News and Updates

Trusted expert and internationally recognized caregiver advocate for reducing clinician fatigue and improving employee engagement, Dr. Stephen Swensen,  Professor Emeritus, Mayo Clinic, met with members of the Vancouver Physician Staff Association this January. He shared lessons learned over his three-decade-long career with the Mayo Clinic.

“Many physicians are working in a state of professional distress,” stated Dr. Swensen. “This goes beyond burnout and includes PTSD, emotional exhaustion, clinical depression, moral injury, compassion fatigue, and suicidal thoughts. When you’re in this state, you’re more likely to make a medical error. You have relationship problems, addiction problems; your productivity goes down as does your level of quality of care. One of the biggest opportunities we have to improve patient care is by caring for each other.”

An ideal workplace has three elements that Dr. Swensen calls agency, coherence and camaraderie. The happiest teams at the Mayo Clinic, he said, have the agency to make decisions, feel connected to their group, and celebrate each other’s milestones.

Leadership behaviours

Dr. Swensen identifies five behaviours (Leader Index Behaviours) that make for better leaders:

1. They are inclusive.
2. They communicate transparently.
3. They value your ideas.
4. They are interested in your career.
5. They appreciate your work.

Mayo Clinic staff are surveyed annually on how their leaders rate in these areas. Those with low scores are coached to improve these or are moved out of leadership roles because leaders who don’t exhibit these five behaviours are causing harm to patients.

Medicine is a calling

Some people go to work every day for the paycheque; others see their career as a means to accomplish goals and receive acknowledgement of their contributions. It is common for those who choose a career in health care to also see their work as a calling, as a means of helping patients, their families and the greater community. When that sense of purpose is lost, said Dr. Swensen, physicians can develop professional distress.

“Engagement is the antipode to burnout; it connects us to meaning and purpose,” he said. “The number one driver of happiness is meaningful work so you would think health care should have the lowest rate of burnout. But sometimes we lose sight and have to be reconnected to our purpose. Coherence can do that. Coherence exists when all parts of the system fit together to form a united whole.”

To create coherence, leaders need to ask, listen and empower.

“It’s that annoying pebble in your shoe that holds you back rather than the mountain you need to climb. The research is clear that when departments work together to identify the ‘pebble’ they reduce burnout. You can apply this to Cerner. Superusers could monitor who’s using the system on weeknights and weekends and then ask them if they need assistance. A superuser can save a physician three to five hours a day by teaching them shortcuts.”

Architects rather than carpenters

The pronouns we use when we talk about our organization are a clue to how well that organization is thriving. When we think in terms of ‘us’ and ‘them’ rather than ‘we’ and ‘our,’ the institution flounders.

“If physicians are treated as partners, they behave that way,” said Dr. Swensen, who recalled how the Mayo’s chair of haematology addressed her team’s high burnout rate.

“She decided to be a leader, a champion—rather than a middle manager. Instead of saying this is what they’re telling us to do, let’s all just be carpenters, she empowered her physicians to be architects. They weren’t going to be told how to do something by people who don’t understand what they do. The team created the solutions.”

When we do our work, improve our work, and care for each other, our patients have the best doctors imaginable. Lean into tomorrow, Dr. Swensen encouraged, to see what difference you can make.

Further reading: Finding and Creating Joy in Work white paper (IHI white paper, co-authored by Dr. Swensen)

 
Thank you to the Vancouver Physician Staff Association (VPSA) for sharing this article and photos. >

My father, who was an obstetrician, worked at the tertiary care teaching hospital in Edmonton. He used to say he would frequently see Dr Snell—the CEO of the hospital at the time—in the hallway. If there was an issue to discuss, the two of them would just talk about it. Today, doctors may never see the CEO or other senior executives.  Read more >

Physician burnout was the topic of a recent Doctors of BC event, hosted by Dr Andrew Clarke, Executive Director of the Physician Health Program (PHP). Attendees included close to 50 physicians representing medical staff associations (MSAs) and divisions of family practice. For Dr Clarke’s brief summary of the background, intention, and goals of the session and the PHP, read “Helping to meet the challenge of physician burnout.”

Across BC, 67 facilities are now involved in the Facility Engagement Initiative. Of those, 51 physician groups have received full funding to carry out local activities and are in various stages of implementation. Some are setting priorities and initiating activities, while others are building on the successes of early adopters with additional rounds of projects.

As activities gain momentum, a number of stories are emerging that demonstrate physician leadership and successful approaches to achieve medical staff and hospital / health authority collaboration.

For example, at Lion's Gate Hospital, a collaborative effort to transform ER space improved flow and capacity.  In Vernon, physicians set in motion changes to curb unnecessary repeated patient tests.  At Vancouver General Hospital, a record number of physicians participated in disaster preparedness. In Lillooet, physicians initiated a collaborative solution with the health authority and partners to give children and youth greater access to mental health care.  Read more about these stories and others here > 

If you have stories to share, please forward details to engagement@doctorsofbc.ca or to your Facility Engagement Lead (FEL). 

Increasing Physician Engagement: A Literature Review: A summary of evidence prepared by the UBC evaluation team describes practices, processes or approaches to increasing physician engagement in the context of the FE Initiative and the MOU. 

A Blueprint for Physician Leadership in Transforming Canada's Health Care System:  Stimulating dialogue and action: the central role of physicians in planning and implementing change.

Incomplete Guide to Physician Engagement in Quality Improvement: Some handy tips for engaging busy physicians.

Successful Strategies in Physician Engagement - Jim Pattison Outpatient Centre:  One example of a successful physician engagement approach at a new health care facility.

Do you have helpful engagement resources / literature to share? Please send to engagement@doctorsofbc.ca for posting. 

CLAIMS:  DID YOU KNOW...? Claims should be submitted directly by the FEMS physician member(s) working on an engagement activity, not the Physician Society/ MSA Administrator if possible. 

Why?  When entering a claim, FEMs sometimes asks physicians for feedback about their Facility Engagement activity, and responses to these questions are required to successfully submit the claim. Getting first-hand feedback from the physician's perspective is necessary to evaluate the effectiveness of the initiative. Feedback is anonymized prior to being disclosed to the evaluation team at the University of British Columbia. If you have any questions, please contact: femssupport@doctorsofbc.ca

REGISTRATION TIP: When registering for FEMS, make sure you select your User Type based on your College Sub-Class.  If you’re unsure of your College Sub-Class, please visit the College of Physicians and Surgeons website: https://www.cpsbc.ca/physician_search.

Thank you to sites and physicians who have participated in the provincial evaluation interviews and case studies to date. The Facility Engagement team, along with the UBC evaluation team, are also working to gather greater input about the initiative's progress from local and regional health authority leaders.  The purpose is to capture insights into health authority leaders’ perspectives and attitudes about the Facility Engagement Initiative. 

In March 2017, the Specialist Service Committee’s Facility Engagement Working Group approved funding for the following sites:

•    Surrey Memorial Hospital
•    Children’s and Women’s Hospital
•    Mission Memorial Hospital
•    Langley Memorial Hospital
•    Ridge Meadows Hospital & Health Care Centre
•    Powell River General Hospital
•    Tofino General Hospital
•    Campbell River District General Hospital
•    Lady Minto Gulf Islands Hospital
•    Port McNeill and District Hospital and Port Hardy Hospital
•    Mills Memorial Hospital
•    Lillooet Hospital
•    Boundary Hospital
•    Kootenay Lake Hospital
•    Haida Gwaii Hospital and Health Centre
•    Wrinch Memorial Hospital
•    South Okanagan General Hospital
•    Shuswap Lake General Hospital
•    Golden & District Hospital
•    Queen Victoria Hospital
•    Elk Valley Hospital
•    Princeton General Hospital

 
With all proposals to date, physician leads have been enthusiastic to have the views of the medical staff effectively represented, and to have opportunities to identify and prioritize issues and solutions – all while improving working relationships and communication with their colleagues, health authorities and site administrators. Early examples of activities and progress will be shared soon as the work gets underway.

A team of researchers from UBC has come together to evaluate the Facility Engagement Initiative and the implementation of the Memorandum of Understanding on Regional and Local Engagement (MOU).  The provincial evaluation will:

•    take place from now to early 2019;
•    provide real time feedback about the implementation of the initiative which can be used for immediate improvements;
•    gather evidence to understand and measure the success of Facility Engagement activities; and
•    provide accountability to all stakeholders.

Physician societies and health authorities will receive a package of information shortly outlining when and how to participate in the provincial evaluation.  Read more here >