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Burnout and Wellbeing: Colin West
33 Plays20 days ago
Dr. Colin West is an internal medicine physician and Medical Director for Employee Well-Being at Mayo Clinic. Listen to Colin discuss individual and system-based strategies for addressing burnout, the MVPs of wellbeing (meaning, value and purpose) and research tools for measuring burnout and wellbeing.
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Transcript
Introduction & Guest Background
00:00:09
Speaker
You're listening to The Wound Dresser, a podcast that uncovers the human side of healthcare. I'm your host, John Neary. My guest today is Dr. Colin West.
00:00:21
Speaker
my guest today is dr colin west Dr. West is an internal medicine physician and medical director for employee well-being at Mayo Clinic in Rochester, Minnesota. Over the last 20 years, Dr. West has extensively published on physician burnout and well-being in many premier journals, including the Lancet, JAMA, and Mayo Clinic Proceedings.
00:00:41
Speaker
In addition to his medical degree, Dr. West holds a PhD in biostatistics, which enables him to effectively design studies that seek to better understand burnout. Dr. Colin West, welcome to The Wound Dresser.
00:00:53
Speaker
ah Pleasure to be with you. So I wanted to start off by just ah setting the stage for our listeners by defining some some terms.
Understanding Burnout vs. Depression
00:01:02
Speaker
um Can you define burnout and how it is different than depression?
00:01:07
Speaker
Yeah, so this is i ah surprisingly complex question that I'll try to keep very simple, but it's an important one because these terms get thrown around colloquially. ah Burnout actually has a fairly specific definition. It's a work-associated phenomenon.
00:01:24
Speaker
that is characterized by three main dimensions, emotional exhaustion, depersonalization, and a sense of low personal accomplishment. Depression is a psychiatric diagnosis which has its own DSM-5 classifications and diagnoses, um but it's distinct from burnout in important ways in that it's not necessarily work-specific. It's more about your whole sphere of being.
Impacts of Burnout on Healthcare Professionals
00:01:55
Speaker
um And there is at least some understanding of different models for what drives depression from a neurobiology standpoint, for example, that to date have not yet been fully elucidated for burnout.
00:02:09
Speaker
And yeah, so within that, um can you define um emotional exhaustion, what that is? Yeah, so emotional exhaustion is a sense of emotionally feeling like you have nothing left to give in your interpersonal dynamics at work. And so for for medicine, that's usually our our interactions with patients, sometimes with colleagues, but it's feeling like emotionally you're husked out and you can't tap into emotional reserves to be able to connect with your patients.
00:02:40
Speaker
And then same for depersonalization. How do you define that ah within ah healthcare? care Yeah, so within healthcare, depersonalization is becoming callous toward the experiences of your patients, ah treating them as objects rather than fully formed human beings.
00:02:56
Speaker
And I think all of us in medicine sort of recoil from that description because it's so antithetical to the core values and ideals of medicine. um But we know that this actually happens with a fair bit of frequency where people can reach a point in the broader burnout experience where i they actually find themselves having difficulty i treating their patients as fully formed humans.
00:03:24
Speaker
They become callous toward their their experiences, and that's and a manifestation of that depersonalization dimension of the larger burnout construct.
Resilience & Environmental Challenges in Healthcare
00:03:34
Speaker
And then finally, I wanted to define um resilience. And I know like a subset of that that you often talk about is organizational resilience.
00:03:44
Speaker
Yeah. So i resilience is an interesting term that I think has unfortunately gotten a bit of a bad reputation. i And I'll explain that in a moment as part of the definition. But resilience I think of resilience resilience.
00:04:00
Speaker
the ability for an individual to respond to i stresses or situations in ways that are adaptive or maybe even promote growth.
00:04:16
Speaker
From an organizational standpoint, this is the ability of an organization to respond to stresses in a way that is positive, adaptive, i and promotes growth at the organizational level.
00:04:29
Speaker
And where this has become controversial is because this often feels to individual physicians or trainees like, oh, you're telling me to be ah to have better coping strategies to deal with an environment that is untenable.
00:04:44
Speaker
What are you doing about the environment that we're in in the first place? When the reality is we got to do those things together. We need to bring our best selves to our work. Organizations in the larger healthcare care environment are always going to face challenges.
00:04:57
Speaker
Individuals within health care in many ways chose the profession because we embrace those challenges. So how can we respond to those challenges in a healthy way as opposed to a way that depletes or diminishes us?
00:05:11
Speaker
Resilience is about those adaptive, healthy ways of of coping with stressors. So it's inherently a good thing. But when it's the only solution that people feel put upon them, then they feel like there isn't a responsibility or accountability being taken by the larger environment.
00:05:28
Speaker
And then they develop a cynical sort of negative reaction to it. So now that we kind of built that that foundation of of terms that are, I feel like, pretty frequently and ubiquitous in burnout literature, i'm i'm curious to hear about sort of how you got started in burnout research and and um kind of your journey since then, how how that discussion about burnout has evolved.
Journey into Burnout Research
00:05:50
Speaker
Yeah, it's it's been about 20 years now, which is a little hard to believe as I say it. um Some people got into the burnout and well-being space because they had a personal trauma or they witnessed something very close to them.
00:06:03
Speaker
I actually don't have any of those stories directly. and It's not sort of a trauma-informed focus of mine. Yeah. I was a trainee really through med school and and residency and and grad school even, i who really just, okay, this isn't supposed to be easy.
00:06:20
Speaker
Put your head down, get through it. This is just what you're supposed to do. And I was not terribly aware of deeper issues swirling under the surface.
00:06:32
Speaker
I then became a chief medical resident at Mayo Clinic in internal medicine. And in that situation, suddenly you have a line of sight to, ah in our program, a very large number of people, 170 trainees.
00:06:46
Speaker
And you recognize the breadth of human experience. And you recognize that simply putting your head down and getting through it is not a very effective coping strategy for a lot of people. And there is a deeper well of potential struggles out there.
00:07:01
Speaker
As I was dealing with that from an administrative standpoint, my colleague Tate Shanafelt came to Mayo for his Hemonk Fellowship. ah Tate, who's now the chief wellness officer at Stanford, i approached our training program with an interest in exploring some of these issues around experiences in the learning environment, burnout, depressive symptoms, medical errors, and how they might be interrelated.
00:07:29
Speaker
My PhDs in biostatistics, And so we had a natural connection with an ability to design studies. And so this started from a yes, personally, I'm seeing trainees who are facing challenges, but also professionally, have a skill set that allows us to design studies.
00:07:47
Speaker
And so we built some studies where we were very fortunate to have volunteer residents willing to share their experiences with us over time.
00:07:58
Speaker
And that led to an initial manuscript that was published in the medical education theme issue of JAMA in 2006, which linked burnout and depressive symptoms with major medical errors.
00:08:11
Speaker
That then grew into a discussion at our institutional level about what our faculty were experiencing. Because if this was happening in trainees, well, what's going on with our our attendings and our our physicians and scientists faculty?
00:08:26
Speaker
ah We showed the exact same associations, and we also started to show that at least at the local level, this was a fairly common experience. Burnout was not something that affected just a handful of people. It was actually fairly common.
00:08:41
Speaker
We then extended things to say, well, okay, that's what we're seeing here. What do we see nationally? And then we started partnering with Chris Sinski and others at the American Medical Association on some national studies.
00:08:54
Speaker
And that was a major inflection point because in 2012, we published the first large national study of physician experiences, including burnout, and identified that close to 45 percent of physicians endorsed levels of burnout that were associated with serious consequences.
00:09:13
Speaker
That changed the conversation nationally in a way that I think ah it's easy to forget because of how much conversation has happened in the last decade. But before 2012, we very often had to discuss with people why we should even pay attention to this, because maybe this is just a few people who chose the wrong profession.
00:09:34
Speaker
They didn't realize that they were would get in over their head and couldn't cope with the challenges. i You know, too bad. ah they They made a a poor choice and couldn't handle the profession.
00:09:47
Speaker
That's a mistake. It's wrong. But we needed data to be able to push back against. And I don't think you can hold that view, at least from the vast majority of health care professionals, when you find out that 45 percent are dealing with these kinds of concerns.
00:10:03
Speaker
Now you're not talking about a handful who made a bad choice. You're talking about an environment where incredibly resilient, dedicated, passionate people are struggling.
00:10:14
Speaker
That then led to attention to, okay, if we buy that this is actually a real problem, what do we need to do to try and increase awareness and also understand potential solutions?
Balancing Coping Strategies & System Changes
00:10:28
Speaker
And that's really what a lot of the last decade has been about. Yeah, I've heard you made the distinction when you're thinking about solutions, right? That there's kind of the individual strategies and the system-based strategies. Can you talk about that distinction in the approach to burnout?
00:10:44
Speaker
Yeah, this is a really critical distinction. As I mentioned, there can be an individual i recoil or rejection of individual focused solutions, in part because for many years, those were the main things that people saw put in front of them.
00:11:01
Speaker
Oh, the work is hard. Here's some stress management training. i And stress management training is important, actually. It's helpful. But when it's the only thing put in front of you, people feel like, what do what do you mean? You're putting this back on me. You're essentially blaming the victim.
00:11:16
Speaker
So our approach has been to recognize this is a shared responsibility. We need to bring our best selves to our work, and the work is never going to be easy. So how do we do that?
00:11:28
Speaker
How do we maximize our ability to cope with tough environments? How do we build our skill sets? How do we train effectively to thrive in challenging environments?
00:11:38
Speaker
That's the individual part of things. And the solutions that fit under the individual frame, some of them are things that make people roll their eyes in a way that we need to reverse and say, no, this is actually part of the bigger solution.
00:11:52
Speaker
So resilience training, stress management, self-care. Getting the message across to healthcare care professionals that self-care is not selfish. Self-care is actually part of your pathway to take better care of patients in a way that's more meaningful and affirming for you as the healthcare professional.
00:12:11
Speaker
And so there are a lot of those kinds of, okay, what can I do as an individual to bring my best self forward in my work? That needs to be partnered with the system level solutions where we think about what interferes with with people's ability to connect with the most meaningful aspects of their work and allows them to sustain their work in the best possible way so that these challenges can be met not just for a day at a time, but for years or even decades at a time over fulfilling careers.
00:12:45
Speaker
And those system solutions then start to think about not what individuals need to change, But what we need to change to remove barriers, what some have called the pebbles in the shoe, the hassle factors in medicine, and fundamentally what those orient around is connecting healthcare professionals with what I call the MVPs of well-being, meaning, values, and purpose.
00:13:10
Speaker
Every solution from an organizational level that helps connect individual healthcare professionals with what they want to be doing to make a difference for their patients,
00:13:21
Speaker
gu runs through connecting people more deeply with meaning, their personal values that attracted them to medicine in the first place, and aligns with their sense of purpose in making a difference in the work that they do.
00:13:36
Speaker
And so our organizational solutions that do things like reduce clerical burdens, decrease our documentation time, allow us to spend more time interacting directly with our patients.
00:13:48
Speaker
Those are the things that drive well-being from a system standpoint, because they allow us as individuals to connect with what matters most. And for most of us in clinical medicine, that's actually the time we spend with patients.
00:14:00
Speaker
That's what we treasure. That's where we feel we can make a difference helping other people live better lives. organizational solutions meet us halfway where we say, I'm going to bring my best self to my work so that I can be as resilient and adaptive as possible.
00:14:16
Speaker
And I can trust that my working environment is going to reduce the noise and the hassle to allow me to focus on what I am uniquely trained to do, which is interact with my patients, do procedures, take histories, empathize in ways that help them live better lives.
Leadership & Organizational Values in Healthcare
00:14:35
Speaker
Yeah, I'd like to dive deeper into those MVPs that you mentioned. um I know one thing that's important is having you know leadership that's on board. How does leadership kind of set the tone at a healthcare institution in terms of those MVPs?
00:14:50
Speaker
This is something that we're learning a lot more about in recent years. And it turns out to be absolutely essential. um Just as you phrased it, leaders set the tone. and leaders create the space.
00:15:06
Speaker
for wellbeing efforts. We know from literature over the last five years or so that working groups that rate their leaders more highly, not only have lower burnout levels and at better wellbeing levels in the moment, but they also have higher wellbeing levels two years later.
00:15:28
Speaker
And they're also less likely to leave their jobs and leave their institutions, not just in the immediate future, but two years later. And so this is really important as a sign that what leaders create in their environments gives the space for wellbeing to prosper.
00:15:49
Speaker
And so leaders, if they can tap into recognizing that our path to delivering our leadership objectives runs through wellbeing, it's not actually separate or contrary,
00:16:03
Speaker
to other common leadership objectives in medicine. So these may be things like RVUs or financial targets or a certain number of grants that have been submitted in a year. All of those remain important.
00:16:15
Speaker
But in fact, you are better able to meet those objectives for your group when your group is firing on all cylinders. And when you phrase it that way, it seems sort of obvious.
00:16:26
Speaker
Like if I take care of my people, they'll take care of the mission. But we get fall into a trap in medicine often of saying, well, what did you expect? The job's hard. You just need to see more patients and get through it.
00:16:37
Speaker
You're compensated well. What are you complaining about? This is the job. Just do it. And we have hundreds of thousands of physicians across the country who are a not just for themselves, but because they recognize that they can deliver better for their patients if they have environments that actually allow them to take those breaths, focus on what matters most.
00:17:03
Speaker
But individuals sometimes don't have the direct pathways to pull the levers to be able to say, well, you know, how can I reduce my documentation burden? It's in front of me. I've got to do this. A leader can prioritize and say, OK, let's evaluate the issue.
00:17:17
Speaker
What are we documenting in our practice by policy that we don't need to do? What other resources can we bring in? ambient scribe technology, for example, to be able to say, we can make this more efficient and free you up to focus on the more meaningful parts of your job in ways that are honoring of meaning, values, and and purpose.
00:17:40
Speaker
But the leaders are the creators. They're the facilitators of the environments. And I would like to believe that as a leader, that actually offers inspiration for a leader.
00:17:51
Speaker
Because I've yet to meet a leader, by the way, who wants their teams every morning to suffer. And to not enjoy their work and not like what they're doing. That's not what leaders get up wanting to do.
00:18:04
Speaker
So if we can create environments where leaders can feel inspired to lead through well-being as a pathway to all of our shared objectives, then everybody wins.
00:18:17
Speaker
And most importantly, our patients win. Yeah, everything you see you said seems like a slam dunk, right? like doctors want to take Doctors and all healthcare workers want to take good care of their patients, and and leaders are on board with that, and the path through that is well-being.
00:18:32
Speaker
um I read a piece you wrote in 2023 called ah The value of Values Alignment in Healthcare, care and you kind of discussed you know value discrepancies between healthcare workers and organizations, moral injury,
00:18:46
Speaker
So what what are the health care, what are what are the value discrepancies that exist in health care and like how are they affecting health care?
Financial Implications & Value Misalignments
00:18:53
Speaker
Yeah, I think so. the The issue here is when we largely unintentionally lose sight of why we're here or we make ah rationalizations and say, well, we can deliver our mission, but only if we make sure we take care of the finances and whatever we need to do take care of the finances. That's job number one.
00:19:15
Speaker
Well, what if your efforts to take care of the finances are driving burnout? Then you are actually shooting yourself in the foot. And so this requires a larger awareness.
00:19:28
Speaker
And that's where the values alignment piece comes in. What are our ultimate objectives? And if your ultimate objective in your practice is to generate a certain amount of revenue, then you need to be upfront about that.
00:19:42
Speaker
But if your ultimate objective is, alternatively, we want to sustain our practice in a way that optimally serves our patients, then you're implicitly saying, we have financial responsibilities, yes.
00:19:58
Speaker
but those are in service of our patients. And ultimately we need to be thinking about what our patients experience and a major driver of our patients experience is what our healthcare teams are experiencing.
00:20:11
Speaker
It's a different way of thinking about the values, but when we get ah seduced might not be the right word, gonna just go ahead and throw that out there by short-term, easy to measure financial metrics and think that's the be all and end all.
00:20:27
Speaker
we're at risk of drifting from the core values of medicine. ah Sister Jenna Rose, who is a revered figure in the history of Mayo Clinic, i spoke about this in a variation of a quote that has appeared in the business world for many years.
00:20:42
Speaker
And she starts off the quote in a really familiar way. We've all heard, no money, no mission. And then everyone kind of murmurs and and but she and then she interrupts and says, but we need to remember there's a second half to this.
00:20:57
Speaker
No mission, no need for money. And I think in healthcare, care we sometimes put the cart before the horse and mix up. money and mission. And I'm not saying finance is the only thing that causes issues sometimes, but it does end up being sort of the elephant in the room that that swamps every other ah ability to talk about other drivers.
00:21:19
Speaker
And the key here about the money part of this is burnout's expensive. And so the reality is if you're losing your teams and they're functioning suboptimally,
00:21:32
Speaker
They're costing money. It's almost like having a vampire energy drain in your network or in your grid. You are spending money without even realizing it because your system is not optimized.
00:21:45
Speaker
And if you would invest in optimizing your system, you would actually have much better return, much better ability to deliver all of the objectives that you have as a system.
00:21:57
Speaker
Yeah, that's definitely something we've discussed at our institution that like, for instance, losing a physician that costs like a million dollars to replace them. Like, so they're, you know, those things are very intertwined, both like the the care and the finances.
00:22:10
Speaker
How do you feel like leadership can, um you know, make sure everybody at an institution knows, okay, our mission is is first, and then the finances are kind of what fuels that mission as opposed to the other way around?
Transparency & Resource Allocation in Healthcare
00:22:24
Speaker
So I think there are a number of steps. and And the first most important one, which is also unfortunately a little bit vague and overused as a phrase, is transparency.
00:22:36
Speaker
I think i what we say matters. And I'll give you an example. If you're at an institution where every division or department meeting starts off with a finance update,
00:22:48
Speaker
What you're actually saying to the community is the first thing that matters the most is our finances. Everything else occurs after that. And so that can be turned around.
00:23:01
Speaker
And we could maybe revise that and say, you know, let's talk about our health care team functioning first. And we're going to talk about finances because it's still relevant, still important.
00:23:13
Speaker
But we're going to rotate what what we cover first to model that money isn't the only thing. um So that's one piece. I also think people are watching very closely.
00:23:26
Speaker
And one of my mantras is what we resource demonstrates what we value. And so what investments are we putting into well-being? And sometimes those are hidden from view.
00:23:39
Speaker
So they can be things like we've invested in this health insurance plan and reduced rates for our healthcare care professionals that's costing the institution millions of dollars and actually is an investment in well-being.
00:23:53
Speaker
But it's hidden and we're not advertising Well, why not? That's part of well-being. It's an investment in your staff. We're committed to a competitive compensation structure where we benchmark against other organizations because we want everyone to recognize that they are valued at least at the level of our peer organizations. We don't want anyone falling behind.
00:24:15
Speaker
Model that, demonstrate that. We've invested in mental health resources through national partnerships. Great, that can cost millions of dollars and sometimes it's absorbed into operating costs and not shared with people.
00:24:29
Speaker
By the same token, if you need to invest in ah local leaders and you need to have wellbeing positioned at the executive table in certain divisions or departments or at the C-suite of your institution,
00:24:44
Speaker
then demonstrate the importance of the investment by resourcing it and showing, yeah, we've got a chief quality officer. We're going to have a chief wellbeing officer because wellbeing is essential for us to deliver quality.
00:24:59
Speaker
Model that. Show that. People are watching. And then the last thing maybe I'll say about how to how to model that values alignment from a leadership or institutional standpoint is to actively partner.
00:25:11
Speaker
So sometimes leaders fall into the trap in a problem-solving mode of feeling like, I don't want to burden my teams. I need to solve this problem myself as the leader. So we are going to come up with the solutions, and we're going to implement them.
00:25:23
Speaker
And it can come from a good place of not wanting to overburden already stretched healthcare professionals. But actually, that can foster disengagement because it feels non-inclusive and you're potentially going to come up with solutions that your teams don't actually prioritize.
00:25:42
Speaker
And so my experience has been that healthcare professionals desperately want to have their voice heard in a real way. And so if leaders will take their hands off the steering wheel and encourage and facilitate conversations and then say, okay, you've told us what you need.
00:25:58
Speaker
My job as a leader is to try and make that happen. My job isn't to decide what you need. my desire My job is to listen to what you need and then figure out what's feasible.
00:26:10
Speaker
and be an advocate that fosters engagement and connection and it builds trust and you actually have a more powerful aligned team that feels more values connected by taking that approach but leaders are sometimes in my experience a little bit scared of that approach because it feels like they're diffusing responsibility and putting the burden on other people when they should be doing it themselves as the leader I don't think that's how healthcare teams feel it, though.
00:26:41
Speaker
They actually want to be part of the
Impact of MVPs on Reducing Burnout
00:26:43
Speaker
solutions. They want the leader to help open the door to implementation. And that's a different leadership structure than many leaders are accustomed to.
00:26:53
Speaker
We've been talking about the importance of of of MVPs and values when you have healthcare care workers in an organization, but I want to almost flip the script. um Do you ever think about or or research on you know and MVPs within a doctor-patient relationship? Is having that value alignment valuable ah towards reducing burnout when your patient and doctor have aligned MVPs?
00:27:17
Speaker
So I think yes, to an extent, but I also think it's important to note that we can help our patients, even when we have completely different life experiences, different perspectives on world events, i you know, maybe different political views, for example.
00:27:34
Speaker
ah We can still have a healing relationship with our patients, but ah And so I think it's important that sometimes if there isn't values alignment, that we not fall into the trap of thinking that in that therapeutic relationship, that's a crippling barrier.
00:27:50
Speaker
I think the ability to help people live their best lives is something patients and physicians can align around. And that shared value of working together toward that common goal can be very affirming.
00:28:05
Speaker
i And obviously there are extremes in terms of behaviors from healthcare professionals or patients that will cross reasonable moral and ethical lines. And I won't get into those details.
00:28:17
Speaker
um'm talking about a more normal breadth of human experience type of interaction. In those situations, we don't actually need to be aligned in specifics. What we do need to be aligned in is what are our shared values in terms of what are we aiming for?
00:28:33
Speaker
And I will sometimes step back with my patients and just remind everyone, hey, my goal here is for you to live your best possible life. And I need to hear from you what that means because you're the one living that life.
00:28:48
Speaker
And then the patients will sometimes turn back and say, well, here's what a fulfilling life means to me. And it might not be what I find fulfilling, but we've got it out on the table.
00:29:01
Speaker
And now we don't have to be aligned in the specifics, but we are aligned on our shared objective. And the value becomes fulfilling. How do we both move together toward that shared goal of your most fulfilling life meeting your greatest potential?
00:29:18
Speaker
Which goes back to at the very beginning, you asked me about definitions. And one definition that I would throw out there in addition is well-being itself. What is well-being? And it turns out it's difficult for a uniform definition that everyone will agree upon i to to kind of settle out.
00:29:36
Speaker
But what I've used as a working definition in my own life, in my work life, ah working with patients, is well-being is about each individual's ability to meet their greatest desired human potential.
00:29:51
Speaker
It's not a work dynamic. It's a holistic all-of-life dynamic. And I think we have a unique privilege in medicine in having an opportunity to help connect our patients with the best possible well-being that they have the potential to achieve.
00:30:07
Speaker
And it's hard for me to imagine anything that could be more fulfilling than that. And so the MVPs end up being natural in our interactions with patients. So then is it fair to say that while alignment of MVPs is not really, you know, a necessity in a clinical relationship, you need to sort of have that discussion to really get the most out of a doctor patient relationship?
00:30:29
Speaker
ah Or else it just kind of becomes like symptom management and we we kind of don't have that value compass that's going to guide us towards towards well being? yeah I think that's well said. i think it's important for us to know where our patients are coming from so that we can incorporate that into shared plans that are designed to meet the common objective of helping people experience the greatest possible well-being.
00:30:54
Speaker
And that requires that we step away from our assumptions about what might be best for our patients and incorporate their value structure. And i actually find that very enjoyable. It's part of getting to know people. It's a very personal,
00:31:11
Speaker
i connection and just that nature of that personal connection to me, that's a rebuttal against emotional exhaustion and depersonalization.
00:31:22
Speaker
And it's a rebuttal against low personal accomplishment because I feel like I'm part of helping this patient, their family, their community move closer toward their goals.
00:31:34
Speaker
Doesn't mean we always succeed. Doesn't mean that we make as many strides forward as we want to. And bad stuff can still happen. But we know what we're aiming for and we're working together toward that goal.
00:31:48
Speaker
That's incredibly fulfilling just from a human standpoint. And I think that's an antidote to burnout to a great extent. I want to ask a little bit more about um you know the specifics of some of your burnout
Compass Group Intervention
00:32:00
Speaker
research. I know one of the interventions you've you've tested out before ah is called the the Compass Group.
00:32:05
Speaker
Can you kind of describe ah what that is and whether is that more of like an individual or system-based strategy when you think about building community through that? Yeah, it's, it's, I think it's a great example of a shared responsibility, actually, the way we prefer to frame it. So what compass groups are, and that stands for ah colleagues meeting to promote and sustain satisfaction.
00:32:26
Speaker
We published a paper on this on Mayo Clinic proceedings. i is really about getting small groups of we studied physicians but it can be done with other healthcare groups as well small groups of physicians together to meet on a regular basis and not just have social chat and potentially venting but actually structure those discussions around topics relevant to common physician experiences and so these can be things like How do you balance your work demands with the things your family needs?
00:33:00
Speaker
How do you cope with medical errors? How do you deal with i changes in career stage or you know whatever it might be? But they're anchored around topics that are professionally relevant.
00:33:14
Speaker
And what we found in the studies of these is that these interventions, these compass groups, if people would meet every two to four weeks over a six-month period, with the same group of people over time.
00:33:27
Speaker
They had reduced burnout levels. They reported increased sense of meaning from their work, and they were less likely to report considerations of wanting to leave or look for other jobs at other institutions or potentially leave medicine altogether.
00:33:44
Speaker
I mentioned it's a shared responsibility because individuals are making the space in their lives to meet with their colleagues periodically. Now, some of our groups told us, well, I'm meeting with friends anyway.
00:33:57
Speaker
I've got to have lunch. So this kind of fits into my life anyway. What you're telling me is I just need to talk about certain topics when I'm doing this. All right. Well, I'm willing to do my part for that.
00:34:10
Speaker
What's the other part of the shared responsibility? The other part of the shared responsibility is our implementation at Mayo is that we pay for the lunches or the meals around these meetings.
00:34:22
Speaker
And so those are reimbursed for our physicians. So if they meet before the endoscopy suite opens in the morning, their breakfasts, wherever they choose to do this, are compensated.
00:34:35
Speaker
If they meet at lunch during the workday, compensated. If they do a Saturday picnic where they've gone for a bike ride and then met for an hour over a picnic lunch, that is compensated. And so the institution is investing financially to an extent individuals are showing that they're committed from an individual perspective and that shared responsibility models that both sides have some skin in the game Some people will look at that and say, the time's not worth it for me. That's not enough balance of of institutional investment.
00:35:06
Speaker
Okay, we need to have a more diverse menu. Other people look at that and say, I'm happy to meet and you're going to give me money for this. As one of my colleagues said, I meet with my colleagues anyway.
00:35:19
Speaker
You're going to pay for my lunch to do something I was going to do anyway. Sign me up. So there are different perspectives on this. It's an evidence based way in randomized trials where we can show with a modest institutional investment that actually does not reduce access to care for patients.
00:35:39
Speaker
But does have meaningful well-being benefits, and it's one example of something to add to the menu of potential solutions to help people connect with well-being. Yeah, just as you were talking, i'm I'm thinking about, you know, building community and a healthcare organization seems like there's there's so many options, there's so many ways you could do it. and And perhaps that could, you could almost get lost in all the ways you could
Community & Connection in Healthcare Teams
00:36:02
Speaker
do it. Like who, you know, who are you having in your groups? Are you having just physicians? Are you having all healthcare care workers? Are you having, you know, who's who's actually playing a role in these kind of community building activities? And then, you know, who's taking the lead? Is it the administration? Is it the actual administration? you know, healthcare workers themselves. And then is it kind of like an in-house thing where you, you meet in the hospital? Is it, is it where you meet outside? So it it just seems like there's, do you have any insight into the best way to, as you said, like create that menu?
00:36:29
Speaker
Yeah. So it's, uh, those are such great thoughts and you're absolutely right about all of this. Uh, what we recommend, first of all, the randomized trial data comes from groups of physicians and across disciplines without restrictions, uh,
00:36:44
Speaker
We don't have randomized trial data on interprofessional groups, nurses, other groups of healthcare care professionals. However, the underlying principles still make sense.
00:36:55
Speaker
We know that community is a driver of well-being. There's decades-old work. that sense of community is critical for well-being. We've had recent acknowledgements that the pandemic highlighted, including a Surgeon General's advisory report, that loneliness and social isolation are epidemic concerns, and medicine is not immune from that.
00:37:18
Speaker
So the idea that anything that could build community and connection, maybe even if we're aspirational, build belonging across our healthcare teams, should promote well-being.
00:37:28
Speaker
So I think there's ah there's a um conceptual framework under this that makes sense. I'm really excited by groups that say, hey, we want to do this and we've got an ICU team that is so multidisciplinary but they do so much hard work day to day, they don't really connect at a human level and share their experiences.
00:37:51
Speaker
We want to bring that group together with an opportunity to share these experiences and recognize the the kindred nature of everything that they're doing and really even be reminded of how much they genuinely appreciate one another for their skill sets, something we also don't do enough in medicine.
00:38:10
Speaker
I don't have a randomized trial to show that that interdisciplinary ICU team is going to be effective, but I know it will be because thematically it aligns with the reasons that compass groups exist in the first place.
00:38:24
Speaker
And so what I recommend is if community is a limitation, in a work area, try and get a sense of, well, who's feeling disconnected? Does it cross disciplinary lines? Is it primarily your nursing staff?
00:38:39
Speaker
Is it that your physicians are basically running office to office and feeling completely separate from anyone else at the institution? i Figure out where those hotspots are, and those are where you try to layer on opportunities to restore that connection.
00:38:55
Speaker
And even if you don't have an RCT for that group, I think the conceptual framework dictates that this will be effective in driving well-being, because even without an RCT, we've got decades of work from the burnout and well-being literature from people like Michael Leiter and Christina Maslach to tell us that community is one of the drivers of well-being and engagement, not just in medicine.
00:39:16
Speaker
but across all of work experience. You led me right into my next question.
Burnout Measurement Tools
00:39:22
Speaker
i was going to ask about the Maslach burnout scale. I know that's a validated tool to kind of ah measure burnout.
00:39:29
Speaker
I was wondering if you can kind of just talk about the the strengths and limitations of that tool and and kind of, I guess, the the strength and limits of of quantifying burnout. Yeah, well, I'll maybe start there.
00:39:41
Speaker
ah It's hard to know what you're accomplishing if you're trying to implement initiatives if you don't have some measure of where you started and where you've been.
00:39:52
Speaker
And so assessment and measurement is critical, but there are lots of ways of assessing and measuring. These can be qualitative You can have focus groups, you can have confidential meetings, you can have online i you know sharing spaces i that give you a sense of what's the community feeling.
00:40:14
Speaker
And they can be quantitative. You can have direct sort ah survey assessments. They can be anonymous. um They probably should be anonymous in many situations ah where you're asking directly about burnout. You're asking about job satisfaction. You're asking about meaning at work or other dimensions of well-being.
00:40:32
Speaker
If you choose to do the quantitative assessments to really have something to point to, which is often appealing, there are different instruments that are out there for burnout in particular.
00:40:44
Speaker
Most regard the gold standard for burnout is the Maslach Burnout Inventory, which you mentioned. I'll start with the downsides of the Maslach. So the downsides, first of all, the full instrument is 22 items long.
00:40:57
Speaker
So it's a little bit lengthy if you're talking about doing a large organization with multiple pulse checks. The other main limitation is that it is proprietary. And so you have to pay to use it.
00:41:09
Speaker
And that can be limiting for some groups. ah The benefits are, again, it's got four decades of research behind it It aligns with the established domains of burnout almost by definition because emotional exhaustion, depersonalization, and low sense of personal accomplishment are baked into the instrument.
00:41:33
Speaker
So it gives you that i intrinsically connected assessment of those domains. um And then there are normative benchmarks across medicine and other professions, which are all big advantages.
00:41:47
Speaker
There are other instruments out there. And for listeners, if you're interested in this further, the National Academy of Medicine actually has a website on clinician well-being that has a repository of various well-being metrics and their strengths and weaknesses.
00:42:04
Speaker
For burnout, one of the really popular alternatives, which is available free of charge, is something called the Mini-Z instrument, which is used as part of some American Medical Association assessments.
00:42:16
Speaker
What we know about the Mini-Z, it's a single item and it's free. So it's got a couple of really appealing qualities. The downsides of the Mini-Z are that it's been demonstrated to correlate most strongly with the emotional exhaustion domain of burnout.
00:42:32
Speaker
it doesn't correlate as well with the other two main elements of the construct. So it's a somewhat incomplete view into burnout. It can give you a signal, but it doesn't give you the full picture the way a more robust instrument like the Maslach Burnout Inventory does.
00:42:49
Speaker
That said, It's easy to use. It's quick. And for emotional exhaustion in particular, which many have argued is, in some respects, the most prominent ah first experience of burnout, it's a pretty good starting point.
00:43:08
Speaker
So those are just two instruments that i'll that I'll mention, and then reference to some of the resources that are out there from the National Academy of Medicine. Or certainly feel free to reach out to me as well if there are listeners that are interested in further details.
00:43:23
Speaker
Do you see ah qualitative and mixed methods research playing a bigger role in burnout research in the future?
Role of Qualitative Research in Burnout
00:43:30
Speaker
When you think about, like you were saying, semi-structured interviews, kind of like ah just more holistic tools, I guess?
00:43:38
Speaker
I do actually. and And I say this, this has been an evolution for me as well. I mentioned my PhDs in biostatistics. I have heavily quantitative training background. um But I have grown to deeply appreciate the value of the combination of quantitative and qualitative rigorously conducted assessment.
00:44:00
Speaker
And what we can gain from qualitative work is a deeper understanding of which dimensions of work experiences are actually affecting people the most.
00:44:13
Speaker
And so Leiter and Maslach have talked about six areas of work life. I won't belabor these, but workload, control, reward, community, fairness, and values.
00:44:24
Speaker
Different work settings and different individuals experience those six areas of work life to differing degrees. And if in your work unit, the main driver is not workload, it's community.
00:44:37
Speaker
You need to be able to assess that because if you develop solutions that are designed for workload, but the problem isn't workload, then you're not going to meet the needs of the people that you're trying to help.
00:44:48
Speaker
And that can sometimes be elicited in the most effective way through qualitative methodologies where you actually get voiced experiences from people.
00:44:59
Speaker
And then you try and synthesize those to say, well, here's here are the themes that are emerging. These are really centering around community. We've got some initiatives that we know are evidence-based, like we talked about with Compass programs, to be able to build community.
00:45:12
Speaker
Maybe we should start there. And the qualitative input has directly informed that. For other areas, the they might say, look, the major issue for me is that my in-basket is out of control.
00:45:25
Speaker
I need something that allows me to stop treating the computer on nights and weekends, have time for my family, and have more time directly for my patients during my workday.
00:45:37
Speaker
It's not a community issue for me because I'm drowning in my in-basket. Well, when that emerges, we then highlight a set of solutions that's oriented around that driver of well-being.
00:45:48
Speaker
And so the qualitative piece can really be ah a critical adjunct that helps guide effective solutions in a way that i I'm glad that we're seeing more and more of.
00:46:01
Speaker
You've been doing this ah burnout research, I believe you said, for 20 years. What's surprised you most along the way?
Research Reflections & Motivations
00:46:08
Speaker
There are a lot of twists and turns in this.
00:46:12
Speaker
um I would say early on, i as a novice myself, I was surprised by how prevalent these experiences were across the profession. Because as I mentioned, I was kind of a put your head down and get through it kind of person i and did not have great awareness of what was really going on across the profession.
00:46:32
Speaker
So that was an early surprise. I think more recently, I've been surprised and I'll say encouraged actually by how much energy there is around people who want to promote wellbeing in healthcare care and not for selfish reasons.
00:46:51
Speaker
People do not want to promote wellbeing so that they can have Friday spa days and four hour work days. They want to do this because they care so deeply about the patient experience and their ability to help patients in a meaningful way over fulfilling careers that hopefully last decades.
00:47:14
Speaker
And that spirit of an external service focus, that embrace that self-care is not selfish. It actually serves our mission as healthcare professionals Early on, that was surprising to me because I didn't realize how deep that value was.
00:47:33
Speaker
And then more recently, it's become inspiring because one of the reasons why we keep trying to help leaders and healthcare care professionals advance these objectives is because we know we have the energy of so many thousands of healthcare professionals who that want our health care system to deliver on its full potential.
00:47:55
Speaker
So really, I mentioned well-being is about each individual achieving their greatest desired potential. We have an army of people who want our health care system to be well, to deliver its greatest desired potential.
00:48:07
Speaker
And being part of that larger movement is something that is incredibly rewarding for me. And I know it's, it's rewarding for everyone else that works in wellbeing. It's not a selfish thing that we're trying to put forward to, you know, uh,
00:48:23
Speaker
look at any individual's academic credentials or have a shorter workday just for the sake of getting paid more to do less. It's fundamentally about meeting the mission of medicine.
00:48:34
Speaker
And I think that's just a deeply fulfilling motivational context. With that, it's time for a lightning round, a series of rapid fire questions that tell us more about you.
Rapid-fire Personal Questions
00:48:47
Speaker
So what is your go-to wellness practice? So for me, it's variety. I am big on physical activity. i do different things most days of the week, whether it's tennis or Peloton or, you know, circuit training or just getting some steps in outside with nature.
00:49:06
Speaker
And I also watch more junk TV, sometimes in combination with, you know, jogging on the treadmill. uh than i would care to admit um and there are some shows that i just won't name but like there are a bunch of series that i uh i know the cast better than uh well like i said better than i care to admit
00:49:27
Speaker
uh what's the best part about working ah in rochester minnesota ah The best part of working in Rochester, Minnesota and at Mayo Clinic is that I am surrounded by mission-driven healthcare professionals across every aspect. It's not just our clinicians. It's our desk staff. It's our volunteers who are helping get people from point A to point B. It's our lab people.
00:49:51
Speaker
And just knowing that everyone has the patient's back and you can count on that from everyone that you're working with it's It's impossible not to do the right thing and be be inspired to do the right thing because everyone around you is modeling that.
00:50:09
Speaker
What is your favorite soup?
00:50:13
Speaker
ah Tom Kagai. Thai coconut curry soup. i Shout out, the best one I've ever had. I grew up in Seattle. There's a restaurant in Ballard called Thai Siam.
00:50:25
Speaker
It's been there for 40 years. I grew up on it as a child. i But Tomka guy with chicken is an incredible mixture of ae elaborate, brilliant Thai flavors.
00:50:40
Speaker
have to check that out. um What's a musical act you would like to see? ah Nine Inch Nails. And I was actually had tickets when they were in Iowa City in the 90s when we had a 13 inch blizzard and the show was canceled.
00:50:57
Speaker
And so I was not able to go and I've never made it back since. um But Nine Inch Nails would be tops on that list. And lastly, i I think I might already have a sense for your answer here, but what's one thing that's working well in health care?
00:51:14
Speaker
The people in healthcare care are
Mission-driven Nature of Healthcare Professionals
00:51:16
Speaker
what's working well. We are mission-driven and we are inspired to partner with our patients. Our patients are our reason for doing the work that we do and our colleagues and that common alignment and that shared value structure.
00:51:32
Speaker
The opportunity to positively influence other people's lives, I can't imagine a profession that could be more fulfilling. And that's the drive to allow people to connect with that more and more.
00:51:44
Speaker
i We put a lot of training into this. There's a lot of hard work that goes into being able to help people in the best possible way. ah We need to make that as fulfilling and meaningful a career plan as possible.
00:51:57
Speaker
And we've got the people to do it. They have the right motivations. And we and our patients deserve it.
Conclusion & Closing Remarks
00:52:04
Speaker
Dr. Colin West, thanks so much for joining the Wound Dresser. My pleasure. Appreciate the invitation. And thank you for your interest in this topic.
00:52:22
Speaker
Thanks for listening to The Wound Dresser. Until next time, I'm your host, John Neary. Be well.