Workforce Burnout: Embedding an Organizational Culture of Wellness

00;00;00;26 - 00;00;29;29
Tom Haederle
Even 15 years ago, you often would have searched in vain for a title like Chief Wellness Officer on the payroll of most employers. Today, the job is increasingly common as employers have taken note of the high levels of stress and burnout reported by their employees. This is especially true in health care, where burnout is rampant and costly. Not only is burnout associated with more errors on the job, but a physician who chooses to leave costs on average at least a half a million dollars to replace.

00;00;30;01 - 00;01;08;18
Tom Haederle
This is where a robust wellness program can make a huge difference. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. In this podcast, Elisa Arespacochaga. AHA’s vice president for clinical affairs and workforce, speaks with an expert on developing organizationally wide wellness and well-being programs that are making a difference.

00;01;08;20 - 00;01;24;17
Tom Haederle
As Dr. Kristine Olson, chief wellness officer for Yale-New Haven Hospital, says, "it's not possible to have reliable access to cost effective, safe, high quality, patient centered care without high performing professionals and health care workers." Let's join them.

00;01;24;20 - 00;01;45;10
Elisa Arespacochaga
Thanks, Tom. I’m Elisa Arespacochaga AHA, vice president of Clinical Affairs and Workforce. And I'm joined today by Dr. Kristine Olson, chief wellness officer for Yale New Haven Hospital and director of Work Life, Wellbeing Analytics, a Yale New Haven health system. And today we're really talking about her journey in developing and leading organizational wide wellness programs, what she's learned and what advice she has for others.

00;01;45;13 - 00;01;50;12
Elisa Arespacochaga
So to get started, Kristine tell us a little bit about yourself and your role and how you got to where you are.

00;01;50;14 - 00;02;16;03
Kristine Olson, M.D.
Sure. Thank you for having me. It's great to be here and it's great to see you what the American Hospital Association is doing in making this a priority. My journey is I'm currently the chief wellness officer and I do the data analytics, as you mentioned, that's started. Maybe I'll do it chronologically. I had a grandmother who was very influential, who always helped to make life good for people outside of her family and was civic-minded who encouraged my education.

00;02;16;03 - 00;02;34;20
Kristine Olson, M.D.
I went to the Peace Corps because when you have, you are expected to give back. There I learned a lot about what it means for government and policies to create the environment in which we thrive. And then I came back and I did medical school at University of Minnesota, where I started to look at the health care system.

00;02;34;20 - 00;03;16;20
Kristine Olson, M.D.
I’m...a system-minded person. And I started to be curious and started studying that for the last 25 years. And then when health care reform was becoming evident that that was going to happen, I should say I did internal medicine and pediatrics training at Yale-New Haven Hospital first. And then when health care reform was underway, I went to fellowship at Cornell for Health Services, Research and Epidemiology in 2010 to study the to create models of health care so that we could use professional satisfaction as a compass to tell us the adverse effects from health policies and to find how it was affecting organizational performance as a health care system.

00;03;16;20 - 00;03;51;12
Kristine Olson, M.D.
And so we could identify things that we could correct before they had adverse effects. So that's how I got started in that. And that that took me to 2015 where I got to meet one of my mentors, Mark Linzer, who invited me in to a group that was with the early group of Mayo, Stanford and the AMA, where we were the steering committee for the Joy and Medicine Initiative, and then created the three domain model called the Stanford Model of Culture Climate, a practice efficiency and resiliency and the first recommendations for a research agenda.

00;03;51;15 - 00;04;21;10
Kristine Olson, M.D.
That group went to see the National Academy of Medicine, the American Conference of Physician Health and P-WAC, the Professional Wellness Academic Consortium, of which we were an early adopter. And that takes me into my current role. I should say, maybe, how we socialize that at Yale as well. So in 2016, we did our first burnout assessment to show that we too had burnout similar to the national level.

00;04;21;10 - 00;04;40;25
Kristine Olson, M.D.
So we were seeing that (?) was showing in the triennial surveys. We also coupled that with a path forward that we had to start to work on and the organizational strategies that we put in the first step forward module at the AMA for the joy in medicine. So that showed that it was something that was dynamic in health care.

00;04;40;25 - 00;05;03;20
Kristine Olson, M.D.
It was temporally related to people entering health care, it was dose related to their FTE, whereas otherwise static in the general population. So we knew that it was something that we had to correct as an industry, that it was our responsibility and we adopted that through the School of Medicine and through the Yale-New Haven health system. And then we consolidated them and we're moving forward with that agenda.

00;05;03;23 - 00;05;22;21
Elisa Arespacochaga
So you've spent a while doing this work, and you certainly have come about. I really love the idea that you started with this sense of how do you build thriving more broadly, not just in your community, not just among your fellow physicians, but really how do you build that as a community, as a government, as an organization? How do you put those structures in place?

00;05;22;24 - 00;05;50;19
Elisa Arespacochaga
So you had all of that supporting your knowledge. What helped you refine the strategy, the messaging, the conversations specific to your health system, where obviously you're facing challenges of the focus areas around quality, around patient safety, around the financial pressures that hospitals are under. How did you get that messaging refined to be able to go to your colleagues and your leadership to say this is a problem that we have to address?

00;05;50;19 - 00;05;53;06
Elisa Arespacochaga
It is ours to own.

00;05;53;08 - 00;06;16;02
Kristine Olson, M.D.
One was showing that the numbers were consistent with the national numbers and that we had a problem at the organizational level. It wasn't something that belonged to individuals themselves to fix. We also know that the interventions at an organizational level are more effective than those at an individual level from different systematic reviews. A meta analysis that had been done.

00;06;16;04 - 00;06;47;29
Kristine Olson, M.D.
So that was a galvanizing event and to be able to put together the strategy. But the burning platform of not only the prevalence of the problem, but the fact that health care is dependent on its health care professionals and health care workers, those caregivers. And it's not possible to have reliable access for the population that reliable access to cost effective quality, safe, high quality, patient centered care without high performing professionals and health care workers.

00;06;48;01 - 00;07;26;08
Kristine Olson, M.D.
So we knew that there was plenty of evidence showing that burnout is associated with errors. Burned-out physicians may be present, but their patients know that they're burned out and don't have the same kind of reciprocity in adherence to the recommendations as likely to follow up, show up and follow those recommendations. We knew that it was related to people's perception of quality, the idea of moral injury, if they weren't able to live up to their standards and we knew that it had a very high return on investment. For physicians, for example, just the turnover costs alone is half million to $1.8 million in turnover costs. That was in the literature and we validated that

00;07;26;08 - 00;07;40;17
Kristine Olson, M.D.
that was true at our organization as it was in the literature. So that made it a business case for it as well as you can't carry out the mission and you have to adopt the quadruple aim to include professional well-being and workforce well-being.

00;07;40;19 - 00;08;00;10
Elisa Arespacochaga
Absolutely. Absolutely. We cannot care for others if we're not well ourselves. And I know that's easier said than done. So in addition to the chief wellnes officer, I mentioned that you also do the data and analytics for the well-being program for the system. And I'd like you to talk a little bit about how you approach that work and some of the lessons that you've learned.

00;08;00;12 - 00;08;19;10
Elisa Arespacochaga
Because what I've found over time is that this is a very hard subject to measure. It's not as easy as: you did an intervention, and therefore you've seen this results. The indicators are very lagging. There's a lot of challenge in pinning down what use of help, what is not of help, and really building that evidence in that business case.

00;08;19;13 - 00;08;25;22
Elisa Arespacochaga
So can you talk a little bit about what are the ways that you thought about those analytics and how have you refined that as you've gone forward?

00;08;25;24 - 00;08;44;23
Kristine Olson, M.D.
Yeah, I think first and foremost is always thinking of our mission. We assume good intent of everyone who shows up to deliver health care every day and all of the stakeholders. We assume that all of them are mission driven to make sure that people have access to cost effective, safe, high quality, patient-centered care. So that's the number one thing that we're trying to accomplish.

00;08;44;23 - 00;09;09;28
Kristine Olson, M.D.
So those are always my outcomes that I'm thinking of as most important. But then to make sure that we have people that are engaged and able to carry out some of the outcomes that we're looking at, are looking at burnout. Let me talk about how we think about those outcomes of burnout. So there's the job demand resource theory that we often talk about where the job demands and the resources and latitude of control that you have to meet your demands.

00;09;10;03 - 00;09;35;23
Kristine Olson, M.D.
There may be a mismatch and the conservation of resource theory being that if you have hindering obstacles that prohibits you from being masterful in your mission, that you that makes you feel proud and inspired, that you are going to feel depleted by those obstacles and you're going to withdraw yourself. So burnout is a sense of a lack of accomplishment, and then you're feeling emotionally exhausted and checked out.

00;09;35;26 - 00;10;07;18
Kristine Olson, M.D.
Moral injury would be that you feel like you can't live up to your own values for something you did or didn't do. It was a compromise of your own values or the compassion fatigue that is required to move a patient through a congested system that may have obstacles. So when we think about measuring burnout of professional fulfillment, we're looking to identify those hindering obstacles so we can remove those so that they can engage themselves in the challenges that make them satisfied in which they're absorbed.

00;10;07;18 - 00;10;34;04
Kristine Olson, M.D.
And that is the care for the patient and the challenge of doing that. The diagnose is the treatment, the education and care. So we try to find those obstacles. We look for the outcomes of trying to make sure that people are not burned out, that they're professionally fulfilled, that they don't intend to leave, that they're likely to promote the practice that they promote, the quality of care that we deliver there.

00;10;34;06 - 00;10;58;13
Kristine Olson, M.D.
And then we look for the system, how the system works to try to identify those drivers. So those system elements are how are we as a culture that supports wellness? So if you think about the latitude of control, the professionals and people at work, they all want a sense of agency, they want voice and agency because they are aligned with you in what is to be accomplished, and they just want to be able to accomplish that.

00;10;58;15 - 00;11;32;23
Kristine Olson, M.D.
So if they have voice and agency, they are able to get the job done and feel good about it. And so you want to find a way to communicate with them, to hear from them so that you can identify those things and then take care of those obstacles. So what we do is we look in our culture to find out our leader, our type of wellness informed leadership, often transformational servant style leadership, distributive collaborative that brings out the voices and input from people that we get input. We seek buy-in, especially from our high-stakes complex decision makers.

00;11;32;25 - 00;11;52;14
Kristine Olson, M.D.
So leadership, teamwork, how we work as a team not only in the culture of teamwork, but also in the way we share the care together, in the way we support each other as colleagues, and the sense of belonging that you fit in and you have that voice and agency you're seeing, heard, valued, supported and developed. So that's a culture.

00;11;52;17 - 00;12;22;08
Kristine Olson, M.D.
And then we look at the practice efficiency. Nursing might call it care plans and we might call practice efficiency. But our ability, our workload flow, pace and our latitude of control to live up to our professional standards and do a good job for our patients. And then when you think about personal resiliency, you're often thinking of your ability to maintain work life integration so that you're able to maintain your relationships and your self-care and come back rested and recharged and ready to go.

00;12;22;09 - 00;12;36;11
Kristine Olson, M.D.
So we look at this environment to see how well people are able to do their jobs masterfully and what leads to their professional fulfillment and how those affect the outcomes and the mission that we're trying to accomplish.

00;12;36;13 - 00;12;57;21
Elisa Arespacochaga
I like the idea that you really balance this between the individual responsible to come prepared to address those solutions, create those solutions, identify where there might be solutions and the system responsiveness to really put those into place. I think that that marriage is really essential to this work. So let me ask you, it hasn't all been sunshine and roses.

00;12;57;21 - 00;13;13;14
Elisa Arespacochaga
You've obviously certainly faced some challenges, as we all have when we try to implement a new thing. We all love the idea of change just right up until it lands at our doorstep. So what's one of the biggest hurdles you face in moving forward in your role? And was it something that you said, "Yeah, I know going in.

00;13;13;14 - 00;13;23;25
Elisa Arespacochaga
I know this this department, this challenge, this area is going to be a problem." And how did you prepare for it if you expected it or would you do if it came out of the blue at you?

00;13;23;28 - 00;13;57;24
Kristine Olson, M.D.
Yeah, I think the greatest challenge has been what's happening around the country with the disruption. So much change in leadership. So as I mentioned, how we socialized on both the school medicine side and the health system side and then came together with the consensus that was just the fall of 2019 and then 2020, the pandemic hit and we continued to hold the wellness agenda and advance it and move it forward, especially supporting psychological first aid and peer support and really focusing on that through the pandemic.

00;13;57;26 - 00;14;32;24
Kristine Olson, M.D.
Our earlier preparations created the Care for the Caregiver website and allowed us to be prepared with a safety net because we knew we had to have a safety net first to do the work of removing these obstacles that improved efficiency. So in 2022, today we've had a lot of changes in leadership on both sides of the street. And I think we're seeing that around the country and re-socializing the agenda and being able to create that platform that then moves forward as things are shifting all the time.

00;14;32;27 - 00;14;57;16
Kristine Olson, M.D.
So I think that has been a challenge because you have to do it every day and you have to keep socializing it. The other thing is communications. I wish that I had a dedicated communications officer because there are stakeholders across the organization that are doing things and in keeping our professional fulfillment or health care worker well-being in mind in everything that they do.

00;14;57;18 - 00;15;25;26
Kristine Olson, M.D.
And they may see another initiative that's been implemented, but they don't see how much work goes behind the scenes to make sure that we implement this mandate as easily and as possible without disruption. So I think some of the things that they don't see, that's a challenge too, because you want them to see how much work is going into everything we do on their behalf. I should mention how we use also the assessments to mobilize the whole health care system.

00;15;25;28 - 00;16;05;06
Kristine Olson, M.D.
And that is when we get these assessments, we will get them by every department and section for every hospital and delivery network, for every type of practice model, whether it's private practice, academic or employed. We will get them at every level, whether you're a physician, advanced practice clinician or trainee, for example. We will look at them in every way that we can for every hospital, every delivery network, every practice model, so that we can find where the positive deviants are, so that we can see what we can scale up and we can see the health of our delivery of health care services so we can see if there's a threat somewhere that needs to be

00;16;05;06 - 00;16;28;28
Kristine Olson, M.D.
addressed. And also we order all of those scores so that they go to our stakeholders. So that we use that data driven approach to make policy or governance decisions to find out where service lines or services may be threatened, to find out which stakeholders can take a piece of that puzzle and implement it into their work as a priority.

00;16;29;00 - 00;17;01;12
Kristine Olson, M.D.
And then at the department in section level and then at the individual level. So people feel empowered for themselves. I mentioned that after I mentioned the communications person, because I don't think that each level that we implement vertically and horizontally, I don't think they all know how much the other people are also taking a piece of that puzzle so that they feel like if we all move and we all take a piece of this, that we're going to move our organization faster to make this the professional home, the place to be faster.

00;17;01;12 - 00;17;24;29
Elisa Arespacochaga
You know, it's always a challenge to make sure everyone understands the nuances of what's being done and how it's being done and how people can help. And sometimes it's just those conversations of, Oh, hey, did you know about this? And it it can make such a difference. But sometimes you think this should happen better, more routinely. more standardized. And sometimes it's just impossible to get to that level of communication.

00;17;25;02 - 00;17;41;28
Elisa Arespacochaga
So my last question for you is, you mentioned you've been doing this for quite a while. This is certainly been a passion for a long time. But how do you maintain your enthusiasm for this work? I mean, you're looking at something that has often been a side of the desk activity. It's not always had the focus and attention.

00;17;41;28 - 00;17;51;12
Elisa Arespacochaga
I think it has more now, but how do you keep up engagement to say not only are we aiming for absence of burnout, but we're really aiming for a thriving community.

00;17;51;15 - 00;18;15;26
Kristine Olson, M.D.
I think that's the reason itself. I think being a system thinker and just loving the puzzles of this work, of putting systems together, seeing how they work and wanting to fix them so that they're more efficient and better. I also think that having done a lot of international health and Peace Corps ... in the United States, we take for granted that we have a reliable health care system and I don't want anything to happen to that.

00;18;15;26 - 00;18;34;22
Kristine Olson, M.D.
I really want to make sure that we as a country have the best, most reliable health care in the world and to keep moving toward that. We still have a lot of work to do, but to keep moving toward that because it should be a real point of pride for us. As it has been, as it should be.

00;18;34;24 - 00;18;57;12
Kristine Olson, M.D.
And I want to make sure that my parents in a different state than me have access to reliable, the best health care and my family and my sisters, my loved ones, my friends. I want to make sure wherever they are that there is a reliable health care system in this country. So how do I keep mission-driven? I keep that in mind when I have obstacles.

00;18;57;12 - 00;19;16;10
Kristine Olson, M.D.
I remember that this is just a piece of the puzzle to keep moving in the direction of my calling, my mission. I use gratitude for having a such a problem to deal with these obstacles. I'm very grateful to be in a position now that I think of growth mindset. What can I how can they grow and learn from every situation that I have?

00;19;16;10 - 00;19;26;27
Kristine Olson, M.D.
Every difficulty? Grit to be persistent and grace to give myself grace and to know that I'm doing the best that I can with the resources that I have and I will keep at it.

00;19;26;29 - 00;19;35;06
Elisa Arespacochaga
It sounds like you're very much living the mission of being a well-being officer and really driving wellness in your system. Thank you so much for joining me and for sharing your story.

00;19;35;09 - 00;19;35;26
Kristine Olson, M.D.
Thank you.