Committed to your well-being

April 24, 2018

Colleagues,

The recent sunshine has reminded us all how much we've needed some blue sky days. While there is a lot of hopefulness in the air as we prepare to honor OHSU President Joe Robertson and select from an outstanding field of finalists to succeed him, we also know that the stress level for many in our School of Medicine community is high.

For this reason, we want to talk about wellness. Your well-being and ability to be resilient in the face of the demanding and important work we do is our highest priority as your leaders.

Safeguarding our wellness is important for every learner and every faculty and staff member across missions. It is particularly a matter of national focus for clinicians. More than half of U.S. physicians report symptoms of burnout, and the problems starts early, in medical students and residents. 

Burnout has serious consequences. Not only are clinicians' well-being and even lives at risk, but so is patient safety: clinician well-being is essential for safe, high-quality patient care. 

Recently, the National Academy of Medicine, the AAMC, and the ACGME launched a national Action Collaborative on Clinician Well-Being and Resilience. The goals: improve our understanding of challenges to clinician well-being; raise the visibility of clinician stress and burnout; and elevate evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver. The School of Medicine is submitting a statement on wellness as part of this effort.

In response to concerns about burnout voiced by our house officers, our Graduate Medical Education leadership team is embarking on safe-space listening sessions in which house officers can speak honestly about practices and experiences contributing to stress. We will use this insight to shape recommendations and an action plan for improvements.

Faculty engagement and wellness: lots of work in progress

A number of initiatives are underway at OHSU to address well-being and a related factor, engagement. Engagement and feeling connected with our work and our coworkers is the positive antithesis of burnout and can re-invigorate excitement about doing our jobs.

As part of a focus on faculty engagement and wellness, the OHSU Practice Plan has allocated $375,000 to support early phase clinician engagement and wellness projects, including:

• The eConsults program that allows clinicians to consult each other within the electronic health record and earn wRVUs.
• The use of scribes and Dragon voice recognition software to lessen the burden of charting.
• Piloting a clinical workflow solution team at one primary care and one specialty clinic, to improve the clinical work environment.
• Piloting a modified clinical support staff model in Family Medicine to decrease the EHR burden and improve clinician burnout.

The EHR – and more specifically, the related documentation requirements – are a major source of clinician dissatisfaction. Jeff Gold, M.D., professor of medicine and medical informatics and clinical epidemiology, OHSU School of Medicine, is a pioneer in using simulation to analyze how providers use Epic in order to improve their experience, as well as improve EHR training and software.

In addition, School of Medicine leaders are working to organize, coordinate and enhance our faculty career development opportunities, a key factor in professional satisfaction and resiliency for scientists and clinicians alike. The SoM Faculty Advancement and Development Committee led by Niki Steckler, Ph.D., associate professor in the Division of Management, is playing a major role in this process. 

Many great department-level initiatives

Many departments and cross-departmental teams have also initiated programs to promote faculty engagement and career development and can serve as models. As just a few examples:

• The Educators' Collaborative is a cross-departmental community of practice for faculty interested in education, including teaching, innovation, scholarship, curriculum design and mentoring. Their 2018 Symposium on Educational Excellence is Friday, April 27.
• In Pediatrics, Professor Ben Hoffman, M.D., pioneered a highly successful program called Mentoring/Peers across the Career Trajectory (MPACT) that has spread to the departments of Medicine, Obstetrics and Gynecology, and Ophthalmology. Cohorts of junior faculty participate in structured career advancement activities and, even more so, serve as a sounding board for each other, building an important and lasting support system.
• In Medicine, Associate Professor Andrea Cedfeldt, M.D., created "DOM Cares" (Department of Medicine Career Advancement, Renewal and Enrichment Seminars), a series devoted to career development topics. Targol Saedi, M.D., assistant professor of medicine and director of the Clinical Hospitalist Service, appointed Michael Hendricks, M.D. instructor of medicine, as chair of morale. He leads a faculty recognition program to highlight excellence on the service, from outstanding patient care to exceptional teamwork. Also, on May 1, Don Girard, M.D., professor emeritus, is discussing burnout at Medical Grand Rounds, 8 a.m., OHSU Hospital 8B60.
• In Anesthesiology and Perioperative Medicine, Chair Jeff Kirsch, M.D., promotes wellness through faculty and staff recognitions, departmental gatherings and by sharing strategies as simple but impactful as encouraging colleagues to smile more and greet each other and even people they don't know. Simple acts of kindness can just make the day better.

It's also been encouraging to see intentional efforts to foster a welcoming and inclusive culture at OHSU. From such long-term, institution-wide priorities like the Center for Diversity and Inclusion's Unconscious Bias Initiative to more discreet undertakings like Gratitude Week, which the M.D. class of 2021 sponsored last week, each helps make OHSU a place where people can bring, and feel appreciated for, their talents, perspectives and life experiences.

A word about financial pressures

We also want to acknowledge another area of stress and that's about money.

Nationally, academic health centers face uncertainty in health care and research funding and must work to adjust our financial model to remain competitive.

At OHSU, we are taking specific steps to keep our increasing expenses from outpacing revenue, while also growing our infrastructure to expand our clinical enterprise. We are systematically examining ways to develop a sustainable financial structure through the Accelerate OHSU initiative. This will involve improving efficiency, and together with another initiative focused on funds flow, is intended to improve our systems to align faculty effort, compensation and incentives across all missions. 

We know that workloads are high and that we need to work smarter, protect against burnout and allow for the stability that supports faculty to do their best work.

Confronting our vulnerabilities

To sum it all up, we want to be clear about a few important things.

At OHSU, and in academic medicine in general, our jobs are steeped in teamwork, but our work ethic is more about "I got this."

Please hear us say: Our greatest strength comes from our ability to ask for support when we need it. Our ability to create a culture with zero tolerance for discrimination or harassment depends on building accountability by reporting mistreatment.

Suffering in silence is not noble. It not only perpetuates the very environment we want to change; it can be downright damaging to us as individuals.

If you are struggling or feeling hopeless or overwhelmed, or if you are seeing these signs in a colleague, trainee or student, please reach out.

Sometimes just asking, "Hey, are you doing OK? How can I help?" can make a difference. Sometimes you – or the person you are concerned about – would benefit from a conversation with a caring professional.

The school has created a new wellness resource page to make it easy to identify supports and other offerings you can take advantage of. A new flow chart offers direction on how to get support if you are feeling mistreated in your work setting.

Leaders, please share this new webpage with your department or division. And, faculty, please consider attending The Foundation for Medical Excellence and the Oregon Medical Association's conference on Physician Well-Being May 4. The conference will feature strategies on everything from creating a positive work environment to self-care.

Thank you for being part of a community that cares, for our patients, for each other and for ourselves.  

Sharon Anderson, M.D.
Dean
OHSU School of Medicine

John Hunter, M.D., F.A.C.S.
CEO
OHSU Health System