← Becker’s Healthcare Podcast
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- [00:00]
A
Hello everyone, this is Jacob Emerson with the Beckers Healthcare podcast. Thrilled today to be joined by Dr. Tate Shanafelt, who is the Chief Wellness Officer at Stanford Medicine. Dr. Shanifel, thank you so much for taking the time to be with me on the podcast today.
- [00:15]
B
Great to be with you, Jacob.
- [00:17]
A
Absolutely. And glad you could be here with us. Tate, before we dive into everything, we want to talk with you about some really important issues. I'm hoping you could tell us a little bit more about yourself, your background in healthcare and what it is that you do today at Stanford Medicine.
- [00:33]
B
Sure. I'm a hematologist oncologist. My clinical work is in adult leukemia. I've spent a large portion of my career being a translational researcher running clinical trials and prognostic work for patients with adult leukemia. And, and have also for the last 25 years conducted a number of research studies and ultimately organizational intervention efforts to improve clinician well being and its consequences for quality of care, patient experience. My current role, as you mentioned, I'm the Chief Wellness Officer, Associate Dean at Stanford Medicine.
- [01:19]
A
Fantastic. Well, like I said, we're really glad to have you here with us and to hear about some of the latest work you've been overseeing at Stanford. Part of that you were chatting with us earlier this year. We quoted you about researchers at Stanford surveying practicing physicians to track changes in burnout and well being among the workforce nationally. So before we dive into that, I wonder if we could level set for our audience and talk a little bit about how Stanford Healthcare's well being strategy has evolved over, over the last few years or so. What, what would you say is fundamentally different about that strategy now compared even to a few years ago?
- [02:03]
B
I think our efforts have continued to broaden and deepen the way they permeate the overall organizational thinking and our holistic leadership efforts across the institution. We have both our broad efforts of things that we do at the level of the overall hospitals school of medicine that are, I'll say, sort of raise all boats type efforts. As those efforts have deepened and they include a number of things around optimizing the ambulatory practice environment, reducing documentation burden, enhancing teamwork, mitigating the tsunami, the impact of that tsunami, of messages in the EHR inbox affecting those in the ambulatory practice, also optimizing the procedural environment, the hospital environment. And that really pertains to structural characteristics of the way OR teams work together, the predictability of or scheduling, hopefully trying to help people get home on time and be able to engage in at least elective procedures in A very efficient way. We now have operational plan metrics for our C suite around those targets so that the improvement work in that space is really co owned by all the organization's leaders. There's a number of other broad system level initiatives related to reducing the impact of mistreatment experiences of our healthcare workforce that originates with patients, families, visitors to our centers. Even though it's a small number of people that engage in such behaviors, they really can have a large impact on the work experience of our clinicians. And then complementing those sort of broad efforts that our system level targets, we complement that with tailored work to address the unique needs of different specialists. Given our structure as an academic center that really cascades into our 18 clinical departments goes without saying, pathologists daily work is different than a surgeon's or primary care physicians. And there are things we need to do to improve the daily workflows and work experience for the different needs of those groups. So as our work has matured, we not only now have leaders to advance the well being work in each of those 18 departments with funded time, but we have a holistic annual plan that each One of those 18 departments puts together that speaks to how they're addressing operational inefficiencies unique to their specialty and prioritize based on the needs of that group. In addition to sort of the holistic efforts to improve belongings, sort of mitigate the way work adversely impacts personal relationships distinct to that specialty. And so I think we've just seen continued maturation of both those broad holistic efforts, the commitment of all, all hospital operational leaders to them, complemented with these deeper dives to address the unique needs.
- [05:17]
A
In each department certainly. So clearly there's a lot going into your strategy right now across the enterprise to really broaden your efforts here. And it's interesting you started off by mentioning your efforts to address administrative burnout, because we really do from our side of things, hear so much today from the physician workforce about burnout in that area in terms of messages from patients and, and an overwhelming amount there or dealing with prior authorization and all of that kind of thing. So really fascinating to hear that that's a big area of focus for you. Tate, what would you say comes next in terms of the well being strategy, new efforts or things that are coming down the pipeline?
- [06:02]
B
An area that we've really been spending increased attention on is the way in which work impacts people's personal relationships. As a slightly different way of approaching this problem. We've seen in national studies that we've now published that physicians have a much greater adverse impact of work on personal relationships relative to workers in all other fields independent of hours. And so it's not just about the number of hours and sometimes the unpredictability of the hours physicians work, but the ways in which the professional demands spill over and impact relationships with spouses, partners, family members, other relationships is really consequential. And what our evidence shows is that not only is that something that the person experiencing those impacts cares about, but we've actually shown in prospective longitudinal studies that the scores on that scale for our physicians at Stanford today predict unsolicited patient complaints for that physician over the next one, two and three year interval. And that those scores actually have also been shown to link to malpractice risk. And so that when work starts to have those detrimental effects on personal relationships, it actually undermines our ability as an organization to achieve some of our other priorities like improving patient experience or improving quality of care. And so as we think about that domain, certainly there are things we do as individual physicians to foster work life integration, to recognize the threat, protect our relationships. But I think we have a much more comprehensive view as an organization of what does this mean for us as an organization if this is really undermining our other mission priorities. How are we thinking about the things you touched on, volume of inbox messages that people are handling at night, documentation load that spills over into the evening? Do we have actually meaningful cross coverage when people are on vacation so that they don't have to log in and answer patient messages? Are we thinking about predictability to the daily work schedule for our anesthesia colleagues who might have unpredictable time when their last surgery case will end? You know, all of these things actually show up in that impact to work on relationships domain. They have structural opportunities for intervention and that those moving the needle on that outcome actually is really important for us from an organizational perspective. So that's a domain we've really been thinking about in a different and deeper way.
- [08:58]
A
And that's really fascinating that you're basically saying that your research has shown that you can tie personal issues affecting physicians to, to patient complaints and potentially even malpractice risk. That's, that's really interesting. And I, and I also want to ask you about some other recent research that, that Stanford has been doing. There was a recent national physician survey led by the health system that has shown some improvement in physician burnout rates. So exactly what we're talking about, Tate. But it's also showing that levels are still alarmingly high. When you compare it to the general workforce. It's far above other, other industries. It's probably not very surprising to, to our listeners working in health systems all over the country right now, But I wonder what you would tell them in terms of what to actually do with that information. Are there organizational shifts or leadership mindsets that you would really urge should change in response to some of these numbers that we're still seeing?
- [10:05]
B
It's a great question, and I think about it sort of from two vantage points. One, I do think that the improvement is something we want to recognize and to, you know, it illustrates that it is possible for us to make progress and some of the changes and interventions and things that are going on are probably making a difference, contribute to that improvement. Improvement. And we still have a long way to go, as you point out. And so, you know, my hope is that it does two things. It both motivates us that we have more to do, but also reminds us that we can make progress and there's evidence that we have made progress. So let's accelerate those efforts and that then the next reflection for all of us as leaders is how do we continue to have this more completely or deeply permeate our thinking as leadership teams? And you know, obviously a decade ago, there were no chief wellness officers or individuals who were leading wellness efforts within organizations. Increasingly, more and more large organizations have established a leader who is helping architect the plan for the organization and driving progress. But in the same way that we believe all of our leadership team at all levels owns quality improvement or owns our organizational efforts to improve patient experience or even to reduce costs, you know, this domain is no different that it's not just the quality officer advancing wellness, it's the way in which that individual helps evolve our thinking across all leaders and teams and be a resource to those leaders and teams, but those groups having to do the work. It's really true in the wellness domain of how do we increasingly have all of our operational leaders and teams factoring in the impact of our decisions, changes in the way we do things? How will that impact the experience of the workforce? Are we getting the right input? Is this one of the variables we're reflecting on as we make key decisions? Just like we would not make any decision without thinking about the cost implications, the quality implications, the patient experience implications, we also really need to be thinking, what's the implications for the, for how this will affect burnout, professional fulfillment of the workforce? And it's certainly not the only variable in the equation, but it's one we should never be making major Decisions without having considered and thinking about are there ways that with consideration we can implement decisions or make decisions that are going to help us achieve our other objectives, but do so in a way that doesn't do harm or that in an ideal world even improves the professional experience. So I think that's helping all of our leaders incorporate this into their thinking is something that all organizations are continuing to deepen.
- [13:24]
A
Absolutely. It's a great point that this, these issues require collaborative efforts across departments and across all leadership roles. But I, I think you also made a really great point that, that the existence of a role like yours shows health systems are paying attention to this issue and they're, and they're really trying to, to solve this issue among the clinician workforce. And, and some of what we've seen, Tate, among other health systems, is a lot more strategic and intentional thinking about how to reduce administrative burden that we've been talking about. We've seen new reimbursement strategies around inbox burden. We've seen more, more types of employees try to be hired to reduce some of the documentation load or new technologies introduced to reduce that load. But, but your point is also well heard that, that burnout rates remain high. The survey and the data certainly shows that. So I wonder what you would say to our leaders listening in terms of what does this all suggest about the, of some of these efforts that I just mentioned. And, and are there areas where you think that health systems are still missing the mark or where improvements just, they're working but they're not necessarily showing up in the data? I know that's a long winded question, but, but how are you thinking about all that?
- [14:43]
B
It's, there's, it's a great question and there are a couple different facets to it. I think the first, you know, element I would say is that, you know, we are seeing early indicators of progress both in the national data and in many organizations that have been at this a little longer and are maybe taking on more substantive and holistic interventions, seeing evidence of progress. It's still early days for a lot of organizations. And again, if we reflect back to the nascent days of the quality movement, say 30 years ago, you know, we hadn't solved it by five years. Right. In the sense we were just getting started of really thinking through a system lens about how we could embrace the principles and quality improvement thinking in a way that would transform the organization. So I think encouraging leaders that it is still early days and that the effectiveness is will, will deepen over time. That said, I think the other thought that comes to mind is that for understandable reasons, many organizations came out of the gate deploying a collection of tactics, right? A focus on documentation burden or a focus only on an efficiency element. And those are really important things, but they're, you know, one of many contributors to the challenge. And so I think the other thing that's important for organizations is to make, to reflect and make sure that they've embraced a holistic strategy that includes some of these elements around optimizing the practice environment, reducing inefficiency that are also taking on this dimension that we sort of lump together of characteristics of organizational culture. But that is not just, you know, sort of ethereal, nebulous dimension. It's considering things like leadership behaviors. How are we fostering teamwork? Do we have an environment that allows flexibility? Do we have an environment in which people can authentically support each other with the demands and pressures of healthcare? And are we fostering that? And that those characteristics of both creating more efficient and optimal practice environment, attending to these elements of leadership, teamwork culture are happening in concert with helping support individuals to foster that work life integration and so forth. And so I think the documentation burden inbox burden reduction is really important, but again, on its own probably isn't enough to get us where we aspire to be. That said, again, I will also point out that, you know, we're still also in early days of things like broad rollout around ambient, you know, AI documentation or AI based support for patient portal EHR inbox messages. And the, the data on from the early rollouts looks really quite impressive and consequential. So we've published data from Stanford, there's data from the University of Pennsylvania, there's data from Kaiser, there's data from the University of Kansas. All separate independent rollouts looking at, you know, ambient AI documentation. And these all show that not only is this saving time reducing cognitive load, it's also dramatically reducing burnout. And so I think as that continues to become more widespread across the country, it's a nice one, it's a little bit off the shelf that I think it will make a dent, but it's going to be more effective if it's one component of a holistic approach.
- [18:52]
A
Certainly. And I'm really glad you brought up the ambient AI there at the end there, Tate, because that's also what we're hearing from, from independently from systems all over the country. They really are making inroads towards reducing burnout among their clinician workforce through the introduction of this technology. And the data is reflecting that. So I would agree that some of this early data around this tech is, is really exciting about what it's, what it could achieve for the workforce. But I want to come back to the, to the flexibility culture that you mentioned. What do you think flexible role structures look like in practice on the ground for, for physicians? And we like to give tangible examples and advice to our, to our listeners. So are there any practical approaches that you have seen working well in helping your physicians stay engaged and supported through the different phases of, of their careers?
- [19:47]
B
It's such an important question and I think an important one. All organizations continue to look in the mirror around this. I'll get to maybe some of the specifics you asked for, but I think it's also worth acknowledging that there are differences by specialty in what's possible. You know, something around flexible work schedules may be more readily adopted in certain ambulatory environments than they would be in a neurosurgery or CT surgery environment. Also worth noting that different practice structures also often have different ways to approach this. So how it might work in a productivity based specialty group practice in which an individual can simply choose to work a bit less each week and take home a smaller paycheck might be a path that doesn't work in a model like a Kaiser or in some academic centers. But those centers might have alternative approaches right of due to their size, greater opportunity for people to work less than full time or to job share or to have some flexibility. I'd like as a principle usually to really encourage organizations to think about identifying what you're asking your physicians to do and to the greatest extent possible, let them determine the how so that if you're very fixated on the number of visits a person should have in each week to be considered a full time person or to be considered doing their share for the group. That doesn't mean they all have to be shoehorned into distributing that in the same way over the course of their work week. And that some folks may want to come in a little early, stay a little late, have certain days of the week where they're going to be longer so that they can have other days of the week when they get home at a reliable hour and be able to be part of their kids sports life or other family demands that they need to attend to. And I think that it's tempting. And I've watched many organizations go down a path where out of a desire to increase access and to even promote worthy objectives like fairness, they just standardize everything, right? They standardize the length of visit, the exact template of the visit slots, when they start, when they begin. Every day has to look the same. And I often like to just question them. Is that really the best path to achieve what you're trying to do? And that it's fine to have standards and to say there's a certain amount of work that needs to be done, but we can often give people some flexibility in the how there's a ready excuse. People say, well, that makes it harder to staff things for the desk or other groups. I usually find that as an excuse that really is not the case, that with a little bit of extra effort around that that's not a major barrier and that that is worth the efforts to provide flexibility for physicians. Or maybe I know I'm going a little long here, but also just underline something that you hinted at, which is that needs vary by stage of career. Goes without saying that there are certain times of career. People are more likely to have young kids at home, more likely to have parents who are ill, more likely to have other interests outside of work that they may want to devote more time and attention to. And in addition to some of the flexibility options we just talked about and the ability to maybe work less than full time or to have some of these ability to flex scheduling, I think it's worth noting that even better than giving people the option of working less than full time is to allow enough flexibility support for some of these other activities. For example, support for people when they're returning from parental leave, whether it be lactation support or an on ramp back into the practice. And also implementing some of the burden reduction efforts like we discussed around documentation or inbox that allow a physician to continue to work full time and still meet these other demands, which is good for the physician, it's good for the organization and is desirable over just saying, well, you can go to point eight on your, you know, on your work effort as the only path. So I do like the flexible options and those are the right thing for some folks. But beyond that, if we can think of ways to provide the right support, mitigate some of the unnecessary burden and allow people to work full time in a way that, that they can still meet their personal life aspirations and responsibilities, that's the best outcome for everyone.
- [25:06]
A
Absolutely. No. And you just gave two really great pieces of advice, I think, Tate, of supporting the fact that your physicians have lives and interests outside of being physicians and not trying to shoehorn anyone's strategy across all the different specialties and practice structures that, that, that Modern health systems encompass today. I think it's really great advice for our listeners. So I really appreciate that. And, and before we go, I'd extend a similar question to you. Do you have any other advice or final thoughts that you want to offer our executive leadership listening in from all over the country? Anything else that you want to share with them while you have their ears?
- [25:47]
B
Thanks for the opportunity. I think the last thought, two things that I would offer, you know, one again is to recognize the progress that's been made. You know, we truly are light years ahead in our thinking and organizational action around engineering our work environment so that it is more supportive of the clinician experience and the demands that are upon them. And so I, you know, even as I think it's easy to get discouraged that there's still so much to do as leaders, people are still bringing us concerns, problems that they hope we can address to, to not lose sight that we have made progress and, and that people are bringing us some of those concerns because they see that we do care, we are listening, we're trying, and they're, you know, there's the opportunity for us to build on the progress that we've made. So I think that is the, the first thought and then I, I think on a second front to recognize that occupational well being for our workforce is really a facilitator of all the other things we're trying to accomplish. Sometimes, understandably, we as leaders say this is going to be an anchor on our aspirations to do something else. Improve patient experience, improve quality, expand access by offering new care delivery models. And there's a mindset that the well being of our workforce or our physicians is going to be a barrier or prevent us from doing some things that we know are necessary. And I think that is really flawed thinking because there's so much evidence that when we have an engaged, professionally fulfilled workforce with low burnout, they're much more flexible, they're willing to explore new paths, they provide better care, they're more attuned to patient needs, they are better team members, there are fewer professionalism issues. And so that when we work on this domain, it really enables the others. And so that's the, I guess just a mindset I would encourage leaders to be on the watch for and to correct that thinking when there's this view that if we attend to well being, we won't be able to advance our other priorities, which I think again is the exact opposite is true.
- [28:38]
A
Wonderful. Well, it's some great parting words for us, Dr. Shanafeld. So I want to thank you for taking the time to sit down with us and for sharing about the impactful and important work going on under your leadership at Stanford Medicine. We really appreciate it.
- [28:53]
B
Thanks, Jacob. Great to be with you.
- [28:54]
A
Yeah. And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit Beckershospitalreview.com.