As healthcare organizations look for ways to reduce physician burnout, some are placing their bets on a new C-suite role: chief wellness officer.
Hospitals that appoint an executive to oversee wellness anticipate not only happier employees but also improved patient experience and outcomes.
Physician burnout is at an all-time high. In a recent Medscape survey, nearly two-thirds of doctors reported feeling burned out, depressed or both. Worse, 33% of respondents said those feelings impacted their patient interactions. Burnout rates were highest among family physicians, intensivists, internists, neurologists and OB-GYNs, and were higher among women than men.
This epidemic, if you will, comes as the nation faces a growing shortage of doctors. The Association of American Medical Colleges projects the physician shortage could reach 105,000 by 2030.
Among factors fueling burnout are long hours, increasing regulatory and recordkeeping requirements and administrative and computer tasks. An Annals of Family Medicine report in September found that primary care physicians spend more than half their workday on EHR tasks. But the implications go beyond the looming shortage; physician burnout has been linked to lower productivity and absenteeism, medical errors, poorer outcomes and lack of engagement with patients.
Enter the chief wellness officer, or chief physician wellness officer as the title is sometimes called. The idea is not new, says Linda Komnick, a senior partner and co-leader of the physician integration and leadership practice at Witt/Kieffer. Companies and large organizations have employed them for more than a decade. However, it’s only in the past couple of years that they’ve started cropping up in healthcare.
“I would not call it a ‘trend’ yet,” she told Healthcare Dive. “What is a definite trend is that healthcare organizations are trying to be more holistic in supporting employees.”
The idea of CWOs aligns with the shift toward value-based, patient-centric care. Hospitals are trying to differentiate themselves culturally while they manage cost and risk. And there’s growth in self-insured plans and the overall societal thrust toward wellness.
Last summer, Stanford Medicine became the first academic medical center in the U.S. to designate a CWO, naming Dr. Tait Shanafelt, a hematologist who spearheaded an anti-burnout initiative at the Mayo Clinic.
Creating incentives for wellness
Concerns about chronic disease and rising healthcare costs led the Cleveland Clinic to appoint the C-suite role a decade ago. The question was “could we change the culture and environment of the organization by figuring out incentives to help people stay well and then reward them for staying well?” explains CWO Dr. Michael Roizen. “And what would that do to absenteeism and productivity?”
To do that, the clinic asked employees to achieve six “normal” vital signs — blood pressure, fasting blood sugar, body mass index, LDL cholesterol, healthy urine, learn to manage stress and see a primary care physician once a year. Those who meet those targets or are on a clear path to achieving them get the insurance rates and benefits in effect in 2008, when the CWO program took off. Everybody else gets rates in line with the current economy.
Preventing burnout is a big part of Roizen’s role. He says stress levels for healthcare workers were five deviations above the mean in 1983 when the Perceived Stress Scale was developed. To address the problem, the clinic offers an online stress management program. Those who take it see their stress and burnout levels fall by about 75% and 44%, respectively, he says.
The clinic also designated two physicians to work solely on reducing EHR clicks for physicians and uses scribes to assist its primary care practices.
There have been environmental changes as well, such as removing sugary products from vending machines, eliminating fried foods and trans fats in its eateries and making on-campus fitness centers free to employees.
The effort has paid off. In 2008, about 6% of clinic employees had six normal vital signs. Today, 63.8% of employees are in chronic care management programs and 40% have the six normal numbers. “That’s saved us, compared with competitors, $254 million for 101,000 employees in the past three years,” Roizen tells Healthcare Dive.
In addition, absentee rates have dropped from 1.07% to 0.70%. That change alone, if all the clinic did was replace the nurses, saves about $7 million a year, he adds.
It’s a win for employees, too, Roizen notes. The lower insurance rates translate to about $200,000 more in retirement funds, and employees live about eight years younger, meaning their risk of getting a chronic disease is that of someone younger.
A holistic approach
Dr. Edward Ellison, executive medical director and chairman of Southern California Permanente Medical Group, hired a CWO six years ago after physicians ranked the organization “very low” on wellness support in an internal survey. The response stood in contrast to that of managers and other staff.
The survey was trigger of sorts, Ellison says. “I had been a practicing physician and I knew the stresses. I knew the challenges of the electronic health record and how it had made many positive gains for systems of care and caring for patients, but created an added burden for physicians.” The survey was a “data point for me and what really prompted me to appoint a chief physician wellness officer,” he adds.
To increase physician satisfaction, the group now offers flexible and alternate work schedules, reduced hours, mental health resources and peer-to-peer support. Specified teams help physicians prioritize administrative tasks so that others can handle the clerical work. There is also a physician concierge to help with non-work life planning, social events aimed at reducing the isolation physicians can feel in their job. Doctors are taught to practice personal preventive care and provided access to workout equipment.
“You have to take a very holistic approach,” Ellison tells Healthcare Dive. “It starts with culture, but it’s also about the practical, tactical time in your day. It’s about reducing the hassle factor and some of the bureaucracy of systems, and it’s about personal care and resilience and connecting people so that they don’t feel isolated.”
SCPMG has repeated the survey that showed physicians did not feel the organization supported their wellness. The response today: double-digit improvements on culture and wellness, Ellison says.
An evolving role
So what qualities does a CWO need? Healthcare organizations are still figuring that out, says Komnick. Some are tacking physician and employee wellness onto medical director, chief human resource officer or chief experience officer roles. For those focused on physician wellness, it helps to have someone with a medical degree or research credentials. Other assets include the ability to lay out a vision for long-term wellness and supportive programs and exceptional collaborative and communication skills to get people on board with new ways of working in organizations that are traditionally resistant to change, she says.
The challenges for CWOs are huge and call for a wide continuum of solutions. “It’s not one size fits all, and we have to do this in the face of enormous change in healthcare, a lot of ongoing changes in reimbursement strategies and systems of care,” says Ellison, noting CWOs have to navigate all of that while focusing on wellness and resilience.
Meanwhile, the problem of burnout is only getting worse. Ellison sees a parallel in airline passengers being told to don their own oxygen mask before helping others. “We need to make sure that our physicians are as healthy as they can be because they are then going to be able to be their for their patients and support them,” he says. “It is in line with taking care of our patients.”