How to Infuse Joy in Your Practice: Our Journey to Sustainable Well-Being : Official journal of the American College of Gastroenterology | ACG

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INVITED RED SECTION: IN MY OWN VOICE

How to Infuse Joy in Your Practice: Our Journey to Sustainable Well-Being

Stonnington, Cynthia M. MD1,2; Jones, Keith BS1; Leighton, Jonathan A. MD, FACG1,3

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The American Journal of Gastroenterology: November 2022 - Volume 117 - Issue 11 - p 1723-1727
doi: 10.14309/ajg.0000000000001892
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Abstract

INTRODUCTION

Three-year-old Vada, who dreamed about being a princess, was wearing a sparkly dress and unicorn headband where her hair used to be. She rang a bell signifying the end of 46 grueling rounds of chemotherapy. As she was leaving the hospital, the sound was drowned out by the cheers of the crowd, dressed as princesses, who gathered to celebrate Vada and watch her leave in a Cinderella's carriage, horses, and all. Vada's father, Matt, had wanted her departure to be special, and the hospital staff found a way to make that happen. “Seeing the look on Vada's face when she saw that was magical,” Matt says. He credits the staff—and the support of family and friends—for “getting them through” Vada's diagnosis and treatment. “The staff at the Mayo treats us like humans, not just a number,” Matt explains (1).

For staff to go the extra mile for patients and their families, they need to feel cared for themselves and be given adequate time to respond to the complexities of patient care. Medical professionals aspire to administer expert, compassionate care to their patients. Unfortunately, threats to individual well-being, such as burnout, further exacerbated by the pandemic, challenge care teams' ability to do so (2,3). This paper offers a case study on how medical practices, large and small, can infuse daily joy and well-being in the workplace, so physicians and their care teams remain resilient and fulfilled while providing effective and benevolent care to patients.

Burnout, characterized by emotional fatigue, cynical detachment toward patients, and a feeling of reduced personal accomplishment (4), is highly prevalent among physicians and medical staff (2), and up to 50% of gastroenterologists (2,5). Burnout has been independently associated with more frequent medical errors (6), suboptimal patient care, increased attrition, and lower professional fulfillment (3,7). Lack of authentic connections among team members and leadership and an inability to allocate sufficient time for meaningful work can contribute to burnout (3,8). Moral distress over the practice's focus on transactional over relational metrics of success and mounting clerical burdens are additional factors. At the Mayo Clinic in Arizona, leadership realized that reducing burnout was a necessary but not sufficient step. We also needed a vision and strategy to foster joy and fulfillment. Our team was tasked with developing this plan. The pandemic made our work both more difficult and imperative. We witnessed more conflicts, stressful clinical events, and an increased need to connect and support each other. We describe a roadmap to integrate joy and well-being in practices large and small, academic and private.

INFUSING JOY AND WELL-BEING

Table 1 presents a summary of our initial steps. First, we met with leaders to explain our mission and to ask for their partnership. We discussed useful frameworks for well-being and leadership (9–12). We were also interested in what they were doing for self-care and support, any actions they took for team building, special efforts for recognition, and how they balanced that with productivity needs.

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Table 1.:
Steps toward developing a well-being infrastructure

Second, we listened to our staff. Joy at work depends on meaningful work and feeling seen, heard, and valued. Leaders can make inroads by recognizing valued contributions, supporting at least 20% time dedicated to meaningful work (8), and acting on those “pebbles in the shoe” (13) that unnecessarily diminish professional fulfillment. When we interviewed the Division of Gastroenterology and Hepatology, several staff complained about too many meetings. One allied health member observed, “We are physically separated and there is a difference in the type of work that is done. One day, a nurse is working in an endoscopy suite while a colleague is performing different duties on another campus. Some are working remotely. Our patients and clinical practice are everywhere which makes it hard to feel like we are all one team.” A concern for one physician was improper ergonomics during endoscopy procedures, which can cause physical injuries and end endoscopist careers prematurely. Another physician member needed colleagues to provide support after stressful clinical events. “If team members are too worn out to do that, everyone loses.” A physician leader concluded, “The more we feel like we are a team, we are family, it leads to a lot of stress reduction.”

Third, we reviewed institutional staff surveys that measured burnout, stress and well-being, and the qualitative data from listening rounds. Based on these results, we identified 4 themes and drivers of joy (13) important to our staff, including meaning and purpose, choice and autonomy, camaraderie and teamwork, and psychological and physical safety. In support of these themes, we prioritized 5 tactics that were doable and impactful:

1. “Spread your [email protected] (Joy at Mayo)”. This was a grassroots effort, using funding from the institution. Work areas were empowered to submit low-budget, measurable joy initiatives for their staff. Proposals were predominantly geared around celebration, gratitude, camaraderie, and social connections. Examples included a virtual culinary event, drive-in movie, family Halloween event, and kudos or positivity boards. Some submissions were directed toward physical stress, such as conducting ergonomic assessments and purchasing associated equipment. We approved 81 proposals across inpatient/outpatient, all 3 shields (research, education, and clinical), and support areas, involving 6,685 staff members. Over 95% of respondents felt that their initiative strongly or somewhat strongly affected their team's sense of community. These grassroot, employee driven interventions sometimes occurred over lunch or after hours, typically if the “joy factor” outweighed the additional time required. In some cases, leaders made space within the day for the event.

2. A peer support structure, Healing Emotional Lives of Peers (14), was implemented to leverage support from each other after stressful clinical events. Our goal was to train 10% of physicians and allied health staff in competently addressing the well-being of the affected colleague and not the event itself through active listening and support, along with the necessary infrastructure for staff to activate peer support for affected colleagues. By the end of 2020, more than 100 staff were trained, with over 15 activations. In total, 100% of affected colleagues were satisfied with the support and indicated they would refer the program to others.

3. A reward and recognition program empowered leaders to recognize staff in a meaningful way. For example, physicians and allied health publicly acknowledged an employee in their division who went above and beyond in their work. This employee not only prioritized patients, but also colleagues. Celebrating employees for their efforts does not go unnoticed and helps nurture a spirit of gratitude, purpose, and belonging. By the end of 2020, 120 individuals and 10 work units were recognized. One leader reported, “Good experience for employees and myself. Great to see the smiling faces of the employees. One almost came to tears hearing how much she impacted the department.”

4. Promotion of a simple “Well-being checklist,” for either individual use or incorporation into group meetings. This checklist was adapted from the “Going Home Checklist” created by the National Health Service that included 6 evidence-based micropractices that enhance gratitude, caring for colleagues, recognition, and a positive perspective (Figure 1).

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Figure 1.:
Well-being checklist. Adapted from the National Health Service (https://checkify.com/blog/going-home-checklist-nhs/).

5. [email protected] Partnerships. We felt that a triad leadership model was critical, including physicians, nurses, and administrators. We partnered with divisions and departments that requested our help. The partnerships led to the development of “The Practice,” a well-being intervention, where participants committed to performing a 15-minute daily well-being practice (Table 2), being accountable to other group members, and attending biweekly well-being meetings. The program's biweekly meetings, preferably integrated into an existing meeting rather than an add-on, provided a safe and supportive space for participants to share the benefits of the program and discuss challenges. A nursing manager explained, “I have seen some of our physicians who are participating in the program really change the energy that they bring into the department. Before they would have been a little snippy, maybe difficult to deal with at times. I've noticed an improvement in that.” At 3-month postintervention, our initial pilot data showed a significant improvement from baseline in all measures: well-being, emotional intelligence, professional fulfillment, empathy and connection, burnout, and medical errors (Table 3). When leaders engaged and participated with their teams, we observed increased group participation, reduced collective stress and burnout, and elevated joy in the unit.

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Table 2.:
Illustrative well-being programs and initiatives
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Table 3.:
[email protected] partnership intervention pilot: change in scores between 3-month follow-up and baseline surveys

In 2021, based on evidence-based research, employee surveys, and outcomes observed from the “Spread your [email protected]” grassroots efforts, we developed a more comprehensive approach to increase joy and professional fulfillment that is rooted in our institutional values (Figure 2). Table 2 outlines the examples of strategies and tactics associated with 4 branches: Peer Support and Community Connections, Engage and Empower, Lessen the Burden, and Research, Training and Education. Specific tactics may change depending on baseline and follow-up assessments. For example, based on feedback from “pebble” interviews, in 2022, we prioritized the promotion of “No Meeting Days” (13) and to revamp other meetings so that they feel engaging, useful, and more joyful, for example, integrating the aspects of the “the Practice” or the Well-being checklist into regularly scheduled meetings rather than adding to the burden. In addition, wherever appropriate initiatives are now measured with similar metrics so that their impact can be better compared. The “Office of Joy and Wellbeing” thus emerged in 2022 as a permanent structure to sustain joy and well-being at our institution.

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Figure 2.:
Tree of well-being. Branches depict strategies. Leaves are tactics that can drop off, change color, and renew. The fruits of the tree (meaning and purpose, camaraderie and teamwork, choice and autonomy, wellness and resilience, physical and psychological safety) will sustain well-being at work.

CONCLUSION

For our staff to go above and beyond for patients, each other, and themselves, medical practices must develop the infrastructure to address burnout, practice self-care, and infuse joy and well-being. Sustaining these efforts is even more important. Progress depends on enlightened leadership and grassroots efforts from our staff. The intent is to ensure that we evolve from a transactional healthcare environment to a relational environment where we help each other practice and experience stress-free living (15). Our efforts to address burnout, elevate joy, and increase professional satisfaction led to the creation of the Office of Joy and Well-being at Mayo Clinic in Arizona. We offer our experience as a roadmap to foster and sustain well-being in your practice.

ACKNOWLEDGMENT

We thank Richard Gray, MD; Paula Menkosky; John Caviness, MD; Ryan Fix; Nichelle Baker; Carol Benson; Melania Flores, DNP, MSN, RN; Paul Yardley; Danielle Teal; Taylor Hays, MD; and the Joy & Well-being Advisory Committee for their insight, expertise, and support. We also thank Robyn Finney, APRN, and Evid Rivera-Chiauzzi, MD, for their development of the HELP program and Katie Kunze, PhD, MA, and Duke Butterfield for their biostatistical support.

REFERENCES

1. This story was originally published by Mayo Clinic’s In the Loop on November 29, 2021 (https://intheloop.mayoclinic.org/2021/11/29/princess-vada-leaves-mayo-clinic-in-style-after-finishing-cancer-treatment/).
2. Linzer M, Poplau S, Babbott S, et al. Worklife and wellness in academic general internal medicine: Results from a national survey. J Gen Intern Med 2016;31:1004–10.
3. Shanafelt T, Trockel M, Rodriguez A, Logan D. Wellness-centered leadership: Equipping health care leaders to cultivate physician well-being and professional fulfillment. Acad Med 2021;96:641–51.
4. Maslach C, Jackson S. Maslach Burnout Inventory Manual. 2nd edn. Consulting Psychological Press: Palo Alto, CA, 1986.
5. Barnes EL, Ketwaroo GA, Shields HM. Scope of burnout among young gastroenterologists and practical solutions from gastroenterology and other disciplines. Dig Dis Sci 2019;64:302–6.
6. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc 2018;93:1571–80.
7. Bui AH, Ripp JA, Oh KY, et al. The impact of program-driven wellness initiatives on burnout and depression among surgical trainees. Am J Surg 2020;219:316–21.
8. Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med 2009;169:990–5.
9. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017;92:129–46.
10. Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol 2000;55:68–78.
11. Bohman B, Dyrbye L, Sinsky C, et al. Physician well-being: The reciprocity of practice efficiency, culture of wellness, and personal resilience. NEJM Catalyst 2017 (https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0429) [Epub ahead of print April 26, 2017.]
12. National Academies of Sciences, Engineering, and Medicine. Taking Action against Clinician Burnout: A Systems Approach to Professional Well-Being. The National Academies Press: Washington, DC, 2019.
13. Perlo J, Balik B, Swensen S, et al. IHI Framework for Improving Joy in Work. Institute for Healthcare Improvement: Cambridge, MA, 2017.
14. Finney RE, Jacob A, Johnson J, et al. Implementation of a second victim peer support program in a large anesthesia department. AANA J 2021;89:235–44.
15. Sood A. The Mayo Clinic Guide to Stress-free Living. Mayo Foundation for Medical Education and Research: Da Capo Press; a member of Perseus Books Group, Philadelphia, PA 2013.
16. Ashton M. Getting Rid of Stupid Stuff: Reduce the Unnecessary Daily Burdens for Clinicians. AMA STEPS Forward. December 19, 2019. Team-Based Learning module.
    17. Agarwa G. AMA Steps Forward Toolkit. Scholars of Wellness: Train Physicians to Advance Well-Being with Effective Pilot Interventions, July 22 2021. Team-Based Learning.
      18. Topp CW, Ostergaard SD, Sondergaard S, Bech P. The WHO-5 well-being Index: A systematic review of the literature. Psychother Psychosom 2015;84:167–76.
      19. Law KS, Wong CS, Song LJ. The construct and criterion validity of emotional intelligence and its potential utility for management studies. J Appl Psychol 2004;89:483–96.
      20. Trockel M, Bohman B, Lesure E, et al. A brief instrument to assess both burnout and professional fulfillment in physicians: Reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Acad Psychiatry 2018;42:11–24.
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