Baystate Medical Practices Physician and Advanced Practice Provider Well-Being

Strategic Objectives

The plan is guided by four key strategic objectives, adopted from Stanford’s Model, 16 which are applied to the unique challenges we are facing at Baystate.

1. Foster a Culture of Wellness: Promote a supportive organizational work environment, values and behaviors that promote self-care, personal and professional growth, and compassion for ourselves, our colleagues and our patients
2. Ensure Efficiency of Practice: Through workplace systems, processes, and practices that promote safety, quality, effectiveness, positive patient and colleague interactions, and work life balance.
3. Support Personal Resilience: Gain and sustain individual skills, behaviors, and attitudes that contribute to physical, emotional, and professional well-being.
4. Enhance Communications: Effective two way communication is essential to allow for workplace growth and safety. New ideas can thrive and respect can increase.

Baystate Medical Practices (BMP) Wellness Council

The Council is committed to the shared responsibility of enhancing and supporting physicians and APP’s well-being including a supportive and efficient work environment. This includes the adoption of continuous quality improvement methodology including the administration of baseline and follow-up measures of well-being, and the application of evidence-based improvement strategies.

The BMP Wellness Council is charged with:

1. Identifying Baystate physician and APP's needs and areas of focus
2. Collaborating with local work units to determine and implement pilot interventions
3. Making recommendations to the BMP Board to disseminate change across the organization
4. Communicate with BMP members about the resources, initiatives and ideas involving wellness and burnout
5. Charge sub-groups to collaborate with local work units to develop initiatives and educational sessions aimed at mitigating and/or preventing burnout, improving the professional vitality and fulfillment of providers and other members of the health care team, and examine individualized decompression strategies.

Subcommittee Areas of Focus

• Efficiency of Practice & Team-Based Care. Members develop initiatives to make clinical practice more efficient and to reduce administrative burden. They identify and extract “pebbles in the shoe”. Members develop local demonstration projects to enhance team functioning towards physicians/APPs working at the “top of their license” with the goal of reducing the sense of isolation and to increase ownership of responsibility for patient care at the team level. Members serve as liaisons from our group to the upcoming CIS optimization initiative to ensure that our perspectives are considered in the process.
• Culture of Wellness. This subcommittee focuses on creating a supportive organizational culture that prioritizes the well-being of healthcare professionals and recognizes the importance of personal time and family life. Three areas specifically are: PTO utilization, time protection, & cultural shifts. They also lead our book club. Members work to cultivate a culture within healthcare organizations that values and respects personal time and family commitments. This involves fostering open communication, setting realistic expectations, and modeling healthy work-life boundaries at all levels of the organization.
• Personal & Professional Vitality. This subcommittee is dedicated to addressing the individual well-being of healthcare professionals, focusing on revitalizing their sense of purpose and connection to their core values. Members collaborate to design and implement pilot programs aimed at helping healthcare professionals rediscover meaning in their work. By emphasizing the importance of empathy, compassion, and patient-centered care, the subcommittee seeks to reignite the passion and dedication of healthcare professionals.
• Communications & Publicity. The Communications & Publicity subcommittee plays a crucial role in ensuring ongoing awareness, education, and engagement surrounding the efforts of the BMP Provider Wellness Council. The subcommittee ensures that healthcare professionals here at Baystate are regularly updated on the latest developments and activities through our newsletters.

June 1, 2019: Subcommittee Progress Updates

Worklife Balance

Modification of Post-Call Day
Pilot #1: The Pediatric Surgery Group is trialing a “No Scheduled Clinical Activity after 12:00 Noon” on the post-call day. The team shifted the clinical hours from 8:30-12:30 to 8:00-12:00, maintaining the 4 hour block so patient care was not affected. One medical assistant and one clerical staff come into work 15 minutes early to accommodate. It was decided that there was some flexibility built in so the post-call surgeon would be able to see an urgent patient if needed, staying after 12:00. The office administrator helped facilitate this and will monitor the call schedule, making every effort to adjust the post call days.
Pilot #2: The Cardiology group decided to trial modifying the post-call day by “Starting Clinical Activity at 11:00 am.” This is contingent upon the fact that patient care is not negatively impacted, so if need be, the post-call cardiologist would start earlier. The practice scheduler makes every effort to modify the post-call day, if possible. Results to date: 50% of the time, the post-call physician is involved with patient care before 11:00 am, but the group feels it is still worth doing and reports it has improved moral.

Humanism in Medicine

1. Finding Meaning in Medicine Dinners. As a pilot, this subcommittee held two Finding Meaning in Medicine dinners with Council members. The benefits felt by the group were a sense of community not found elsewhere and a venue to be heard by colleagues who had similar life experiences. However, the group has also learned that finding time in the evening for fellowship is challenging and occasionally family issues prevented attendance even when originally the evening was free.
   
2. October 14 Wellness Committee Panel at Schwartz Rounds.  Council members will present progress to date and open up for discussion and feedback from audience members. We invite others to join us for this generative conversation, Monday, October 14, Noon-1pm, BMC Chestnut 1 a/b. (please note that this is Columbus Day).
3. Seeking New Committee Members. The Humanism in Medicine subcommittee is seeking to broaden the membership with non-Council members who are clinicians at Baystate.

Team-Based Care

1. Teams that Deliver BOTH High Quality Care and Team Member Well-being. The first teams we will bring forward are: A BMC emergency room team, a primary care practice site (Baystate Medical Practices Quabbin Adult Medicine, Ware) and the 140 High Street geriatrics multidisciplinary outpatient team. They will be interviewed to share their strategy and operational tactics that have made their teams successful- both in terms of high quality patient care and team member well-being. Their stories will be videotaped and available for others to glean ideas from in order to generate practice-specific approaches.
   
2. Identification of Additional High Functioning Engaged Teams. As we move forward, ultimately, we envision featured teams to act as consultants and mentors to other teams. As such, we are seeking teams across the organization, from different disciplines, specialties and levels of care (outpatient, ED, inpatient…etc.) that demonstrate concepts and ideas that make their teams successful—professionally and personally. In the near future, we will be eliciting input from teams across the organization. Stay tuned. Additionally, our committee will be utilizing the Press-Ganey Engagement data coupled with the Provider Resilience results to further identify areas of BMP practices that demonstrate strength in team-based care.

EMR Optimization

1. EMR Assessment. This subcommittee has made significant headway in identifying the stakeholders and establishing dialogue to identify aspects of the Baystate Healths’ EMR that contribute to provider engagement and burnout. In particular, we have partnered with the Informatics Department to closely evaluate the EMR and our members are represented on Informatics departmental committees. Our subcommittee members also participated in the Patient Keeper and Provider Collaboration meeting that included Patient Keeper senior leadership, where we provided robust feedback on the current system and suggested valuable solutions for upcoming upgrades.
   
2. New Survey – During Informatics System Upgrades Currently, we are in the process of formulating a survey to evaluate the experience of practice sites and hospitals that are undergoing different informatics upgrades and transformation. The survey will be provided during or immediately after an implementation to gather real time feedback as to what is/is not working well and to collect recommendations/solutions for real-time and post-implementation improvements. Finalization of the survey is planned for early June.

April 3, 2019: Subcommittee Progress Updates

Efficiency of Practice

This subcommittee is currently working on the following projects:

• Flexibility of scheduling options
• Efficiency of billing practices
• A pilot of hiring an assistant to take on administrative duties to help with efficiency of practice in the hospitalist program.

EMR Optimization

This subcommittee is currently working on the following project:

• Developing a tool to evaluate the practices undergoing EMR changes with regard to their experiences related to adequacy of upgrades, IT support, leadership and identify the constituents that were either implemented efficiently or agonizing to execute.

Humanism in Medicine

This subcommittee has held one evening dinner and discussion session.

Team-Based Care

This subcommittee is currently working on:

A variety of best practice team-based care practices and strategies in various departments and levels of care. Examples include:

• Work Life Balance
  This subcommittee has accomplished and continues to work on:
  
  
  • Increasing awareness. Dr. Albert has presented at staff meetings, Grand Rounds, the Patient Experience Seminar, BayCare Board of Directors, PLT and the BH Board of Trustees.
  • Surveying the providers for feedback and suggestions to assess the prevalence of distress at Baystate.
    Establishment of a Provider Wellness Fund within the BH Foundation.
  • Opportunities to build in more flexibility to the schedule particularly; Flexibility in clinic start and end time (i.e. come in later or leave early) and Modifications to post call day rules (i.e. if on call night before, leave clinic by noon).

As a result of these conversations Schedule Flexibility Guidelines have been drafted and will be reviewed at PLT/Directors Meeting on May 2nd.

• Draft Guidelines for Schedule Flexibility for Providers
  The process for approving provider requests for schedule changes is as follows:
  
  
  • Discuss with local practice leadership (MD and PM) to understand how the change may affect the entire team (staff, other providers) and, mostly importantly, access for patients. This will include a notice to Directors/Chiefs where appropriate.
  • Financial/RVU targets must be met.
  • The care and access for patients may not be compromised - the needs of patients come first.

Prioritize Your Well-being and Work Life Needs

Visit the Baystate Healthy home page for a host of resources that support your physical, mental & emotional, and financial well-being along with resources to help you integrate your personal and work life.

Mental Health Resources

Mental health concerns come in all shapes and sizes. The most common conditions are anxiety, depression, panic disorders and anger issues. One of the most effective ways to address these concerns is by engaging a licensed professional to help you with healing and coping techniques to feel better. Therapy can also help treat phobias, PTSD, eating disorders, ADHD, self-harm, OCD and alcohol and substance use. Baystate Health offers employees a variety of avenues to help you feel your best. See below for more information.

Baystate offers programs like Employee Assistance Program (EAP) and Marvin telehealth, which offers free unlimited access to therapy to Baystate employees and those in their household. Go to the Baystate Healthy Website to learn more.

Financial Wellness

Through your Baystate Health-paid benefit, My Secure Advantage® (MSA), you’ve got what you need to live a financially healthier life.

Your benefit includes 365 days of confidential, unbiased money coaching EVERY year at NO COST to you!. Think of a Money Coach as a mentor for your money. Whether you're digging out, getting by, or saving big, talk with a Money Coach to get started. No hidden agendas or sales gimmicks. Their only job is to help you reach your goals.

Start by taking the online financial assessment. You’ll receive a personalized action plan that will pinpoint your goals and lay out your next steps toward achieving them. Then partner with a Money Coach for guidance, accountability and support along the way.

Get Started Now

baystate.mysecureadvantage.com
888.724.2326

Physical Wellness

Effective January 1, 2024, spouses and dependents enrolled on your medical plan will also be eligible for reimbursement! Individual plan members can receive up to $200 per calendar year and family plan members can receive up to $400 total, per calendar year ($200 per individual on plan). Plus, we’ve added even more ways to get reimbursed, including athletic event registration fees, bike shares, and school/town sport fees. Login to your HNE portal at my.healthnewengland.org and select Forms.

Recharge Your Batteries

A deep passion and purpose to serve humanity in a career that provides the opportunity for continued growth and advancement, has its rewards and its challenges. This drive often comes with a heightened sense of personal responsibility and this level of dedication to others makes it very easy to become consumed by the work. Self-care is a critical part of maintaining and regaining health and well-being in order to be an effective and fulfilled healthcare provider. Even a saw needs sharpening.

Reconnect with Who You Are (and Those Around You)

Continually, find opportunities to reconnect with who you are and what it is that brings you joy.

Learn more about Finding Meaning in Medicine.

• History of Finding Meaning in Medicine Groups

Regularly start your day recalling why you went into the field.

Recall your passion, desire and ambition that led you here. Reflect on the people whose quality of life has been improved as a result of your passion, training and expertise.

Explore complementary aspects of healing.

Learn more about Integrative Medicine and Alternative Therapies at BH. (coming soon!)

Attend Schwartz Rounds

Attend and gain greater insight into your feelings and responses.

Make someone else feel amazing

Take a moment to recognize a colleague. Not only will you contribute to enhancing another's well-being, you'll strengthen your social connectedness and your own well-being. Seek out opportunities to recognize your peers using Baystate Celebrates online recognition system--it's easy! And even easier when you use the app. In the app store, select Globoforce Mobile and enter your Baystate Health email address and login credentials.

Know When to Ask for Help

We all know that healthcare and caring for patients is difficult and demanding work and can leave us feeling irritable, frustrated, overwhelmed and very sad and lonely at times. Part of the challenge is that we are so immersed in our work that it becomes difficult to recognize and respond to our own, very human, mental and emotional health needs. Another part of the challenge is our physician nature or “personality”.

• We are committed and thorough and often find ourselves considering what else could be done or whether or not we have missed something in caring for our patients. • As a group we tend to have an exaggerated sense of personal responsibility that makes it difficult for us to not be consumed by our work.
• We have a survival mentality and believe things will get better.
• We tend to opt to fix our own problems, which are difficult to fix when we are exhausted or have concerns about confidentiality.

In part, what makes us good at what we do, can be a double-edged sword. Unattended distress has ramifications on our quality of life and well-being. But, we do not need to just accept that feeling distress is part of the role of being a physician. We encourage you to think about attending to your own needs and to utilize the resources needed to help you stay well or begin your own healing process.

Peer Support at Baystate

Baystate Health implemented a formal Peer Support Program in 2019. Through a pilot program organized by the Betsy Lehman Center, 20 Peer supporters were trained from the Emergency Department, Trauma Surgery and General Surgery. There were Nurses, Doctors, Advanced Practice Providers, Patient Care Technicians and Administrative Associates who were trained. Our Wellness Council co-chair and a member of Spiritual Services were formally trained by the Betsy Lehman Center to become trainers themselves and since then 6 more training sessions of 7 hours were completed. Baystate Medical Center now has over 90 Peer Supporters from 12+ divisions. Peer supporters wear a “badge buddy” to identify themselves. Peer support is activated by the quality department when an adverse event occurs, when a supervisor reaches out on behalf of an employee, or when an employee reaches out directly and they are contacted within 48 hours. All interactions are kept confidential. Peer Supporters also facilitate group debriefs for entire teams involved with adverse patient events. Those in need of support can choose to have someone from their own unit or not. If continued support is necessary, our Peer Supporters have a comprehensive knowledge of the other resources through HR partners to direct them for additional help.

Coaching

Recent literature around burnout in healthcare, specially for physicians and APPs, has shown that coaching has dramatically decreased burnout and increased vitality. We have created a pilot to partner with MGH to offer external coaching. We have also re-imagined and re-worked the internal coaching program that existed at Baystate. Since the relaunch, one-on-one coaching has increased participants. Currently, there are 5 physicians across multiple departments that are being coached by Dr. Jobbins (who is a certified coach and ACP Well-being Champion) in weekly or bi-weekly 1-hour sessions. These sessions focus on key concepts of coaching topics which include but are not limited to all-or-none thinking, self-talk, professional goal setting, boundaries and purpose. The areas for growth around coaching at Baystate is one that can be used for leaders at any level. Future internal coaching offerings will include group coaching sessions, expanding individual coaching sessions, and workshops around critical coaching, engagement and leadership topics.

Professional Development

The success of our faculty is critical to our regional medical school campus and to Baystate Health's continued excellence in health care delivery. OFA is a resource for all faculty seeking academic appointment and promotion as well as professional development opportunities. Please take time to explore our programming including the Physician Leadership Academy, Division Chief Leadership Bootcamp, Mentors Matter and the Inspired Physician Leadership Podcast.

Please find out more here

The BMP Wellbeing Council meets the first Wednesday of the month from 7:30 a.m.- 9 a.m. If you are interested in observing, contact ProviderWellbeing@bhs.org

Goals

The mission of the BMP Wellness Council is to promote the health and wellbeing of our providers. The council is charged with overseeing all aspects of BMP provider wellness efforts both through education and initiatives that foster emotional, physical, mental, and social health. The council will also provide regular updates and action-oriented recommendations to the BMP Board.

Scope

• BMP physicians and APPs engagement, resiliency, and retention
• BMP provider vitality and fulfillment, decompression strategies, and burnout reduction
• All BMP disciplines, BMP affiliated team members and sites of service

Membership

The BMP Wellness Council membership is constituted with appointment by the BMP President. The committee leadership comprises 2 physician co-chairs, who also serve as the institutional WBCs from distinct specialty areas who will be mentored by a BMP Board member serving as an Executive sponsor.

Committee membership:

• 2 co-chairs/WBCs
• 1 additional senior clinical leader BMP Board member
• MSEC President
• 1 at-large BMP Board member
• Liaison to Diversity, Equity, Inclusion
• Liaison to BMP Practice Operations Medical Director or Director, Employee Health
• Liaison to the BMP department of Quality
• Liaison to BMP HR
• BH team member engagement representative
• Liaison to EAP
• Up to 15 professionally diverse BMP members with special consideration given to the need for broad representation across geographic regions, clinical specialties, advanced practice providers, ethnic/cultural/gender diversity, and stage of career

Suggestion & Participation

Pilot Changes in Your Department

Several Council members have begun piloting changes in their individual practices by Getting Rid of Stupid Stuff (GROSS) and making changes to enhance the work environment for all practice members.

Take Action

If you have thoughts about potential pilot projects in your area that address any of the below, send your ideas to ProviderWellbeing@bhs.org:

• Efficiency of Practice
• Professional or Personal Vitality
• Joy in Medicine
• Communications
• Join the Wellness Council

BMP Wellness Council Co-Chairs

Katie Jobbins, DO, MS, FACP (Internal Medicine)
Zach Testo, MD (Emergency Medicine)

1. Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs http://healthaffairs.org/blog/2017/03/28/physician-burnout-is-a-public-health-crisis-a-message-to-our-fellow-health-care-ceos/
2. Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Shanafelt T, Noseworthy J. Mayo Clin Proc. 2017 Jan;92(1):129-146. doi: 10.1016/j.mayocp.2016.10.004. Epub 2016 Nov 18.
3. StepsForward AMA. https://www.stepsforward.org
4. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Shanafelt TD, et.al. Mayo Clin Proc. 2015 Dec; 90(12):1600–1613.DOI: http://dx.doi.org/10.1016/j.mayocp.2015.08.023
5. Understanding the Real Costs of Recruiting NEJM http://www.nejmcareercenter.org/minisites/rpt/understanding-the-real-costs-of-recruiting/
6. The staggering costs of physician turnover, Recruitment spending is only the tip of the iceberg: the average group of 10 hospitalists loses roughly one provider every year. David A. Frenz. Today’s Hospitalist. August 2016.
7. Utility of a brief screening tool to identify physicians in distress. Dyrbye LN1, Satele D, Sloan J, Shanafelt TD. J Gen Intern Med. 2013 Mar;28(3):421-7. doi: 10.1007/s11606-012-2252-9. (The Well-Being Index. https://www.mededwebs.com/well-being-index)
8. 10 Bold Steps to Prevent Burnout in General Internal Medicine. Mark Linzer, Rachel Levine, David Meltzer, Sara Poplau, Carole WardeJournal of General Internal Medicine. January 2014, Volume 29, Issue 1, pp 18–20
9. Maslach C. Job Burnout. Annu. Rev. Psychol. 2001. 52:397–422.
10. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis Colin P West, Liselotte N Dyrbye, Patricia J Erwin, Tait D Shanafelt. Lancet 2016; 388: 2272–81
11. Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism: A Randomized Clinical Trial. West CP, MD . JAMA Intern Med. 2014;174(4):527-533. doi:10.1001/jamainternmed.2013.14387
12. Can scribes boost FPs' efficiency and job satisfaction? Earls ST, Savageau JA, Begley S, Saver BG, Sullivan K, Chuman A. J Fam Pract. 2017 Apr; 66(4):206-214. PMID: 28375393.
13. Stanford physician Wellness committee
14. Kaiser Permanente physician Wellness committee
15. Kaiser Permanente physician Wellness committee ToolKit
16. Stanford’s domains of our WellMD Professional Fulfillment Model http://wellmd.stanford.edu/center1.html
17. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Thomas Bodenheimer, MD, Christine Sinsky, MD. Ann Fam Med November/December 2014 vol. 12 no. 6 573-576. http://www.annfammed.org/content/12/6/573.full

Burnout Studies

1. A Crisis in Health Care: A Call to Action on Physician Burnout
2. Report and Recommendations of the Workgroup on Physician Wellness and Burnout
3. Burnout, Drop Out, Suicide: Physician Loss in Emergency Medicine, Part I

Additional References

1. https://store.aamc.org/downloadable/download/sample/sample_id/465/
2. https://www.ama-assn.org/practice-management/physician-health/joy-medicine-health-system-recognition-program
3. https://www.ama-assn.org/practice-management/physician-health/road-map-helps-health-systems-address-physician-burnout
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9904500/pdf/pone.0281406.pdf
5. https://www.mayoclinicproceedings.org/action/showPdf?pii=S0025-6196%2821%2900787-4
6. https://betsylehmancenterma.gov/news/at-massachusetts-general-hospital-physician-coaching-reaches-beyond-the-1-1-relationship-to-benefit-the-organization
7. https://acpinternist.org/archives/2022/03/championing-well-being-amid-covid-19.htm
8. https://www.acponline.org/practice-resources/physician-well-being-and-professional-fulfillment/acp-well-being-champions
9. https://www.amwa-doc.org/our-work/initiatives/physician-well-being/
10. https://www.acep.org/globalassets/sites/acep/media/wellness/acepwellnessguide.pdf