 Alright guys, I think we're going to get started now. So we have a very special Grand Rounds prepared today. It's on the topic of wellness and academic medicine. It's a topic that I feel like personally it's very important because reducing physician burnout will allow us to really provide the best care for all of our patients. So we have the pleasure of having Dr. Robin Marcus. He's actually the chief wellness officer at the university, come to speak to us. We also have our very own Dr. Ord, Lisa Ord, as well as Dr. Griffin Jardine who will be speaking to us about this topic as well. To jump start the session, I'm going to ask Dr. Olson to come up and share a few words. So this whole area of burnout is a national epidemic and if you look at your numbers you follow these, you want to say is it getting better or is it getting worse? It's getting worse. Ten percent increase nationally over the period of just the last few years, a whole host of reasons but this just has to be addressed seriously and I want everybody to know from the top that I am very concerned about this, that I am very interested that we do everything we can to make sure that people have appropriate work-life balance and all the tools and the rest in place to help with what they do. We've got an incredible individual who is willing to be the champion for this, Griffin Jardine has taken this on with incredible enthusiasm and excitement. We are unbelievably fortunate, uniquely fortunate to have Lisa Ord in our department who has both the skill set and the desire and the interest to help us in regards to this. I know that we have an issue of making sure exactly where we are and based on this we did get this time a very, very complete survey so that we are going to report to you exactly where we are as a department and Griffin is going to present that so you have that in place. We want to make sure that everybody knows that we have all the resources available, Robin is a champion of this and she is amazing at what she is doing and then she has further backup with all that she is going to present and put in place and then we are going to regularly be talking to people about the tools and the rest they need. This is at every level. This is at residence level, this is at fellows level, this is at faculty level so this is something that we all are engaged in and we all need to help and support each other to recognize that this is bad for us, this is bad for our patients, this is bad for our families in that we want people to be excited about what they are doing and where they are engaged in. With that I will turn it over to my good friend Robin. Tell us about it. Thank you Dr. Olson. Dr. Jardine I really appreciate being asked to come and share just a few minutes with you before we hand it off to the other two speakers. So I want to let you know first of all I am just going to give a little background information to follow up with what Dr. Olson said. Provider wellness and I am going to start with provider wellness but forgive me but I am not going to end with provider wellness. I am going to talk about the whole team but I want to talk about provider wellness because it is a little bit about what we know about with the literature. You all know about the triple aim. Well the fourth aim is taking care of the team of people that actually are responsible for the triple aim and you know we have identified this, we are actually looking for a little bit better graphic but this is what I have right now. So what we really want to talk about is how important it is and how our institution recognizes the importance of taking care of yourselves so that you can take care of others. So that is something that I think is as Dr. Olson said really coming from the top down at this institution. So the outer circle there really is clinician and also staff and team satisfaction, wellness, resilience, all the other words we are going to use to talk about that. So let me talk to you a little bit about what we know about national burnout rates. I kind of hate to start this talk with burnout, I would rather actually talk about resilience with I think is a more positive way to look at this but you can't talk about this without talking about burnout. You can't open the time magazine without talking about physician burnout these days. So we know quite a bit about observations of physician perceived burnout. Residents are in particular residents are affected by this. 50 to 75% of people across residents across the country are identifying themselves as being burnt out. Physicians are also above 50% and as Dr. Olson pointed out this is particularly scary because it has seen an increase of 10% in a relatively short amount of time and really there's no indication that this is decreasing at this point. Again I want to say we know that all healthcare professionals are at risk and in our institution we really have an institution wide initiative to address this. So a little bit about our own data, we have a, let me just give you a little bit of history, so we put together a GME wellness committee about a year ago and over that period of time, it's a very multidisciplinary committee and over that period of time we initially started with a resident and fellow survey. That was quite an extensive survey, some of you in here probably took that survey and we actually hired a wonderful clinical psychologist who now is the director of GME wellness who's part of our team. And what we identified in that initial survey was that about 46% of residents were self-identifying as burnt out and another and about fewer but 23% of the fellows on that same survey were self-identified as burnt out. And then there was another survey that we did with the faculty where we identified that about 30% of our faculty across the system and this was, I think we had an N of about 608 people take this survey so it's not all of our physicians but this was a physician survey, faculty survey. And the important point here is that 30% we think represents is actually very conservative because it was representing only one piece of burnt out which is emotional exhaustion so on surveys where you're looking at a few different pieces of burnt out those numbers are expected to go up. So it correlates with burnt out, you could probably tell me right in the room but what we know from the literature is one of the number one things is a sense of control and autonomy in what you do. We also know that regulatory requirements are affecting provider levels of burnout, productivity pressure as well, work hours and not only the number of work hours and that isn't directly correlated with burnt out interestingly but the flexibility of those work hours is very much correlated with burnt out. Whether you perceive what you're doing is important and appreciated by your superiors is also highly correlated with burnout and then things that are in my wheelhouse like whether you eat well, whether you sleep well, whether you get enough physical activity those are things that are also associated with burnout, your stress level, whether you're satisfied with your job and I will tell you that in our survey that we did here we have very, very high job satisfaction and we still have a relatively significant large amount of burnout so in our survey in particular just because you were satisfied with your job did not mean that you were not self-identifying as burnt out but nationally that does seem to be an issue and then importantly team function and we have found that to be significantly correlated with people self-perceived burnout. So failure to respond and I probably don't have to tell you about this but when I talk to leadership we really push this because it is very, very important that we respond to this as Dr. Olson said. We know that burnout is associated with poor medical outcomes so poor outcomes of the patients that you see that's very important. It's also associated with patient satisfaction. There the disruptive behaviors that are associated with burnout are something that colleagues have to deal with. It's significant productivity, lack of empathy. Those are important things, satisfaction and engagement. Again the numbers here speak loudly to people that are concerned with costs and I put this number up here because we used to say when I first started doing this talk when we looked in the literature we tried to find as much information as we could and we used to say that it costs about $250,000 to replace a physician and actually the most recent data is suggesting that if we include both the indirect costs and the direct costs of replacing a physician in an academic medical center it approaches close to a million dollars. So if we lose a physician because of burnout not only is it a terrible thing for them personally and I don't mean to say that I put that down low because it's not important it's extremely important. The personal consequences of burnout are very important but our systems consequences and the financial consequences of burnout are very important. So we don't neglect to mention that now. And then finally and again I put this last more to emphasize it because the very real personal consequences of burnout are something that we're all very concerned about. So this is hot off the presses the organizational plan value kind of road map for fiscal year 18 and the reason that I put this up is if we look at this yes I have a maybe I don't it's okay. If you look at this slide you can see obviously the patient experience quality and financial strength those are our main areas that where goals are written for our organizational plan and this year we have provider experience and wellness workforce planning employee engagement and clinical support down in the lower left hand corner of this those are all very much related to having a staff and faculty that is not burnout. So you know and you can actually look across here there are several of these issues that can be and should be addressed by keeping our employees our faculty our staff your teams well and satisfied and so I think that this wasn't there if you looked at the fiscal year 17 or 16 it wasn't it's starting to come in and now it's very explicitly identified on our our roadmap to success for the institution. So I think that's a good that's a very good sign. So I'm going to talk to you just briefly about where a lot of this work is gone. So I told you that GME about a year ago we established a committee and that ended up with us having a GME wellness director now and about at the same time we brought together a group again of a very interdisciplinary group of individuals to start talking about physician and I will say physician because that's where it started out physician wellness and resiliency and basically what we were talking about around the table was what can we do to prevent what we know might be inevitable if we don't do something and that is really really terrible outcomes not only patient outcomes but personal outcomes for our physicians because academic medicine medicine in general is hard and hard things happen and we need to address this. So this was a group of people that came together across the system including risk management my office the faculty affairs office and others and the result of this was um over about a three month period of time was we decided that we wanted to go to leadership to propose a resiliency center um and that resiliency center we decided by the end of this about three month period of meeting needed to address resiliency from more than the physician's perspective the physician is very very important but the team was also very important and so the resiliency center was born basically and the resiliency center is is now a reality and it is we've identified certain pillars and I'll talk about those in just a minute but the resiliency center we want to be a hub for coordinating and supporting our entire health system relative to wellness and resilience it will bring together uh undergraduate medical education graduate medical education uh at UUMG there there's compassionate workforce of our huntsmen there are a lot of of uh moving pieces that we're trying to coordinate and the three programmatic pillars that have been identified as being important to the resiliency center are listed here so one is faculty and staff wellness initiatives I'll talk briefly about in a second another one is a communication skills program and another one is a peer counseling program oh and finally sorry there we also are bringing on site uh an EAP provider um who will be here at the institution 40 hours a week EAP that employee assistance program and I'll talk a little bit more about that just a second so the the first pillar being faculty staff wellness initiatives just to let you know so what we're looking at is there are a lot of really great things and and just looking out here what you guys are doing here is phenomenal and we're not trying to obviously take that into the resiliency center but we want to be able to help share the good work that's going on across the system and learn from from each other and start to provide what we think is best practices so we want to build capacity and support local innovation that's occurring with wellness in the departments and the clinics we also want to coordinate faculty staff wellness initiatives that are aimed at engagement and satisfaction so we're working with HR as well and one of the things you'll be pleased about I hope is we're trying to coordinate the number of surveys we send out and try to figure out who's sending what and why what information we're getting because right now it's a little bit confusing so we're hoping to to identify that one of the initiatives that we started about a year ago again was the faculty wellness champion program and that will be coordinated under the resiliency center now as well we hope to have a coordinated approach to mindfulness both at the individual level and the team level because there are a lot of people doing a lot of good things in mindfulness but we want to coordinate this so that we can share again what's working we also and importantly because we're an academic medical center we want to track outcomes we want to show impact or not and change course if we're not having an impact and we want to share best practices across the health system but also we want to be able to disseminate information across the country so in fact right now my colleague who is one of the associate directors of the resiliency center is at the AMA in Chicago at a meeting presenting some of this information so I mentioned the second pillar being a communication skills program it's pretty clear that communication skills are both across the team between team members between team members and patients the the better we communicate the less burnt out we seem to be and the more resilient we seem to be so that's a very important piece we were we're planning on modeling this program off of a program that you're probably familiar with which is the u cope program in palliative care but we're it's not going to be the exact same program so we're trying to modify that program to meet the needs of our providers and the teams and we really hope that again this is there are a lot of communication programs going on across campus and what we're trying to do is we're trying to bring those together and coordinate so that your as providers you're not asked to go to six different communication programs so that we can we can hopefully coordinate our efforts here the third pillar is a peer support program and very very important in preventing burnout and improving resilience the ability to talk to someone like you who's going through the same thing and whether that is a nurse to nurse or whether that is a doctor to doctor we're hoping to build this program based on a pretty successful program that's currently working out of stanford where we will train people we'll train peers at our institution and have a group of people that are available to you when needed and then finally I said that we're going to have a an EAP individual on on campus so the employee assistance program is great we have a great benefit here but oftentimes it's not used and part of the reason why it's not used is because it's not here and so what we are we're teaming with our EAP provider and there'll actually be three different providers and they will be here early and late and part of the middle of the day for some direct crisis management direct counseling but more importantly they're going to be part of this team for prevention so it's not just you need to go see an EAP provider hopefully this will be integrated into our the whole preventive aspect of the resiliency center so just to finish up here I just have a couple more slides one of the things that I want to point out is we understand that resilience is not just telling you all to buck up and bounce back it is the system and the individual and my role really is to champion this at the system level to make sure that we're getting we have the capacity and the ability to change the system so what I thought was wellness two years ago I had no idea that wellness was epic okay but wellness is epic and I understand that now and not that I can change epic but that's the role that you know I can help play and the resiliency center leadership can help play so this is not just at the individual level although we think but we can we can't offer more important and valuable individual programs we need to address this so that at the individual at the department at the clinic level at the to fulfill our academic mission and at the health system level and so many of the meetings that I've had have been with you know Howard Weeks with epic things that I never thought as a wellness professional that I would be doing but I want you to understand that at least our leadership is understanding that so the resiliency center will be in the HSEB located just south on the fifth floor just south of faculty affairs importantly we they will also be electronically available so even though we know that's across the street it's across the street so they will be electronically available and they will also be on the road so you can expect to see them and hopefully working with your providers over here we have two faculty co-directors who are terrific Amy Locke and in department of family and preventive medicine and Ellen Morrow and the department of surgery are leading the effort from the physician side and then we have hired a new clinical psychologist her name is Megan Call she will hit the ground on May 1st next Monday here and she is coming to us from Dartmouth where she has been involved in their physician wellness initiatives I don't I can't tell you the AP providers are yet because we don't have names so I'll just finish by saying that you know again resilience is the capacity to respond to stress in a way such that goals are achieved at minimal psychological and physical costs resilient individuals bounce back after challenges while also growing stronger but that's not we don't just expect you to suck it up and bounce back we're hoping to actually provide resources to help you so I'll finish there and if you want any questions