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Workforce Burnout: Embedding an Organizational Culture of Wellness

High levels of stress and burnout in the health care field not only cause more errors on the job, but can cost hospitals and health systems millions of dollars to replace departing staff. Having a robust employee wellness program has become a huge priority, moving the needle in recruiting and retaining staff. In this conversation, Kristine Olson, M.D., chief wellness officer at Yale New Haven Hospital, discusses the steps to developing organization-wide wellness and well-being, and how these types of programs are creating positive results in their workforce.

Transcript
Speaker:

Even 15 years ago, you

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often would have searched in vain

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for a title

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like Chief Wellness Officer

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on the payroll of most employers.

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Today, the job is increasingly common

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as employers have taken note

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of the high levels of stress and burnout

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reported by their employees.

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This is especially true in health care,

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where burnout is rampant and costly.

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Not only is burnout associated

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with more errors on the job,

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but a physician

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who chooses to leave costs on average

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at least a half a million dollars

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to replace.

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This is where a robust wellness program

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can make a huge difference.

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Welcome to Advancing

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Health, a podcast

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from the American Hospital Association.

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I'm Tom Haederle with AHA Communications.

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In this podcast, Elisa Arespacochaga.

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AHA’s vice president

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for clinical affairs

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and workforce,

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speaks with an expert on developing

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organizationally wide

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wellness and well-being programs

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that are making a difference.

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As Dr.

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Kristine Olson,

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chief wellness officer

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for Yale-New Haven Hospital, says,

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it's not possible to have reliable access

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to cost effective,

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safe, high quality, patient centered care

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without high performing

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professionals and health care workers.

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Let's join them.

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Thanks, Tom.

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I’m Elisa Arespacochaga AHA,

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vice president of Clinical Affairs

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and Workforce.

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And I'm joined today by Dr.

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Kristine Olson, chief wellness officer

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for Yale New

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Haven Hospital

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and director of Work Life, Wellbeing

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Analytics, a Yale

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New Haven health system.

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And today

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we're really talking about her journey

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in developing and leading

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organizational wide wellness programs,

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what she's learned

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and what advice she has for others.

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So to get started, Kristine

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tell us a little bit about yourself

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and your role

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and how you got to where you are. Sure.

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Thank you for having me.

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It's great to be here

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and it's great to see you

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at the American Hospital

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Association is doing

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and making this a priority.

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My journey is

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I'm currently the chief

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wellness officer

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and I do the data analytics,

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as you mentioned, that's started.

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Maybe I'll do it chronologically.

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I had a grandmother

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who was very influential,

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who always helped to make life

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good for people

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outside of her family

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and was civic minded

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who encouraged my education.

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I went to the Peace Corps

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because when you have,

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you are expected to give back. There

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I learned a lot

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about what it means

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for government

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and policies

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to create the environment

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in which we thrive.

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And then I came back

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and I did medical school

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at University of Minnesota,

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where I started to look

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at the health care system.

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I’m...a system minded person.

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And I started to be curious

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and started studying that

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for the last 25 years.

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And then when health care reform

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was becoming evident

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that that was going to happen,

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I should say the internal medicine

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and pediatrics

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training at Yale-New

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Haven Hospital first.

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And then when

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health care reform was underway,

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I went to fellowship at Cornell

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for Health Services,

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Research and Epidemiology

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in 2010 to study

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the to create models of health care

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so that we could use

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professional satisfaction

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as a compass

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to tell us

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the adverse effects from health policies

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and to find

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how it was affecting

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organizational performance

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as a health care system.

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And so we could identify things

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that we could correct before

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they had adverse effects.

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So that's how I got started in that.

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And that that took me to 2015

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where I got to meet one of my mentors,

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Mark Linzer, who invited me in to a group

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that was with the early group

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of Mayo, Stanford and the AMA,

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where we were the steering committee

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for the Joy and Medicine Initiative,

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and then created the three

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domain model

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called the Stanford Model

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of Culture Climate,

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a practice efficiency and resiliency

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and the first

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recommendations for a research agenda.

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That group went to see

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the National Academy of Medicine,

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the American Conference

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of Physician Health

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and the UEC,

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the Professional Wellness

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Academic Consortium,

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of which we were early adopter.

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And that takes me into my current role,

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I should say,

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maybe how

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we socialize that at Yale as well.

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So in 2016,

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we did our first burnout assessment

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to show

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that we too

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had burnout

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similar to the national level.

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So we were seeing that

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xenophobia showing

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in the triennial surveys.

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We also couple that with a path forward

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that we had to start to work on

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and the organizational strategies

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that we put in the first step

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forward module

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at the AMA for the joy in medicine.

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So that showed that it was something

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that was dynamic in health care.

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It was temporally related

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to people entering health care,

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it was dose

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related to their FTE,

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whereas otherwise static

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in the general population.

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So we knew that it was something

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that we had to correct as an industry,

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that it was our responsibility

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and we adopted that

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through the School of Medicine

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and through the Yale-New

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Haven health system.

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And then we consolidated them

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and we're moving forward

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with that agenda.

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So you've spent a while doing this work,

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and you certainly have come about.

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I really love the idea

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that you started with this sense of

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how do you build thriving

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more broadly,

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not just in your community,

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not just among your fellow physicians,

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but really

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how do you build that

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as a community,

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as a government, as an organization?

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How do you put those structures in place?

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So you had all of that

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supporting your knowledge.

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What helped

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you refine the strategy, the messaging,

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the conversations

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specific to your health system, where

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obviously you're facing

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challenges of

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the focus areas around

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quality, around patient safety,

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around the financial pressures

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that hospitals are under.

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How did you get that

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messaging refined

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to be able to go to your colleagues

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and your leadership to say

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this is a problem

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that we have to address? It is ours too.

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One was showing that

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the numbers were consistent

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with the national numbers

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and that we had a problem

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at the organizational level.

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It wasn't something that belonged

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to individuals themselves to fix.

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We also know that the interventions

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at an organizational level

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are more effective than those

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at an individual level

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from different systematic reviews.

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A meta analysis that had been done.

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So that was a galvanizing event

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and to be able

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to put together the strategy.

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But the

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burning platform of

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not only the prevalence of the problem,

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but the fact that

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health care is dependent

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on its health care professionals

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and health care workers,

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those caregivers.

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And it's not passive role

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to have reliable access

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for the population

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that reliable access

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to cost effective quality,

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safe, high quality, patient centered care

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without high performing professionals

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and health care workers.

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So we knew that

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there was plenty of evidence

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showing that burnout is associated

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with errors

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burned out

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physicians may be present,

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but they their patients know

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that they're burned out

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and don't have

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the same kind of reciprocity

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in adherence to the recommendations

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as likely

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to follow up,

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show up and follow those recommendations.

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We knew that it was related

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to people's perception of quality,

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the idea of moral injury,

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if they weren't able

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to live up to their standards

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and we knew that

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it had a very high return on investment

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for physicians, for example,

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just the turnover costs

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alone is half

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million to $1.8 million in turnover costs

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that was in the literature

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and we validated that

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that was true at our organization

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as it was in the literature.

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So that made it a business case for it

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as well as you can't

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carry out the mission

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and you have to adopt the quadruple aim

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to include professional

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well-being and workforce well-being.

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Absolutely. Absolutely.

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We cannot care for others

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if we're not well ourselves.

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And I know that's easier said than done.

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So in addition

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to the chief science officer,

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I mentioned that you also do

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the data and analytics

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for the well-being program

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for the system.

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And I'd like you to talk a little bit

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about how you approach that work

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and some of the lessons

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that you've learned.

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Because what I've found over time

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is that this is a very hard

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subject to measure.

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It's not as easy as you did

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an intervention,

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and therefore you've seen this results.

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The indicators are very lagging.

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There's a lot of challenge

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in pinning down

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what use of help,

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what is not of help,

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and really building that evidence

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in that business case.

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So can you talk a little bit about

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what are the ways

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that you thought about those analytics

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and how have you refine that

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as you've gone forward?

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Yeah, I think first and foremost

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is always thinking of our mission.

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We assume good

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intent of everyone

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who shows up to deliver

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health care every day

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and all of the stakeholders.

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We assume that

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all of them are mission driven

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to make sure

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that people have access

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to cost effective, safe, high

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quality, patient centered care.

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So that's the number one thing

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that we're trying to accomplish.

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So those are always

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my outcomes

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that I'm thinking of as most important.

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But then to make sure that we have people

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that are engaged

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and able

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to carry out

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some of the outcomes

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that we're looking at,

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are looking at burnout.

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Let me talk about how we think

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about those outcomes of burnout.

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So there's the job demand resource theory

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that we often talk about where the

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job demands

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and the resources and latitude of control

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that you have to meet your demands.

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There may be a mismatch

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and the conservation

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of resource theory

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being that

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if you have hindering obstacles

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that prohibits you

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from being masterful in your mission,

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that you

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that makes you feel proud and inspired,

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that you are going to feel depleted

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by those obstacles

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and you're going to withdraw yourself.

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So burnout

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is a sense of a lack of accomplishment,

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and then you're feeling emotionally

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exhausted and checked out.

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Moral injury would be that you feel like

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you can't live up to your own values

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for something you did or didn't do.

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You Didn't you?

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It was a compromise of your own values

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or the compassion fatigue

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that is required to move a patient

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through a congested system

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that may have obstacles.

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So when we think about measuring

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burnout of professional fulfillment,

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we're looking to identify

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those hindering obstacles

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so we can remove those

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so that they can engage themselves

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in the challenges

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that make them satisfied

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in which they're absorbed.

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And that is the care for the patient

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And the challenge of doing that.

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The diagnose

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is the treatment, the education and care.

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So we try to find those obstacles.

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So we look for those obstacles.

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We look for the outcomes of trying

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to make sure that people

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are not burned out,

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that they're professionally fulfilled,

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that they don't intend to leave, that

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they're likely to promote the practice,

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that they

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promote, the quality of care

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that we deliver there.

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And then we look for the system,

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how the system works

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to try to identify those drivers.

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So those system elements are

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how are we as a culture

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that supports wellness?

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So if you think about the

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attitude of control,

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the professionals and people at work,

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they all want a sense of agency,

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They want voice and agency

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because they are aligned with you in

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what is to be accomplished,

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and they just want to be able

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to accomplish that.

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So if they have voice and agency,

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they are able to get the job done

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and feel good about it.

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And so you want to find a way

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to communicate with them,

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to hear from them

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so that you can identify those things

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and that

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and then take care of those obstacles.

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So what we do is we look in our culture

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to find out our leader,

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our type of wellness

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informed leadership,

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often transformational servant style

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leadership, distributive collaborative

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that brings out the voices

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and input from people that we get, input

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we seek by,

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and especially from our high stakes

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complex decision makers.

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So leadership,

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teamwork, how we work as a team

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not only in the culture of teamwork,

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but also in the way

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we share the care together,

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in the way

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we support each other as colleagues,

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and the

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sense of belonging that you fit in

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and you have that voice and agency you're

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seeing, heard, valued,

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supported and developed.

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So that's a culture.

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And then we look at the practice

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efficiency.

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Nursing might call it

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care plans

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and we might call practice efficiency.

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But our ability,

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our workload flow pace

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and our latitude of control to live up

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to our professional standards

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and do a good job for our patients.

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And then when you think

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about personal resiliency,

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you're often thinking of your ability

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to maintain work life integration

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so that you're able

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to maintain your relationships

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and your self-care and come back rested

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and recharged and ready to go.

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So we look at this environment

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to see how well people are able

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to do their jobs masterfully

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and what leads

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to their professional fulfillment

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and how those affect the outcomes

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and the mission

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that we're trying to accomplish.

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I like the idea that you really balance

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this between the individual responsible

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to come prepared

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to address those solutions,

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create those solutions, identify

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where there might be solutions

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and the system responsiveness

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to really put those into place.

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I think that that marriage

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is really essential to this work.

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So let me ask you,

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it hasn't all been sunshine and roses.

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You've obviously

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certainly faced some challenges,

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as we all have

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when we try to implement a new thing.

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We all love the idea of change

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just right up

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until it lands at our doorstep.

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So what's one of the biggest hurdles

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you face in moving forward in your role?

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And was it something that you said?

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Yeah, I know going in.

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I know this

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this department, this challenge,

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this area is going to be a problem.

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And how did you prepare for it

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if you expected it or would you do

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if it came out of the blue at you?

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Yeah,

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I think the greatest challenge has been

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what's happening around the country

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with the disruption.

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So much change in leadership.

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So as I mentioned, how we socialized on

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both the school

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medicine side and the health system side

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and then came together with the consensus

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that was just the fall of 2019

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and then 2020, the pandemic hit

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and we continued to hold the wellness

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agenda and advance it

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and move it forward,

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especially supporting psychological

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first aid and peer support

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and really focusing on that

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through the pandemic.

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Our earlier preparations

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created the Care

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for the Caregiver website

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and allowed us to be prepared

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with a safety net

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because we knew

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we had to have a safety net first

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to do the work of removing

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these obstacles that improved efficiency.

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So in 2022, today

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we've had a lot of changes

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in leadership on both sides of

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the street.

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And I think

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we're seeing that around the country

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and re socializing the agenda

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and being able to create that platform

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that then moves forward as

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things are shifting all the time.

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So I think that has been a challenge

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because you have to do it every day

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and you have to keep socializing it.

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The other thing is communications.

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I wish that I had a dedicated

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communications officer

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because there are stakeholders

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across the organization

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that are doing things

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and in

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keeping our professional fulfillment

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or health care worker well-being in mind

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in everything that they do.

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And they may see another initiative

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that's been implemented,

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but they don't see how much work

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goes behind the scenes

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to make sure

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that we implement

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this mandate as easily

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and as possible without disruption.

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So I think some of the things

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that they don't see,

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that's a challenge too,

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because you want them to see

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how much work is going into

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everything we do on their behalf,

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as you mentioned, how

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we use

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also the assessments

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to mobilize the whole health care system.

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And that is

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when we get these assessments,

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we will get them by every department

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and section for every hospital

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and delivery network,

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for every type of practice model,

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whether it's private practice,

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academic or employed.

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We will get them at every level,

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whether you're a physician, advanced

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practice clinician

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or trainee, for example,

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we will look at them

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in every way that we can

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for every hospital, every delivery

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network, every practice model,

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so that we can find

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where the positive deviants are,

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so that we can see what we can scale up

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and we can see the health

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of our delivery of health care services

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so we can see if there's a threat

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:

somewhere that needs to be addressed.

591

:

And also we order all of those scores

592

:

so that they go to our stakeholders

593

:

so that we use that data

594

:

driven approach

595

:

to make policy or governance decisions

596

:

to find out where

597

:

service lines or services

598

:

may be threatened,

599

:

to find out

600

:

which stakeholders

601

:

can take a piece

602

:

of that

603

:

puzzle and implement it into their work

604

:

as a priority.

605

:

And then at the department

606

:

in section level

607

:

and then at the individual level.

608

:

So people feel empowered for themselves.

609

:

I mentioned that after I mentioned

610

:

the communications person,

611

:

because I don't think that each level

612

:

that we implement

613

:

vertically and horizontally,

614

:

I don't think they all know

615

:

how much

616

:

the other people

617

:

are also taking a piece of that puzzle

618

:

so that they feel like if we all move

619

:

and we all take a piece of this,

620

:

that we're going to move

621

:

our organization faster

622

:

to make this the professional home,

623

:

the place to be.

624

:

Faster,

625

:

you know, it's always a challenge

626

:

to make sure everyone understands

627

:

the nuances of what's being done

628

:

and how it's being done

629

:

and how people can help.

630

:

And sometimes it's

631

:

just those conversations of,

632

:

Oh, hey, did you know about this?

633

:

And it it can make such a difference.

634

:

But sometimes you think

635

:

this should happen better.

636

:

It more routinely more standardized,

637

:

and sometimes it's just impossible

638

:

to get to that level of communication.

639

:

So my last question for you

640

:

is, you mentioned

641

:

you've been doing this for quite a while.

642

:

This is certainly been

643

:

a passion for a long time.

644

:

But how do you maintain your enthusiasm

645

:

for this work?

646

:

I mean, you're looking at

647

:

something that has often been

648

:

a side of the desk activity.

649

:

It's not always

650

:

had the focus and attention.

651

:

I think it has more now, but

652

:

how do you keep up engagement to say

653

:

not only are

654

:

we aiming for absence of burnout,

655

:

but we're really aiming

656

:

for a thriving community.

657

:

I think that's the reason itself.

658

:

I think being a system thinker

659

:

and just loving the puzzles

660

:

of this work,

661

:

of putting systems

662

:

together, seeing how they work

663

:

and wanting to fix them

664

:

so that they're more efficient

665

:

and better.

666

:

I also think that having done

667

:

a lot of International Health

668

:

and Peace Corps

669

:

in the United States,

670

:

we take for granted

671

:

that we have

672

:

a reliable health

673

:

care system

674

:

and I don't want anything

675

:

to happen to that.

676

:

I really want to

677

:

make sure that we as a country

678

:

have the best, most reliable

679

:

health care in the world

680

:

and to keep moving toward that.

681

:

We still have a lot of work to do,

682

:

but to keep moving toward that

683

:

because it should be

684

:

a real point of pride for us.

685

:

And as it has been, as it should be.

686

:

And I want to make sure that my parents

687

:

in a different state

688

:

than me have access to reliable, the best

689

:

health care

690

:

and my family

691

:

and my sisters,

692

:

my loved ones, my friends.

693

:

I want to make sure wherever they are

694

:

that there is a reliable health

695

:

care system in this country.

696

:

So how do I keep mission driven?

697

:

I keep that in mind

698

:

when I have obstacles.

699

:

I remember that

700

:

this is just a piece of the puzzle

701

:

to keep moving

702

:

in the direction of my calling,

703

:

my mission.

704

:

I use gratitude

705

:

for having a such a problem

706

:

to deal with these obstacles.

707

:

I'm very grateful

708

:

to be in a position

709

:

now that I think of growth mindset.

710

:

What can I

711

:

how can they grow and learn

712

:

from every situation that I have?

713

:

Every difficulty?

714

:

Grit to be persistent

715

:

and grace to give myself grace

716

:

and to know that I'm doing the best

717

:

that I can with the resources that I have

718

:

and I will keep at it.

719

:

It sounds like you're very much

720

:

living the mission

721

:

of being a wellbeing officer

722

:

and really driving

723

:

wellness in your system.

724

:

Thank you so much for joining me

725

:

and for sharing your story. Thank you.

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Advancing Health
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