Case StudiesWeill Cornell Medicine
How Weill Cornell Medicine Used Data to Make the Case for Physician Well-Being
With no baseline data and a need for leadership buy-in, Weill Cornell’s Chief Quality and Patient Safety Officer turned to the Well-Being Index. The result: 81% physician participation and a measurable drop in distress.
Weill Cornell Medicine used the Well-Being Index to give leadership the data it needed to invest in physician well-being. Led by Chief Quality and Patient Safety Officer Dr. Klaus Kjaer, the rollout reached 81% participation among attending physicians, and their mean distress score fell 41%, from 1.84 in June 2019 to 1.08 by the end of 2019.
- Why: Weill Cornell framed burnout as the underlying cause of patient complaints, malpractice costs and low bandwidth for quality and safety work.
- How: a brief, mobile-friendly assessment, support from the Dean, incentives to participate, and department-level results shared privately with each clinical chair.
- Results: distress dropped below the national mean of 1.57 and rose only slightly, to 1.2, through the pandemic by June 2021.
- Recognition: published in NEJM Catalyst Innovations in Care Delivery in December 2021, with Kjaer as lead author.
The challenge
A quality and safety problem with a well-being root cause.
At Weill Cornell Medicine, the push for physician well-being didn’t start in a wellness office. It started with Dr. Klaus Kjaer, Chief Quality and Patient Safety Officer, who saw that physicians couldn’t take on quality and patient safety initiatives without the bandwidth to do so.
“I couldn’t in good conscience ask our physicians to do all of this quality and patient safety work with no consideration for how they’re doing.”
— Dr. Klaus Kjaer, Chief Quality and Patient Safety Officer, Weill Cornell Medicine
The link became clearer in multi-institutional malpractice collaborative meetings. Patient complaints and grievances were often an early indicator of later malpractice costs. Kjaer and his colleagues began to see those complaints as symptoms, and burnout as the underlying disease.
“We decided that maybe the complaints and grievances are symptoms of a disease and that the disease itself is burnout.”
— Dr. Klaus Kjaer, Weill Cornell Medicine
There was one obstacle: no data. Kjaer knew senior leadership would not commit resources without a data-driven imperative, and the organization had nothing to tell the story with.
“I realized that there was not going to be buy-in at the highest levels unless we could create an imperative based on some sort of data.”
— Dr. Klaus Kjaer, Weill Cornell Medicine
Klaus Kjaer, MD
Chief Quality and Patient Safety Officer, Weill Cornell
Dr. Klaus Kjaer is Chief Quality and Patient Safety Officer and an Associate Professor of Clinical Anesthesiology at Weill Cornell Medicine. In his role as Chief Quality and Patient Safety Officer, Dr. Kjaer works with the leadership of Weill Cornell Medicine and New York-Presbyterian Hospital to support physician-led initiatives focused on improving quality, patient safety, and risk management across all clinical departments. His focus is on consistent delivery of high-quality and high-value medical care, redesign of clinical processes to support patient safety and mitigate risk, and adoption of quality metrics to improve performance. Dr. Kjaer joined Weill Cornell in 2000 after completing his Obstetric Anesthesia Fellowship at Brigham and Women’s Hospital and Massachusetts General Hospital in Boston. Dr. Kjaer received his undergraduate degrees as a BA in Economics and a BS in Biology from Stanford University. He earned his MD from the University of California San Francisco School of Medicine, and his MBA in Organizational Change, General Management, and Finance from Columbia University’s Graduate School of Business.
The approach
Choose a tool physicians will actually complete.
The team compared several measurement options, including a longer Stanford inventory that required IRB approval, Gallup, and a custom survey built in Qualtrics. They worried the longer instruments would hurt participation, so they chose the Well-Being Index, developed at Mayo Clinic.
“We started looking for measurement tools and decided on the Well-Being Index because it seemed easier to use and physicians had access to resources at the end of the survey.”
— Dr. Klaus Kjaer, Weill Cornell MedicineSecure support from the top.
Kjaer took the Well-Being Index to the Dean, knowing that people won’t engage without support from the top of the leadership structure. The Dean agreed, and the rollout began. To make the case, Kjaer spoke honestly about what physicians were facing day to day and shared literature showing burnout was a national trend.
“If you can convince your leaders that they’re not completely going out on a limb, but in fact they’re part of a larger trend, then that can be very effective.”
— Dr. Klaus Kjaer, Weill Cornell MedicineMake participation easy and worthwhile.
Weill Cornell offered raffles for yoga, meditation and healthy cooking classes, and massages. Later, completing the Well-Being Index became one way physicians could earn a discount on their malpractice insurance through a new patient safety program. The assessment itself kept the ask small: it’s a mobile-friendly assessment of nine validated questions that takes about 60 seconds to complete.
“It takes a very small amount of time and you can do it on your phone. It’s not like you have to attend a one-hour teaching session somewhere, so that’s been very popular.”
— Dr. Klaus Kjaer, Weill Cornell MedicineBuild buy-in one relationship at a time.
Support from the Dean opened the door, but participation depended on the leaders physicians work with every day. Clinical chairs went back to their departments and told their people the work mattered. Hearing it from their own chair, alongside the backing from the top of the leadership structure, gave physicians a reason to take the assessment and trust what would be done with the results.
Turn the data into a story.
Kjaer used the results to show clinical chairs and the board how each specialty compared with its national peers, using the Well-Being Index’s national benchmarks. Instead of sending one data sheet to all chairs, he wrote each chair an individual email about their own department and shared it with them first, so leaders knew the data would not be used to blame them.
Ask physicians for solutions.
Three months after the Well-Being Index rollout, a follow-up “Solutions Survey” asked frontline physicians how to reduce burnout. Ideas included changes to the electronic health record and reconfiguring care teams so physicians do less non-physician work. A Well-Being Task Force then developed 10 solutions, working with department leaders and focus groups to tailor programs to each clinical area. Measures included peer support programs, healthier campus food options and more relaxation spaces.
“Having a friend at work is one of the most important predictors of people staying in their jobs.”
— Dr. Klaus Kjaer, Weill Cornell Medicine
The results
Mean distress score, Weill Cornell physicians
Lower is better · dashed line: national mean (1.57)
Figures as reported by Weill Cornell Medicine; see Sources below.
What is burnout costing your organization? Get your free burnout cost analysis →Participation that gives leaders confidence in the data.
59% of attending physicians completed the Well-Being Index in the first five weeks. Once the assessment also counted toward a malpractice insurance discount, participation reached 81%.
Distress fell, and stayed down through the pandemic.
In June 2019, Weill Cornell physicians reported a mean distress score of 1.84, above the national mean of 1.57. After the well-being measures took hold, the score dropped to 1.08 by the end of 2019, a 41% reduction. Despite the pandemic, it rose only slightly, to 1.2, by June 2021.
National recognition.
The results were published in NEJM Catalyst Innovations in Care Delivery in December 2021, with Kjaer as lead author. The authors suggest Weill Cornell’s grassroots approach could serve as a model for other institutions.
Less pushback than expected.
The main objection was why measure without a plan to fix it. Kjaer’s answer: a baseline is the only way to know later whether any solution is working.
“It’s important to start with a baseline assessment even if you don’t know what the solution is going to be.”
— Dr. Klaus Kjaer, Weill Cornell Medicine
Measurement became routine.
The Weill Department of Medicine’s 2022 Well-Being Plan lists monitoring faculty responses to the annual Well-Being Index survey as part of its feedback and transparency work.
Weill Cornell’s path gives you a playbook for getting leadership to approve a well-being investment.
Tie well-being to the metrics leaders already track.
Weill Cornell framed burnout as a driver of patient complaints, malpractice costs and participation in quality and safety work.
Lead with a baseline.
You can’t show that an intervention worked without a starting point to compare against.
Use national benchmarks.
Showing chairs and the board how each specialty compares with national peers turns a wellness conversation into a performance conversation.
Show it’s a national trend.
Leaders are more willing to act when they know they aren’t going out on a limb.
Pick a tool people will finish.
A brief, mobile-friendly assessment helped Weill Cornell reach 81% participation.
Share results with care.
Department-level results delivered privately to each chair build trust instead of defensiveness.
Connect it to retention.
In a competitive market, Weill Cornell’s goal is to be the employer of choice, because physicians who aren’t treated well will go elsewhere.
“If we’re a great place to work, our doctors will do a better job, there will be lower malpractice costs, and there will be greater uptake with our quality and patient safety initiatives.”
Frequently asked questions
How did Weill Cornell Medicine measure physician well-being?
Weill Cornell Medicine used the Well-Being Index, developed at Mayo Clinic. The team compared several options, including a longer Stanford inventory that required IRB approval, Gallup, and a custom Qualtrics survey, and chose the Well-Being Index because it was easier to use and gave physicians access to resources at the end of the assessment.
How much did physician distress drop at Weill Cornell Medicine?
Weill Cornell physicians' mean distress score fell 41%, from 1.84 in June 2019 (above the national mean of 1.57) to 1.08 by the end of 2019. Despite the pandemic, it rose only slightly, to 1.2, by June 2021.
How did Weill Cornell reach 81% physician participation?
59% of attending physicians completed the Well-Being Index in the first five weeks. Weill Cornell offered raffles for wellness classes and massages, the assessment is mobile-friendly and takes about 60 seconds, and once completing it counted toward a malpractice insurance discount, participation reached 81%.
How did Weill Cornell get leadership buy-in for physician well-being?
Dr. Klaus Kjaer, Chief Quality and Patient Safety Officer, took the Well-Being Index to the Dean and shared literature showing burnout was a national trend. He then used the results to show clinical chairs and the board how each specialty compared with its national peers, sharing each department's results privately with its chair first.
Why start measuring well-being before you have a solution?
A baseline is the only way to know later whether any solution is working. As Dr. Kjaer put it, it's important to start with a baseline assessment even if you don't know what the solution is going to be.
Get the data your leadership needs.
See how the Well-Being Index can give your organization a validated baseline, national benchmarks and a clear way to measure progress.
- A validated baseline
- National benchmarks
- A clear way to measure progress
Sources
- Klaus Kjaer interview with Champions of Wellness
- Effort to Combat Physician Burnout Shows Progress, Weill Cornell Medicine Pediatrics, December 23, 2021
- Well-Being in the Weill Department of Medicine, Weill Cornell Medicine
Header photo: Weill Cornell Medicine, 1300 York Avenue by Kenneth C. Zirkel, licensed under CC BY-SA 4.0.