Article in brief
Clinicians used focus groups at a facility to identify sources of burnout before beginning to address them through systemic changes.
When Deborah Young Bradshaw, MD, FAAN, decided to tackle burnout in her department, she took advice from the Mayo Clinic, a leader in clinician wellness research and strategies for attenuation over the past decade.
In 2017, Tait Shanafelt, MD, director of Mayo’s Physician Wellness Program until it moved to Stanford University, and John H. Noseworthy, MD, FAAN, president and chief Mayo’s leadership, published an article, “Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Foster Engagement and Reduce Burnout,” about the Clinic’s anti-burnout strategies. Dr. Bradshaw liked what she read.
“I’m following the recipe because it’s a proven recipe, and it tells me what to do step by step,” said Dr. Bradshaw, associate director of the education and residency program in the department of neurology at the University of Washington. New York Upstate Medical University Syracuse.
As a member of AAN’s Lead Well, Live Well 2018 cohort, Dr. Bradshaw leads her department through the first three strategies of the Mayo document: 1) recognize and assess the problem; 2) harnessing the power of leadership; and 3) developing and implementing targeted interventions.
“We take a tactical approach to burnout,” said Luis J. Mejico, MD, FAAN, chair of the neurology department.
Results of a departmental survey found that 73% of full-time faculty members reported at least one symptom of burnout, compared to 60% of neurologists nationally (result of the survey from the department). conducted in 2016). On the other hand, 63% of upstate residents reported at least one symptom of burnout, compared to 73% of neurology residents nationally (result of another AAN survey conducted in 2016) .
Despite the high rate of burnout, faculty members reported high levels of meaning in their work. “So people are burnt out, but they still find their work meaningful, which I think keeps them going,” Dr. Bradshaw said.
Another takeaway from the survey results: Fourth-year residents reported fewer work hours and better sleep than their colleagues in previous years, but higher levels of interpersonal disengagement. “And you can see that when you talk to them,” Dr. Bradshaw said. “Cynicism, which is at the heart of burnout, builds up, regardless of the hours worked.”
The survey was followed by focus groups—two for those working in the outpatient clinic; one for neurologists working in stroke/ICU; one for residents – to gather their thoughts on burnout factors and potential solutions. Other subgroups such as neurologists who work on the stroke department will have focus groups in the future.
“This step, as simple as it was, made our teachers realize that they are not alone and that they are heard,” Dr. Mejico said. “It gave them hope that there will be improvement.”
The sessions identified simple issues, for example, how after-hours outpatient phone calls are handled, which are immediately addressed by clinic or division managers. Working groups will be created to deal with more complex issues, Dr. Mejico said.
During this time, Dr. Bradshaw was inspired by Mayo’s No. 2 strategy – harnessing the power of leadership – to develop a leadership program for neurology residents.
“Lead physician behaviors are very important to physician well-being — that’s a huge thing for me that came out of Mayo’s work,” she said. “They found that a small increase in the leadership skills of people in managerial positions led to a several-point reduction in burnout.”
The Leadership Academy’s three-year program, which launched this year, consists of monthly noon lectures to teach residents the fundamental qualities of leadership. First-year residents will be introduced to basic concepts such as effective listening and building high-performing teams. Second-year residents will practice skills such as difficult conversations and conflict resolution, and third-year residents will teach the program to their younger colleagues.
“We take a tactical approach to burnout.”
—DR. LUIS J. MEJICO
Faculty members will develop and present modules on topics of their choice, such as emotional intelligence or leadership styles. “Our faculty seem really interested and excited about this,” Dr. Bradshaw said. “These are things they want to know for themselves.”
Past AAN President Terrence L. Cascino, MD, FAAN, a Mayo professor of neurology and chair of the AAN Leadership Development Committee, has been recruited to come to Syracuse this summer to launch the Leadership Academy.
Advice from the front lines
Dr. Bradshaw shared these details with others who might want to follow his lead.
Because she wanted to compare her department’s results to those of neurologists nationwide, Dr. Bradshaw chose the survey instrument developed by the AAN for its 2016 National Study of Neurologists. She modified the instrument by replacing the Maslach Burnout Inventory, which requires payment for its use. , with the Stanford Professional Fulfillment Index, which can be used free of charge. She also added some questions about sleep, which is associated with clinician well-being.
The investigation lasted a week; 100% of residents and 85% of faculty members participated.
Each focus group was led by a faculty member who does not work directly with focus group participants. A movement disorder specialist led the group of neurologists on the stroke team, for example.
“I recruited people who would be a neutral person,” Dr. Bradshaw said. “I’ve asked section heads not to attend (focus groups for their work units) so professors can be open and not worry about hurting their feelings.”
She gave each manager a PowerPoint presentation to guide the discussion and coached them to focus on departmental issues rather than them, for example, electronic health record technology and quality metrics for the performance monitoring.
“The Mayo people said, ‘Try not to spend too much time on things we can’t fix,'” Dr Bradshaw said. “So let’s try to focus on the things that are within our ability to change.”
The leader used participant feedback to create a list of the top burnout factors identified by the group.
Rohit Swarnkar, MD, who completed his residency at Upstate this spring, said the focus group was worth it because it gave attendees a chance to share their perspective.
“The questions were quite open: ‘What do you think is an excessive burden on your time?’ and “Is there anything we could take off your plate that would improve your educational experience?” he said.
Beyond Neurology at Upstate
As Dr. Bradshaw pointed out, many important burnout factors, such as electronic medical record (EMR) technology, cannot be addressed at the departmental level. Upstate Chief Medical Officer Amy Tucker, MD, Medical Staff Chair Leslie J. Kohman, MD, and members of the Upstate Wellness Task Force are tackling it.
“The EMR that we have has been a pain point for our clinicians, as well as clinicians nationwide,” Dr. Tucker said.
A brief survey of medical staff was conducted to ask two main questions: 1) What changes in the EMR system would improve your life? 2) What changes in the medical staff environment would improve your life?
In response to many suggestions for improving the EMR system, an EMR User Group has been created and voice recognition software is being added to reduce the number of clicks and the amount of scrolling doctors have to do each day.
“The second thing people wanted was a space where medical staff would have somewhere to sit, hang up their coats, have a cup of coffee and interact with each other,” Dr. Kohman, thoracic surgeon. To that end, upstate leaders agreed to create a Clinical Collaboration Center, something akin to the doctors’ lounges that were commonplace in hospitals.
Physicians also expressed dissatisfaction with some professional aspects of their work. “Medical staff feel like they don’t get the proper recognition and respect for all the very hard, difficult and excessive work they feel they are doing,” Dr Kohman said.
This will be addressed by increasing opportunities for committee appointments and leadership opportunities for young faculty members and finding ways to improve working relationships.
“We know that a person’s well-being at work relies heavily on their interaction with their immediate supervisor, and we really want to improve those relationships,” Dr. Kohman said.
While wellness initiatives that support personal resilience are important, Dr. Kohman was keen to say it’s not the top priority.
“The most important thing is to remove systemic barriers so people can look their best at work and feel their best,” she said.