Author: Tricia James, M.D., internal medicine physician, general medicine faculty and medical director of wellness, Providence Portland Medical Center
Like many of my fellow providers and health care leaders, I’ve been worried about provider stress and burnout for a long time. My concern ramped up considerably during COVID when we were dealing with unprecedented fear, exhaustion and uncertainty. Many of us, along with our amazing inpatient care teams, were burning the candle at both ends with no end in sight.
The national burnout rate for providers is 62%, a statistic that surprises no one who works in health care. While burnout often is viewed as an individual struggle, experts estimate that 80% of burnout is attributable to our workplaces. Burnout also affects patients, who may experience suboptimal care if their provider is feeling significant stress. Furthermore, burnout is correlated with providers leaving their organization or medicine entirely.
Seeing my colleagues and residents in such distress lit a fire in me. I felt strongly that we needed to do things differently.
Approaching the problem
Armed with a generous $160,000 grant from the Providence Portland Medical Foundation called “Supporting the PPMC Hospitalist Group During the COVID-19 Pandemic,” a group of us set to work.
For our hospitalist intervention group, we included 64 providers (58 physicians and six nurse practitioners) from Providence Portland Medical Center. Our control group consisted of hospitalists at Providence St. Vincent Medical Center (59 physicians and six nurse practitioners).
After an initial three months of planning, we conducted the 12-month pilot from October 2020 to October 2021. Surveys to gauge burnout and stress were conducted before and after the 12-month period.
The results were positive, and the degree of impact was surprising given the immense challenges faced during that period.
The results of our work were published in the February 2023 issue of Journal of Internal Medicine.
Significant reduction in burnout
When we started our project, the two groups were statistically the same in every metric we measured. In the post-intervention survey, the intervention group reported 32% burnout while the control group reported 56%. Within the Providence Portland group, 48% said they couldn’t ask for anything more in regard to their wellness support, and 96% reported that their wellness had been supported by Providence.
The post-intervention survey revealed that the Providence Portland group experienced feelings of appreciation, manageable work hours, organizational value alignment and significantly higher perceptions of organizational leadership at follow-up.
It’s important to note that the experiences of the control group mirrored national trends during the same time period. In other words, this is not a Providence St. Vincent problem. Instead, it’s a national health care problem seen in hospitals around the U.S.
We developed and used a number of successful strategies, or interventions, for the Providence Portland hospitalists. They included:
- “Wellness warriors” – Three hospitalists were appointed and trained as “wellness warriors” who worked to identify and address stressors affecting the hospitalists.
- Online COVID groups – The group met every one or two weeks to share information, address stressors and build community.
- One-on-one coaching – I became certified as a coach and offered one-on-one coaching to interested hospitalists. About 38% of the hospitalists accessed this resource.
- Social gatherings – We hosted dinners with wellness warriors and hospitalist group leaders to get their input about group needs and to check in on their own well-being. We also hosted outdoor gatherings for hospitalists and their families. Newly hired hospitalists were welcomed with a Zoom happy hour.
- Small tokens of support – We hosted lunches, brought in massage therapists for 15-minute massages, and provided small gifts to show appreciation during surges and periods of increased stress.
As principal investigator, I was paid for eight hours a week to work on the project. This included training the wellness warriors, coaching, and helping to identify stressors and develop interventions. Wellness warriors were paid for two hours a week to develop, coordinate and implement the various interventions.
What we learned
The No. 1 successful intervention was to help everyone examine and acknowledge the complex problems they faced every day – and then to acknowledge where they have control. With so much uncertainty during COVID, it was easy to feel as if we had no control over anything. However, we learned not only were there many areas within our control, we could have an impact in addressing them. I can’t overstate the importance of this concept. As health care has become more complex, many of us have experienced a loss of autonomy and have lost sight of where we do have control.
For example, early in the pandemic the hospitalists who were new to the COVID service joined meetings to share tips. They also shared barriers and needs with group leaders, who could follow up and advocate for additional support. As the pandemic progressed, focus shifted toward efficiency, and hospitalists who excelled in certain areas came and shared best practices with the group.
More recently, the group identified patient complexity as a major challenge and invited long-term hospitalists to come in and share strategies to make the day go more smoothly. The group also identified that it would benefit from a “medicine board” to consult colleagues on challenging cases, such as the growing number of patients with delirium. Group members subsequently have worked to identify clear, specific ways in which additional support is needed to better care for these patients.
One of the biggest victories from this pilot project is that Providence Portland restructured its leadership team to incorporate a wellness leader. As of July 2022, I have a new position – the medical director of wellness for the hospital, in which I support the entire medical staff. The Providence Portland hospitalist group also saw the value in this work and restructured its local leadership to include a wellness director as of September 2022.
This is the first Providence hospital in Oregon to make this commitment, and our hospitalist team is deeply grateful. We also appreciate the initial grant from the hospital’s foundation that made this work possible. A majority of my time is now dedicated to wellness work, while I also continue to work in my clinical and faculty residency roles.
My goal is to share this work more broadly across Providence. Burnout is affecting every one of our care teams and yet the stressors for each are unique. By training and empowering wellness leaders, it allows those unique stressors to be identified and addressed in real time. This has the potential to truly transform our workplaces and our organization as a whole.
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