The Growing Role of Chief Wellness Officers in Health Care

00;00;00;26 - 00;00;21;04
Tom Haederle
If someone at a party should ask, "What do you do?" And you reply, "I'm a doctor," most people get it right away. But if your answer is, "I'm a chief wellness officer," you might very well be asked, "What's that?" There is a growing group of chief wellness officers, sometimes called
chief well-being officers, currently employed by hospitals and health systems in the U.S.

00;00;21;06 - 00;00;37;21
Tom Haederle
In a nutshell, their job is caring for those who care for patients, and there's a great need for their services.

00;00;37;23 - 00;01;03;17
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Today, we hear more about the important role that a chief wellness or well-being officer can play in support of the mental, emotional and physical wellness of doctors, nurses and other health care professionals. Dr. Jon Ripp is among the first people in the country to hold such a position and can truly be called a definer of the job.

00;01;03;19 - 00;01;15;11
Tom Haederle
The very idea of a chief wellness officer has evolved and come a long way in the past dozen years or so. As Dr. Ripp explains, we were building the ship as we were sailing it. Let's join the discussion.

00;01;15;14 - 00;01;34;25
Elisa Arespacochaga
Thanks Tom. I'm Elisa Arespacochaga, AHA's vice president of clinical affairs and workforce, and today I'm really happy to be joined by Dr. Jon Ripp, dean for well-being and resilience and chief wellness officer at the Icahn School of Medicine at Mount Sinai and the inaugural president of the Collaborative for Healing and Renewal in Medicine. More commonly known as CHARM.

00;01;34;27 - 00;01;53;21
Elisa Arespacochaga
Today we're talking about the role of the chief well-being officer, chief wellness officer, depending on where you are. And Jon, you are if not the second or third, one of the first chief well-being officers in the country. So can you tell me just a little bit about yourself and your role and how you got there?

00;01;53;24 - 00;02;20;10
Jonathan Ripp, M.D.
Sure. Yeah. Thanks. Thanks for the opportunity. Thanks again. It's great to be with you and have this opportunity to chat. So that's correct. I am the chief wellness officer here at Mount Sinai in New York City. I've been in this role coming up on on six years. I am a practicing general internist. I originally came to Mt. Sinai for a residency training in internal medicine and then pretty much been here ever since, going on well over two decades now.

00;02;20;12 - 00;02;51;19
Jonathan Ripp, M.D.
And when I got started as after residency in working as a general academic internist, I began, like many of us do in academic medicine, exploring possibilities for career interests, for a career focus. And it was around that time in the very early 2000s that I became interested in well-being, specifically of residence was where I got started, and specifically from a scholarly pursuit.

00;02;51;19 - 00;03;20;06
Jonathan Ripp, M.D.
I was sort of fascinated about the very nascent literature at the time and thought this might be something interesting to do and really got started in that way. And so I began doing some small studies, and then as I grew my my career, my academic focus, I began doing some multicenter studies and probably around a dozen years ago or so, my interests kind of were following what was going on nationally.

00;03;20;06 - 00;03;48;23
Jonathan Ripp, M.D.
And a lot of us were starting to say, you know, well, we don't want to just study a problem. We want to try to be part part of the solution. And increasingly, health care systems, schools of medicine and so forth, recognize, okay, we've got a problem here and we should we should do something about it. And it was around that time that I began working more closely with our office of graduate medical education, looking at the well-being of residents across our pretty large system we have.

00;03;48;26 - 00;04;13;21
Jonathan Ripp, M.D.
So I began as an administrative role addressing well-being in that group, in residence and and fellows, and began as an associate dean and was in that role for a little while when about, I guess, seven years ago or so now, I was approached by the dean of our school of medicine, who really had the foresight to recognize that this was not going to be a challenge limited to any one group within the constituency, the school of medicine.

00;04;13;24 - 00;04;30;01
Jonathan Ripp, M.D.
And it was right around the time that this idea of a chief wellness officer was was being developed — Tait Shanafelt at Stanford typically gets credit for being the first. I was probably within the first four or five. You know, there's many now, there's probably 60 or 70.

00;04;30;03 - 00;04;51;03
Elisa Arespacochaga
That's great. And I really do believe that a lot of this work really did start in looking at small groups and then expanding out and realizing, wait, if this group is experiencing this, maybe this other group is as well. And I know that's been part of your work and focus is to understand in small slices where the challenges are.

00;04;51;03 - 00;05;08;11
Elisa Arespacochaga
But then to take a look at that slice and say, okay, where else is this happening? So as you have really, you know, been one of the definers of the role of a chief wellness officer, how do you explain it to people and how it fits into the organizational structure of the typical hospital?

00;05;08;19 - 00;05;29;26
Jonathan Ripp, M.D.
Yeah, it's a great, great question. One that I that I would say I deal with all the time because part of the role actually is explaining to people who you are and what you do and why there's a need for you and, you know, I think it still remains that there are those that recognize the importance and there are the naysayers for sure.

00;05;29;29 - 00;05;57;05
Jonathan Ripp, M.D.
And I will just say, by the way, in followup to your previous comment, I mean, I think in addition to, so part of the need for chief wellness officers to address the well-being concerns of a large group of individuals and and each health care system or school of medicine is a little different in terms of the constituency that a chief wellness officer might be connected with, but ultimately the health care professions and health care professionals.

00;05;57;11 - 00;06;23;21
Jonathan Ripp, M.D.
You know, we're all interconnected. We work. There's a very large amount of team-based care, right? And so and similarly, we train our future health care professionals, our students and trainees. In that context, you can't really pay attention to one group isolated from the other. The interconnectedness is key. So what is a chief wellness officer?

00;06;23;24 - 00;06;48;10
Jonathan Ripp, M.D.
I think it's pretty fair to say that those of us who have been doing it, dare I say, as long as I have, which is not that long, but it's still very new, we're part of a cohort that kind of you know, we were building the ship as we were sailing it, so we recognized that there was a need for a leader who was responsible for overseeing a large effort at the institutional level.

00;06;48;10 - 00;07;09;29
Jonathan Ripp, M.D.
I mean, that at its base is, is why we believe there's a need for a chief wellness officer, because there's a level of work here that requires some unique expertise. So you need you need an individual that brings that. It's a volume of work that can't be absorbed in some other existing position. There's just too much of it.

00;07;10;04 - 00;07;34;20
Jonathan Ripp, M.D.
And it's distinct work. It's distinct from those other areas. Those principles, I think, underscore why there's a need for a distinct position. And that's, I think, what got a lot of us, those of us who had already developed some of the expertise involved to be named in these positions in the early years. So that was kind of, you know, sailing the ship and we've been building it.

00;07;34;22 - 00;08;13;17
Jonathan Ripp, M.D.
And I'd like to think that we're kind of at phase two, you know, 2.0 now, where at least in broad strokes, we have a sense of what the core functions are of a chief wellness officer. And the way I describe those and I do it regularly here, you know, we are the individuals that bring the expertise that's needed to measure the problem, to really understand how do you take the pulse of of how a given group of of health care professionals and trainees are doing and perhaps more importantly, how do you measure the drivers that are impacting how they're doing?

00;08;13;19 - 00;08;33;25
Jonathan Ripp, M.D.
And then it's that you can't just gather information. You have to be able to disseminate it and disseminate it in a meaningful, digestible fashion. So that's a critical part of the role, which I think is often not given enough attention that, we now know how to collect, do surveys where we collect these data and understand the drivers.

00;08;33;27 - 00;08;56;25
Jonathan Ripp, M.D.
But there's a lot of data. So we need to be able to digest it and provide that to given stakeholders that are enabled to act on it in, you know, in every health care system and school is a little different. We're all matrixed and there's lots of different leaders at different levels. But in the end we need to deliver that information at the unit level, whatever you want to call that unit, because there's going to be variations.

00;08;56;25 - 00;09;27;10
Jonathan Ripp, M.D.
We need to be able to give that information to surgeons and primary care doctors and, you know, procedural lists, but also, you know, to trainees, to students, we need to break it down, slice and dice it, and give it to the leaders who can act on it in a way that's action-oriented, that's solutions-focused. The other big piece of what we do is we lead by influence and we try to direct the development of solutions that we think might and we've studied and we know are likely to have impact on those drivers that we identify.

00;09;27;10 - 00;09;49;01
Jonathan Ripp, M.D.
So measuring, measuring the data and the drivers digesting and disseminating and providing it in a way to leaders so that they can act on it. And usually the last piece I should add is that a lot of us now are overseeing what we call well-being champions or directors. These are individuals embedded in and associated with a given unit.

00;09;49;03 - 00;10;13;05
Elisa Arespacochaga
So a lot of what you just said makes it sound like your critical partners are basically across the organization. But can you talk a little bit about who are those folks that you really, in addition to well-being champions or directors who are working as sort of part of the team, who are those critical partners in your leadership circle that really help this work move forward?

00;10;13;08 - 00;10;49;01
Jonathan Ripp, M.D.
So I frequently say that chief wellness officers are leaders who lead by influence in the truest sense. We can only really be effective if we're able to influence those individuals who are at the helm of given system-level responsibilities that are likely to have dramatic impact on the well-being of the workforce. And it's important to take one step back and and really speak to how we think chief well-being officers, chief wellness officers should focus, right?

00;10;49;01 - 00;11;05;26
Jonathan Ripp, M.D.
So actually, I think there's been some work in the last several years as chief wellness officers that come about to help us define our focus, because actually, in the end, well-being can be all things to all people. I mean, just about anything can be construed to influence one's well-being. So we need to have some focus.

00;11;05;26 - 00;11;37;20
Jonathan Ripp, M.D.
And those of us who are chief well-being officers, largely we ascribe to the idea that we need to try to impact the system. We're more about kind of creating the environment that enables our health care workforce to flourish and thrive. And maybe preventing those barriers to thriving. And so really our focus tends to be on the system and therefore our partners who we try to influence through collaborative relationships, are going to be situated in relationship to some of those drivers.

00;11;37;20 - 00;12;01;27
Jonathan Ripp, M.D.
So what do I mean by that? Well, clearly your operational leaders right? The folks that help enable work to be done, folks that are in the quality work space that already have an improvement mindset. Well, a lot of well-being work is just improving work conditions as opposed to quality, perhaps where the output is some kind of metric of, you know, patient care.

00;12;01;29 - 00;12;26;26
Jonathan Ripp, M.D.
The metric for us in improvement is some measure of the well-being of the workforce, and they're intimately interrelated. So, you know, our operational leaders are quality leaders, are continuous improvement leaders, but also, as you know, no stranger to the audience that's listening, no doubt is, you know, the relationship with the electronic health record.

00;12;27;00 - 00;12;46;20
Jonathan Ripp, M.D.
We have to partner with our IT colleagues, our electronic health record colleagues. There's many others, quite honestly, who we need to connect with. Our mission, the way we've kind of designed it in Mt. Sinai is we want to, you know, enable all our workforce to be able to efficiently and effectively do their work in a place where they feel valued.

00;12;46;20 - 00;13;13;26
Jonathan Ripp, M.D.
And so our belief that if we can do that, then they're going to be able to unlock the inherent meaning in the health care professions. So anyone involved in cultural work, leadership trainers and folks, even folks in human resources, even though they do a lot of work that's distinct from ours, they're often involved in onboarding and sort of critical times of of providing content that help influence the culture a bit.

00;13;14;04 - 00;13;25;16
Jonathan Ripp, M.D.
A lot of the work of the chief wellness officers building those relationships with these individuals so that when there is an ask that we ask of them, they understand who we are and why it's important and we can move forward.

00;13;25;20 - 00;13;56;18
Elisa Arespacochaga
Absolutely. Nothing at this leadership level gets done by yourself in a room. So really being able to have those connections is key. For organizations that either don't have this role yet or are thinking about how to do it or are still figuring that out, what are some of the ways that you've seen people start to champion this work and really bring about a focus, if not necessarily a position at first?

00;13;56;20 - 00;14;30;18
Jonathan Ripp, M.D.
You know, I often speak about what I'm speaking with you about today in various venues and settings across the country. And this is a common question. Well, it's great that you're a chief wellness officer and you have a team and a budget and you have all this work that you're doing. But I'm at an organization that is not going to commit to that, and what I will say is I've been doing this work for 20 years and it's been a journey and every institution is at a different phase in terms of their level of commitment.

00;14;30;18 - 00;14;55;08
Jonathan Ripp, M.D.
And we're all moving in a direction towards making this work more standard. So if you don't have a chief wellness officer, I'm not sure my recommendation would be to put all your stock in trying to get one or trying to get one approved. It's more about actually understanding some of what we've already discussed in terms of what are the outputs of a chief wellness officer, what are the roles and responsibilities.

00;14;55;10 - 00;15;21;16
Jonathan Ripp, M.D.
And if you don't have one person on the team that's dedicated to that, well, maybe you do it in parts, or maybe you don't do it for your entire health care system. Maybe you start with one constituent group where there's greater buy-in from some some local leaders. So maybe it's about just gathering some survey data for one of your large departments or one of your health care professional groups. Is it physicians,

00;15;21;16 - 00;15;43;26
Jonathan Ripp, M.D.
is it the nurses? Maybe it's just about starting some some of the basic programming and solutions that we think have impact at the system level. So you just focus on bringing well-being-centered leadership training to your institution so that more of your leaders understand the  ways in which they lead are going to impact the well-being of your people.

00;15;43;26 - 00;16;08;20
Jonathan Ripp, M.D.
So the difference is that a chief wellness officer actually is getting, there's enough of a commitment tangible for meeting the metrics that are associated with the roles and responsibilities of the position. So if you're at an institution that doesn't have that level of commitment, well, then maybe you're just going to take on some of that. There's basically a lot of places that are at those stages, and that's okay.

00;16;08;22 - 00;16;21;02
Jonathan Ripp, M.D.
It's actually really important to try to understand where your institution is at, what the level of commitment is, where you're likely to have impact, who your partners are that are going to work with you. So that's that's how I would think about it.

00;16;21;05 - 00;16;50;28
Elisa Arespacochaga
That's wonderful. And I really want to thank you and your colleagues at CHARM for the work we've done thus far and hope to publish very soon. That really highlights some of the learnings that you all have gotten through. I guess just blood, sweat and tears, because you didn't have a manual to do it. Just to wrap up, I have one more question, which is just briefly, where do you see this role going in the future, at least maybe just for you, maybe for the field?

00;16;51;00 - 00;17;11;03
Jonathan Ripp, M.D.
I think I'll answer from the standpoint of the field. I feel very fortunate that, you know, I'm able to do the work that I do and I've been able to reach this position. I can remember being on a panel some years ago. I think someone said, how do you get to to where you are? And one of the panelists said, well, you can just, you know, just follow

00;17;11;04 - 00;17;34;10
Jonathan Ripp, M.D.
the chief wellness officer track that Jon followed. And I remember thinking, I don't remember this track. I kind of just followed my passion and, you know, and sort of advocated that certain things be be put into place. And I had the fortune of being somewhere where leadership valued this and put me in this position that I've been so fortunate to hold for the last several years.

00;17;34;17 - 00;17;57;03
Jonathan Ripp, M.D.
The kind of aspirational state, the ideal future state, is one in which this work is recognized. Yeah, as I mentioned before, as being part of the standard operations of health care systems and health care professional schools. I'd like for it to be reflexive that this is part of the standard group of of leaders running a health care system.

00;17;57;10 - 00;18;26;16
Jonathan Ripp, M.D.
One interesting dynamic of that is that, you know, it should be so standard that when you're doing improvement work, for example, when you're trying to enhance the function of your health care system, that there are a few outcomes that you're looking for. You know, you want to be able to deliver high value care. You want to be productive and efficient and and provide high quality care that, you know, is well received by the patient population.

00;18;26;20 - 00;19;00;11
Jonathan Ripp, M.D.
But it also should be, should be that the work is done to improve the experience of the workforce and that it's just part of of what's done. Some of us feel a little antsy about that because maybe it means like we won't be necessary down the road. But I would argue that even when that, you know, let's say that in that ideal future state, it's standard that we have, you know, well-being, that we always pay attention to  the well-being of the workforce as one of the outcomes of our work.

00;19;00;13 - 00;19;19;03
Jonathan Ripp, M.D.
You know, you'll still need folks who understand how to measure it, who understand how to track the drivers and who can be those partners with the other, you know, the other leaders who are responsible for their priority. You know, for the quality and the patient and the value of the health care delivery.

00;19;19;05 - 00;19;43;17
Elisa Arespacochaga
Absolutely. I don't think in any way we need fewer of you. We need more of you. And I'm really excited for where this role may go from the advocate to really being a integral part of the system and how it operates. So, Jon, thank you so much for sharing your expertise and your just your deep knowledge about this topic with us today.

00;19;43;20 - 00;19;44;25
Jonathan Ripp, M.D.
Thank you. It's been a pleasure.