Episode #69 Let’s Build on the Momentum: Stoelting Conference 2021 Wrap-up

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 back for one more show in our series on the 2021 APSF Stoelting Conference, Clinician Safety, To Care is Human. For our fourth show in the series, we are going to ask some questions, offer some potential answers, and hear from some of the people who helped make the conference so informative and inspirational.

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

To start the show, let’s hear from one of the speakers and moderators at the conference, Della Lin. I am going to let her introduce herself now.

[Lin] “Hi My name is Della Lin. I am on the ASPF board of directors. I practice in Honolulu Hawaii and I am affiliated with the John A Burns School of Medicine in Hawaii.”

[Bechtel] To kick things off today, I asked Lin about her experience at the conference and what are the most important takeaways. She provides some wonderful insight.

[Lin] “I learned that even if we think, I’ve got this. It’s more. Previous to this, I had spoken about burnout at almost 100 venues. I’m frankly humbled. It’s more. We are only scratching the surface. I learned that incivility and rudeness is not just about major events or even middle sized events where someone has an outrage in the operating room and the entire room walks around on eggshells for the next two hours. Rudeness highjacks the brain and it’s not just the emotional brain. It highjacks the cognitive brain. Cognitive bias are more frequent. Sharing information between team members is constrained. Creativity is dulled. More errors are made and it’s a contagion. Someone who experiences rudeness is more likely to pass it on. To put it bluntly, it is infectious. We know now that this is not just a manifestation of hierarchy or tribal professions. Lateral bullying happens pervasively in the perioperative arena. It’s universal. We need to pivot that. We need to support each other. Not as extra, but as essential.”

[Bechtel] What a great way to start the show. Now, we are going to cover a Q and A session. Just as audience members at the conference had questions, you might have questions after our series on the conference. We are hoping to address some of those questions now.

First up, is a question about the rollout of a new wellness initiative which may be met with pushback from faculty or employees. In other words, how do we change the culture? The first step is to acknowledge that mandatory wellness sessions during time off is actually part of the problem and may even lead to worse burnout. To get buy-in from the more senior clinicians in a group, you may want to start the culture change by asking about their personal coping skills and how they developed resilience in their career. The next part of the conversation may be to ask about any of their colleagues who have left the workplace over the years and what was the impact of this? For newer clinicians out of training, you may want to start by acknowledging that they may be upset about programs that put the burden on the clinician to get well. This simple acknowledgement can go a long way. Keep in mind that not all wellness programs are applicable to everyone. The rollout of these programs depends on leadership, flexibility, and buy-in from the stakeholders. The ultimate goal is to change the culture, but before we get there, we need to identify what are the behaviors that we need to adapt to get there so that overtime there will be a culture of safety and wellbeing.

The next question relates to the return on investment with wellness initiatives. Is there evidence in this area? The good news and simple answer is there is evidence that there is value to investing in wellness. The ratio that has been reported is about 1:3, thus investing one dollar will yield a 3 dollar return. There is evidence that frequent users of healthcare wellness initiates may lead to decreased healthcare costs as well as better employee recruitment and retention.

Finally, what are the priorities for leaders to create a workplace that places a priority on clinician wellbeing? Not an easy question or a simple answer, but here are some areas that should be at the top of the list:

• Mitigate any sense of loneliness at the workplace
• Foster a sense of teamwork and engagement
• Maintain a shared vision
• Lead from the heart and recognize accomplishments on the team
• Recruit other leaders to work towards a common goal
• Create an environment of clinician wellbeing: The physical space is important. Simple things may include having toothpaste available in the locker room, creating a shared faculty lounge rather than a separate and isolated anesthesia lounge. It is necessary to have adequate rest areas, to have areas for engagement with others, and provide the necessary space for people with diverse backgrounds and roles and needs. If you think about the people first, then this investment in the shared facilities will have large dividends.

Some of these ideas and solutions seem so simple and some are much more difficult to implement, but it is hard work that needs to be done in order to create a culture of clinician wellbeing.

We are going to hear from Lin one more time. I asked her, “What do you hope to see going forward?”

[Lin] “Action. This is more than a nice to know activity. We have the information for why this is important. We have the what, the data, cohesively shared at the conference as to the current state. Now comes the how, the action, not just the islands of progress in a few anecdotal places. WE need to create a scaffolding for clinician well-being that includes four things: How we, one, structurally design our workplaces. Two, structurally design and develop our people, our workforce. Three, importantly, what are the balance metrics in addition and beyond annual survey inventories and four, we heard loud and clear at the conference that leadership needs to own this at every level. This is a huge opportunity to connect HR, finance, hospital patient safety metrics intimately and weave clinician wellbeing into everything we do. The common goal of helping every clinician be the best they can possibly be.”

[Bechtel] It is time for action! So, what are the action items that came out of the conference? Formal recommendations from the conference are in the works now, but the conference wrapped up some of these calls to action so that you can get started working on this now.

We need to invest in the team.

We need a champion! Just like our Enhanced Recovery After Surgery program champions…these programs would not be successful without the champions to help drive buy in and facilitate implementation and answer questions and respond to feedback. Thus, for any successful clinician wellbeing program, you will need a champion in this area.

We need leadership! And this likely needs to be part of the strategic plan and part of the CEO incentive plan.

We need to build on momentum. There is a recognition of the impact of burnout right now and a push towards improved clinician wellbeing and we need to keep the momentum going because the time is right, right now. There is real value in supporting clinician wellness and working to prevent burnout that has been highlighted by the pandemic. We have a call to action to be prepared for ongoing healthcare challenges in this pandemic as well as the next pandemic and natural disasters going forward.

We need a culture of psychological safety so that all team members feel comfortable speaking up without fear of retaliation.

We need investment in team members in a way that each member of the team feels valued and appreciated for the work that they do. This understanding may allow for creative solutions to organizational challenges such as predictable scheduling, paid time for extra work, and non-clinical time for additional out of OR responsibilities.

We need to listen to team members…then start with the easy asks which may be related to volunteer opportunities, relaxed dress code, financial advisors and then move on to bigger programs until ultimately there is a culture change. Another benefit of this listening is that when it is not possible to do what the team members are asking based on safety of the clinician or patient, you can communicate with your team about these reasons which lends itself to trust and psychological safety.

What about the relationship between wellbeing and productivity? More work needs to be done in this area, but what we do know is that institutions that do not support clinician wellbeing are more likely to see higher rates of turnover and decreased retention which is very costly.

We need to recognize a job well done. This is great for morale. This may be an institutional recognition program where team members can recognize other team members who have done a good job. The reward could be a simple thank you note, or a coffee card, or wide range of awards depending on the event. This kind of program is likely underutilized in healthcare institutions, but would go a long way towards improved well-being and a sense of community.

Finally, we started by asking the question, how is patient safety connected to provider wellness? This is not a simple equation. Without wellness, patients may not have access to necessary care due to reduced clinicians in the workforce. Without wellness, clinicians may not be able to provide safe and necessary care.

Before we wrap up for today, we are going to hear from Josh Lea. I met Lea at the Stoelting Conference this year. He was a moderator for the session, “Panel Discussion – Perspectives on Solutions by Different Stakeholders.” We are happy to have him on the show today and I will let him introduce himself now.

[Lea] “Hi, my name is Josh Lea and I am an assistant clinical professor at Northeastern University Nurse Anesthesia Program. I am a CRNA at the Massachusetts General Hospital and I serve on APSF’s editorial board and board of directors.”

[Bechtel] During my conversation with Lea, I asked “What made him passionate about clinician wellbeing?” Let’s take a listen to his response.

[Lea] “Like many of my colleagues, I pursued a career in healthcare because I wanted to help people. And it has always given me a little bit of a pause that occupational burnout is so often excepted as an unavoidable workplace hazard of choosing a career in the healthcare industry.  And truly this concern is what inspired me to investigate burnout and potential predictors among CRNAS and my anesthesia colleagues and considering where we’ve been and where we currently are on this topic, I think that the Covid pandemic has really put a spotlight on cracks in the healthcare system that have potentially always been there. That said, you know, a silver lining in this whole thing is that now we are all talking about burnout and working together to find real strategies and solutions to address it.”

[Bechtel] With clinicians like Lea dedicated to studying burnout and potential predictors and dedicated to finding solutions, we are definitely going in the right direction. What direction is that? Well, I also asked Lea what he hopes to see going forward. Let’s see if he can help point us in the right direction.

[Lea] “Moving forward, I hope more clinicians appreciate the importance that wellbeing has on their health and also the health of their patients. And I would love to see healthcare leaders and organizations implement strategies to decrease burnout and improve clinician wellbeing. Now, this initiative is going to take a lot of work, but it’s the right thing to do for our patients, our clinicians, and most certainly for the next generation of anesthesia professionals and their future patients.”

[Bechtel] Well, we have our work cut out for us to improve clinician wellbeing and with it patient safety. Going forward, there is hope that perhaps meetings and talks about clinician wellbeing and even podcasts like this series will not be necessary since it will just be an integrated part of our everyday experience in healthcare.

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.  Thanks for tuning in and if you liked this show, please share it with your friends and colleagues, and leaders at your institution. Plus, if you get a chance, can you leave us a 5 star review. This helps our show to stay visible so that every interested in perioperative patient safety is able to tune in.

We also want to thank everyone visited with us at Anesthesiology 2021 and who participated in signing the wall in person or virtually to join the #APSFcrowd and raise $15 with each signature from Fresenius Kabi! Did you try out the Dip Jar at the meeting as well?! Thank you so much for your contributions. Coming up on the podcast, we will be diving into the newest APSF Newsletter from October 2021! There are so many great articles that it will be hard to pick out which one to start with, so you are just going to have to tune in next time to find out!

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

© 2021, The Anesthesia Patient Safety Foundation