Seeking Wellness? Find a Cultural Fit

As attention increasingly turns toward improving the work life of clinicians, a new study reveals the need for physician leaders to create organizational environments where the “Quadruple Aim” can thrive.

While sometimes a “soft” element of organizational leadership, culture within health care cannot be overstated. Happy, healthy employees can influence the patient population as well. | 123RF Stock Photo

There is a clear and compelling link between physician wellness and the impact on patient care quality and safety. Increased turnover, reduced productivity and decreased patient engagement are associated with burn-out, resulting in serious repercussions for public health. And each is significant, considering the following:

• By 2025, the U.S. physician shortage is expected to reach at least 34,600, and perhaps up to 88,000, according to the Association of American Medical Colleges. That makes physician retention, health and workload critical issues.

• Physician vacancies are costly. The Journal of the Association of Staff Physician Recruiters estimates the cost at $1 million a year per primary care physician, and higher for many specialties.

• Clinicians’ interaction and influence on a positive patient experience can affect reimbursements, provider ratings and reputation, and patient retention and attraction.

Cejka Search (a physician and health care executive recruiting firm) and Vital WorkLife (a behavioral health consulting company) have tracked physician burnout for nearly a decade. Contemporarily with the industry movement to improve physicians’ work environments, the organizations partnered for a 2017 study that looks at factors contributing to physician burnout, as well as key organizational strategies to improve physician satisfaction and fulfillment.

The findings also uncover barriers to clinician wellness, pointing to a critical need for health care leaders to assess their workplace culture as the primary influence over physician wellness and retention.

In the study, physicians and advanced practitioners weighed in on the factors influencing overall wellness and the barriers to it across three broad categories — self-care solutions, cultural attributes and business processes that advance quality. Culture emerged as the greatest factor among physicians across all measures.

Physicians reported cultural attributes as “extremely important” to the desire to stay in one’s current job (60 percent), mental or emotional health (62.5 percent) and work-life balance (71.5 percent). A majority also viewed culture as extreme-ly important to their compassion for patients (53.5 percent) and relationships with care team members (56 percent).

In a related 2016 study by Stanford Medicine, a culture of wellness also was linked to physicians’ level of professional fulfillment. The study found that only 17 percent of physicians report high professional fulfillment.

Meanwhile, a high level of professional wellness in physicians is associated with better quality of care, according to a 2015 report (Scheepers, et al) in the International Journal of Behavioral Medicine.

The absence of efforts to improve physician wellness likely will result in substantial economic costs. Stanford Medicine estimates that, without any interventions, the two-year economic loss to compensate for physician burnout-related departures would be between $22 million and $88 million. But if the burnout rate can be halved, so would the costs of physician recruitment.

CULTURE AND LEADERSHIP INTERSECT

Shaping and reinforcing culture is one of the most important responsibilities of a leader in health care, the Cejka Search-Vital WorkLife study indicates.

Physicians value skilled leadership (84.3 percent) that demonstrates awareness or concern for their needs (87.8 percent) and creates an environment where team members are collaborative (88.8 percent) and employees are held accountable (86.5 percent). Even within the category of business processes that advance quality, the themes of strong leadership and team collaboration were reiterated, along with effective staffing ratios.

Similarly, the Stanford Medicine study found the following culture of wellness strategies were rated the highest among physicians:

• Strategies to promote leadership traits associated with improved professional satisfaction (69 percent).

• Clear recognition and support of importance of physician wellness from leaders (67 percent).

In fact, the culture of wellness factors that were the strongest determinants of professional fulfillment — including perceived appreciation, personal/organizational alignment and peer supportiveness — all were associated with perceived leadership support.

IMPROVING THE CARE EXPERIENCE

There is abundant evidence that many within health care lack deep joy and meaning in their work. When it comes to creating the conditions for physicians to feel more engaged, happy and loyal to medical groups, physicians reveal a strong desire to have a voice in how their time is structured, as well as a say in the policies and practices of the organization, according to Cejka’s 2016 Healthcare Perspectives Study of 700 physicians.

Further evidence supporting the need to improve work-place practices and policies comes from Stanford Medicine research, with more than 60 percent of physicians rating potential organizational strategies as “very helpful” or “extremely helpful.” Leadership development strategies and involving physicians in clinical practice improvement solutions received the highest rankings. In addition, physicians rated the helpfulness of practice strategies in improving wellness, and found “empowering physicians to re-engineer clinical process and flows” and “physician involvement in decisions regarding support staff” as the most highly rated.

To help provide physicians a “seat at the table,” organizations can:

• Establish physician representation on boards and committees.

• Gather input from physicians on major initiatives, including technology requirements, quality metrics, value-based compensation and incentives, care-transition/care-team planning, financial improvement measures and workflow planning.

• Select physicians who can serve as effective “mission ambassadors” by gathering and delivering information pertinent to organizational goal alignment.

• Align compensation and other incentives with team and unit goals as well as organizational goals.

• Provide clear, frequent communication with physicians on the organization’s goals and initiatives, including the financial and medical evidence behind each.

Physicians want to be engaged as partners in tackling the challenges facing health care today. The more involved they are in setting the organization’s agenda and policies, and the more data they receive to support the organization’s decisions, the more supportive and satisfied they will be.

THE RIGHT PUZZLE PIECE

The first step in physician retention is to ensure the right cultural fit from the start. To do so, organizations must have internal clarity on the role and requirements; interview in a variety of settings, including social and informal; use behav-ioral interviewing; and conduct thorough reference checks.

It’s also important to remember that physicians today have their choice of employers, and they are screening potential employers for cultural fit as much as the organization is.

Once on board, search experts recommend assigning a peer as a mentor — someone who can answer questions during assimilation — and creating a support structure not only for the physician but also for relocating family members.

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Culture often is regarded as a “soft” element of organizational leadership. Yet within health care, where patients’ health and lives are constantly on the line, the impact of workplace culture cannot be overstated. Health care is an industry in which employee satisfaction is closely linked to patient satisfaction. And when it comes to making strides in physician wellness, curbing burnout and reducing turnover, culture is king.

YOUR TURN: What are you doing, as a physician leader, to modify the culture in your organization to promote wellness among your people? Tell us — and your fellow physician leaders — what’s working, what isn’t and why. Send your thoughts to journal@physicianleaders.org to be considered for publication.

Vivian M. Luce, MBA, is vice president of Cejka Search , a Missouri-based organization that specializes in the health care industry.