Scholars of WellnessTrain Physicians to Advance Well-Being With Effective Pilot Interventions

What qualities should a physician lead have?

The physician lead should be respected by both executive leadership and physician colleagues. The chief resident model is useful to consider here as the person should have credibility with both constituencies and serve as a bridge in communication. A coach approach to faculty development is one way to teach physician colleagues, while a systems approach can be applied to change management. Personal qualities including flexibility, patience, strong oral and written communication skills, and reliability are crucial.

How much time should the physician lead dedicate to the SOW program?

At least 20% time should be protected for the physician lead to direct this program.

What if there is no physician well-being expert within the organization?

Prior experience is not required to be a successful physician lead in an SOW dyad. A variety of resources are available to help a motivated physician who wishes to learn more about well-being act as the lead. Examples include:

• The American Medical Association's Practice Transformation website

• Other toolkits on the AMA STEPS Forward™ website that address burnout and well-being

• National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience

What could an administrative lead anticipate in terms of time commitment and responsibilities?

On average, an administrative lead can anticipate assisting the physician lead for 8 hours per week, with additional hours required at certain times throughout the year. Sample responsibilities include:

• Manage annual timeline, budget, and all logistics (including food and room bookings)

• Manage application process and organize steering committee meetings

• Act as the central communication contact and organize:

  • Bi-weekly communication with Scholars to ensure progress is maintained

  • Bi-weekly communication with process improvement coaches

  • Bi-weekly planning sessions with physician leads

  • Regular communication and coordination with designated course facilitators

• Own and create all standard work documents for facilitators, participants, and coaches

• Coordinate accountability touchpoints such as mid-point presentations and graduations

How much funding is needed to start this program?

The amount of funding needed will depend on the:

• Specific objectives of the program at your organization

• Comprehensiveness of in-scope projects

• Decision whether to pay the Scholars for their participation in the program

• Salaries of the program leaders

For the most comprehensive version of the program at Northwestern Medicine, the Scholars are funded for 5% time (eg, given 5% protected time from clinic and credited with equivalent RVUs). Physician leads are funded for 20% to 30% time, and administrative leads are funded 20% to 40% time for supporting the program. The Scholars of Wellness Program created and selected projects with a total annual budget between $20 000 to $50 000 per year and provided meals for Scholars during class time.

Should Scholars be paid?

Give strong consideration to providing some level of funding to Scholars if they are being asked for comprehensive pilot interventions in addition to the program's faculty development objective. Workload and work–life integration are important drivers of burnout, so adding work alone can amplify burnout in these leaders. If monetary compensation is not possible, there is still value in mentorship and development opportunities available exclusively through the SOW program that may lead to career advancement.

What are the best ways to promote this opportunity to physicians?

The communication plan for recruitment is a critical step for obtaining a diverse range of projects and candidates to select from as you build your Scholar cohort. While everyone who applies may have a sincere interest in wellness, not all individuals with this interest have the skills and attributes necessary to be effective change agents and leaders.

Strategically promote the program to stakeholders by:

• Sending flyers and communications to The Chief of Staff and Medical Staff Office email communications liaisons

• Sending personal emails to chairs and department leaders

• Sending personal emails to system function leaders

• Posting flyers in the physician lounges

• Sharing announcements with existing well-being councils and committees at department and organization levels

• Delivering individual in-person department presentations to speak directly to physicians

• Hosting a wellness “kickoff” day, complete with a well-being-related Grand Rounds speaker, that also serves as a forum for announcing the program to a variety of individuals who are already interested in the topic

It is essential in all these communications to highlight the faculty development opportunity as well as curriculum topics, CME credits, funding, and coaching support.

What should an application include?

Applications should not be complicated and could even be distributed as an online survey. It is important to include questions that ask the applicant to:

• Describe their pilot intervention and ensure that it is addressing a driver of burnout in their practice setting

• Explain any baseline or anecdotal evidence supporting the pilot intervention idea

• Begin thinking about metrics, such as which and how many individuals will be affected by the intervention and what success will look like

• Predict possible barriers, support needed, costs, and time to implement

Applicants should also include a letter of interest, their CV, and a letter from their supervisor indicating support for their application and pilot project.

Who should act as coaches?

The physician lead of the SOW project should be the well-being coach for the Scholars. They can also enlist an assistant physician lead to help.

The appropriate process improvement coach will depend on the specific pilot intervention chosen by the Scholar. For example, a Scholar working on a pilot project to make EHR changes may benefit from an IT process improvement coach's support.

Is formal coaching training available or recommended?

Formal coaching training can be helpful and is available through various organizations. However, a coach approach is sufficient to help the Scholars develop and examine their thought processes around making constructive change and process improvement.

What is the time commitment required for the coaches?

The purpose and time commitment of the coaches will likely vary based on the time of year. In the first 3 to 4 months of the program, the well-being expert coach has a primary role as the Scholar's knowledge and skills are growing. In the second half of the year, the Scholar spends most of his or her time with the process improvement coach as they begin to implement the pilot program.

The Scholars should meet with one of their coaches at least once a month. Coaches should keep a progress report to identify issues and barriers early on and ensure continued progress and commitment to the program.

Why is mentorship important?

The coaching and mentorship resources provided for the Scholars can:

• Foster loyalty to the organization

• Reduce turnover intent and improve retention of faculty

• Increase the likelihood of recommending your organization as a place to work

• Build a community of like-minded individuals across departments

• Encourage fruitful cross-pollination of ideas

• Build a common vocabulary and mission

Continued involvement of Scholars in leadership and wellness initiatives after the curriculum ends is a wonderful marker of success.

How does an SOW program help an organization identify future leaders?

It is rare to have a one-year opportunity to observe how someone leads change before promoting them to a high-profile role. The SOW program provides this unique opportunity to select the appropriate people to continue the path towards a culture of health. If a Scholar has the aptitude, emotional self-regulation, and passion to be a well-being leader, try to promote the Scholar to a role needed in the organization. This shows that the program can foster career advancement, generating deeper commitment to the program by future Scholars.

How can Scholars gain organizational leadership skills through the SOW program?

Scholars typically start the SOW program solely focused on implementing the pilot they proposed in their application. They are not often aware of the need for their personal development in terms of skills, knowledge, and influence. However, throughout the year, they learn how to:

• Assess the drivers of burnout within themselves and others

• Prioritize and create solutions that are for them and the program

• Build buy-in and build consensus on the approach to well-being to overcome potential dissenting views and voices

• Learn how to remove barriers and make persuasive arguments to secure funding

• Listen to their colleagues' needs without bias

• Use formal and informal measurement tools to analyze areas of need

• Prepare themselves to guide a coalition to implement the pilot

As a result, Scholars transform from well-being advocates into organizational leaders. They learn the skills to work constructively with other organizational leaders, leverage system resources, and expand their well-being interventions.

What are some helpful ways to measure our program's success?

The dual objectives can guide appropriate expectations to measure the success of the program. For example, in any version of the program, the development of faculty well-being leaders is the definitive measure of success. However, as pilots begin to integrate into the program and culture, measuring the program's success can shift to include the individual accomplishments of the pilot interventions.

How many people should a pilot intervention aim to include?

There is not a set number of physicians that we feel a pilot should touch to be viable. Providing a realistic scope for the pilot is a vital skill; many people tend to want to “boil the ocean” and please everyone, leading to indefinite delays or initiatives diluted to the point of having no impact. We aim to help as many physicians as we can; however, we are most interested in making a meaningful difference in people's lives rather than checking a box.

What are the characteristics of a promising pilot intervention to implement through an SOW program?

In the Northwestern Medicine experience, the pilots with the highest probability of success were the ones that followed the process improvement methodology instead of trying to skip steps. Closely following the methodology means the Scholars have:

• Taken the time to accurately diagnose the drivers of burnout and identified one that they want to address

• Listened to how their colleagues experience the selected driver and how it impacts their work

• Included their affected colleagues in the design of the intervention so there is strong buy-in for the pilot

Rather than becoming an additional burden or unwanted change with unintended consequences, these pilots support Scholars and physicians in the way they want to be helped.

What does a mid-point presentation look like?

The recommended mid-point presentation is an “elevator pitch” PowerPoint presentation lasting about 5 to 8 minutes. The presentation framework addresses the following components:

• The Scholar's identified driver of burnout

• The measurements and methods the Scholar used to identify need(s) and to listen to and collect colleague input

• An analysis of those measurements and methods

• The Scholar's proposed intervention(s) and next steps

Consider inviting department and division leaders, vice presidents of system functions, presidents of the hospital and medical groups, and the chief of staff to join the audience. Inviting senior leadership from various functions gives senior leadership a sense of ownership in the pilot, as they want to be helpful and contribute to the pilots' success. It also encourages chairs and department heads to assist with the pilot interventions to ensure the interventions' success while highlighting their own efforts to improve the work-unit climate for the physician community.

What does graduation look like?

Graduation is an opportunity for broad dissemination of the piloted intervention, best practices learned, and the intervention results. A high-traffic area where faculty and leaders are likely to walk by is an ideal venue to hold a poster session to encourage faculty and leaders to stop to learn about the work was done. Distribute invitations and announcements for this session broadly across the organization. Making graduation more accessible creates an opportunity to recruit future Scholars as they see the various ongoing efforts implemented from the program. Finally, after the poster session, display the posters in the physician lounge and on your website so that other departments with similar challenges can learn from them in the future.

How can a Scholar highlight this work on their curriculum vitae (CV)?

Scholars can cite both their SOW training as well as their pilot intervention on their CVs. For example:

• Scholars of Wellness (SOW) Professional Development Program, Northwestern Memorial Hospital

• Team-Based Care Pre-Visit Planning Pilot, 2018-2019

Or consider a more detailed version:

• Northwestern Medicine Scholar of Wellness (2018-2019):

  • Selected to complete a professional development program with a primary focus on becoming a wellness expert who drives meaningful change in the work environment to reduce physician burnout and improve physician well-being

  • Used a data driven quality strategy for improving processes (DMAIC method), designed and led an interdisciplinary wellness project involving multiple operational changes and optimizations to increase care team productivity and physician professional fulfillment

  • Achieved a 19.2% reduction in average physician burnout score, a 19.7% increase in average professional fulfillment score, and a 24.7% reduction in average work exhaustion score using the Stanford Professional Fulfillment index after implementation and without hiring additional staff

  • Conducted a post-intervention survey that found physicians felt their care teams worked more efficiently together, reduced amount of time spent on the electronic health record (EHR) system, and gained control over their workload