Article In Brief
Wellness officers—a new executive position established by many health systems to address the burnout epidemic—share the initiatives they've taken their institutions.
Many health systems across the country are establishing a new executive position—chief wellness officer—as a strategy to address the burnout epidemic among physicians and other clinicians.
Jonathan Ripp MD, MPH, chief wellness officer at the Icahn School of Medicine at Mount Sinai, said there were only a handful of chief wellness officer positions when he was appointed to the role in May 2018.
“There have been at least a dozen more who have been named in the past year, and several more places that are looking to create the position,” said Dr. Ripp, professor of medicine, medical education and geriatrics and palliative medicine. “I would not be surprised if, 10 years from now, it's commonplace for most large organizations to have a chief wellness officer or equivalent, taking this challenge on, and doing so in a way that is effective.”
Dr. Ripp was a co-author, along with Neil Busis, MD, FAAN, director of community neurology at the University of Pittsburgh Physicians, and others in a 2018 Health Affairs blog post that issued a “call for action” for executive leadership to address clinician burnout.
Working on behalf of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-being and Resilience, the authors encouraged health systems to create the position of chief wellness officer to give wellness the attention it needs.
“This individual should facilitate system-wide changes, including the implementation of evidence-based interventions that enable clinicians to effectively practice in a culture that prioritizes and promotes their well-being,” the blog post said. “This leader—a Chief Wellness Officer (CWO)—would have the authority, budget, staff, and mandate to implement an ambitious agenda.”
Dr. Busis said the chief wellness officer position is analogous to the positions of chief patient-safety officer, chief quality officer, and chief medical informatics officer.
“It's not that the person in that position does everything, but they lead a team responsible for wellness,” he said. “And by being in the C suite, it makes a statement that the organization takes this seriously and is willing to devote resources.”
Taking the Lead on Wellness
Children's Mercy Hospital in Kansas City does not currently have a chief wellness officer position, but neurologist Jennifer Bickel, MD, FAAN, serves as medical director of the hospital's Center for Professional Well-Being. That position reports directly to the executive leadership and serves on the hospital's Physician Administration Council and Quality and Safety Council.
“The fact that this role was going to be inserted into the fabric of administration in order to have an influence was really important to me,” said Dr. Bickel, chief of the headache section at Children's Mercy and professor of pediatrics at the University of Missouri-Kansas City.
One of her first priorities after assuming the job in January 2019 was formalizing the hospital's commitment to the NAM Action Collaborative. Like the other institutions that have made formal commitments, Children's Mercy identified specific tactics it is undertaking. They include reducing non-meaningful work for clinicians, evaluating policies and procedures that decrease clinician autonomy and professionalism, and coaching leaders on how to identify and reduce burnout.
Dr. Bickel is working to understand the specific causes of burnout among her colleagues and identify mitigation strategies that target them.
“While there are, of course, national drivers of burnout-—the way we are reimbursed, prior authorizations, regulatory hassles—all of which are major issues, I am a big believer that we should focus on what we can do within our sphere of influence as a hospital or as department leaders or as individual physicians,” she said.
For example, Children's Mercy Hospital is making some improvements to the medical staff lounge at the main facility and creating lounge spaces in other locations to make it easier for physicians to build a sense of community with their colleagues.
A hospital-wide survey for physicians, advanced practice providers, psychologists, and trainees to measure burnout rates and perceived causes was underway before Dr. Bickel stepped into the new position. She met with every physician leader to discuss the results for his or her work unit and identify hospital-level issues that might contribute to clinician burnout.
She also blocks time in her schedule each week for appointments with physicians to discuss any concerns and issues, and she has already met with about 10 percent of the faculty one-on-one.
“Most of these situations are people telling me about different system-level problems that they see contributing to burnout,” she said. “The vast majority of people are coming not just to complain; they are there because they want to be better doctors, they love their work, they want to be able to be connected with their patients more.”
No Single ‘Best Practice’
To help prepare for her new role, Dr. Bickel participated in a weeklong chief wellness officer workshop at Stanford Medicine WellMD Center, which brought together a wide range of individuals interested in becoming wellness leaders.
“It was incredibly eye-opening to see the wide variety of titles and responsibilities and degrees of influences within the room,” she said. “Some people were truly just starting to learn about wellness; some people were already in a wellness leadership role, perhaps for their department but not for their hospital. And there were others who are system-level leaders in their organizations.”
Cormac O'Donovan, MD, associate professor of neurology in the department of neurology and internal medicine at Wake Forest University Baptist Medical Center, attended the chief wellness officer training to advance his own knowledge of wellness leadership and to expand his network of clinicians working to address clinician burnout.
Dr. O'Donovan, director of the Peer Support Program at Wake Forest Baptist, started educating himself about physician wellness after his own experience with burnout. One takeaway from the Stanford course was that health systems are addressing the burnout epidemic in a variety of ways.
“There is no one-size-fits-all,” he said. “The way each organization tackles this is very different and based on the strengths that their institution brings to the task.”
Organizations also have different structures—hospitals with nurse unions, for example, have a different culture than those that do not—and different dynamics that may contribute to burnout, Dr. Bickel said. Thus, wellness leaders need expertise in change management, strategic planning, and leadership development.
“I appreciated that the workshop was not about providing a bunch of patches for solving burnout because the solution is going to be different in each hospital or even each department,” she said.
At Mount Sinai, for example, Dr. Ripp is focused on workplace efficiency—making the electronic health record system less cumbersome and limiting physicians' administrative burden—and workplace culture. Each of 24 departments, including neurology, has a wellness champion that works on department-level issues and serves as an information conduit with the Office of Well-being and Resilience, which Dr. Ripp leads.
At Ohio State University, the chief wellness officer co-chairs a university-wide health and well-being council that is in the fourth year of a multifaceted wellness plan.
According to a case study written by Dr. Busis and co-authors, the plan tracks outcomes in three categories: the culture and environment of health and wellness; population health; and fiscal health/value of investment in wellness.
Since starting the wellness plan, the university has seen increased productivity and its cost for health insurance is actually decreasing; indeed, for every dollar invested in wellness, the university is seeing a $3.65 return on investment.
At Children's Mercy, a second survey to measure burnout rates was sent out this fall, and Dr. Bickel hopes to continue surveying clinicians every year. She does not expect dramatic or quick changes from one year to the next, but each survey is an opportunity to get feedback from staff and ideas for new programs or initiatives.
“Of course, I hope to see the numbers start to trend down over the next few years, but that's going to take some time,” she said. “More than anything, I hope people know we are sincerely working on making the system better and providing support services for those who need it. This is a long game.”