How one local organization has approached peer support
The genesis and momentum for putting together a wellness program for EvergreenHealth’s medical staff started approximately 18 months ago when drug diversion was discovered, and two valued employees were found to have significant substance-abuse problems.
How did we fail to see that our valued employees and coworkers were struggling?
At that time, our CEO, Bob Malte, first asked the obvious question of why our systems failed to prevent the diversion. His second question was, how did we fail to see that our valued employees and coworkers were struggling? What followed was a focused effort around the questions of substance abuse in health care and how we could identify and help those finding themselves in that situation.
During additional discussions, our medical staff president, Dr. Scott Burks, and immediate past president, Dr. Jack Handley, asked us to make sure we were addressing issues around physician burnout and stress management. In addition, our department chair for obstetrics and gynecology, Dr. Dawn Russell, emphasized the importance of having a strong process to help medical staff members who find themselves in either a professional or personal crisis.
From these discussions, we developed our EvergreenHealth Medical Staff Wellness Program Charter:
Improve patient safety and quality of care by developing a safe and respected program that fulfills our pillars of accountability:
- Provider impairment and support
- Provider resiliency/burnout prevention
- Crisis intervention during difficult times (divorce, litigation, death of loved one).
The goal of this program is to achieve the following:
For medical staff members
- Focus on medical staff wellness
- Prevention through education
- Safe and confidential communication
- Honest and factual interventions
- Effective treatment pathways
- Respectful monitoring processes
- Effective support for medical staff leadership committees
For the referring party
- Commitment to follow through on any referral
- Clear communication on process and disposition of referrals
- Prevention through education
For the organization
- Improved safety and quality of care delivered to our patients
- Integration with the EvergreenHealth Employee Wellness initiatives
- Effective support for medical staff and administrative leadership committees
- Compliance with regulatory statutes
INSTITUTING PEER SUPPORT
We have established an EvergreenHealth Practitioner Peer Support Committee comprised of interested members of the medical staff from various specialties, our Chief Medical Officer, and our Vice President of Human Resources. Our first order of business was to develop a set of rules and regulations, as well as bylaws, that would guide and govern the activities of the committee. In addition, we put together a wellness survey to get a baseline understanding of the overall status of our medical staff with regard to stress and burnout.
MEDICAL STAFF SURVEY HIGHLIGHTS
The survey’s quantitative results show us that the vast majority of respondents—82 percent—are satisfied with their practice at EvergreenHealth. Nonetheless, many are experiencing some degree of burnout (41 percent) and are feeling a negative impact of their medical career on their family life (42 percent).
These quantitative results are echoed in the qualitative results from the survey’s open-ended questions. The qualitative results suggest that:
Stressors are large and have a great deal to do with:
- “Work and family” conflicts and pressures
- Frustration over the quantity and efficiency of work, with particular concerns over staffing levels and the EMR system
Despite the stressors, there is a strong sense of community among respondents:
- The community is now seen as collegial
- Respondents want even more collegiality in the future With the benefit of a strong, collegial community, we have the opportunity not only to listen, but also to act. We can look to an engaged medical staff, medical staff leaders, and supportive administrative leadership to assist this process.
We also engaged Washington Physicians Health Program and Physicians Insurance to help us understand the scope and challenges of the issues we are facing. The wellness committee as well as our administration elected to contract with Physicians Insurance to help us in several areas.
First was to help the EvergreenHealth Practitioner Peer Support Committee explore its strengths, weaknesses, and the opportunities to develop resources to effectively fulfill our charter. The second area was in developing an initial schedule of educational forums during which Physicians Insurance experts will help our medical staff understand the impact of stress and burnout on their professional and personal lives and begin to understand how to mitigate that impact.
OTHER INGREDIENTS FOR SUCCESS
As with any important initiative, many contributors will ensure our effectiveness. Top administrative support has been present from the beginning. EvergreenHealth’s IT professionals will be engaged to support the technology infrastructure imperative to delivering on our goals. We’ve also enlisted ongoing input from the medical staff we aim to serve. We’ve learned it is important to “know your audience”—for instance, if the term “wellness” elicits a tiresome groan from providers or sounds pedantic, it’s wise to consider other relevant or more apt terms. For us, “peer support” rings true because it is an understood concept; plus, it reinforces continued collegiality and the notion that we’re all in this together.
This effort is gaining significant momentum as our organization creates the space for constructive dialogue about the difficult and frustrating aspects of health care and how they impact us on a personal level. We are moving forward with the express goal of working together to create positive change where we have the opportunity.
While we’re pleased to know that our providers can rely upon a sense of collegiality for support, we have a goal of further formalizing that support to avoid the chance that anyone who may be suffering will slip through the cracks. Our providers are highly trained with exceptional skills to help people be well. We need the supportive structure that also keeps them well so they can continue to thrive and put their exceptional skills to use in the patient communities that need them.
Dr James D. Brown is an internist/family doctor and former medical staff president and Chairman of the Practitioner Peer Support Committee.