Episode #68 Tackling the Problem of Clinician Safety

October 19, 2021

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Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast will be an exciting journey towards improved anesthesia patient safety.

We are back with the third installment in our series on the 2021 APSF Stoelting Conference, “Clinician Safety: To Care is Human.” Today, we are focused on the panel dedicated to the topic: “Clinician Wellbeing – Promising Solutions.”

We discuss potential solutions in the following areas:

  • “What Can Departments Do?” Thank you to Michael Gropper for his talk and for contributing to the show today.
  • “What can a Private Practice Do?” with a talk by Richard Dutton related to his work with US Anesthesia Partners.
  • “What can Healthcare Organizations do?” with a talk by Kerry Olsen, a surgeon at the Mayo Clinic.
  • “What Can Societies Do?” with a talk by Amy Vinson, the chair of the ASA Committee on Physician Wellness. Spoiler alert: We discuss her research on burnout and the number 1 risk factor as well as a hot off the press proposal from her committee to create a better culture of support.
  • “What Could We Learn From Other Industries? With a talk by Jim Bagian, an anesthesiologist and astronaut.

Here is the link to the full schedule of the 2021 APSF Stoelting Conference: https://www.apsf.org/event/apsf-stoelting-conference-2021/

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© 2021, The Anesthesia Patient Safety Foundation

Hello and welcome back to the Anesthesia Patient Safety Podcast.  My name is Alli Bechtel and I am your host. Thank you for joining us for another show. We are in the middle of our podcast series on the 2021 APSF Stoelting Conference, Clinician Safety, To Care is Human. Today is our third show in the series and there is still so much to talk about related to the intersection of clinician wellbeing and patient safety.

Before we dive into today’s episode, we’d like to recognize Merck, a major corporate supporter of APSF. Merck has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Merck – we wouldn’t be able to do all that we do without you!”

I invite you to join the discussion with a fresh cup of coffee or lace up your sneakers for a walk outside. Here we go with the third panel. The focus for this panel is Clinician Wellbeing – Promising Solutions. It is moderated by Della Lin, one of the APSF Board of Directors members.

First up for this exciting panel is a talk by Michael Gropper to discuss, “What can Departments do?” He kicks off his discussion about academic medicine and the missions related to education, scientific inquiry, leadership and at the heart of it, clinical excellence. Before we get more into his talk, we are going to hear from Gropper himself. I am going to let him introduce himself now.

[Gropper] “Hi, my name is Michael Gropper and I am the Chair of the Department of Anesthesia and Perioperative Care at the University of California and San Francisco.”

[Bechtel] To help kick off the show today, I asked him why he feels so passionate about this topic? Let’s take a listen to what he has to say.

[Gropper] “I’ve had a lot of standing interest in patient safety and quality, but it’s only been over the last few years that I’ve made the connection between clinician wellbeing and patient safety and quality. In addition, I lead a large department and I’m constantly trying to recruit faculty for a growing health system and I can’t afford to lose anyone. So, I was delighted to be invited to the conference to talk about many of the projects that we’ve undertaken and most importantly, the leadership structure that we’ve put in place focusing on clinician wellbeing at UCSF.”

[Bechtel] Thank you so much to Gropper for helping to kick off the show today. Now, let’s get into his talk.

Gropper opens by highlighting what makes academic medicine and those that practice in this space unique? These may be clinicians who desire additional roles and responsibilities beyond clinical care including research and education, but this may come at the cost of decreased compensation. The balance here is a broad range of opportunities and resources from a larger academic institution. An important question is, “Can clinician wellbeing be an academic pursuit?” The answer to this question involves understanding the stressors in the academic environment including stress related to training residents and teaching other learners as well as the stress related to research, publication, and academic advancement. Gropper talks about his experience at UCSF. At his institution, he has seen an increase in the anesthesia faculty net promoter score. This score is determined by the answers to the following questions: Would you recommend this as a place to work and would you recommend this as a place for clinical work. Reasons for this increase over the past 5 years may be improvements in supportive programs including paid family leave time as well as focusing on diversity, equity, and inclusion and recognizing the need for flexible solutions for different groups.

Next up, Gropper discusses medical education and well-being at UCSF. This education starts early as part of a core curriculum topic and teaching the scientific basis of wellness. His department supports a 3 year anesthesia residency well-being curriculum with additional opportunities for faculty to participate in the curriculum to foster connections and networking. For example, they have a new coaching program called “GAIN”, which stands for Grow and Advance through Intentional Networking, with monthly 1 hour virtual networking sessions. This can help grow engagement and build community. Another program at UCSF is the VISIPAP program where a fellow and attending go to another institution to each give a talk. This further builds community and allows for opportunities for academic advancement as well. What about faculty development? The Departmental Clinical Seed Fund provides money for research as well as mentorship and there is a faculty development series with professional development related to finances, social media, and time management. The overall impact of these programs is to build a sense of community within an academic anesthesia department and to foster wellbeing within the department. Do you have any of these programs at your institution?

Going forward, what can department leadership do? For starters, always tell the truth and maintain open lines of communication. For example, tell people what you are doing, show them the data and communicate about what you are doing about problems that come up. It is vital to invest in wellbeing while balancing all of the financial components of the department, clinical compensation, research, and more. This investment must also include empowering members of the department to value wellbeing. Department wellbeing leadership may include leaders dedicated to diversity, equity, and inclusion who work with an associate chair of well-being with input from leaders in academic affairs. The associate chair of wellbeing may then lead a steering committee with input and help from site champions and task forces depending on the size of the department.

Now, we are really getting into some potential solutions, so let’s keep going.

The 2nd talk, for this panel is “What can a Private Practice Do?” and was given by Richard Dutton. He speaks about his experience with US Anesthesia Partners which is made up of 10 states, 4,500 clinicians, 2500 anesthesiologists and 2300 CRNA and 200 CAA with 700 medical service office staff. He makes the case for wellness which includes that the demand for anesthesia clinicians is so high right now…this is due to demand for anesthesia services in and out of the ORs combined with anesthesia clinicians retiring from the workforce.  As a result, being the best employer will provide a recruitment and retention advantage. In addition, a healthier, happier workforce will lead to better clinical care and improved service to surgeons and facilities. There is a circle between well physicians providing better care and support for wellness initiatives leading to increased clinician satisfaction.

Next, Dutton gets to the core of his talk. What are the tangible resources to support clinician wellness? Get your pencils ready:

  • Compensation and financial support
  • Employee assistance program including virtual doctor visits
  • Leadership training…this potential solution empowers clinicians to be challenged through career development opportunities and engagement with committees
  • Diversity and inclusion training and hiring
  • Family support such as a lactation policy
  • Clinical document warehouse, bulletin board, and expert support
  • Job training including internal and external courses
  • Supplies including personal protective equipment and tools to provide safe anesthesia care

What about the intangible resources that are necessary to support clinician wellness? Sharpen your pencils once again. Here we go:

  • Provide support with the motto, “We’ve got your back.” This solution combines a reduction of non-value added activities and increased expert resources to solve clinical and non-clinical problems from legal, billing, and coding resources.
  • Work/life flexibility
  • Autonomy over daily practice including scheduling flexibility and variety of career tracks
  • Data driven performance benchmarking with quality metrics and patient satisfaction
  • Transparency of governance and authority
  • Celebrating individual and team wins. This may include providing performance reports and feedback from patients. This can even be part of an M and M type discussion where instead of discussing an M and M, a Great Save case is discussed. Do you have something like this in your group or department?

Our next step on this panel is a surgeon from Mayo Clinic, Kerry Olsen who is here to talk about “What can Healthcare Organizations do?” To get at the answer to this question, we need to look at determinants of health in a population which includes:

  • 30% genetics
  • 40% behavior
  • 15% social circumstances
  • 5% environmental exposures
  • 10% healthcare

From this starting point, Olsen introduces the concept of worksite wellness and this is so important because we spend so much time at work including 40 or more hours a week and often eating at least 1/3 of your meals at your place of work. The idea of worksite wellness led to the development of the Dan Abraham healthy Living Clinic that was built in 2007 and subsidized by the Mayo Clinic. This clinic included fitness floors, group fitness classes, health evaluation suite, pools, relaxation suite, healthy café and demo kitchen. The focus of this place was to create an environment that was welcoming and inclusive so people felt comfortable going to the clinic and using the facilities. Now, you may be thinking this is a cool idea, but does anyone have the time or energy or motivation to use this clinic. Well, here are several takeaways that helped to make this clinic successful: Extended hours and open 360 days a year, availability of childcare, decreased clinic fees when you used it more, dress code so that everyone felt comfortable, adult only clinic that is open to staff and spouses of staff.

Another strategy for what healthcare organizations can do to support clinician wellbeing includes supporting worksite wellness champions in different departments that work on wellness from a variety of different domains. Another program involves the integration of health care and healthy living at the wellness facility. This involves a collaboration between primary care physicians and the health and wellness specialists. Some of the referrals to the Healthy Living Clinic include the following: obesity/overweight, metabolic syndrome, stress program, sleep disturbance, back pain, balance and fall prevention.

Olsen rounds out the talk with the important factors for staying healthy and doing so for a long time. These include adequate sleep, level of education, and social connection. He leaves a call to action that as a healthcare organization you can be effective in changing the corporate culture of health by creating visible reminders and demonstrating that leadership really cares about the health of its employees and members. Clinician wellbeing depends on leadership, dedicated staff with the necessary resources, providing a variety and holistic approach to health and wellness, and being flexible and able to adapt to change.

We are moving up the chain and next is Amy Vinson to talk about “What Can Societies Do?” She is the chair of the ASA Committee on Physician Wellness. She discusses the ASA’s approach to well-being, how the ASA supports well-being, and what the Committee on Physician Wellbeing is working on in this area. As background information, the ASA committee on Physician Wellbeing started out as a task force and was related to the impact of latex allergy on physician wellbeing. It has come a long way since then. For example, the education and endeavors working group is creating a database that is searchable for wellbeing groups and interventions to foster collaboration currently.

The goal for what societies can do is advocacy for a culture of support in the workplace supported by the ASA. This culture of support is vital for clinician wellbeing. Vinson reports on her research on the burnout rate and risk factors in anesthesiologists in the United States which was recently published in Anesthesiology. The study included a unique look at people who were not just high risk for burnout, but who were experiencing complete burnout syndrome. One of the risk factors for high risk for burnout and complete burnout included not feeling supported in your work life. This factor was impressively at the top of the list. It is something that anesthesia professionals may experience in a myriad of ways every single day. Has the Covid pandemic added more stressors or more risk factors for burnout? It may be that it just exposed these very vulnerable areas in the workplace. She reminds us that providing patient care is a really hard job and it will continue to be a hard job, but now the conversation has shifted to how can we be curious about this to make things better?

So, how do we change the culture of medicine? This is a very big question. It must be a team that works together with two-way communication and no fear of reprisal. There must be accountability and transparency and a partnership between clinical staff and leadership. The proposal that will come from this committee is to create a better culture of support in medicine which includes some of the following components.

  1. Removing the stigma of mental health care.
  2. Recognizing the diversity of the workforce which needs to accommodate flexibility in scheduling. Let’s inject some creativity here when it comes to scheduling and childcare.
  3. Accommodations for loss of academic productivity
  4. Availability and support for general wellness initiatives which includes physician wellbeing as well as diversity, equity, and inclusion.

One more area that we will turn to for promising solutions is from other industries. The next speaker is Jim Bagian who is here to talk about “What Could We Learn From Other Industries?” So, here we go. He starts the discussion by highlighting the importance of knowing where we are going and having a clear goal which is aligned with our stakeholders. Bagian’s background includes being an anesthesiologist as well as an astronaut. Anesthesiologists are uniquely suited to evaluate systems in the healthcare setting while working to provide safe patient care. If we look to other industries such as the military and aviation, there is a focus on evaluating close calls in order to make improvements as well as effective reporting strategies with effective communication about the follow-up. This leads to confidence in the organization by understanding the reasons behind decisions that are made and the ability to have a conversation about these important topics.

Other lessons learned include:

  • Standardization, not uniformity while working towards the goal
  • The commander is the last one to eat, the last one to bed down, and the last one to leave the worksite. This is a lesson that can be learned in healthcare, but we are not doing this now given the hierarchical structure of healthcare.
  • Having the “I’ve got your back mentality.”
  • A priority on briefing and debriefing which leads to engagement across the team.
  • Striving to be better and do better as we work towards safer patient care and this depends on having the resources available and consistent priorities
  • Follow-up, accountability, and respect.

Before we sign off for today, we are going to hear from Michael Gropper again as he shares what he hopes to see going forward with regard to clinician wellbeing.

[Gropper] “What I’d like to see going forward is intentionality about incorporating clinician wellness into everything we do, whether that’s designing a new hospital, designing a new call schedule for clinicians or developing curricula for residents to learn about incorporating wellbeing into their everyday work. The next generation of learners is expecting this and if we don’t do it then we won’t be able to engage them and they will our care givers in the future and so it is essential that we incorporate this into their training and as a result, all of our working environments will be better.”

Thank you so much to Gropper for contributing to the show today and leaving us with a call to action for better working environments. Thank you to all the speakers who contributed to this panel and for sharing this vital knowledge as we work towards improved clinician wellness on our way to zero patient harm.

If you have any questions or comments from today’s show, please email us at [email protected].

Visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2021, The Anesthesia Patient Safety Foundation