How the AMA's Recovery Plan is helping provider organizations reduce clinician burnout and improve organizational well-being

Clinician burnout is a major health care issue. It affects both clinician and organizational well-being as well as patient care. Although reducing burnout is a top priority for many healthcare organizations, a more strategic approach is needed to increasing wellness for the long run.

In a Becker's Hospital Review webinar sponsored by the American Medical Association Health System Program, Nancy Nankivil, Director of Practice Transformation at the , and Luis Garcia, MD, FACS, MBA Clinic President of Sanford Health System, headquartered in Sioux Falls, S.D., discussed burnout and shared ways to improve organizational well-being. Sanford Health's proactive approach provides a model.

Four key takeaways were:

1. The AMA has developed a recovery plan for America's physicians. The AMA Recovery Plan for America’s physicians addresses five important issues: reducing physician burnout, reforming Medicare payment, fixing prior authorization, addressing scope of practice and supporting telehealth. This webinar focused on reducing burnout.
2. The AMA recommends focusing on five key areas to improve well-being. According to Nankivil, in 2019, fewer than half of physicians were experiencing burnout symptoms. "As the pandemic started to become the reality . . . burnout began increasing while the overall satisfaction of physicians decreased. This combination affects people's intention to leave the profession." Ms. Nankivil focused on five areas that are opportunities to improve system drivers of burnout.

• Workload and workflow. Reduce administrative burden and low-value work.
• Technology. Better in-basket management, EHR usability, a streamlined patient portal and telehealth opportunities.
• Work environment. Healthcare staff want compliance guidelines to align with workflows, clear vacation and time-off policies and reduction of the stigma around mental health.
• Cultural changes. Leadership communication that is transparent, authentic, and timely, proper infrastructure and resources, and a psychologically safe environment where joy, purpose and meaning in work are possible.
• People. All employees want to feel valued as team members. This requires focusing on peer support, community and diversity, equity and inclusion.

3. Sanford Health faced burnout challenges and knew it was time to act. Garcia, who trained by working 100-hour weeks, was previously a non-believer in burnout. But he came to see the significance and to realize that Sanford needed to act. "Burnout is characterized by exhaustion directly caused by work-related activities," Dr. Garcia said. "That, in turn, results in decreased performance, which means reduced quality, negative outcomes and decreased patient satisfaction."

According to a survey by the Physicians Foundation, 50 percent of physicians have experienced inappropriate anger, tearfulness and anxiety. Other research found that a high level of burnout increases the chances of medical error by three times and is associated with a 17 percent increase in the likelihood of a malpractice suit.

"At Sanford, the programmatic structure to support clinician well-being was fragmented," Dr. Garcia said. "We were working in silos and did not have a cohesive strategy or a team in place."

4. A proactive focus on well-being is critical to a long-term, sustainable strategy to address and prevent burnout. "Once you get to burnout, you have lost a valuable window of opportunity. We should be acting before someone gets to that point." Dr. Garcia said. "Research shows that if you act on the negative, your system is becoming reactionary. A better approach is to focus on a culture of positivism and proactiveness."

Dr. Garcia summarized five dimensions of employee well-being: mental and emotional support; sense of purpose; personal support; financial health and meaningful connections. He also shared a maturity model for a well-being strategy with four levels where well-being is: 1) a healthcare benefit; 2) for personal development; 3) for business performance and 4) for social good. Ascending to higher levels of organizational well-being takes time and investment.

With this in mind, Sanford Health has invested in clinician well-being with three well-being priorities:

• Engagement priorities: "These priorities are designed to target clinicians in the first two years of practice to make sure they adapt to our culture," Dr. Garcia said. "In addition to the new provider orientation, all clinicians go through a three-month onboarding program and are paired with a mentor."
• Resiliency priorities: These priorities include a clinician assistance program, internal coaches and a clinician wellness counsel. "These are designed to support established clinicians and provide support in a confidential manner, free of charge," he explained.
• Leadership development: "We want to create programs that allow for succession planning and identify rising stars and support them in their leadership development," Dr. Garcia said.

Healthcare organizations can follow Sanford Health’s lead in creating a well organization by implementing a proactive approach to clinical well-being using tools and resources from the AMA Health System Program. The AMA Health System Program partners with your leadership to tailor solutions that allow you to maximize support for your physicians and care teams. This program places a premium on assisting with improving joy in the practice of medicine, cultivating and spotlighting thought leadership and amplifying your physicians’ voices in health care policy. To learn more about the AMA Health System Program, visit ama-assn.org/enhance-support.

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