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Workforce Burnout: Embedding an Organizational Culture of Wellness · Advancing Health

• 0:00
  Even 15 years ago, you
• 0:02
  often would have searched in vain
• 0:03
  for a title
• 0:04
  like Chief Wellness Officer
• 0:06
  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
• 0:27
  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.
• 0:48
  Welcome to Advancing
• 0:49
  Health, a podcast
• 0:50
  from the American Hospital Association.
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  I'm Tom Haederle with AHA Communications.
• 0:55
  In this podcast, Elisa Arespacochaga.
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  AHA’s vice president
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  for clinical affairs
• 1:00
  and workforce,
• 1:01
  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.
• 1:08
  As Dr.
• 1:09
  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
• 1:20
  professionals and health care workers.
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  Let's join them.
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  Thanks, Tom.
• 1:25
  I’m Elisa Arespacochaga AHA,
• 1:27
  vice president of Clinical Affairs
• 1:28
  and Workforce.
• 1:28
  And I'm joined today by Dr.
• 1:30
  Kristine Olson, chief wellness officer
• 1:32
  for Yale New
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  Haven Hospital
• 1:33
  and director of Work Life, Wellbeing
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  Analytics, a Yale
• 1:36
  New Haven health system.
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  And today
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  we're really talking about her journey
• 1:39
  in developing and leading
• 1:40
  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
• 1:53
  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
• 2:00
  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
• 2:11
  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,
• 2:18
  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
• 2:31
  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
• 2:49
  and pediatrics
• 2:50
  training at Yale-New
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  Haven Hospital first.
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  And then when
• 2:53
  health care reform was underway,
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  I went to fellowship at Cornell
• 2:57
  for Health Services,
• 2:58
  Research and Epidemiology
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  in 2010 to study
• 3:02
  the to create models of health care
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  so that we could use
• 3:05
  professional satisfaction
• 3:07
  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
• 3:13
  how it was affecting
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  organizational performance
• 3:15
  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
• 3:25
  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
• 3:56
  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
• 4:18
  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
• 5:33
  obviously you're facing
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  challenges of
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  the focus areas around
• 5:37
  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.
• 5:53
  One was showing that
• 5:55
  the numbers were consistent
• 5:56
  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
• 6:09
  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
• 6:37
  that reliable access
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  to cost effective quality,
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  safe, high quality, patient centered care
• 6:43
  without high performing professionals
• 6:46
  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
• 7:14
  and we knew that
• 7:15
  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
• 7:21
  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
• 7:50
  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
• 8:13
  what use of help,
• 8:14
  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?
• 8:25
  Yeah, I think first and foremost
• 8:27
  is always thinking of our mission.
• 8:28
  We assume good
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  intent of everyone
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  who shows up to deliver
• 8:32
  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
• 8:43
  that we're trying to accomplish.
• 8:44
  So those are always
• 8:45
  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
• 8:52
  and able
• 8:52
  to carry out
• 8:53
  some of the outcomes
• 8:54
  that we're looking at,
• 8:55
  are looking at burnout.
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  Let me talk about how we think
• 8:58
  about those outcomes of burnout.
• 8:59
  So there's the job demand resource theory
• 9:01
  that we often talk about where the
• 9:04
  job demands
• 9:05
  and the resources and latitude of control
• 9:07
  that you have to meet your demands.
• 9:10
  There may be a mismatch
• 9:11
  and the conservation
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  of resource theory
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  being that
• 9:14
  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.
• 9:35
  Moral injury would be that you feel like
• 9:38
  you can't live up to your own values
• 9:40
  for something you did or didn't do.
• 9:42
  You Didn't you?
• 9:44
  It was a compromise of your own values
• 9:46
  or the compassion fatigue
• 9:47
  that is required to move a patient
• 9:49
  through a congested system
• 9:52
  that may have obstacles.
• 9:54
  So when we think about measuring
• 9:56
  burnout of professional fulfillment,
• 9:57
  we're looking to identify
• 9:58
  those hindering obstacles
• 10:00
  so we can remove those
• 10:01
  so that they can engage themselves
• 10:03
  in the challenges
• 10:04
  that make them satisfied
• 10:06
  in which they're absorbed.
• 10:07
  And that is the care for the patient
• 10:09
  And the challenge of doing that.
• 10:11
  The diagnose
• 10:11
  is the treatment, the education and care.
• 10:16
  So we try to find those obstacles.
• 10:19
  So we look for those obstacles.
• 10:20
  We look for the outcomes of trying
• 10:22
  to make sure that people
• 10:23
  are not burned out,
• 10:24
  that they're professionally fulfilled,
• 10:26
  that they don't intend to leave, that
• 10:27
  they're likely to promote the practice,
• 10:29
  that they
• 10:30
  promote, the quality of care
• 10:32
  that we deliver there.
• 10:34
  And then we look for the system,
• 10:36
  how the system works
• 10:37
  to try to identify those drivers.
• 10:39
  So those system elements are
• 10:42
  how are we as a culture
• 10:43
  that supports wellness?
• 10:45
  So if you think about the
• 10:46
  attitude of control,
• 10:47
  the professionals and people at work,
• 10:49
  they all want a sense of agency,
• 10:51
  They want voice and agency
• 10:52
  because they are aligned with you in
• 10:54
  what is to be accomplished,
• 10:56
  and they just want to be able
• 10:57
  to accomplish that.
• 10:58
  So if they have voice and agency,
• 11:00
  they are able to get the job done
• 11:03
  and feel good about it.
• 11:04
  And so you want to find a way
• 11:05
  to communicate with them,
• 11:07
  to hear from them
• 11:08
  so that you can identify those things
• 11:10
  and that
• 11:11
  and then take care of those obstacles.
• 11:14
  So what we do is we look in our culture
• 11:16
  to find out our leader,
• 11:18
  our type of wellness
• 11:19
  informed leadership,
• 11:21
  often transformational servant style
• 11:22
  leadership, distributive collaborative
• 11:25
  that brings out the voices
• 11:26
  and input from people that we get, input
• 11:28
  we seek by,
• 11:29
  and especially from our high stakes
• 11:31
  complex decision makers.
• 11:32
  So leadership,
• 11:33
  teamwork, how we work as a team
• 11:35
  not only in the culture of teamwork,
• 11:38
  but also in the way
• 11:40
  we share the care together,
• 11:42
  in the way
• 11:42
  we support each other as colleagues,
• 11:44
  and the
• 11:45
  sense of belonging that you fit in
• 11:47
  and you have that voice and agency you're
• 11:49
  seeing, heard, valued,
• 11:50
  supported and developed.
• 11:51
  So that's a culture.
• 11:52
  And then we look at the practice
• 11:54
  efficiency.
• 11:54
  Nursing might call it
• 11:56
  care plans
• 11:56
  and we might call practice efficiency.
• 11:58
  But our ability,
• 11:59
  our workload flow pace
• 12:02
  and our latitude of control to live up
• 12:05
  to our professional standards
• 12:07
  and do a good job for our patients.
• 12:09
  And then when you think
• 12:10
  about personal resiliency,
• 12:11
  you're often thinking of your ability
• 12:13
  to maintain work life integration
• 12:15
  so that you're able
• 12:16
  to maintain your relationships
• 12:18
  and your self-care and come back rested
• 12:20
  and recharged and ready to go.
• 12:22
  So we look at this environment
• 12:25
  to see how well people are able
• 12:27
  to do their jobs masterfully
• 12:29
  and what leads
• 12:30
  to their professional fulfillment
• 12:32
  and how those affect the outcomes
• 12:33
  and the mission
• 12:34
  that we're trying to accomplish.
• 12:36
  I like the idea that you really balance
• 12:38
  this between the individual responsible
• 12:41
  to come prepared
• 12:42
  to address those solutions,
• 12:44
  create those solutions, identify
• 12:46
  where there might be solutions
• 12:47
  and the system responsiveness
• 12:49
  to really put those into place.
• 12:50
  I think that that marriage
• 12:52
  is really essential to this work.
• 12:54
  So let me ask you,
• 12:55
  it hasn't all been sunshine and roses.
• 12:57
  You've obviously
• 12:58
  certainly faced some challenges,
• 12:59
  as we all have
• 13:00
  when we try to implement a new thing.
• 13:02
  We all love the idea of change
• 13:04
  just right up
• 13:05
  until it lands at our doorstep.
• 13:06
  So what's one of the biggest hurdles
• 13:09
  you face in moving forward in your role?
• 13:11
  And was it something that you said?
• 13:12
  Yeah, I know going in.
• 13:13
  I know this
• 13:14
  this department, this challenge,
• 13:16
  this area is going to be a problem.
• 13:18
  And how did you prepare for it
• 13:20
  if you expected it or would you do
• 13:22
  if it came out of the blue at you?
• 13:23
  Yeah,
• 13:24
  I think the greatest challenge has been
• 13:27
  what's happening around the country
• 13:28
  with the disruption.
• 13:29
  So much change in leadership.
• 13:31
  So as I mentioned, how we socialized on
• 13:34
  both the school
• 13:34
  medicine side and the health system side
• 13:36
  and then came together with the consensus
• 13:38
  that was just the fall of 2019
• 13:41
  and then 2020, the pandemic hit
• 13:44
  and we continued to hold the wellness
• 13:47
  agenda and advance it
• 13:48
  and move it forward,
• 13:49
  especially supporting psychological
• 13:52
  first aid and peer support
• 13:54
  and really focusing on that
• 13:56
  through the pandemic.
• 13:57
  Our earlier preparations
• 13:59
  created the Care
• 14:00
  for the Caregiver website
• 14:01
  and allowed us to be prepared
• 14:02
  with a safety net
• 14:03
  because we knew
• 14:04
  we had to have a safety net first
• 14:06
  to do the work of removing
• 14:08
  these obstacles that improved efficiency.
• 14:11
  So in 2022, today
• 14:14
  we've had a lot of changes
• 14:15
  in leadership on both sides of
• 14:18
  the street.
• 14:19
  And I think
• 14:20
  we're seeing that around the country
• 14:21
  and re socializing the agenda
• 14:24
  and being able to create that platform
• 14:27
  that then moves forward as
• 14:30
  things are shifting all the time.
• 14:32
  So I think that has been a challenge
• 14:35
  because you have to do it every day
• 14:37
  and you have to keep socializing it.
• 14:39
  The other thing is communications.
• 14:41
  I wish that I had a dedicated
• 14:43
  communications officer
• 14:44
  because there are stakeholders
• 14:47
  across the organization
• 14:49
  that are doing things
• 14:50
  and in
• 14:51
  keeping our professional fulfillment
• 14:53
  or health care worker well-being in mind
• 14:55
  in everything that they do.
• 14:57
  And they may see another initiative
• 14:59
  that's been implemented,
• 15:01
  but they don't see how much work
• 15:02
  goes behind the scenes
• 15:03
  to make sure
• 15:04
  that we implement
• 15:06
  this mandate as easily
• 15:08
  and as possible without disruption.
• 15:10
  So I think some of the things
• 15:11
  that they don't see,
• 15:12
  that's a challenge too,
• 15:14
  because you want them to see
• 15:16
  how much work is going into
• 15:17
  everything we do on their behalf,
• 15:20
  as you mentioned, how
• 15:21
  we use
• 15:21
  also the assessments
• 15:23
  to mobilize the whole health care system.
• 15:25
  And that is
• 15:26
  when we get these assessments,
• 15:28
  we will get them by every department
• 15:30
  and section for every hospital
• 15:31
  and delivery network,
• 15:33
  for every type of practice model,
• 15:35
  whether it's private practice,
• 15:36
  academic or employed.
• 15:38
  We will get them at every level,
• 15:39
  whether you're a physician, advanced
• 15:41
  practice clinician
• 15:42
  or trainee, for example,
• 15:45
  we will look at them
• 15:46
  in every way that we can
• 15:49
  for every hospital, every delivery
• 15:50
  network, every practice model,
• 15:52
  so that we can find
• 15:53
  where the positive deviants are,
• 15:55
  so that we can see what we can scale up
• 15:57
  and we can see the health
• 15:58
  of our delivery of health care services
• 16:02
  so we can see if there's a threat
• 16:03
  somewhere that needs to be addressed.
• 16:05
  And also we order all of those scores
• 16:07
  so that they go to our stakeholders
• 16:09
  so that we use that data
• 16:11
  driven approach
• 16:12
  to make policy or governance decisions
• 16:15
  to find out where
• 16:16
  service lines or services
• 16:18
  may be threatened,
• 16:20
  to find out
• 16:21
  which stakeholders
• 16:22
  can take a piece
• 16:23
  of that
• 16:24
  puzzle and implement it into their work
• 16:27
  as a priority.
• 16:28
  And then at the department
• 16:30
  in section level
• 16:31
  and then at the individual level.
• 16:33
  So people feel empowered for themselves.
• 16:35
  I mentioned that after I mentioned
• 16:36
  the communications person,
• 16:38
  because I don't think that each level
• 16:41
  that we implement
• 16:43
  vertically and horizontally,
• 16:44
  I don't think they all know
• 16:46
  how much
• 16:46
  the other people
• 16:47
  are also taking a piece of that puzzle
• 16:50
  so that they feel like if we all move
• 16:53
  and we all take a piece of this,
• 16:55
  that we're going to move
• 16:55
  our organization faster
• 16:57
  to make this the professional home,
• 17:00
  the place to be.
• 17:01
  Faster,
• 17:02
  you know, it's always a challenge
• 17:03
  to make sure everyone understands
• 17:05
  the nuances of what's being done
• 17:06
  and how it's being done
• 17:07
  and how people can help.
• 17:09
  And sometimes it's
• 17:10
  just those conversations of,
• 17:12
  Oh, hey, did you know about this?
• 17:13
  And it it can make such a difference.
• 17:15
  But sometimes you think
• 17:17
  this should happen better.
• 17:18
  It more routinely more standardized,
• 17:20
  and sometimes it's just impossible
• 17:22
  to get to that level of communication.
• 17:25
  So my last question for you
• 17:26
  is, you mentioned
• 17:27
  you've been doing this for quite a while.
• 17:28
  This is certainly been
• 17:29
  a passion for a long time.
• 17:31
  But how do you maintain your enthusiasm
• 17:33
  for this work?
• 17:33
  I mean, you're looking at
• 17:35
  something that has often been
• 17:37
  a side of the desk activity.
• 17:38
  It's not always
• 17:40
  had the focus and attention.
• 17:41
  I think it has more now, but
• 17:44
  how do you keep up engagement to say
• 17:46
  not only are
• 17:47
  we aiming for absence of burnout,
• 17:48
  but we're really aiming
• 17:49
  for a thriving community.
• 17:51
  I think that's the reason itself.
• 17:53
  I think being a system thinker
• 17:55
  and just loving the puzzles
• 17:56
  of this work,
• 17:57
  of putting systems
• 17:58
  together, seeing how they work
• 17:59
  and wanting to fix them
• 18:01
  so that they're more efficient
• 18:02
  and better.
• 18:03
  I also think that having done
• 18:05
  a lot of International Health
• 18:07
  and Peace Corps
• 18:08
  in the United States,
• 18:09
  we take for granted
• 18:10
  that we have
• 18:11
  a reliable health
• 18:12
  care system
• 18:12
  and I don't want anything
• 18:14
  to happen to that.
• 18:15
  I really want to
• 18:17
  make sure that we as a country
• 18:19
  have the best, most reliable
• 18:22
  health care in the world
• 18:23
  and to keep moving toward that.
• 18:25
  We still have a lot of work to do,
• 18:26
  but to keep moving toward that
• 18:27
  because it should be
• 18:29
  a real point of pride for us.
• 18:31
  And as it has been, as it should be.
• 18:34
  And I want to make sure that my parents
• 18:37
  in a different state
• 18:37
  than me have access to reliable, the best
• 18:42
  health care
• 18:42
  and my family
• 18:44
  and my sisters,
• 18:44
  my loved ones, my friends.
• 18:46
  I want to make sure wherever they are
• 18:47
  that there is a reliable health
• 18:49
  care system in this country.
• 18:52
  So how do I keep mission driven?
• 18:54
  I keep that in mind
• 18:55
  when I have obstacles.
• 18:57
  I remember that
• 18:58
  this is just a piece of the puzzle
• 19:00
  to keep moving
• 19:00
  in the direction of my calling,
• 19:02
  my mission.
• 19:03
  I use gratitude
• 19:05
  for having a such a problem
• 19:07
  to deal with these obstacles.
• 19:08
  I'm very grateful
• 19:09
  to be in a position
• 19:10
  now that I think of growth mindset.
• 19:13
  What can I
• 19:13
  how can they grow and learn
• 19:14
  from every situation that I have?
• 19:16
  Every difficulty?
• 19:17
  Grit to be persistent
• 19:19
  and grace to give myself grace
• 19:21
  and to know that I'm doing the best
• 19:23
  that I can with the resources that I have
• 19:25
  and I will keep at it.
• 19:26
  It sounds like you're very much
• 19:28
  living the mission
• 19:28
  of being a wellbeing officer
• 19:30
  and really driving
• 19:31
  wellness in your system.
• 19:32
  Thank you so much for joining me
• 19:33
  and for sharing your story. Thank you.