Like all healthcare professionals, hospitalists are at risk for burnout, and COVID-19 has made burnout symptoms worse, according to survey data of hospitalists at Mayo Clinic sites.(1) Burnout is destructive; it is associated with shorter lifespan, depression, staff turnover, medical errors, and high costs to healthcare systems.(2-6)
Hospitalists, as leaders of healthcare teams in the hospital setting, also face personal risk in caring for hospitalized patients during the pandemic. They risk contracting the virus at work as well as transmitting the infection to members of their families.(1) Burnout across the healthcare workforce is highly prevalent, affecting 35–50% of nurses and physicians according to recent estimates.(4)
Individuals have varying responses to stress; not all interventions meet everyone’s needs. Many groups developed various and creative means for supporting the wellness and resilience of healthcare workers early in the pandemic. At one New York City health system, hospital leaders fostered the emotional well-being of staff with individual and group counseling sessions, respite rooms, wellness rounds, assistance with transportation, childcare, and temporary lodging.(7) A culture committee at Stanford University created several initiatives to address the needs of healthcare workers, including obtaining donations of masks and gift cards, providing snacks, and creating safe social interactions through podcasts and virtual gatherings.(8) Others have offered workshops on mind-body practices.(9)
We report on a simple, low-cost effort led by wellness physician champions to directly support the well-being of frontline hospitalists at a large academic medical center: the personal interview. We do not purport to have invented the personal interview; rather, the innovative aspect of our project is the context to which this well-known instrument is applied and the purposes it is meant to serve.
Setting and Participants
Our hospitalist group comprises 65 MDs, DOs, and advanced practice providers (APPs) providing care to medical patients in a 950+ bed academic medical center in Durham, North Carolina. Despite the pandemic, providers continue to be recruited, interviewed, hired, and onboarded. This is a process that has been conducted with virtual interviews and informal luncheons, but with no in-person component
Applicants for open hospitalist positions are not able to tour the hospital personally, meet with prospective teammates in person, or even get a brief glimpse of the team’s culture outside of virtual gatherings. Further, typical team-building activities for established faculty such as lunches, happy hours, and organized group activities were no longer allowed by state and institutional guidelines. Our hospitalist group, for instance, has always met twice weekly for faculty meetings, journal clubs, and other academic pursuits; these interactions were combined with fellowship and a meal. Though the meetings have continued during the pandemic, we now pick up a boxed lunch and participate in the meetings virtually and remotely from an isolated workstation.
We needed safe, improved avenues to promote resilience, form connections, get to know new teammates, and maintain relationships with established colleagues in a time of intense strain. With the backing of the larger Health System Wellness Committee, which had identified wellness champion leaders early in the pandemic, we embarked on a variety of hospital medicine wellness activities.
Knowing that various team members might respond to interventions differently, we offered a variety of types of support. These included virtual coffee hours, virtual baby showers, and virtual happy hours. We directed team members to well-being resources curated by the larger and well-resourced health system. To foster positive emotions, we led gratitude initiatives supporting custodial staff and the emergency department, and we collected donations for local school lunch programs. These initiatives are established methods for promoting positive emotion to support well-being.(4)
We sought volunteers to provide snacks and meals for teammates. We created a buddy system to encourage teammates to intentionally and regularly check in with their peers. These have been crucial aspects of our team building.
Intervention
Despite these many important undertakings to support our team, we continued to miss the connections that deliberate and personal interactions bring. Virtual meetings left little room for relaxed social exchanges, and the constant presence of the computer screen for patient care and now for all social engagements was vexing. Attendance at virtual social gatherings waned amid this progressive strain. An offer for health system psychologist-facilitated conversations garnered little interest from the group.
Spurred by the need for more fulfilling and more nuanced social interactions, we began a complementary venture using a vastly different approach in the form of a series of one-on-one telephone interviews with teammates.
Hospitalists are accustomed to talking on the phone; they respond to pages by contacting patient care nurses and other staff by phone; they discuss patient care with consultants via phone; they update patients’ families by phone; and, importantly, they sign out to oncoming teammates by phone. Because of the severe restrictions placed on social interactions, these essential exchanges with hospitalist teammates were now, at times, taking place between teammates who had never met.
The endeavor to leverage personal interviews began to take shape after we hypothesized that continued social isolation, the stress related to ongoing upheavals relating to caregiving of school-aged family members at home, and the emotional exhaustion of intermittent pandemic surges impaired our team’s well-being and ability to work cohesively as a team.
Starting in late 2020, we developed a set of personal interest interview questions. We began contacting hospitalists by email to determine their interest in participating in a one-on-one interview with a peer, and to determine a convenient time for the conversation. Hospitalists were contacted in no particular order, although hospitalist leaders participated early in the intervention.
Deliberate care is taken to avoid interfering with patient care responsibilities by engaging teammates on their days off, in the evenings, or even during a commute to or from work. The voluntary interviews last 30–60 minutes and are conducted by telephone in a friendly, informal, non-academic get-to-know-you structure.
At the beginning of the session, the physician interviewer outlines the basic format: participants have the option of skipping or omitting any question and have the opportunity to review their own responses for accuracy at the conclusion of the interview. Further, the caveat is communicated that some information may be lost in simultaneous transcription.
The interviewee participates on speakerphone, and the unrecorded conversation is concurrently typed and transcribed into an email by the interviewer. We selected this method of transcription because of its relative speed and the ease of use, and because we wanted to avoid more complicated technology. In a time when we have relied so heavily on virtual meetings and recorded lectures, the low-tech format is appealing.
Interview questions are wide-ranging and incorporate non-career items of interest, such as, “What are some of your hobbies?” and “What is your favorite food?” as well as “How have you been managing stress during the pandemic?” (see Table 1). After the interview, the interviewer carefully reviews the document. Spelling errors are corrected, italics are added when indicated, and omitted or skipped questions are deleted. A photograph of the hospitalist interviewee and the content of the interview are sent via listserv for review by the entire group. Newly hired hospitalists, nocturnists, and veteran hospitalists have all participated to date. The study was given exempt status through the university’s institutional review board.
In a large group of hospitalists, teamwork, trust, and comradery are indispensable. The high-acuity, high-stress work environment with repeated patient care hand-offs(10) means that knowing one’s teammates is critical for the safety of patients, as well as for preserving the resiliency of our colleagues. Diminished sense of well-being and higher levels of burnout in healthcare workers have been linked to poor outcomes for patients.(3,4,6,11) Despite working closely together, sometimes for years, colleagues often lack opportunities to learn important details about a teammates’ life outside of work. Our aim was to improve these connections to promote resiliency, teamwork, and safety.
Results
In the absence of formal, in-person welcome gatherings for new hires and since curtailment of regular in-person faculty meetings, these wellness conversations have bridged some gaps. To determine whether this approach was helpful, we conducted a brief 10-question survey of the group (see Table 2). The survey was completed by 41 hospitalists, ranging from early career hospitalists to hospitalists with 10+ years of experience.
More than 92% of respondents reported reading the email interviews “always” or “most of the time.” In comparison, 57% of respondents reported reading emails from the wider hospital leadership “always” or “most of the time,” indicating that readership is significantly higher for these wellness interviews.
The benefits of these interviews are clear. More than half (59%) of respondents reported feeling subjectively less burned out after reading the interviews, while 41% reported no change in burnout symptoms after reading the interviews (see Figure 1). Notably, 100% of respondents indicated that they agreed that the resiliency interviews helped them get to know their peers better. When asked which wellness initiatives were most helpful, respondents rated wellness interviews the highest.
Figure 1. Results from Survey Question 5: “After reading the interviews, in regard to burnout, (check the one that applies best).”
Teammates can learn important, as well as trivial, personal information about each other in a safe way. There is no required virtual meeting or deadline for reviewing the emails; hospitalists can read the information at their convenience, or they may even ignore the messages entirely without any repercussions. There is no expectation of response; reading is based on pure curiosity. Because the physician interviewer is a peer and not an outsider, team members have been enthusiastic about participating and express gratitude for the conversation.
Of the 51 hospitalists interviewed so far, we have learned that a large majority of the group self-identify as introverts (73%). This can explain some of the positive reception the interviews have received, as we are able to disperse a large amount of interesting information to the entire group, information that may never have been revealed otherwise or may have taken years of friendship to learn. Further, the interview questions focus on positive, non-medical, non-professional items of interest, such as hobbies, hidden talents and nicknames.
One hospitalist noted that the interviews “continue to be a wonderful diversion to what otherwise seems exclusively to be 100% no-fun-please-do-more-work-emails.” Another hospitalist commented, “The interviews are a great way for us to get to know our colleagues better in a time when we are unable to socialize like we used to. I LOVE reading them and look forward to the emails every time. I think they have been an uplifting/positive support for us during a tough time.” Recognizing the importance of well-being at work, one hospitalist commented that in the battle against COVID-19, “no one can sustain clinical care if burned out.”
In a large group of hospitalists caring for widely dispersed patients in a hospital consisting of many floors, units, and buildings, we may not interact with some of our coworkers for months; these conversations make eventual interactions more personable. The interviews may even build foundations for future social interactions. The anecdotes collected outside of the workplace can be imported to encourage pleasant social interactions. Additionally, the conversations have unveiled humorous, quirky sides of teammates, eliciting laughter during the interviews as well as for readers following their publication.
The uses of the collected personal information are vast, as long as care is taken to protect privacy. For the virtual holiday party at our institution in December 2020, for instance, the responses to interview questions were formed into a trivia contest. On a personal level, the physician interviewer (NI) finds the conversations exceptionally rewarding. In a time when we are starved for non-COVID discussions, having an opportunity in engage intentionally with each person on the team — nocturnists or APPs or hospitalists with limited clinical time — has been welcome. Beyond the joy that comes from the conversations in the moment, learning that teammates later enjoy the interviews has further promoted personal feelings of well-being.
Discussion
This intervention has limitations. The interviews are conducted by a single interviewer (NI), and the questions have been changed periodically. Much detail is lost in the transcription from telephone to email. We believe this is an acceptable trade-off, as the low-technology method allows for greater dissemination speed and offers a break from virtual interactions. The interviews cannot fully replace the joy that an in-person social gathering can elicit, and the format may not appeal to everyone; some hospitalists (five) have chosen not to be interviewed.
Our survey showed that these interviews are well-received and provide some descriptive data; however, we did not have a pre-intervention comparison group, nor was burnout specifically measured with a validated tool, only self-reported. Additionally, the survey respondents may be the same hospitalists who are also more likely to read hospital emails and the wellness interviews.
A measurement of hospitalists’ symptoms of burnout and emotional exhaustion is a crucial area of study and is periodically measured at the health system level for all healthcare workers at this institution. We are currently undertaking a project to directly measure well-being among hospitalists at Duke University Hospital. Critically, it remains to be seen how COVID-19 will affect the long-term resiliency of hospitalist teams as well as attrition rates. Might there be creative ways to prevent burnout from occurring at all? This is the type of question we are currently pursing.
Conclusion
We all hope that in-person social gatherings will be safe in the near future; our hospital faces yet another recruitment season with virtual-only and outdoor interactions. Holiday festivities were postponed for a second year, and local and regional conferences are again being moved to virtual formats due to surges in the pandemic.
The prolonged duration of the pandemic speaks to the crucial need for continuing support of healthcare workers’ well-being. Leaders can help their teams get to know each other a little better with this interview modality. These interviews, which foster collegiality, may improve future interactions among peers.
Our data also indicate that this type of intervention may combat burnout and thereby potentially improve both staff well-being and patient outcomes. Interviews are inexpensive, timely, and can be scalable to any sized program. They could be used at teaching institutions with learners or at community programs, in inpatient and outpatient settings.
While this particular intervention involved one large hospitalist team, we believe that because of the universality of professional emotional exhaustion within the healthcare profession, this personal interview undertaking could be easily applied at other programs. In the current pandemic situation, now persisting into 2022, where humor and fun are in short supply, these interviews can cultivate connections and engender much-needed levity.
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