Learn how ChristianaCare developed a comprehensive suite of wellness services overseen by a Chief Wellness Officer (CWO) and gain an understanding of the CWO scope and role.
Why a Chief Wellness Officer (CWO)?
In recent years, ChristianaCare undertook the daunting yet vital task of redefining its organizational values and behaviors, namely a commitment to “serve together, guided by values of Excellence and Love.” These values are part of the reason ChristianaCare chooses the term “caregiver” to describe all of its employees, both patient-facing and nonclinical.
In early 2016, ChristianaCare created a robust Center for Provider Wellbeing (the Center). The Center included a comprehensive suite of services offered to physicians and advanced practice clinicians, overseen by a Director of Provider Wellbeing. The business plan for development of the Center called for sequential expansion of the Center's work to encompass all employees and medical/dental team members by year 3. To reflect this expanding scope and the need for continued partnership with system leaders on an organization-wide effort, the Chief Wellness Officer (CWO) role was created in the spring of 2019.
What Is the CWO's Scope and Role?
The Center decided that the scope of work for the CWO should include all caregivers, as this scope applies to all other C-suite positions. To reflect this scope, the knowledge base guiding the team's approach expanded to include not only the growing literature on physician well-being, but also the broader occupational health literature. Accordingly, the services offered by the Center evolved to reflect both the common needs of all occupational groups as well as the unique needs of each caregiver population.
With new CWO oversight, the Center for Provider Wellbeing became the Center for WorkLife Wellbeing. The Center's mission is to foster WorkLife meaning, connection, and joy. The mission is achieved by providing responsive and proactive well-being services for 13 000+ caregivers working in a wide variety of roles and capacities across the organization, creating structured opportunities that empower caregivers to enhance the well-being of their colleagues, and advocating for and enacting local and system-level changes that promote WorkLife well-being. The balance of team members necessary to deliver on this mission has expanded, and their roles and responsibilities have shifted (Figure 1). Today, the Center is staffed by 10 full time team members and 2 part time physician champions for a total of 10.4 FTEs.
The Center for WorkLife Wellbeing Organizational Chart
The CWO reports to the Chief People Officer (CPO), who reports to the CEO. In addition to the work of the CWO, the CPO also oversees Organizational Development, Human Resources, and System Learning. The CWO collaborates closely with leaders in multiple key departments whose operations impact caregiver well-being. This organizational structure has proven beneficial, as the synergies amongst these workflows are considerable, and effective partnerships have developed among the respective teams. Proactive, careful allocation of the CWO's time and effort has been essential for maximizing influence and impact. In addition to dedicating sufficient time to team development, strategy, and oversight, a substantial portion of the CWO's time is spent interfacing regularly with key internal stakeholders. This includes leadership in Human Resources (HR), information technology (IT), nursing, quality and safety, Graduate Medical Education (GME), performance improvement, marketing and communications, patient experience, inclusion and diversity, finance, strategy and planning, and departmental leadership. Strategic choices to participate in key systemwide committees, task forces, advisory councils, and other group forums have been necessary. The CWO has recently promoted 1 team member to the position of Director of the Center for WorkLife Wellbeing. This has freed the CWO to interface more regularly with stakeholders external to the Center, as well as with important contacts regionally, nationally, and internationally.
How Is Positive Change Measured?
The response to the creation of the Center for WorkLife Wellbeing has been overwhelmingly positive. While anecdotal appreciation for the Center's work is gratifying, it has been essential for the CWO to clearly delineate success measures for the Center's team, and to differentiate those from success measures of the organization as a whole. Organizational metrics of success include leading indicators (satisfaction with the EHR, leadership quality, measures of collegiality, control, appreciation, values alignment, mistreatment perception, and psychological safety) as well as lagging indicators (burnout, turnover, and professional fulfillment). These organizational metrics are important to track, but are multifactorial in nature, influenced significantly by factors outside of the control of the CWO or well-being team. These data are collected annually for the caregiver population and displayed transparently in dashboard format.
The more real-time, immediate assessment of the Center's success includes programmatic utilization rates, net promoter scores, and qualitative feedback. Measures of well-being, engagement, and experience are measured for all caregivers in a pulse fashion more frequently, and improvements in these metrics are built into the organization's Annual Operating Plan goals. Teams throughout the organization also create goals around each component of the Quadruple Aim, including caregiver experience, and discuss barriers and solutions in their daily team huddles.
What Lessons Were Learned?
Choose your team wisely.
Launching what the Center came to see as essentially a startup within a larger organization required assembling a talented team with a unique blend of collective skills, including well-being subject matter expertise, data analysis and management, intervention skills, administrative skills, and business acumen. All team members must display a high level of emotional intelligence, creativity, good judgment, and flexibility.
Ethical dilemmas abound.
The well-being team members are privy to a tremendous amount of sensitive information. Whether via the Center's well-being survey, focus groups, resource liaison line, coaching forums, or 1:1 conversations, there are now channels for communication of sensitive information that did not previously exist. This sensitive information must be handled with the utmost respect and caution. The individual's need for privacy and confidentiality not infrequently conflicts with the organization's need for information (reporting requirements, identified themes regarding leadership deficiencies, for example). In addition, the team is often in the position of communicating difficult feedback regarding the current state and advocating for a future state more aligned with a culture of well-being.
RACI charting is your friend.
RACI, which stands for Responsible, Accountable, Consulted, and Informed, is a tool to identify roles and responsibilities. As the Center listened to caregivers, multiple unmet needs were unearthed. The Center knew it wasn't feasible to tackle all those unmet needs and thus used RACI charting to help prioritize and delegate efforts. Navigating the interface with other departments to meet the needs of caregivers required honest conversations with leaders to determine who should “own” vs support the effort. Sometimes, a given department that seemed appropriate to take on the Responsible (“R”) role was not able to meet the need in the current state. In these instances, the Center decided to take on a project to get it off the ground, then transition into a Consulted (“C”) or Informed (“I”) role. Sometimes, such difficult, controversial conversations and decisions created waves, as the Center's work bumped up against that of more long-standing departments. Proactive relationship management with key stakeholders was essential to navigating these challenges.
Attend to your team's well-being.
As a group, the individuals who choose to work in health care are often self-sacrificing. Those who choose to care for other health care providers may be even more self-sacrificing by nature. Further, these individuals tend to be highly motivated and passionate. In their efforts to improve the well-being of their colleagues, they inevitably hit roadblocks in interactions with colleagues who are not as motivated, nimble, or open to change. Recognizing and anticipating that tendency, as well as the stress of additional exposure to others' challenges, is essential to maintaining a healthy well-being team. Help the team in reframing experiences and understanding that culture change is long, slow work. Persistence and grit can help carry the team through challenging times. Remember to reconnect with the “why”!
The role of the CWO is new and evolving. This success story offers the perspective and experience of one health system. While there is no one-size-fits-all solution, the Center hopes this peek into the inner workings of their CWO's role and work helps inform you on your own organization's journey.
Headquartered in Wilmington, Delaware, ChristianaCare is one of the country's most dynamic health care organizations, centered on improving health outcomes, making high-quality care more accessible, and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, medical aid units, 3 hospitals (1299 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women's health. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. We are continually ranked by U.S. News & World Report as a Best Hospital. With our unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care. Learn how we deliver greater quality and value at https://christianacare.org.