Optimizing Well-being, Practice Culture, and Professional Thriving in an Era of Turbulence

Notably, we pursued this work without explicit support or interference from senior leaders in our institution. There were no competing organizational efforts addressing hospitalist efficiency, turnover, or burnout until 2017 (Excellence in Communication, described below). Furthermore, we avoided individually targeted resilience efforts based on feedback from our group that “requiring resilience activities is like blaming the victim.” Intervention participation was not mandatory, out of respect for individual choice and to avoid impeding hospitalists’ daily work.

Before designing interventions, we created a measurement tool to assess our existing culture and track evolution over time (available upon request). We utilized the instrument to provoke emotional responses, surface paradoxes, uncover assumptions, and engage the group in iterative dialog that informed and calibrated interventions. The instrument itself drew from validated elements of existing tools to quantify perceptions across nine domains: meaningful work, autonomy, professional development, logistical support, health, fulfillment outside of work, collegiality, organizational learning, and safety culture.

Several subsequent interventions focused on the emotional experience of work. For example, we developed a formal mechanism (Something Awesome) for members to share the experience of positive emotions during daily work (eg, gratitude and awe) for five minutes at monthly group meetings. We created a Collaborative Case Review process, allowing members to submit concerning cases for nonpunitive discussion and coaching among peers. Finally, we created Above and Beyond Awards, through which members’ written praise of peers’ extraordinary efforts were distributed to the entire group.

We also pursued interventions designed to increase empathy and translate it to action. These included leader rounding on our clinical units, which sought to recognize and thank individuals for daily work and to uncover exigent needs, such as food or assistance with conflict resolution between services. We created “Flash Mobs” or group conversations, which are facilitated by a leader and convened in the hospital, in order to hear from people and discuss topics of concern in real time, such as increased patient volumes. Likewise, we established “The Incubator,” a half-day meeting held four to six times annually when selected clinical faculty applied design thinking techniques to create, test, and implement ideas to enhance workplace experience (eg, supplying healthy food to our common work space at low cost).

Another key focus was professional development for group members. Examples included a three-year development program for new faculty (LaunchPad), increasing the number of available leadership roles for aspiring leaders, modifying annual reviews to focus on increasing individuals’ strengths-based work rather than solely grading performance, and creating a peer-support coaching program for newly hired members. In 2017, we began offering members a full shift credit to attend the hospital’s four-hour Excellence in Communication course, which covers six high-yield skills that increase efficiency, efficacy, and joy in practice.

Finally, we revised a number of structures and operational processes within our group’s control. We created a task force to address the needs of new parents and acquired a lactation room in the hospital. Instead of only covering offsite conference attendance (our old policy), we enhanced autonomy regarding use of continuing education dollars to allow faculty to fund any activity supporting their clinical practice. Finally, we applied quality improvement methodology to redesign the clinical schedule. This included blending value-stream mapping, software solutions, and a values-based framework to analyze proposed changes through the lens of waste elimination, IT feasibility, and whether the proposed changes aligned with the group’s core values.