Building a Wellbeing Program at a Major Academic

Building a Wellbeing Program at a Major Academic Health System DCHA Educational Symposium 11/15/18 Daniel Marchalik, MD Rebecca Evangelista, MD Karen Jerome, MD

Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Washington Regional Transplant Community (WRTC) and the District of Columbia Hospital Association (DCHA). WRTC is accredited by the ACCME to provide continuing medical education for physicians. WRTC is accredited as a provider of continuing nursing education by the California Board of Nursing Education.

Agenda • Physician Wellbeing • Med. Star Health • Georgetown University School of Medicine Mind Body Medicine Program • Guided Meditation • Mind Body Medicine Program Expanded • Med. Star Washington Hospital Center • Summary

Physician Burnout Data* Burnout in U. S. alone: >40, 000 Medical Students >60, 000 Residents and Fellows >500, 000 Physicians 54% of physicians | 2 x general population *Shanafelt; Mayo Clinic Proceedings 90(12)

Why Investing in Physician Burnout Matters PERSONAL PROFESSIONAL Productivity 1. 43 OR of decreasing FTE Recruitment and Retention 2 x more likely to leave job Quality and Safety 1. 9 OR for suicide Patient Satisfaction Substance Abuse 5 -11% increase in reporting an error 2. 28 OR for decreased satisfaction Suicide 1. 25 OR for alcohol abuse Depression 2 x rate of the general population Broken Relationships 2 x rate of work-home conflicts Mayo Clin Proc 92: 1 | JAMA 296: 1071 | JAMA 304: 1173 | JAMA 302: 1293 | Ann Int Med 136: 358 | Ann Surg 251: 995 | JAMA 306: 952 | Health Psych 12: 93 | JACS 212: 42 | Ann Int Med 149: 334 | Arch Surg 146: 54

CULTURE What does it feel like to be at work? Culture of Wellness Efficiency of Practice Professional Fulfillment SYSTEM How hard is it to do my job? Personal Resilience Burnout: SELF How do I stay balanced and healthy? Emotional Exhaustion Depersonalization (Callousness) Lack of Personal Achievement

Med. Star Health • Physician Wellness Academic Consortium (PWAC) • Medical Director, Physician Wellbeing • Care. com • Wellness Champions • Working with HR

Mind-Body Medicine Program Georgetown U School of Medicine (Created by Nancy Harazduk, MEd, MSW) Group Format Session Structure • • 10 students and 2 faculty facilitators per group Optional elective during first and second years 2 hours once a week for 11 weeks • • • confidentiality, respect, compassionate listening, non-judgment Check-in • • Slide Adapted from Aviad Haramati Strict adherence to safe environment guidelines Reflections, insights, stressors Introduction of a new mind-body medicine skill Process the experiential exercise

Mind-Body Medicine Program Georgetown U School of Medicine Skills and Experiences • • Mindfulness Meditation Guided Imagery Autogenic training/biofeedback Drawing Music Movement Journaling Group support Slide Adapted from Aviad Haramati

Experiential Learning

Mind Body Medicine Program Expansion MGUH Anesthesiology Residency • “Voluntold” for each PGY cohort • Protected time from Department Chair • Away retreat plus monthly group meetings Continued Expansion • Other residency programs • Looking outside GME

Med. Star Washington Hospital Center (MWHC) • Executive Support—CMO, now President • Faculty recruitment and training – Med. Star Health Mind—Body Medicine Physician Wellness Training Program • 3 day retreats at Aspen Wye River Conference Center • 25 Med. Star Health physicians trained in 3 sessions – 10 MWHC physicians trained • Training applied – Residency/fellowship faculty leaders

MWHC (Continued) • Clinicians being more broadly engaged – By CQO and Medical Director, Physician Wellbeing – Resilience groups being organized • MBM-trained faculty facilitators to lead groups – Multispecialty and at different career stages – Attendings, residents, and advanced practice providers (e. g. PAs, NPs, AAs) • Dedicated physician wellness space planned • Clinician support for unanticipated outcomes – Care for the Caregiver – Patient Communication Consult Service

Summary • At Med. Star Health we’ve embraced the fact that physicians and other healthcare providers need to take care of themselves if they are to remain emotionally and physically healthy and successfully care for others. We started with our medical students. Next we engaged our trainees. Now it’s time for the rest of the team. • Here’s hoping that this activity is contagious.

QUESTIONS?