Article Figures & Data
Tables
PROJECT MANAGEMENT PLAN – Flourish Through CREATION Health
Vision Statement Our vision is to build resilience in residents through experiential small-group activities grounded in the CREATION Health principles of choice, rest, environment, activity, trust, interpersonal relationships, outlook, and nutrition. In addition to providing all residents with a space for personal exploration, this initiative will examine whether participation in these small groups influences resident burnout, perceived stress, empathy, and/or well-being. Team Objectives Through their participation, AdventHealth residents will be able to understand the 8 CREATION Health principles of well-being with an emphasis on choice, trust, interpersonal relationships, and outlook
build trust and enhance communication skills
practice strategies designed to reinforce resiliency skills, including internal reflection, examining emotions, expanding choices, deepening empathy, reclaiming personal meaning, and enriching relationships
Success Factors The most successful parts of our work were the outcome of improved trust among residents and the reported appreciation of the small-group format. We were inspired by the Center for Physician Wellbeing's improved relationships with residents, as well as the increased awareness of and access to our services. We were also inspired by resident reactions to the content of the curriculum and direct feedback on how to improve the program to best meet their needs. Barriers The largest barrier encountered was that the Center for Physician Wellbeing designed and delivered the program but is a department outside, resulting in unclear roles, responsibilities, and ownership of the project among partners. Participants experienced survey fatigue and confusion about when to complete assessments. We worked to overcome these barriers by creating an advisory board consisting of faculty members, residents, facilitators, program developers, and the GME chief academic officer. We also increased communication with the research team and added time to final sessions to complete surveys. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to make sure that the well-being/resiliency interventions are supported by and driven from within GME (leadership, faculty, and/or residents). Do not approach well-being initiatives as a manualized, one-size-fits-all approach. PROJECT MANAGEMENT PLAN – Examining the Impact of a Support Group on Burnout and Resilience in Graduate Medical Trainees
Vision Statement Our vision is to create a culture in the clinical learning environment such that resident physicians and those supporting resident training are well versed in identifying and managing available resources to address and promote well-being. Team Objectives Our primary aim was to establish and sponsor resident support groups at one metropolitan hospital across three departments: family medicine, OB/GYN, and internal medicine. We aimed to establish a safe atmosphere to process professional challenges, develop coping skills to manage burnout, and create a template for work-life balance and healthy lifestyle choices. Success Factors The most successful parts of our work were the implementation of support groups and the increased awareness among faculty and GME. We were inspired by the engagement of our residents and their willingness to participate. Barriers The largest barrier encountered was finding protected time for residents to participate and the lack of a one-size-fits-all support group. We worked to overcome this barrier by planning to have small-group review to identify ideal length, structure, and content. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to include a customized toolbox to allow residents to self-select appropriate strategies. PROJECT MANAGEMENT PLAN – Tomorrow Begins Today
Vision Statement Our vision is to increase awareness at multiple levels of the importance of faculty and resident well-being and strategies to optimize physician well-being at Advocate Lutheran General Hospital and at Advocate HealthCare. Team Objectives Objectives for this project were to conduct a baseline ACGME Inventory of Elements of Institutional Well-being – C-suite, program directors, residents, faculty, medical staff leadership
survey the impact of our physician commitment to professionalism as a component of and marker of well-being
assess hospital and system resources
develop a well-being curriculum for the family medicine residency
Success Factors The most successful part of our work was being able to make sure the conversation about physician well-being was at the forefront at multiple levels. Another successful part was quarterly Wellness Wednesdays with the family medicine residency. We were inspired by conversations about various initiatives in individual programs and beginning steps toward a more systematic approach. Barriers The largest barrier encountered was the transition to Epic; it consumed time, attention, and energy and was a source of burnout. Turnover and lack of support by our research department also delayed progress on our data analysis and paper preparation. Further, team members had many other often competing commitments. We worked to overcome these challenges by persevering and raising the concerns to the highest level. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to have a clear vision, both aspirational and pragmatic, and to persevere, understanding that well-being is not an issue to be solved but to be addressed with a long-term commitment by both individuals and organizations. PROJECT MANAGEMENT PLAN – Bridging Effective Communication of Patient Assignments Between Physicians and Nursing to Reduce Stressors
Vision Statement Our vision is to study the effects of systematic controls and flexibility surrounding transition-of-care communications in our hospital setting and their effects on the well-being and burnout of resident physicians and nurses. Team Objectives We aimed to study and analyze potential causes of stress and burnout between residents and nurses in a clinical setting; design a research study to test an intervention to reduce stressors and improve measurable well-being; and conduct the study, analyze results, and publish findings. Success Factors The most successful part of our work was the collaboration between physicians and nurses throughout our project. The team was inspired by the shared goal of wanting to provide the best patient care as a team. Barriers The largest barrier encountered was the lack of voluntary participation in the study. Approximately half of the nurses opted out of participating in the survey. Some nurses opted out before receiving the presurvey, while others expressed concerns specific to the survey questions and opted out after receiving it. It was also difficult to get both physicians and nurses to complete the surveys in a timely manner. We were able to overcome some of the concerns by having discussions with alarmed participants, and in some cases, we were able to alleviate their concerns. We overcame the slow response rate by having consistent and timely follow-up with the participants. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to consider doing the intervention with the entire service and all nursing units instead of a couple of the teams so the sample size is adequate. We had concerns about our physician sample size being too small, but we hoped to have a much larger sample from nursing. When half of the nurses on our control and test units opted out, our sample size was too small. PROJECT MANAGEMENT PLAN – Institutional and Resident-Led Wellness Interventions
Vision Statement Our vision is a sustainable culture of wellness driven by engaged, empowered residents and faculty. Team Objectives Objectives of this study were to implement and assess a series of wellness interventions; involve residents in their design and instantiation; and collect quantitative and qualitative data to measure impact and disseminate results in the medical education literature. Success Factors The most successful part of our work was empowering residents to generate their own wellness initiatives and educating them about institutional wellness resources. As a result, faculty became engaged and program-level wellness committees were formed. These committees were the most effective model for sustainable wellness activities. We were inspired by resident engagement. Barriers The biggest barrier encountered was that the engaged residents represented a small percentage of the larger resident population; competing priorities made engagement difficult. We worked to overcome the lack of engagement by focusing on wellness as an aspect of professional development rather than as an extracurricular consideration. This change led to faculty members being more motivated to engage. Limitations to this approach are reflected in low attendance at some events. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to understand that faculty-resident partnerships are the key to driving change. Program directors and the GME office have the authority to mandate participation, but just their authority is not enough for active engagement. Residents have the perspective and motivation to effect change but no access to resources. Faculty working with and on behalf of residents in wellness committees garner both the power of resident motivation and legitimacy in the eyes of program leadership and the institution. PROJECT MANAGEMENT PLAN – Improving Health, Inspiring Resiliency, Promoting Well-Being: Building Resources for Our Programs
Vision Statement Our vision is to improve the health of residents while inspiring resiliency, promoting well-being, and creating a renowned clinical learning environment. Team Objectives Objectives for this intervention were perform a needs assessment of individual program activities and needs to support well-being initiatives
offer a mentor development program for faculty and peer mentors focused on developing overall mentoring skills that support resident well-being
establish quarterly monitoring of program-level well-being scores using the Mini-Z
establish a Wellness Council, consisting of both faculty members and trainees, that will promote trainee and faculty well-being, make recommendations to the GME office and the GMEC regarding ongoing well-being initiatives, and assist in implementing and assessing the efficacy of various interventions and well-being experiences
Success Factors The most successful part of our work was the implementation of the mentoring development workshop and the establishment of a Wellness Council. We were inspired by our programs and their continuous development to assist the residents. Barriers The largest barrier we encountered was project management. Early in the project, we should have assigned specific tasks to individuals on the team to remain on track. Delegation and designation of a project manager would have ensured more structure and tracking of the project. We worked to overcome this barrier by scheduling standing meetings with the project team to discuss different aspects of the project. An additional member of our Center for Physician Leadership and Development was added to the project team to assist with the facilitation of the survey, focus group, and faculty development. Other barriers were faculty and resident participation/engagement (largely related to lack of time and other obligations) and additional difficulties with access to resources and finances. Limitations of the size of the travel team was another barrier, and it hindered us at the collaborative meetings. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to communicate with stakeholders multiple times throughout the initiative, not just once. PROJECT MANAGEMENT PLAN – GME-Wide and Program-Specific Initiatives to Strengthen a Culture of Well-Being
Vision Statement Aurora Health Care's GME programs will be nationally recognized for preparing our current and future physicians to help people live well—our patients, each other, and ourselves. Team Objectives Our GME aims/objectives were as follows: Serve as well-being system leaders through the development of clear GME protocols and procedures
Identify and provide GME-specific and systemwide resources/support to team members
Improve resident and faculty well-being through residency/fellowship program-specific initiatives
The objectives/aims of each of the 4 participating programs were as follows:
Internal Medicine: (1) Create a personal team for incoming residents to help with the transition into residency and (2) provide and promote education about the importance of personal health including exercise/diet
OB/GYN: (1) Implement workload changes and time for wellness and (2) identify existing data sets and/or develop a quick check-in survey as process and outcome measures for resident/faculty well-being
Family Medicine: (1) Design and implement a systems-based intervention that improves resident wellness and prevents burnout
Radiology: (1) Promote well-being self-awareness, (2) identify program-specific contributing factors of burnout, and (3) implement departmental changes to improve well-being
Success Factors Our intentional design approach as outlined in our initial application was successful. We created win-wins to reduce checkbox burnout; we used the IHI Model for Improvement (eg, aim, measures, 2 PDSA cycles, disseminate, and sustain) to meet ACGME requirements; we met requirements for quality improvement and scholarly activity (for residents and faculty); and our well-being scores are good. Working with our health system leaders, we continue to strive to make them better. We were inspired by the creativity, commitment, innovation, persistence and successes of our residency program team leaders and our GME successes in working with the system to accept clinician well-being as a crucial element of high-quality, safe patient care. Barriers The largest barrier we encountered was acceptance that well-being is vital to phenomenal patient care with actions/resources. We aren't done and probably never will be. Thus, we see this as a journey where we must continue to work on the recognition that well-being is vital for our common goals of amazing health for patients, providers, and populations. We must use multiple strategies; the addition of a Director for Well-Being for Academic Affairs will expand our reach and possibilities. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is that over time, a series of small steps builds recognition of the problem and identification/implementation of approaches at the system and individual levels: persistence, teamwork, data, and dissemination/spread. PROJECT MANAGEMENT PLAN – ResWell: Design and Implementation of a Resident Wellness Program
Vision Statement Our vision is for resident physicians at Bassett Medical Center to be intellectually, emotionally, spiritually, and physically prepared to engage in a stimulating and fulfilling life and career. The mission for ResWell is to engage our residents in trainee-directed activities and interventions to elevate them toward a higher level of well-being. Team Objectives Objectives for this project were to make ResWell a central player in the development of wellness activities and interventions for the residents at Bassett Medical Center
plan and organize activities that address each domain of well-being
have the institutional GME office include residents in decisions and strategies that pertain to their wellness
have ResWell members meet with the CLER site visitors when they are at Bassett
have the steering committee supervise and administer the wellness and resiliency survey three times annually
observe participation in ResWell activities and obtain feedback
receive administrative and financial support from the GME office
Success Factors The most successful part of our work was the residents' recognition that they are valued by the institution and that they have some control over their lives. Residents were engaged with wellness activities and found value in the activities. Resident mental health services are strengthening and becoming more visible, and residents are more aware of resources. We are inspired by spinoff programs and interventions, such as the Arts in Healthcare program. Barriers The largest barrier encountered was attrition of resident participation in the ResWell steering committee. We worked to overcome this challenge by providing the committee with more consistent administrative support. We received limited responses to anonymous periodic surveys. We worked to overcome this challenge by providing multiple mechanisms to access the surveys, utilizing ResWell committee members to encourage participation and publicizing the survey results along with changes that occurred because of the results. Lessons Learned Providing emotional and administrative support to the residents who lead ResWell is paramount to make the group sustainable and to prevent burnout of those actively trying to prevent burnout. Resident participation in activities is enhanced by making the activity resident directed and by encouraging and responding to constructive feedback. PROJECT MANAGEMENT PLAN – Resident Wellness Week
Vision Statement Our vision is to develop long-term and innovative strategies to improve resident well-being across a variety of areas including community, mental health, exercise, healthy eating, good sleep habits, and work-life balance. Ideally, we would like to see healthy habits form during training that will continue to aid our graduates in maintaining wellness and good health throughout their careers. Team Objectives Our objective for this project was to provide trainees with education on tools and resources through an annual wellness week. Goals were to (1) teach trainees a wide variety of strategies to combat burnout and improve wellness and (2) ensure that trainees are able to self-identify when they are stressed, burned out, or struggling mentally/emotionally. Success Factors The most successful part of our work was the amount of trainee participation in various activities. We were inspired by trainee enthusiasm in the wellness events and how simple activities, like bringing in therapy dogs, were the most effective. Barriers A large barrier was trainee engagement in the activities, including time to participate and support from medical staff to allow participation. We worked to overcome this challenge by using house staff champions, overly communicating the schedule of activities, scheduling activities at different times of day, and including a raffle of donated prizes. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to involve trainees in the planning. PROJECT MANAGEMENT PLAN – Walk a Day in My Shoes
Vision Statement Our vision is to improve empathy by building stronger relationships within the healthcare team through a shared understanding of our roles and how we can work better together through shadowing experiences. Team Objectives Objectives for this project were to assess the short- and long-term impact on empathy, understanding, and communications of existing nurse-resident shadowing experiences during orientation for our programs in internal medicine and OB/GYN
expand the program to other residencies and programs to have residents shadowing each other across specialties
expand the shadowing experience to other healthcare students and residencies and even wider into the system as part of the systemwide provider orientation
develop a program by which nurses can shadow residents and attendings to understand their workflow and structure
Success Factors The most successful part of our work was the organic learning that occurred when the residents observed that many of their assumptions were incorrect and their ability to build a better understanding of the nurses' role and how to work with them. We were inspired by the quality and quantity of reflection by the residents and how open the nurses and residents were to participate. Barriers The largest barrier encountered was the recognition of the value of shadowing across the department. We worked to overcome this challenge by ensuring that the whole department was aware of our intentions and goals with this activity and by building nurse-resident shadowing as a protected activity for more residents going into the next orientation period. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to build this experience into protected orientation time. PROJECT MANAGEMENT PLAN – Studies on Physician Resiliency and Well-Being in Rural Montana
Vision Statement Our vision is to be a learning laboratory for the rural healthcare workforce of the future and for our graduates to be healthy and balanced experts in the care of complex medically ill patients in rural environments. Team Objectives Our objectives were to address challenges faced by residents to support resilience and well-being and to survey internal medicine physicians in rural areas to examine factors associated with professional satisfaction in rural practice. Success Factors The most successful part of our work was collaborating across our organization on physician engagement and well-being and creating resident leaders and faculty mentors. We were inspired by the opportunity to collaborate with other institutions and by our residents' engagement. Barriers The largest barrier encountered was the transition to a new program director in the middle of this project. We worked to overcome this by working with our Office of Medical Education. Lessons Learned The single most important piece of advice to provide another team embarking on a similar is to choose stakeholders thoughtfully. PROJECT MANAGEMENT PLAN – Improving Housestaff Access to Wellness Resources
Vision Statement Our vision is to promote resident well-being by creating an environment that fosters resiliency, a positive work-life balance, and a supportive community. Team Objectives Our objective was to consolidate access to resources and enable them to be accessible in a resident-friendly mode through a mobile application. Success Factors The most successful part of our work was developing an enthusiastic multidisciplinary group that has engaged in providing well-being activities for housestaff beyond this project. We were inspired by everyone's sustained interest in promoting resident well-being. Barriers The largest barrier encountered was getting good data to judge the efficacy of the project. We administered the Resident Wellness Scale multiple times but found that the scale did not fit with the evaluation of our project, so we needed to come up with another data collection plan. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to plan usable data collection. PROJECT MANAGEMENT PLAN – A Comprehensive Systems Approach to Resident Well-Being
Vision Statement Our vision is to connect the value of strategic investment in provider well-being to the advancement of our institution's core values of Love and Excellence and the Quadruple Aim and to optimize the experience of providing care within our organization. Team Objectives We aimed to address resident well-being at the individual, programmatic, and organizational and leadership levels of the institution. Objectives were to engage residents in well-being education and programming
cultivate resilience and social support through quarterly psychologist-led sessions focusing on reflection and self-awareness
promote mental health and encourage help-seeking behaviors by developing institutional policies that protect clinicians' dignity, safety, and privacy, along with increasing access, familiarity, and exposure to psychologists
initiate clinical learning
initiate clinical learning environment change via the residency program annual performance evaluation process with Academic Affairs
Success Factors The most successful parts of our work were the addition of well-being goals to the annual performance evaluation, a marker of significant partnership between GMEC, Academic Affairs, the Center for Provider Wellbeing (CPW), and residents/fellows
increased consultation, involvement, and collaboration between program leadership and the CPW
increased help-seeking behaviors by residents and fellows in distress
continued expansion of quarterly well-being sessions to new residency and fellowship programs
collaborative, mutually respectful relationships among Academic Affairs, GMEC, CPW, and residency/fellowship program leadership
the openness, interest, engagement, and participation among residents and fellows in discussing topics such as burnout, wellness, and organizational culture
senior leadership/CEO/C-suite buy-in and institutional support
Christiana Care organizational values and shift toward Love and Excellence
Barriers The largest barriers encountered were fostering open communication and collaboration between resident well-being champions and program leaders
helping program directors feel empowered to enact real organizational change
time
attending and participating in monthly GMEC meetings
forming collaborative work groups and teams across departments and roles
promoting cooperation by framing our roles as collaborative consultants
collecting data to bolster initiatives
creating an FTE entirely dedicated to the well-being of those in the clinical learning environment
Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to develop data-driven initiatives for resident physician wellness at both the individual and organizational levels. Individual and organizational factors are highly interrelated. PROJECT MANAGEMENT PLAN – A Multipronged Approach to Creating a Culture of Resiliency Support
Vision Statement Our vision is to create a culture of resilience for our caregivers in a safe environment where they feel empowered and supported when faced with the inevitable challenges of providing world-class care for their patients. Team Objectives Objectives of this project were to assess current practices in each of the residency programs related to caregiver wellness, survey caregivers to determine gaps in support, and create a plan to address their needs. Success Factors The most successful parts of our work were our engagement with the residency programs, our response rate, and the ability to create a more visible presence for our employee assistance plan resources. We were inspired by the thoughtfulness of the resident responses to the resiliency questions. Barriers The largest barriers encountered were residents' availability, follow-up on team assignments, and timing of survey rollouts. We worked to overcome these barriers by increasing communication from team leadership. Lessons Learned The most important advice to provide another team embarking on a similar initiative is have clear messaging that explains the purpose of the project
have NI VI team members who attend resident meetings inform the residents about the project vs relying on chief residents and program directors
use a QR code (it made the process accessible for the residents)
PROJECT MANAGEMENT PLAN – “We” for Wellness
Vision Statement Our vision is to create an environment that fosters the well-being of both our learners and our instructors. We strive to create a safe, inclusive, and supportive training environment for all involved. Team Objectives An objective for this project was to decrease resident burnout, as measured by the Wayne State University Resident Wellness Scale, by 5%, from our baseline of 3.59 to 3.77 over a period of 9 months by giving residents a half-day of dedicated wellness time. Another objective was to encourage program-specific wellness initiatives within each of our residency programs. Success Factors The most successful parts of our work were residents' recognition of efforts made for resident wellness and the appreciation of the wellness half-day. We were inspired by buy-in from residents when we listened to their desire for autonomy. Barriers The largest barriers encountered were time constraints around meeting, scheduling, and planning our events and the amount of time dedicated to our group. We worked to overcome these barriers by engaging appropriate administrative staff, learning who the key schedulers were at each program, and scheduling meetings well in advance. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is don't underestimate the value of having your whole planning committee together on a regular basis; preplan these meetings well in advance. PROJECT MANAGEMENT PLAN – Improving Well-Being and Work-Life Balance of Residents
Vision Statement Our vison is to foster a learning environment that promotes physician well-being, improve resiliency in our new physicians and find effective methods of reducing stress and burnout, and enhance our culture of wellness and better our patient care through bettering ourselves. Team Objectives Objectives for this project were to use the concept model of human coping reservoir
identify stressors in residents via survey
implement interventions involving the promotion of well-being and perform periodic assessments
Success Factors The most successful part of our work was its completion. We were inspired by everyone's accomplishments presented at the other meetings. Barriers The largest barriers encountered were time management and resident turnout at the interventions. We worked to overcome these barriers by dedicating a rotation for the PGY2 participants to carry out the remainder of this project. We also recruited a PGY1 to facilitate the events and aid in data collection and the social promotion of well-being. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to form a committee to help implement a plan and have events frequently. PROJECT MANAGEMENT PLAN – Resiliency in Residency – A “SHORE” Thing
Vision Statement Our vision is that resilience and wellness will be incorporated and integrated into all aspects of our training environment. Our mission is to foster a culture of well-being for our resident physicians and fellows by creating a curriculum based on the needs of our trainees to enhance and maintain their resilience and wellness. The curriculum will provide an array of services designed to encourage healthy lifestyles, promote optimal work-life balance, and build resilience. The knowledge, skills, and attitudes obtained by our house staff through this program will prevent compassion fatigue and serve as an essential foundation for lifelong physical and mental well-being for themselves and their patients. Team Objectives Our objective was to investigate whether 3 months of weekly protected time for residents to learn and practice wellness activities improved their wellness, degree of burnout, and professional fulfillment. Success Factors The most successful part of our work was gathering all our residents together in one room for a kickoff event during which they were asked to complete a survey either online or in paper form. In addition, we brought more awareness to the issue of burnout and resiliency in residency and emphasized the importance of wellness through grand rounds, the kickoff event, and the 12-week program. Overall, this project was successful in introducing wellness tools to our residents. We were inspired by the active interest of our residents across subspecialties in this wellness initiative and other studies that have shown positive outcomes from implementing a wellness program. Barriers Barriers included the following: Compliance of residents with the program
Program ending during the winter (associated with higher rates of depression)
Postsurveys completed during the middle of the year when residents may be more burned out
Potential variations in the implementation style of the wellness activities between subspecialties due to each subspecialty having a different wellness champion
Inability to compare all the data due to less than anticipated participation on postsurveys
Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to implement a closing session. The closing session would be an opportunity, similar to the kickoff, to gather residents in a group setting to complete the postsurvey. PROJECT MANAGEMENT PLAN – Assessment of Resident Well-Being
Vision Statement At HealthPartners, we aim to assess our residents' well-being on a regular basis and support them in any way we can during their training time with us. Team Objectives We plan to incorporate a well-being survey into each resident's semiannual evaluation process and use the results to get them additional help or resources they may need. Our organization is aware of the data regarding depression and suicide in resident trainees, and we want to focus efforts on assessing and helping our residents. Success Factors The most successful parts of our work were implementing the well-being self-assessments
implementing resident visits to our hospital resiliency center
adding a wellness tab/section to the GME website
getting feedback from residents on our project
completing our project
Barriers The largest barrier encountered was that, due to schedules/meeting times, emergency medicine was the only program that participated in the project from start to finish. In the end, however, we found that having only one residency program trial our project worked well. Emergency medicine was the right size program for us to try our methods and get feedback that we can now use throughout our GME system. Another limitation was that we did not get feedback regarding the wellness resource section of the GME website. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to keep the project size and time frame realistic. We completed our project because we kept the focus and trial group small. Other advice is to get the key hospital personnel involved (in our case, the director of the health and wellness center) and to get GME buy-in for the project, as they were a great support for us. PROJECT MANAGEMENT PLAN – Building Resiliency With Empathy Training
Vision Statement We are committed to advancing and supporting a culture of well-being across our institution and specifically in the newest generation of medical providers. We firmly believe that to successfully champion a physician well-being culture, we must articulate, develop, and implement a proactive, sustainable approach to nourishing a culture that values and enhances strengths, balance, resilience, and well-defined resources as opposed to simply trying to fix accumulated stress and burnout after the fact. Team Objectives Our team objectives were as follows: Make HonorHealth the employer of choice
Develop an enhanced program for prevention of caregiver burnout
Develop processes and resources for caregiver crisis management
Identify and map a resident-centric well-being program for all GME programs
Create and implement a sustainable empathy education/training program
Develop accessible prevention and treatment resources
Enhance resident physician and caregiver engagement and alignment
Prevent caregiver burnout, thereby reducing adverse patient outcomes and improving patient and provider satisfaction
Promote a trauma-informed culture and response to secondary trauma contributing to caregiver burnout
Promote and support healthy teamwork and a compassionate culture
Success Factors The most successful part of our work was gaining a commitment from our institution for a systemwide sustainable, scalable well-being program. We were inspired by everyone's unique stories of resilience and collaboration and their desire to build upon and enhance these efforts. Barriers The largest barrier encountered was lack of accessibility to and time with residents due to their varying schedules. These time constraints led to our pilot project having a revised timeline and schedule and a smaller sample of participants than anticipated. We worked to overcome these barriers by soliciting buy-in and support from program directors and House Council leadership. Other limitations included survey fatigue, varying motivation for individual prevention improvement efforts, and a potential ceiling effect with the Connor-Davidson Resiliency Scale baseline mean score, which may have limited the ability to see significant change, in addition to a small sample size. Lessons Learned Important advice to provide another team embarking on a similar initiative is to use qualitative vs quantitative data collection methods whenever possible. Honor and value the multiple existing resources as well as the diversities encountered.
be open and willing to adapt and change initial plans as work unfolds.
openly communicate and demonstrate action based upon feedback from stakeholders. Keep everyone informed.
continually reassess and enhance engagement.
remember that a sense of community and connectedness is the underpinning of success and the key to project sustainability.
PROJECT MANAGEMENT PLAN – Improving Resident Wellness with FirstCall Assistance
Vision Statement Main Line Health System (MLHS) is committed to a continuous learning environment that must be nurturing and attentive to promote wellness. MLHS will be a thought leader in this area and will take measures to decrease burnout and promote wellness in residents, faculty, and health system employees. MLHS believes that wellness will propagate safety and quality. Team Objectives The purpose of our project was to assess, adapt, and ultimately connect our residents and fellows with the MLHS EAP, FirstCall. Success Factors The most successful parts of our work were administering the burnout surveys to residents and beginning a healthy dialogue with human resources (HR) about resident-specific needs within the EAP. We were inspired by the willingness of residents to be honest about their levels of burnout in their responses to the survey. Barriers The largest barrier we encountered was our inability to demonstrate the impact of our interventions within the time frame provided. We encountered barriers with FirstCall implementing some of our suggested interventions, including tracking resident use of services and issuing flyers and presentations specific to residents. FirstCall was unable to meet with and educate all residency and fellowship programs about their services during the project timeline. We are working to overcome these barriers by organizing feedback sessions between GME and HR/EAP. The internal medicine program hired a wellness director who should help bridge the perceived gap between these two departments. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to encourage residents to assume leadership roles in the project and to ensure that program directors designate time for residents to participate in meetings. PROJECT MANAGEMENT PLAN – Investigating Gender Bias at an Independent Academic Medical Center
Vision Statement Our vision is that our clinical learning environment will be free of gender bias such that every member of the healthcare team is treated with respect and equity. Team Objectives Our mission is to provide a better institutional understanding of the scope and nature of gender inequity experienced by physician trainees at Maine Medical Center (MMC). This knowledge will allow us to design targeted interventions that can be shared with other interprofessional and interdisciplinary leaders in our institution to investigate the experience and extent of gender bias among other MMC stakeholder groups. Success Factors The most successful aspects of the project were engagement from trainees
overall positive response from institutional leaders
trend toward improved perception of quality of clinical work being negatively affected by perceived gender bias after interventions
creation of 2 new positions: Title IX officer and dedicated GME social worker
Barriers Barriers and limitations included rare response from leaders, either undermining effort or discounting report
lack of local expertise
significantly decreased response rate from trainees in the postintervention survey
bias from not sampling the same trainee group one year to the next
Lessons Learned The project taught us to communicate early and frequently with senior leaders
understand that GME learners are employees and that human resources needs to be involved early and often in a sensitive topic such as this one
engage local experts
PROJECT MANAGEMENT PLAN – Monmouth Medical Center Well-Being Program
Vision Statement Our vision is to foster a medical education experience committed to an encouraging, supportive, and healthy pursuit of knowledge, learning, training, and growth. As a healthcare organization, we are devoted to a healthier community that acknowledges and is prepared to address well-being, including among our own residents and staff. Team Objectives Our objectives were to increase the collective well-being score by 10% of at least 70% of measured groups
incorporate and destigmatize wellness through monthly correspondence and education
build a scalable program extending throughout the hospital, and eventually the system, with support from physician leaders and the C-suite
Success Factors The most successful parts of our work were the increased participation, awareness, and specificity of wellness efforts, as well as the investment in infrastructure to support a sustainable wellness culture. We were inspired by making progress on our milestones. Barriers The largest barrier we encountered was keeping a consistent group moving forward on multiple projects at once. Accountability was difficult to maintain, and projects would slow down and hit barriers at different points across the initiative, many times out of the control of the steering committee's hands. We worked to overcome these difficulties by using several smaller, more focused meetings rather than steering committee meetings which often involved different constituents each time, resulting in repetition of past meeting information and competing priorities/agendas. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is that broad, hospitalwide initiatives are great for the culture, but information still must be delivered specifically and curated toward intended targets. Ensure leadership is committed and lends significance, finance, and importance to the efforts. PROJECT MANAGEMENT PLAN – Innovating Resident Well-Being
Vision Statement Our vision is to improve the condition of resident well-being at Ochsner through the enhancement of wellness infrastructure, accessibility, and awareness and to measure success through improvements in Maslach Burnout Inventory (MBI) measures. Team Objectives Our objectives were to administer an MBI baseline and postintervention survey
implement wellness and awareness strategies
administer a follow-up survey on resident awareness of wellness resources
inventory all existing wellness strategies in programs
Success Factors The most successful parts of our work were moving up the timeline for resident integration into the institution's provider wellness initiative and installing the new Office of Provider Wellness. We were inspired by resident sincerity and openness during focus groups. Barriers The largest barrier we encountered was a lack of resident interest/time in participating in the project. We worked to overcome this challenge by continuing to recruit participants and modifying focus group times to encourage participation. Another limitation was the low MBI and awareness survey response rates of 48% and 23%, respectively. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to ensure protected time from other operational commitments to sustain project momentum. PROJECT MANAGEMENT PLAN – Better Me, Better WE
Vision Statement Our vision is to strengthen our culture of wellness in order to become the place where physicians want to teach, trainees want to learn, and people receive high-quality community-centered care. Our mission statement is to deliver a comprehensive and innovative wellness curriculum across medical education targeted to the needs of each residency program. Team Objectives The objectives of our project were to decrease burnout among residents and faculty
offer a consistent and transparent wellness framework across medical education, driven by resident leadership and ideas and supported by faculty
support targeted interventions within each residency program
enhance awareness of burnout as a system/environmental issue and workplace hazard
enhance our culture of wellness within medical education where impediments of wellness are recognized and faculty/residents work to remove the impediments
Success Factors The most successful part of our work was engaging residents in a culture of residents. We saw a change in resident attitudes with this initiative compared to previous years of trying to reduce burnout. Residents across various programs became engaged in creating new wellness initiatives, diving deeper into existing issues and working to improve initiatives started by other programs. We were inspired by the success of some early interventions and watched as interest snowballed into action. Barriers The largest barrier encountered was the differences between the residency programs. Each program encountered unique challenges, and our wellness initiatives needed to be program-specific. We had inconsistent faculty support in some programs, and residents started to identify more systemic and hospital drivers of burnout outside of medical education, which will require more time and effort to fix. We worked to overcome these limitations by individualizing efforts and supporting our resident and faculty champions in each program. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is that meaningful change takes time and persistence. We were met with initial negativity and residents who were “burned out talking about burnout.” However, as we continued to ask our residents how to help them and acted on their suggestions, a spirit of friendly competition and a desire to engage in making things better emerged. We now have resident and faculty champions leading various interventions targeted to their needs, and a consistent support from medical education will keep that driving forward. PROJECT MANAGEMENT PLAN – Wellness at Orlando Health
Vision Statement Orlando Health as an organization will be a place where all employees, and more so learners, will find balance in personal and professional goals. We aim to create awareness within supportive programs tethered to each branch of our organization and to improve physician burnout rates and develop resilience. Team Objectives Our objectives were to decrease physician burnout by 10% within 6 months, and in the process, promote resilience and a joyful working environment. Success Factors The most successful parts of our work were establishing a database for burnout rates across all programs in our institution and participating in the development of a website for wellness for the entire organization. We were inspired by GME/DIO support to encourage residents to engage with physician coaches. Barriers The largest barrier encountered was skepticism on the part of residents about answering the questionnaire honestly for fear of punitive measures, especially in very small programs. We worked to overcome this challenge by providing reassurance through lectures, champions, small group settings, and a website for GME well-being. Other barriers included challenges in choosing an appropriate tool for assessing burnout
stigma of being labeled with a psychiatric diagnosis with some responses
deterrent associated with an online survey (fear of lack of anonymity)
challenge of identifying the most cost-effective intervention to decrease burnout rates
Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to educate, engage, and reassure residents/fellows/subjects of the confidentiality of their responses; we learned to not underestimate the degree of skepticism and fear of stigmatization by learners. Lessons learned were utilized to establish baseline burnout data for all programs with ongoing data collection postintervention. PROJECT MANAGEMENT PLAN – Collaborative Task Force to Restore the Joy in Medicine
Vision Statement In relentless pursuit of better, Our Lady of the Lake will work to enhance the well-being of our physicians and residents by providing them with the tools to better address their personal needs. We will also work to create an organizational culture that values and prioritizes physician well-being and spiritual growth. Team Objectives Our objectives were to increase wellness knowledge and self-care skills in our physicians and resident physicians
provide wellness resources to our physicians and resident physicians
create an organizational culture that values and prioritizes physician well-being and spiritual growth
Success Factors The most successful part of our work was convincing the C-suite of the importance of physician wellness. We were inspired by the willingness of our physicians to engage with the task force and share their personal wellness concerns. Barriers The largest barrier we encountered was unforeseen leadership changes that delayed C-suite decision-making related to the implementation and sustainability of wellness initiatives. Change in culture, particularly at the system level, takes time under any circumstance. We worked to overcome this delay by exercising patience and giving the leaders the time they needed to focus on the change before continuing with our work. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to be as clear as possible on what your measures of success will be before you begin. The project also needs buy-in and commitment from physicians and the C-suite. PROJECT MANAGEMENT PLAN – Creating a Culture of Wellness
Vision Statement The AIAMC project will raise awareness and provide specific tools to enhance trainee well-being throughout our institution. Team Objectives Our objectives were to assess trainee well-being, develop and implement programs and resources, and advocate for the importance of addressing trainee and physician well-being throughout the institution. Success Factors The most successful part of our work was engaging the residents on topics of importance to them and their wellness. It was important for us to get their feedback on what they wanted. We were inspired by the institutional culture change and strong focus on wellness that aligned with our efforts. Barriers The largest barriers we encountered were attendance and scheduling sessions that worked well for both the OB/GYN and family medicine residency programs. We worked to overcome these barriers by working closely with program participants, who worked hard to promote and protect time for the sessions. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to include residents in planning sessions to find out what they want. PROJECT MANAGEMENT PLAN – Promoting Resident and Faculty Well-Being – The 3 Ps: Policy, Practices, and Programs
Vision Statement Sinai Hospital of Baltimore promotes a culture of well-being that supports and strengthens the ability of resident physicians, faculty physicians, and all healthcare team members to grow and thrive in their professional and personal lives. Team Objectives Our objective was to develop policies, practices, and programs that equip resident physicians and faculty physicians with resources and practical skills that build self-awareness and flexible thinking, promote regulation of emotions and energy levels, and build connections that promote community at work and improve the clinical and educational environment. Success Factors The most successful parts of our work were raising awareness of the complexity of the drivers of burnout and engaging residents, physicians, and the GME community at our hospital in the process of creating working and learning environments to combat burnout and support engagement. Barriers Finding a training partner for the faculty train-the-trainer aspect of our project was very difficult. In addition, the time needed to fully implement this project was ultimately beyond the time team members could devote. We worked to overcome this difficulty by scaling back our project to focus on surveying our faculty and residents to determine their levels of burnout and stress. We continued to provide education, training, and support to our residency programs for well-being activities and initiatives. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to either select a small project or obtain a commitment from leadership to assign a staff member full time to the project. PROJECT MANAGEMENT PLAN – Creating Camaraderie and Connectedness at Christ Hospital
Vision Statement We recognize the individual nature of each person's whole health. As physicians, we hope to be models for our patients, and we hope to care for ourselves so we can best serve others. We as a group will strive to foster a community and culture that are diverse, supportive in times of adversity, connected, and reaffirming of each person's goals and dreams. Wellness is multifaceted, as is burnout. We envision providing both the intangible and tangible resources needed to maintain wellness and resilience during the challenging period of residency and beyond. Many things are beyond one's control in residency, but where possible we will foster peer connection, a sense of meaning in one's work, recognition of our success, and resilience in the day-to-day struggles. As a group, we intend to create events that span the different residency programs. These events will serve many functions and be composed of stress-reduction activities such as yoga and mindfulness, as well as social events and community service. The aim is to bring us together as a larger community. These events will be periodic and scheduled so as many people as possible can attend over time. Our hope is that by connecting the different programs we will have a better sense of collegiality and camaraderie at work which will aid in clear communication, positive morale, and excellent patient care. We also envision creating a site that will provide resources for wellness in the community including places to eat, religious communities to attend, athletic pursuits, and family activities, as well as mental and physical health recommendations. Team Objectives Our objectives were to create onsite events that bring different residencies and fellowships together and provide resources about health and mental counseling. These objectives require funding and some organization from both the GME office and residents in each class. Success Factors The most successful part of our work was seeing more residents engaging with one another outside of these events in the cafeteria and on the floors. We received positive feedback and requests for new and different events. We were inspired by other residencies in the system and what they have already started doing to inspire and foster wellness in their residents. Barriers The largest barriers we encountered were lack of time and energy organizing events, getting event organizers together, and getting the residents to attend events. We worked to improve attendance by having multiple reminders at meetings by residents who were involved. Word of mouth seemed the best way to motivate people to come to events. We also sent official invites for the event that was off campus to which people RSVPed appropriately. Another barrier we faced was difficulty obtaining clear feedback with low yield on surveys, likely because of email/survey fatigue from residents. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to have a team leader, delegate roles early on, and have people stick to their roles. Recognize that residents' schedules are chaotic, and having a point person in the GME office to focus on planning and organizing events is very useful. We were lucky to have someone willing to do that. PROJECT MANAGEMENT PLAN – Physician Collegiality and Wellness
Vision Statement We envision TriHealth being a place where our physicians (residents, faculty, attendings) come to work feeling energized, refreshed, and engaged in our overall mission of patient care. We want to create a healthcare environment that can identify factors associated with physician frustration and burnout and that works systematically to reduce or eliminate these factors, knowing such efforts have been shown to improve patient outcomes. Team Objectives The project required development of a consultation compact with expected behaviors for all of the physicians in GME as well as inventories of current wellness initiatives from each program. Stakeholders include representatives from all residency programs, GME and CMO leadership, and IT. Our participation in this initiative will help us move toward a culture that promotes physician well-being, a supportive work environment, decreased physician turnover, and improved patient outcomes. Success Factors The most successful part of our work was finding consensus among the resident representatives and faculty around the need to improve the consultation process to reduce burnout and improve satisfaction in the work of patient care. We were inspired by the stories, both good and bad, about how collegiality (or lack thereof) affected patient care. Barriers The largest barrier we encountered was that much of the frustration and difficulty in the consultation process originated from physician staff outside of GME. To overcome this obstacle, we found a physician leader late in the project who was independently working on a similar project in his department. We agreed to work together to establish our compact in the ICU. Other limitations included the lack of ability to give feedback during positive and negative interactions and the systemwide tool for evaluating wellness being transitioned by our organization midproject. Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is that when your project coincides with a systemwide change you intend to be part of your work, make certain that the timelines being promised by your organization are realistic and fit the timeline of your project. A large portion of our project was dependent on platforms that were delayed in their deployment by our organization. If you are considering a project that involves making a significant change (especially behavioral) in your organization, enlisting key stakeholders from outside GME to actively participate in your project is critical. PROJECT MANAGEMENT PLAN – Developing and Improving an Institutional Approach to Resident Well-Being
Vision Statement By obtaining and analyzing mental wellness of residents in each program, we hope to establish interventions that aid in the reduction of depression, sleep deprivation, and other stressors. We also intend to educate residents on the tools available for self-assessment to recognize depression, dependence, and sleep deprivation. With this project, we attempted to provide mechanisms for residents to handle these issues. Team Objectives To address mental health and wellness in residents, we aimed to develop institutional interventions that could be planned as regular activities and used by programs in which residents are known to have these issues. We planned to educate residents on the tools available for self-assessment to prepare them for when they are practicing independently. Success Factors Two successes resulted from this project: the creation of the GMEC wellness subcommittee and the development of a wellness core conference curriculum. The committee is comprised of residency faculty, residents, GME leadership, medical school leadership, and an employee assistance representative. The wellness core conference curriculum is a series of lectures created to address common issues/stressors identified through surveys. These lectures are open to all residency programs and recorded for those who are not able to attend. We were inspired by the comments provided by responders, giving some insight into the challenges residents face. We were also inspired by the engagement of faculty in addressing these issues. Barriers Project evaluation and lack of time were the largest barriers. Finding the time needed between collecting and analyzing data from surveys and implementing interventions was a challenge, and determining if an intervention directly affected the data from the follow-up survey was difficult. We are strategizing on how to assess interventions in proximity to the implementation, which would allow us to better assess correlation. Another limitation was developing institutional surveys that were voluntary, self-reported, and analyzed to create one-size-fits-all interventions distributed across programs. Lessons Learned Communicating results to residents is essential to the success of survey longevity. We saw from repeated surveys that some residents are not aware of interventions implemented as a result of the initiative. We think continuing this dialog and ensuring that we are connecting the dots of the survey/intervention relationship are important. PROJECT MANAGEMENT PLAN – Creating a Culture of Resident Well-Being: Access, Support, and Connection
Vision Statement Our vision is to inspire others to work toward respect, support, and wellness for all people. Team Objectives The following hallmarks guided this project's aims: Trust and support define the relationship among residents and faculty.
There is no hesitation to ask for help in the GME program.
When help is needed, it is available.
The processes for how to support residents are transparent, fair, and well understood by residents and faculty.
Residents feel connected to their purpose in medicine.
Success Factors The most successful part of our project was realizing that the work of the residents was impacting other target populations within the organization (providers and multidisciplinary teams). For example, the deep dive into understanding a process which had been created but had fallen into latency resulted in the reignition of that process and its spread to also apply to providers (S.O.S. became the topic of a rapid process improvement workshop that resulted in Auto-Pause). We were inspired by the receptivity of our multidisciplinary team members to partner with us to tackle the issues, seek solutions, and try a few things (eg, intern-to-intern social workers, wards tournament with hospitalists and medical students, and death rounds with the palliative care attending). Barriers The largest barrier we encountered was lack of designated time for residents to work together in teams. Offsite rotations take valuable team members offline for large chunks of time. We worked to overcome this barrier by having multiple team members share the tasks through handoffs and selecting team members who had at least 2 to 3 years left in their tenure at the organization. Other limitations included competing priorities, as well as difficulty operationalizing resources, freeing the funds, and providing leadership for management (eg, a social worker for intern-to-intern groups). Lessons Learned The single most important piece of advice to provide another team embarking on a similar initiative is to trust the process and make small incremental improvements, steadfastly with joy and patience. Also, use your existing internal tools.
In this issue
Proceedings of National Initiative VI
Jump to section
- Article
- Why a National Initiative?
- Role of the AIAMC
- National Initiative I
- National Initiative II
- National Initiative III
- National Initiative IV
- National Initiative V
- National Initiative VI
- ALLIANCE OF INDEPENDENT ACADEMIC MEDICAL CENTERS BOARD OF DIRECTORS
- ALLIANCE OF INDEPENDENT ACADEMIC MEDICAL CENTERS COMMITTEE ON THE INTEGRATION OF ACADEMICS AND QUALITY – NATIONAL INITIATIVE VI
- ALLIANCE OF INDEPENDENT ACADEMIC MEDICAL CENTERS National Initiative VI Participating Institutions and Team Leaders
- ABBREVIATIONS/ACRONYMS
- AdventHealth (Florida Hospital), Orlando, FL
- Advocate Illinois Masonic Medical Center, Chicago, IL
- Advocate Lutheran General Hospital, Park Ridge, IL
- Advocate Lutheran General Hospital, Park Ridge, IL
- Arrowhead Regional Medical Center, Colton, CA
- Ascension Providence Rochester Hospital (Crittenton Hospital Medical Center), Rochester Hills, MI
- Atrium Health Carolinas Medical Center (Carolinas HealthCare System), Charlotte, NC
- Aurora Health Care, Milwaukee, WI
- Aurora Health Care, Milwaukee, WI
- Aurora Health Care, Milwaukee, WI
- Aurora Health Care, Aurora St. Luke's Medical Center, Milwaukee, WI
- Aurora Health Care, Milwaukee, WI
- Bassett Medical Center, Cooperstown, NY
- Baylor University Medical Center at Dallas, Dallas, TX
- Baystate Health, Springfield, MA
- Billings Clinic, Billings, MT
- Cedars-Sinai Medical Center, Los Angeles, CA
- Christiana Care Health System, Newark, DE
- Cleveland Clinic Akron General Medical Center, Akron, OH
- Community Health Network, Indianapolis, IN
- Guthrie – Robert Packer Hospital, Sayre, PA
- Hackensack Meridian Health/Jersey Shore University Medical Center, Neptune, NJ
- HCA South Atlantic Division, Charleston, SC
- HealthPartners Institute, Minneapolis, MN
- HonorHealth, Scottsdale, AZ
- Main Line Health System, Bryn Mawr, PA
- Maine Medical Center, Portland, ME
- Monmouth Medical Center – RWJBarnabas Health, Long Branch, NJ
- Ochsner Health System, New Orleans, LA
- OhioHealth – Riverside Methodist Hospital, Columbus, OH
- OhioHealth – Riverside Methodist Hospital, Columbus, OH
- OhioHealth – Riverside Methodist Hospital, Columbus, OH
- OhioHealth – Riverside Methodist Hospital, Columbus, OH
- Orlando Health, Orlando, FL
- OSF Healthcare, Peoria, IL
- OSF Healthcare, Peoria, IL
- Our Lady of the Lake Regional Medical Center, Baton Rouge, LA
- Saint Francis Hospital and Medical Center, Hartford, CT
- Sinai Hospital of Baltimore, Baltimore, MD
- The Christ Hospital Health Network, Cincinnati, OH
- TriHealth, Cincinnati, OH
- UnityPoint Health – Des Moines, Des Moines, IA
- Virginia Mason Medical Center, Seattle, WA
- Figures & Data
- Info & Metrics
- References
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