For Dr. Keith Frey, Chief Medical Officer of CommonSpirit Health Arizona Division, it wasn’t a matter of if they should invest in clinician well-being, but how—and how fast they could start. During his ten years in healthcare administration and prior thirty years as a practitioner, Dr. Frey had seen the prevalence and impact of physician burnout first hand, cementing his belief that clinical excellence begins with supporting staff wellness.
“Running a successful healthcare organization is not only about the patient experience; it’s equally about taking care of your clinical workforce,” said Dr. Frey. “An improved clinician experience—what we would know as physician fulfillment or physician well-being—is a critical component of the overall delivery of high-quality, safe, and affordable healthcare.”
Understanding the importance of maximizing employee well-being is one thing. Acting on it and implementing impactful initiatives is another, especially in an organization as large as CommonSpirit Health. Operating more than 700 care sites and 142 hospitals in twenty-one states, CommonSpirit Health is the second-largest non-profit health system in the United States. Dr. Frey knew they needed to utilize the latest resources and evidence-based tactics to make a real difference and efficiently protect the mental health of CommonSpirit’s thousands of providers. To begin their journey, they focused on developing a new organizational culture guided by the seminal research being done at Mayo Clinic and by implementing the Well-Being Index in their wellness programming.
National health system
Physician, Advanced Practice Provider, Employee
From the beginning, Dr. Frey and his team of physician leaders determined that the key to improving staff well-being is creating a culture that is attentive to the clinician experience. To meet this goal, they implemented a three-domain model to work from based on the Stanford WellMD model, a framework created by Well-Being Index Co-Invented Dr. Tait Shanafelt. CommonSpirit’s modified version places culture at the base to reflect the organization’s specific values and to signify the importance of a healthy workplace culture in supporting staff wellness, upon which everything else is built. “A culture of wellness and professional fulfillment is the sustaining lifeforce that will keep well-being going over the next generation of physicians,” said Dr. Frey.
The wellness team at CommonSpirit Health didn’t want one-time campaigns that do little to truly impact the well-being of providers; they wanted to build a lasting culture and initiate a generational shift that would continue to support staff into the future. “We should be the leadership generation that people look back and say that we owned the issue and started to create solutions,” said Dr. Frey. “Well-being should only get better from here on out.”
As an organization, CommonSpirit is young. In February of 2019, CommonSpirit Health was born through the merger of Catholic Health Initiatives and Dignity Health, creating the largest Catholic health system and second-largest nonprofit hospital chain in the United States. Just eight months after the formation, Dr. Frey organized CommonSpirit’s wellness committee, called the Professional Fulfillment Council, which he chairs. The group is comprised of thought leaders and physician leaders across the organization with the goal of driving employee fulfillment and well-being.
To create a new culture focused on prioritizing the clinician experience, the Professional Fulfillment Council would have to clear several hurdles, including getting organizational buy-in from leadership. “One of the very first things we felt we needed to spend money on in this new company was a launch of the Well-Being Index for our 25,000 physicians,” said Dr. Frey. However, implementing initiatives in a large, multi-state health system is no small task and one which requires commitment from the very top. To help ensure buy-in, Dr. Frey and the Council communicated that along with a moral obligation to continue protecting staff, further prioritizing staff wellness will lead to a healthy financial return to re-invest in communities and technology to continue the mission of providing excellent healthcare. As the clinician experience improves, operational excellence will also improve, subsequently attracting more talent, retaining staff, and bringing in more patients.
As part of this effort, Dr. Frey also utilized national wellness data from the Well-Being Index along with research on the industry-wide epidemic of clinician burnout. “It’s important to have a story for the C-Suite that you’ll need to influence so they can spread the message to the rest of the team,” said Dr. Frey. “That’s how we create culture change.”
To maximize and protect the mental health of their thousands of providers, leadership understood that they needed accurate and ongoing measurement of staff well-being and a seamless way to provide vital resources throughout the entire system. To accomplish this, they immediately implemented the Well-Being Index.
One of the most useful features of the Well-Being Index is the aggregate admin reporting. In an organization as large as CommonSpirit, it’s a daunting task to accurately gauge the state of well-being among tens of thousands of providers across dozens of states. Through anonymous assessment data, the Well-Being Index allows organizational leadership to quickly see how their staff is doing. Upon launch, Dr. Frey’s team worked with their dedicated Well-Being Index specialists to have each delivery site demographically labeled to easily determine where the hot spots were and where to focus support. “The tool has been very valuable to my council as we begin to prioritize where we want to focus our efforts,” said Dr. Frey.
Along with determining the most at-risk populations through the de-identified assessment data, CommonSpirit’s wellness council is also able to examine resource access reporting to see what categories certain populations are searching for help in. “This reporting gives me breadcrumbs on what areas people are most curious about, or where they are experiencing the most distress,” said Dr. Frey. “Then we can find some patterns that could initiate a more specific wellness program.”
CommonSpirit Health used the Well-Being Index's customized reporting capabilities to create dashboards of the exact data they were looking for.
Utilizing Physician Leaders
Unlike in smaller organizations, the wellness committee at CommonSpirit Health is not able to work directly with all staff to facilitate new tactics. To effectively communicate their strategy and implement initiatives, the team turned to department leaders and managers for help.
“I couldn’t personally reach out to 5,000 doctors,” Dr. Frey explained. “Knowing this, I switched our focus to educating the physician leaders within our organization. The data we could retrieve from the Well-Being Index proved immensely helpful in leading conversations with these leaders and arming them with the evidence to continue the discussions with their staff. Their goal was to keep this topic top-of-mind and continue to build a culture of support.”
By equipping department leaders with anonymous assessment data, CommonSpirit leadership was able to grow the awareness and support needed among their teams.
Relying on Research
As previously mentioned, the CommonSpirit team based their wellness programming on research conducted by Well-Being Index inventors at both Mayo Clinic and Stanford University. Dr. Frey and the Professional Fulfillment Council combined the elemental thinking taught by Dr. Tait Shanafelt as part of the Stanford WellMD program with the utility of the Well-Being Index to organize their tactics and achieve their goals.
Relying on this seminal research and the validated tool, the Professional Fulfillment Council set up a three-domain model to improve clinician well-being with culture at the base, fulfillment in the center (rather than just burnout prevention), and empowering personal sustainability and optimizing sites of clinical care on either side. Both of these outer initiatives work together to improve clinician fulfillment and are achieved through the use of the Well-Being Index. The Well-Being Index not only provides data and insights to assist leaders in optimizing care sites, but it also offers a host of participant benefits to empower individual sustainability and wellness. These include the ability to anonymously measure personal well-being in less than one minute, immediately compare scores to peers’ and national averages, provide specific feedback to the organization, and access a variety of customized local and national mental health resources.
CommonSpirit Health knew they needed to rely on data, not guesses. To gather this data, Dr. Frey turned to the validated assessment tool invented by Mayo Clinic.
Through studying the science of system change and implementing the latest resources such as the Well-Being Index, CommonSpirit Health has successfully launched a wellness program aimed at creating and maintaining a culture that is more attentive to the clinician experience.
The work to improve provider well-being is never finished, however; it’s an ongoing mission. “We’re definitely on a journey,” said Dr. Frey. “As the largest nonprofit in 21 states, we knew that this would be a great endeavor that required everyone to be on board.” Dr. Frey and his team of dedicated leaders are optimistic about the future and are seeing signs that their new culture is forming. “We are starting to see that consciousness of the burnout problem that is spreading from our senior leaders to our clinical staff. And that has been very exciting.”
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