identify Existing Organizational Programs, Gaps, and Resources
Define and Develop Your Team's Mission and Strategy
Establish Partnerships, Thematic Task Forces, and Distributed Leadership
Develop a Bidirectional Communication Strategy
Set Performance Metrics for the Organization and the Team
Avoid Common Pitfalls and Mistakes
STEP 1 Clearly Define Your Scope and Charge
When assuming your CWO leadership position, an important first step is to be clear about your scope and charge. Chief wellness officer roles in health care organizations fill a gap in an organization's efforts to build a practice environment that cultivates engagement, well-being, and esprit de corps.1 In industries like manufacturing or technology, the human resources department typically houses the CWO role; their primary purpose is to reduce health care expenditures by encouraging healthy lifestyles and individual approaches to foster stress reduction and personal resilience. CWOs in these organizations typically oversee all employees, including any number of what could be vastly different job descriptions, each with their own obstacles to reducing stress. The original focus of CWO roles in organizations like these, coupled with the need to reach all workers in dramatically different job types, generally results in efforts focusing on the individual (eg, personal resilience, mindfulness, exercise, self-care, etc.).
The health care CWO has a dramatically different role and function.1,2 While individual well-being resources are still important, the health care CWO's main focus is on addressing the unique needs of health care professionals by improving the efficiency of the practice environment, reducing unnecessary administrative burdens, supporting work life integration for clinicians, and improving organizational culture.3 Examples include4:
Your organization should have already decided whether the CWO position is responsible for physician well-being only or if it is responsible for the well-being of other members of the health care team, as well. Whatever your organization decides, keep your focus on the target group. Much of the CWO's work intersects with efforts of other functions within the health care organization; it is also necessary to coordinate efforts with these areas.
Strategy
As CWO, you and your team will set the strategic vision of why and how the organization will improve the work environment to advance the well-being of health care professionals. This project will involve making the needs of physicians and other clinicians a fundamental consideration in all organizational decisions. CWOs must oversee the development and execution of the organization-wide strategy to advance professional well-being and lead the implementation of numerous targeted initiatives and tactics.1 There are many potential improvement opportunities, and no CWO or organization can take them all on at once, no matter how authentic their commitment. It is critical to identify and ensure the success of the most important strategies for organizational progress. To effectively drive forward those most critical, the CWO may be required to say “no” to other worthy endeavors.
Advocacy
As CWO, you perform an indispensable function as a physician advocate and organizational influencer that may be analogous to the chief quality officer, chief medical officer, or chief patient experience officer. The goal of these efforts is to serve as a catalyst to spur the evolution of the organizational culture toward more affirmational qualities, including:
Assessment
CWOs are also typically directly responsible for assessing professional fulfillment and distress, benchmarking the organizational experience relative to other medical centers, and tracking these measures over time.6 This data must be granular at the work-unit level (department, division, section, or clinic) and used to:
Engage the leadership of those work areas
Provide support and guidance on how to deploy tactics for improvement
Support local efforts to make progress
In addition to systematically engaging all units, you should also use this data to identify hot spots that require greater time, attention, and support from leaders outside the work unit to make progress.
Table 1 describes how 4 different organizations have defined the scope and responsibilities of the CWO and their location in the organization's leadership structure. Additional considerations regarding the CWO role and job description are provided in the STEPS Forward module, Establishing a Chief Wellness Officer Position.
How Do I Set Up a CWO Position at My Organization? Real Life Examples From 4 Organizations (277 KB)
STEP 2 Study and Understand Your Organization
Before you can start implementing and tracking new initiatives in your role as CWO, you must have a strong foundation of knowledge regarding the gaps and needs of the organization. The following areas of focus are fundamental:
Organizational structure in terms of size, geographic distribution, number of sites, and leadership hierarchy7
Relationship of the organization to its physician workforce—direct employment, an open staff model, an affiliated network, or some combination of these—and the reporting structure for overseeing these individuals
Key priorities outlined by the executive leadership team and typically articulated in the organization's strategic plan. Priorities may include expanding access, improving quality, market expansion, evolving toward new payment models, pursuing contracts with local employers, or preparing for value-based payments
Current financial health of the organization
Existing reputational strengths and risks
External landscape and competitiveness of the practice environment in which the organization functions
Once these broad organizational factors are understood, it is also crucial to obtain quantitative data. Such assessment typically involves an institution-wide survey of physicians and other professionals within the CWO's scope. Such surveys should include standardized and validated instruments for which there are national benchmarks and that holistically evaluate dimensions of professional fulfillment and occupational distress. Examples include the Well-Being Index by Mayo Clinic, the Stanford Model of Professional Fulfillment™, the Maslach Burnout Inventory, and the AMA Organizational Assessment.
Quantitative data can catalyze qualitative conversations throughout the organization. Deploy a Listening Campaign to further understand the data and how it intersects with physician perspectives and experiences at your organization. A Listening Campaign can involve sharing survey results with different work units, obtaining feedback on whether the results accurately reflect experiences, and soliciting input on the greatest system-wide and local opportunities for improvement.8,9
At this juncture, it is important to emphasize that the organization is at the data-gathering stage and will use this input to prioritize the issues it will address. Avoid setting the expectation that the CWO and institutional leaders will fix every problem articulated in these sessions. These conversations can also include discussing positive elements using the appreciative inquiry framework. Appreciative inquiry asks session participants to articulate 2 or 3 aspects of their work that are going well in addition to the 2 or 3 most frustrating things.
Building the team is an essential early step for a CWO who is founding a center or program. The optimal timing of your effort in the sequence of other activities can be somewhat flexible. After determining your position's scope, role, and structure, many of the specific functions and skills required for your center will become apparent. Your team should include:
Administrative or operational leaders
Administrative assistants
Project managers
Statistics and methodology experts
Event planners
Communications professionals to assist with both external and internal communication
While all centers will need to attend to some of these roles, such as communications, for many centers, the other roles are best contracted or outsourced (eg, survey administration and statistical analysis).
STEP 4 Identify Existing Organizational Programs, Gaps, and Resources
Quiz Ref IDBefore devising the organizational strategy, you and your team must identify what programs, resources, and activities are already in place to advance your efforts. Most organizations have existing training and activities to promote personal resilience. Others have formalized programs to advance professionalism, leadership development, teamwork, and diversity and inclusion. The goal for your team is not to take over all these activities or topic areas but to:
Integrate support and increase utilization of programs and resources that already exist
Identify notable gaps that new efforts could fill
It can also be informative for you and your team to understand what previous initiatives the organization has tried and discontinued due to lack of interest, low efficacy, unsustainable costs, or other factors.
To facilitate these efforts, you should meet with other relevant organization leaders, including the:
Chief quality officer (CQO)
Chief medical officer (CMO)
Chief experience officer (CXO)
Chief medical information officer (CMIO)
Chief diversity officer (CDO) or other leaders of diversity and inclusion
Chief human resources officer (CHRO)
Chief operations officer (COO) and other key members of the operational leadership team
These meetings can provide an understanding of what activities and efforts these leaders have in their respective portfolios and allow you, as CWO, to ensure that new initiatives are complementary and integrated into existing programs. As part of these meetings with the other executive leaders, you may also begin to discern which are natural allies and which may be more resistant to some well-being programs, plans, or initiatives.
STEP 5 Define and Develop Your Team's Mission and Strategy
Once your team is in place, the priority is to define and develop your team's mission and a strategy to achieve it.
While the mission for your center or program can typically be developed in a single brainstorming session or over a few days, developing a cogent strategy typically takes several months and requires extensive input and review from stakeholders both inside and outside the center. Your organization's unique opportunities, priorities, gaps, and resources will direct your strategy.
The strategy should specify a limited number (3 to 5) of long-term focus areas. A well-developed strategy will undergo minimal changes from year to year, even as the tactics to advance that dimension of the strategy change. Many physicians have limited experience with strategic thinking and strategic planning. They often mistake a collection of tactics or a conceptual framework for a strategy; this is a critical error. Deploying an array of tactics without considering a plan's core dimensions typically results in a fragmented and ineffective effort to make organizational progress, even if the tactics themselves are proven effective.
The strategy of one organization cannot simply be wholesale adopted by another organization. Again, conceptual frameworks are not the same thing as a strategy.17,18 Conceptual frameworks are, by design, holistic overviews intended to provide a comprehensive view of the variables contributing to the challenge and/or the opportunities. No program, however, no matter how robustly staffed or resourced, can effectively advance all components of such models at one time. One of the most critical elements of a strategic plan is to help determine what the team will doandwhat it will not do. Developing a strategy is best done as a team, followed by vetting and input from multiple leaders and advisors. Published literature can provide design considerations for strategic plans for organizational well-being programs, and executive-level training courses for CWOs can assist with the strategic planning process.19,20
STEP 6 Establish Partnerships, Thematic Task Forces, and Distributed Leadership
To be effective as CWO, you will need to develop partnerships with other executive leaders, such as the CMO, chief clinical officer (CCO), CXO, CHRO, CMIO, and COO. If you work in an academic medical center, you will also need to collaborate closely with the deans of undergraduate and graduate medical education, the dean of faculty development, and the ombudsman.
In addition to these enterprise-level partnerships, a successful CWO must regularly interact with department chairs and hospital executives. It can also be helpful to build a network of local well-being leaders within each department or work unit. These department or work-unit-level leaders should receive basic leadership training before helping to implement local tactics and acting as a conduit for bidirectional communication between the CWO and the CWO's teams.
As CWO, you may periodically commission thematic, time-limited task forces to help the organization progress on specific issues spanning multiple organizational groups or departments. Such task forces may focus on the needs of physicians at different career stages, the needs of physician parents (such as breastfeeding mothers), or other topics. Quiz Ref IDEven though others will lead these task forces, you should not underestimate the logistical support and time demands such task forces require. You and your team may help craft the task force mission, charge, and timeline before appointing other institutional leaders to lead the task force. Generally, a CWO should not oversee or commission more than 1 task force per year. Accordingly, you should identify, prioritize, and commission potential focus areas for task forces in sequence.
Unless coordinated and commissioned together, you must also take care not to commission task forces on topics squarely in the leadership purview of other executives—particularly the CQO, CHRO, CMIO, or COO. Task forces that fall under this category of joint coordination and commission include those focused on:
Other broad task force topics, such as specific dimensions of organizational culture, should typically be launched by the dean or CEO rather than the CWO. In these cases, your role as CWO may be to chair, rather than commission, the task force. Other topics, such as efforts focused on practice efficiency, are typically best addressed at the work-unit level and not by an enterprise-level task force.
STEP 7 Develop a Bidirectional Communications Strategy
Physicians need to know what their organization's leaders are doing for professional well-being and that they have a voice in these efforts; this is the guiding principle of a bidirectional communications strategy. You can find examples of essential components in a successful communications strategy in Table 2.
STEP 8 Set Performance Metrics for the Organization and the Team
As CWO, you should review and decide upon performance metrics for both your organization and your team.1,5These metrics are discussed in detail in the STEPS Forward toolkit,Establishing a Chief Wellness Officer Position. Remember the critical distinction between organizational metrics (Table 3) and metrics for you and your team (Table 4). CWOs cannot be held responsible for the burnout scores of their organization but can and should be responsible for providing education, advocacy, and leadership, as well as developing a strategy to guide the organization.
Many other factors that are dominant determinants of well-being are not under a CWO's control. These factors can include:
Productivity expectations
Adequacy of staffing
Compensation models
Organizational leadership
Teamwork characteristics
Transitions to new facilities
EHR characteristics or features
You and your team cannot fix many of the local department-specific or work-unit-specific issues that frustrate care team members. Although you and your team can help identify these issues and support work-unit-level efforts, addressing these issues is the responsibility of the local work unit leaders. Accordingly, the high-level outcome metrics of the well-being and professional satisfaction of the organization's physicians and other clinicians are a shared responsibility of all organizational leaders. Such a framework is consistent with the shared responsibility of corporate leaders for quality outcomes, financial performance, and other measures.
STEP 9 Avoid Common Pitfalls and Mistakes
Common pitfalls and mistakes for a new CWO include:
Conflating metrics of organizational progress with the metrics of CWO efficacy
As discussed, you and your team do not have direct authority over many organizational decisions and factors that impact professional fulfillment (eg, productivity expectations, leadership, staffing, workflows, the EHR, and the efficiency of the practice environment). Therefore, it is critical to distinguish organizational metrics and goals from the measures by which the organization will assess the efficacy of you and your team.
Failing to develop a strategy
Another common pitfall is failing to invest the appropriate amount of time in developing an organizational strategy. Deploying an array of tactics, even if they are proven effective, is unlikely to lead to organization-level improvement. A well-thought-out organizational strategy is necessary for the team to identify and prioritize critical focus areas and the worthwhile alternative opportunities that you will pursue later.
Rushing to build your team
Selecting the right team members, hiring, and onboarding these individuals, and deploying them in alignment with the strategy all take time. This process takes 6 to 12 months, even in optimal circumstances. Although you can move some of the elements described in this toolkit in parallel with team building, fulfilling many of your center's initiatives and actions will require you to complete this process first.
Trying to directly oversee too many initiatives
Although you and your team will need to develop and implement a number of your own initiatives, other efforts require partnering with other leaders and groups in a supporting or advisory role instead. Trying to oversee or execute too much puts your team's well-being at risk and is a recipe for failure.
Trying to do too much too fast
The natural tendency for a new CWO is to hit the ground running. However, CWOs must be careful not to launch too many initiatives too quickly. Doing so often decreases the effectiveness of all endeavors. It is more important to start with a limited number of projects and activities to gain traction before expanding the portfolio. Given the extent of the need and the breadth of the opportunities you might pursue, adhering to this principle requires substantial discipline—even with a well-devised strategy.
Becoming the complaint department
Distress and frustration among physicians are widespread and substantial. Once a CWO is appointed and a center created, these individuals can finally express their dissatisfaction, concerns, and ideas. This often results in individuals directing all types of complaints to CWOs and their teams. An influx of complaints presents a dizzying array of challenges, including many far beyond a CWO's scope and responsibility. CWOs have received complaints or requests about:
Policy changes to allow physicians to bring their pets to work
Length of commute
Lack of parking
Lack of on-site childcare
Cost of living in the community
Cleanliness of the call rooms
Firing certain physicians
Terminating all the administrators
Invalidating efforts to uphold professional standards
Although you and your team can listen respectfully and acknowledge the concern/complaint, you should avoid becoming the clearing house for all complaints about the organization. Doing so will distract you from pursuing your strategic priorities.
Trying to please everyone
Much like thinking the CWO's center is the complaint department, people tend to believe their pet project or activity should be and will be prioritized for implementation by the CWO's team. This is not feasible given the limited time, attention, and resources available; it is not a successful path to organizational change, either. You will inevitably face criticism as a result of this, and it is helpful to have “thick skin” in this regard.
Becoming a personal resilience officer rather than the CWO
Your primary function as CWO is not to develop a portfolio of personal resilience and self-care offerings. However, because such individual offerings are relatively easy to make and give the illusion of progress, many CWOs initially devote attention to such activities. Although systematic efforts focused on improving the efficiency of practice, optimizing workflows, evolving leadership behavior, and addressing problems with the organizational culture take more time, they are the initiatives that will ultimately result in a more significant impact. It is thus imperative to invest the energy necessary to launch such efforts rather than focusing exclusively on personal resilience offerings or devoting the majority of your energy to initiatives targeted to individuals.
Failing to develop a robust communication arm
Failure to build the infrastructure to facilitate bidirectional communication between the CWO's program and the physicians in the organization can be consequential. Even when a CWO and their team are effectively executing their strategic plan and making progress on multiple fronts, it is challenging to keep physicians across the organization informed of these efforts. Poor communication could lead physicians and the organization to perceive the CWO as ineffectual, and the CWO may miss valuable opportunities to foster organization-wide well-being.
A CWO is a unique and vital leadership position within a health care organization. Using an established road map to success can help recently-appointed CWOs navigate this new territory.
Journal Articles and Other Publications
Chief wellness officer
Kishore S, Ripp J, Shanafelt T, et al. Making the case for the chief wellness officer in America's health systems: a call to action. Health Affairs Forefront. October 25, 2018. doi:10.1377/hblog20181025.308059
Shanafelt T, Farley H, Wang H, Ripp J; CHARM CWO Network. Responsibilities and job characteristics of health care chief wellness officers in the United States. Mayo Clin Proc. 2020;95(11):2563-2566. doi:10.1016/j.mayocp.2020.09.004
Brower KJ, Brazeau CMLR, Kiely SC, et al. The evolving role of the chief wellness officer in the management of crises by health care systems: lessons from the COVID-19 pandemic. NEJM Catal Innov Care Deliv. 2021;2(5):10.1056/CAT.20.0612. doi:10.1056/CAT.20.0612
Castellucci M. Chief wellness officer role at the center of effort to reduce burnout. Modern Healthcare. March 9, 2019. Accessed January 29, 2023. [requires subscription] https://www.modernhealthcare.com/physicians/doctor-burnout-targeted-hospital-chief-wellness-officers
The practice transformation journey. American Medical Association. Accessed February 26, 2023. https://www.ama-assn.org/system/files/2020-09/practice-transformation-toolkit.pdf
Well-being and burnout
Shanafelt TD, West CP, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life integration in physicians during the first 2 years of the COVID-19 pandemic. Mayo Clin Proc. 2022;97(12):2248-2258. doi:10.1016/j.mayocp.2022.09.002
Han S, Shanafelt TD, Sinsky CA, et al. Estimating the attributable cost of physician burnout in the United States. Ann Intern Med. 2019;170(11):784-790. doi:10.7326/M18-1422
Shanafelt T, Swensen SJ, Woody J, Levin J, Lillie J. Physician and nurse well-being: seven things hospital boards should know. J Healthc Manag. 2018;63(6):363-369. doi:10.1097/JHM-D-18-00209
American Medical Association. Joy in Medicine™ Health System Recognition Program 2023 program guidelines. Accessed February 28, 2023. https://www.ama-assn.org/system/files/joy-in-medicine-guidelines.pdf
New Surgeon General advisory sounds alarm on health worker burnout and resignation. HHS Press Office. May 23, 2022. Accessed February 26, 2023. https://www.hhs.gov/about/news/2022/05/23/new-surgeon-general-advisory-sounds-alarm-on-health-worker-burnout-and-resignation.html
Addressing Health Worker Burnout. The U.S. Surgeon General's Advisory on Building a Thriving Health Workforce. 2022. Accessed February 26, 2023. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. National Academies of Sciences, Engineering, and Medicine; 2019. Accessed January 29, 2023. doi:10.17226/25521
National Plan for Health Workforce Well-Being. National Academy of Medicine; 2022. Accessed January 29, 2023. doi:10.17226/26744
Workplace and workstreams
Swensen S, Shanafelt T. Mayo Clinic Strategies To Reduce Burnout: 12 Actions to Create the Ideal Workplace. Oxford University Press; 2020. https://academic.oup.com/book/36545
Shanafelt T, Stolz S, Springer J, Murphey D, Bohman B, Trockel M. A blueprint for organizational strategies to promote the well-being of health care professionals. NEJM Catal Innov Care Deliv. 2020;1(6). doi:10.1056/CAT.20.0266
Sieja A, Markley K, Pell J, et al. Optimization sprints: improving clinician satisfaction and teamwork by rapidly reducing electronic health record burden. Mayo Clin Proc. 2019;94(5):793-802. doi:10.1016/j.mayocp.2018.08.036
Sinsky CA, Panzer J. The solution shop and the production line - the case for a frameshift for physician practices. N Engl J Med. 2022;386(26):2452-2453. doi:10.1056/NEJMp2202511
Sinsky CA. Riding the wave: seven steps to scheduling success. Fam Pract Manag. 2022;29(6):19-24. https://www.aafp.org/pubs/fpm/issues/2022/1100/wave-scheduling-tips.html
Singh N, Lawrence K, Sinsky C, Mann DM. Digital minimalism - an Rx for clinician burnout. N Engl J Med. 2023;388(13):1158-1159. doi:10.1056/NEJMp2215297
Websites
Practice transformation. American Medical Association. Updated February 20, 2023. Accessed July 18, 2023. https://www.ama-assn.org/practice-management/sustainability/practice-transformation
Joy in Medicine™ Health System Recognition Program. American Medical Association. Accessed February 26, 2023. https://www.ama-assn.org/practice-management/sustainability/joy-medicine-health-system-recognition-program
AMA recovery plan for America's physicians. American Medical Association. Accessed February 26, 2023. https://www.ama-assn.org/amaone/ama-recovery-plan-america-s-physicians
Health worker burnout. U.S. Department of Health and Human Services, Office of the U.S. Surgeon General. Accessed February 27, 2023. https://www.hhs.gov/surgeongeneral/priorities/health-worker-burnout/index.html
Stanford Medicine WellMD & WellPhD. Accessed February 27, 2023. https://wellmd.stanford.edu/
Debunking regulatory myths. American Medical Association. Updated February 28, 2023. Accessed February 28, 2023. https://www.ama-assn.org/practice-management/sustainability/debunking-regulatory-myths
Well-being Index. Accessed July 18, 2023. https://www.mywellbeingindex.org/
Maslach Burnout Inventory™ (MBI). Mindgarden. Accessed July 18, 2023. https://www.mindgarden.com/117-maslach-burnout-inventory-mbi
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