112. Pizza doesn’t work. This does | An evidence-based intervention that reduced physician burnout and increased job satisfaction

Burnout is not a foregone conclusion. While individual efforts play a pivotal role, continually battling systemic challenges can be exhausting. In this episode, we delve into a simple and cost-effective systemic intervention that not only mitigates burnout but also enhances job satisfaction. We then discuss how you can recognize when your colleagues might be in distress, what to do about it, what to say, what not to say, and how to break through the stigma of seeking help. 

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Guest Bio: 

We Discuss

A study of two hospitalist groups. One struggled. One thrived.

• During peak COVID, a real-world study was conducted with two hospitalist groups to evaluate the potential to reduce burnout.
• One group was instructed to continue their usual routine, while the other underwent a specific intervention.
• Before this intervention, both groups had similar levels of burnout and job satisfaction.
• Post-intervention results were staggering, with burnout levels in the control group being nearly double that of the intervention group.
• The intervention consisted of several components. A significant element was the commitment of three hospitalist partners who consistently met to address the well-being of the group. Their focus was on identifying major stressors and strategizing solutions, even for challenges that seemed insurmountable.

Study reference: James, Tricia T., et al. “Creating a Comprehensive Pandemic Response to Decrease Hospitalist Burnout During COVID-19: Intervention vs Control Results in 2 Comparable Hospitals (HOSP-CPR).” Journal of General Internal Medicine 38.5 (2023): 1256-1263. PMID 36764984 

The intervention group’s mandate was threefold: Listen, identify the pain points, find agency

• The intervention actively sought to identify areas within the group’s control, even amidst the overwhelming challenges presented by COVID.
• A strategic approach was adopted: while they couldn’t control the number of COVID patients, they could collaborate with the COVID service to understand efficient workflows, logistical challenges, and unmet needs. This facilitated better day-to-day navigation and enabled more effective communication with higher-ups in the hospital leadership.
• A significant aspect of the intervention was fostering a sense of agency among the hospitalists, ensuring they felt empowered and not helpless.

The Role of regular debriefing, sharing experiences, and addressing uncertainty

• “COVID groups” were initiated as a weekly virtual gathering during lunchtimes, given the constraints of the pandemic.
• Recognizing the rapid evolution of treatments and workflows, an infectious disease doctor was invited to the initial part of these meetings to provide updates and answer pressing questions.
• Beyond the informational updates, these sessions also served as platforms for debriefing, sharing experiences, and discussing specific topics crucial to the group.

Engagement levels were high

• The engagement levels with the “COVID groups” were remarkably high, with over 90% of the intervention group participating in at least one session. Furthermore, more than 75% attended over half of these sessions.
• To ensure inclusivity, recordings were made available for those who couldn’t attend, and meeting minutes highlighting essential points were disseminated after every session.

The Intervention Group continued meeting after the study, and it helped. A lot

• These groups have persevered for over three years post-intervention, albeit with reduced frequency. Their meetings have now become bi-weekly to monthly.
• The scope of discussion topics has broadened, covering subjects like caring for aging parents and addressing challenges posed by polysubstance use patients.
• As the acute stress of COVID has subsided, the group’s activities have diversified, with a shift towards in-person interactions, lunch meetups, happy hours, and even dog park gatherings. However, the core philosophy of uniting individuals around shared stressors remains intact.

It’s not just talking about medicine and logistics. There’s a sense of cohesion and mutual support:

• The group has a palpable sense of camaraderie, evident in their mutual support and shared experiences. This unity has been a cornerstone of their resilience and success.

Outcome of the two groups

• The intervention group had nearly half the burnout and twice the job satisfaction as the non-intervention group

• The non-intervention group’s subsequent struggles reflected national data, which showed a surge in burnout rates across the board. Once an organization’s morale deteriorates to a certain extent, recovery becomes arduous. The same trend seems to be playing out nationwide.

Challenges in wellness funding

•  Funding for wellness initiatives can be difficult to secure.
•  Many wellness champions cease their efforts due to a lack of support.
•  There is a continual need to seek grant money, even when faced with frequent rejections.

The value of funding and compensation for wellness initiatives

• The work done by wellness champions is significant and deserves compensation.
• The time and effort invested in such programs should be recognized and rewarded.
• Often, wellness champions volunteer their time, but the lack of support can lead them to withdraw, causing programs to collapse.

Approach to securing grants

• Persistence is crucial; many rejections may precede a successful grant application.
• It’s essential to regularly reflect on one’s motivation and purpose (the “why”) to maintain enthusiasm and drive.
• Creativity and thinking “outside the box” can lead to alternative funding sources.
• Dr. James sought funding for a new program and faced multiple rejections.
• She explored various avenues, such as:
  •  Meeting with insurance plan leadership.
  •  Exploring national grant opportunities.
  •  Discussing the link between unwell physicians and increased malpractice risks with the risk department.
  •  Engaging with the advocacy team to explore legislative support for funding.
  •  Emphasizing the importance of the work, both with data and personal stories, is crucial when making a case for funding.

Data and stories are great for persuasion. But it’s empathy and curiosity that will win the day. 

Most start by approaching administration for grants

• Immediate financial return is often a priority for administrators, making securing funds for projects without direct monetary benefits challenging.
• People are motivated based on their personal interests and benefits.
• Understanding the motivations and interests of the person you’re trying to persuade is essential.
• When discussing issues with administrators, consider focusing on the long-term benefits and interests, such as the high cost of replacing doctors or decreased efficiency when fewer doctors are working.
• Setting aside personal judgments and understanding the perspectives of administrators is crucial.
• Some executive leaders feel overwhelmed by constant complaints from professionals on issues beyond their control.

The first step when creating an in-house clinician-run program to build agency and thwart hopelessness

• Find allies. 
• Engage group leadership. They don’t have to fully buy-in, but they must at least be partly on board.

Staffing is a significant stress for many and can seem insurmountable. What can you as an individual do about it?

• A nearly universal medical stressor is inadequate staffing, contributing significantly to stress and dissatisfaction.
• While the situation can seem insurmountable and beyond individual control, it’s essential to differentiate between systemic issues and areas of personal influence.
• Recognizing areas of control is pivotal. For instance, one can control their treatment of colleagues and strive to create a more supportive workplace environment. Fostering positive relationships can indirectly influence staff retention and recruitment.
• Engaging with the larger group, discussing such concerns, and collectively brainstorming solutions can be beneficial.

Emotional suppression in healthcare professionals 

• Healthcare news rarely focuses on positive changes, often leading to feelings of frustration and disparity among professionals.
• Clinicians often suppress their feelings due to the demanding nature of their work.
• Suppressed emotions can lead to distress, requiring processing either through self-reflection, talking to friends, or seeking professional help.

Our tendency to conceal weakness

• Clinicians are trained to show no weakness, often leading them to hide their distress and not seek help.
• Even when struggling, they maintain a facade of strength and competence, making it hard to detect their pain.

How to identify when one of your colleagues is in distress

• Warning signs can be subtle, and professionals are adept at hiding their true feelings.
• Trusting one’s instincts when something seems off is essential, and approaching colleagues with genuine care and concern is essential.

Approaching a distressed colleague

• Express genuine care and curiosity.
• It’s not the responsibility of peers to fix the situation but to offer support.
• The challenge is to avoid trying to provide solutions and just be present for the distressed individual.

Hey, I just noticed something doesn’t quite seem right. I care about you. I just wanna check in.” Sometimes, they’ll say, “I just didn’t sleep well last night.” And that’s fine. And a lot of the time, there’s more there.

What to do if you ask a distressed colleague how they’re doing and they repeatedly say, “I’m fine,” but it’s clear they are not

• Your job is to express genuine caring and curiosity. 
• You are not responsible for them
• Leave the door open

I have noticed that you just seem a little irritable. I really care about you. I’m here for you if you need anything.

It’s not our job to fix our colleagues that we’re worried about. But we can step in and offer an invitation.

The hardest part about reaching out to offer support is trying not to fix it

Importance of asking hard questions

• Asking direct questions about mental well-being, including suicidal thoughts, can provide an avenue for someone to seek help.
• Such questions can normalize and validate the feelings of someone in distress.

The internal and external barriers to seeking help when we’re struggling | Tricia paid for counseling out of pocket, so no one would know about it

• After seeking help for her struggles, Tricia viewed trainees’ challenges through a new lens during her chief year.
• Recognizing the systemic problems in the healthcare system, she implemented changes to support trainees’ well-being.
• Tricia’s experiences fueled her passion for organizational change, emphasizing the need to better support healthcare professionals.

A light switch went off for me. Oh, this isn’t a me problem. This is a system problem. What are we doing?  That our trainees have this degree of burnout and depression just to want to take care of people.

Dr. James’ vision for medicine

• The quality of experience for medical professionals should be a measurable and prioritized metric.
• Historically viewed as superhuman, doctors and medical professionals must grant themselves the grace to be human.
• Clinicians possess significant power and influence. It’s essential to be intentional about defining one’s relationship with medicine. Whether it’s about merely focusing on the immediate responsibilities or actively influencing broader changes, it’s a personal choice.
• The collective strength and influence of clinicians can drive transformative change.