Episode Transcript
Interviewer: It's the Pathways podcast with the Spencer Fox Eccles School of Medicine at the University of Utah. Today, we are making more connections talking about some of the challenges in academic medicine that we're all trying to face and what we can do to overcome those challenges. Today, behind the microphones, we’re really excited to talk about wellness.
Why don't we go ahead and find out who's here today? What's your name and where are you from?
Bree Andrews, MD, MPH: I'm Dr. Bree Andrews. I'm from the University of Chicago. I'm the Chief Wellness Officer there.
Interviewer: Alright, and who's in the middle?
Amy Locke, MD: Hi, I am Amy Locke, University of Utah, Chief Wellness Officer.
Lauren Peccoralo, MD, MPH: I'm Lauren Peccoralo from the Icahn School of Medicine at Mount Sinai in New York City. And I am the interim dean for the Office of Professional Engagement and Development.
Interviewer: Alright, and you all have something in common, which is wellness. First of all, how do you all know each other? How'd you end up behind these microphones together? Amy, why don't you go ahead and start?
Amy Locke, MD: Well, the chief wellness officers around the country tend to hang out together in a whole bunch of different places.
Bree Andrews, MD, MPH: I met Amy in 2022 when we were at the Chief Wellness Officer course at Stanford. We've been going to a number of other meetings together.
Lauren Peccoralo, MD, MPH: I was in the Chief Wellness Officer program the year after that. But I met them through our Chief Wellness Officer at Mount Sinai, John Rip.
Interviewer: Okay. So you all hang out together at these conferences. When people are like, "What did you do this morning?" Most of us say, "Well, I kind of laid around for a little bit," but you're like, "No, we did yoga. We went for a five-mile walk."
Bree Andrews, MD, MPH: Those of us who are runners were told we shouldn't run on the river here in San Antonio because every runner falls in.
Interviewer: What? Who told you that?
Bree Andrews, MD, MPH: People.
Interviewer: Okay, and did you heed the warning?
Bree Andrews, MD, MPH: I did. I figured I'll sleep a little bit longer, not end up in the river.
Interviewer: Alright, well, let's talk about wellness from an academic medical center standpoint. There's a session tomorrow that Bree and Lauren are going to be a part of. Why don't you tell us a little bit about what that session is? What is it that you're going to discuss?
Bree Andrews, MD, MPH: We were approached to describe programs at our organizations that we think really can advance well-being. So each of us proposed a written document, and this is the presentation of those programs. My program is around fixing administrative and health burdens at the University of Chicago. It's called #WhatToFix, also #WTF.
Lauren Peccoralo, MD, MPH: Our program is a grant program that we offer to faculty, but we also encourage faculty to pair up with administrators, nurses, and other team members to create mini-projects. We think about this in terms of quality improvement, but instead of outcomes being patient care or quality-related outcomes, our outcomes are around how physicians feel about their work. Are they being more efficient? Also, at the end of the day, do they feel better, more satisfied, and potentially even more connected? We've given about 16 of these grants over the course of five years.
Interviewer: From an outsider's perspective, when you think of wellness, you tend to think of mental health, physical health. I never really thought of this as like, "How do you feel about your job" as an important component of that. Amy, do we have a program at the U that you would like to talk about?
Amy Locke, MD: Well, I've been thinking about models to train the trainer. So how do you help each person think about their own well-being and that of other teams? Bree and Lauren, both of you have projects that really help other people. Bree, could you tell us about how the folks who engage in your program might be moved from an idea into action?
Bree Andrews, MD, MPH: We crowdsource our ideas, and we really try as a team to take that idea—that fix that needs to be done—and strategize about how we can give back that fix to the community. So we teach everyone, "Hey, we fixed this." There might be a tip sheet around that. There might be information about how that fix could impact practice. We are heavily reliant on those people who put in the fixes and say, "Hey, I think something could be a little bit better here." Or "I can think of a way forward to make it better." And we try to facilitate it.
Amy Locke, MD: Would you say that the fix is in the locus of control of the person who comes up with the idea, or with you all as the supporters?
Bree Andrews, MD, MPH: The idea generation is local, so that person says, "I think if it worked this way, it would be better." We vet it. We say, "Oh, do we really understand it? Who could help with this? What processes could help with this?" We put that forward.
Amy Locke, MD: How about you, Lauren?
Lauren Peccoralo, MD, MPH: That made me think about that sense of autonomy. Our program works a little bit differently, so that the fix actually happens at the level of the people proposing the idea. What's really cool is that, on our committee of folks who are choosing what's going to go forward, we have folks in quality improvement, in nursing, and across the board who can say, "Yeah, this is feasible." When they get the money, we're going to actually help connect them to the people that can really get the work done. But ultimately, they are seeing the project all the way through. It creates this sense of, "Wow, I can do something that at the end of the day is going to improve the lives of not only myself, but my colleagues that I'm working with every day."
Amy Locke, MD: So it sounds like both of you have local generation of ideas, but then a fair amount of support to take that project to fruition and onto the next step. What does that infrastructure really look like for each of you as you're putting together that team for support?
Bree Andrews, MD, MPH: We have a network of people, from high-level administrators to lower-level administrators, and I think that the reason they stick with us is that we're connecting them to the work. We say, "If you can make this change and help us fix this, so many people will benefit." We have so many systems in medicine that don't work that way. People are given a to-do list, and it's not connected to taking better care of patients or taking better care of our administrative staff.
So I think that they buy in because of that. We can move things, kind of escalate them, toward a higher level in the organization. Or we can say to the person, "You know, an analyst who needs to help us with a medical record is really going to improve the clinician's experience or the parents' experience for pediatric patients," for example. That makes a big difference to them. There's a lot of buy-in from those folks.
Lauren Peccoralo, MD, MPH: I'll just add that, on our end, we actually have collected a ton of leaders in digital technology, ambulatory care research, and nursing who are similarly invested in well-being and want to be at the table—want to be the choosers of the projects that go forward. They know that when those folks need help, either with their IRB process or with their quality improvement process, we can connect them with someone who can program the new template that they want to create in the medical record.
Amy Locke, MD: It's interesting to think about the parallels. At the University of Utah, we've had a number of different programs over the years that have thought about choosing projects, facilitating them through completion, and then having poster sessions to celebrate. Would both of you feel comfortable sharing a specific example of a project that you saw identified and then taken forward?
Lauren Peccoralo, MD, MPH: Yeah, I'll talk about our program that happened within my own clinic. A number of excited primary care physicians came up with a new template for our residents to use for their primary care visits. There was a very old template that was littered with unnecessary information, and a lot of people were just copying it forward.
They created a new template that was problem- and diagnosis-focused. That allowed the note to be, first of all, more readable, but also shorter. What ended up happening in terms of the outcome was that 90% of residents and close to 85% of faculty were using this new note template. And there were significant reductions, not only in the character counts of the notes, but in the time it took for folks to complete their notes per appointment per day. There were significant results, the team has presented at a number of conferences, and hopefully we'll have a paper out soon.
Interviewer: I have a question I wanna pop in. That sounds more like a technical or a clerical thing. Explain how that ties back to wellness.
Lauren Peccoralo, MD, MPH: Imagine that you're seeing 10 patients in a morning, right? And each of those patients' notes takes you 10 minutes to complete. So now you have 100 minutes. Sounds insane, right? Right. That happens. Imagine cutting that in half, right? So now you're completing notes in under an hour. Now I get to spend time with my family, I get to go home earlier, I get to relax and watch TV at night, and I'm not scrambling to do my notes at 9:00 or 10:00 pm. That is an inherently positive and uplifting thing that's going to make you hopefully more well at the end of the day,
Amy Locke, MD: It's not uncommon for us to show up in the wellness space and for folks to have a pretty strong idea of what wellness is and what it isn't. Recognizing that work design and the culture that you show up into is about 80% of what drives your experience of the workplace, rather than thinking about occupational well-being as a specific item like what I had for breakfast this morning, or did I get my run in, and did I not fall into the river.
Bree Andrews, MD, MPH: I'd like to reflect on a project that we started that's similar to yours. We created a form for family medical leave. Great. That's easy to access in our medical records, so that when you go to the doctor and say, "Hey, I need to leave because I am under the weather, or I'm having surgery," that clinician can spend more time with you and less time on the form. They can click through the form.
It's standardized across our organization, so anyone who needs this style of paperwork can get it easily from their doctor. We've cut down that time so the doctor can say to a patient who needs surgery, "Tell me how you're feeling about the surgery," rather than, "I need to go spend 10 minutes on this paperwork that you gave me." That was great because it applied to so many people and so many clinicians across the organization.
Interviewer: Tie that back into wellness.
Bree Andrews, MD, MPH: Seeing patients is a big part of well-being. Then we also know that we're doing well by the patients. Can I connect with those patients? Do I have to do fewer administrative tasks for them? We're giving them advocacy for their time off, and I think that's really good for our clinicians.
Amy Locke, MD: That makes me think of one of the projects that my own clinic has done over the last few years, which is leaning into that culture space. If you think about your experience at work, it's impacted by the people you show up and work with day to day. Our clinical well-being lead, or our wellness champion, who is now actually the medical director, she really leaned into what values do we want to stand by in the clinic? And then how will we know that we're acting in accordance with those values?
For example, if we say respect is really important in the clinic, what does it mean when I'm talking with my medical assistant or they're talking to me? When we're going to lean into respect, does that mean that I stop what I'm doing and listen? Do I rush in and just start getting things done? The clinic I'm in right now is one of the most enjoyable places to work that I've had clinically in my entire career.
Interviewer: Incredible stories. Do you have any final thoughts that you would like to bring up for people in similar positions such as yourself thinking about creating wellness?
Bree Andrews, MD, MPH: I think well-being can be a single touch, a single moment where you say, "I care about you today." That can be in any interaction. To Amy's point, it can be with a clinical person, one of your patients, an administrator, or with a dean.
Amy Locke, MD: Well-being or wellness is not something you can designate to a person or even a team of people. It really is how we all show up in the workspace. We each have a role to play in making where we work a place where we want to show up and be ourselves.
Lauren Peccoralo, MD, MPH: I'll just add to your point earlier. When we come in, a lot of us think about wellness as, do we do yoga? Do we do mindfulness? Are we exercising all the time? But really, we're thinking about workplace well-being. We often think about the culture of the space in which we're swimming. What does it feel like? Do we enjoy going to work every day? Do we enjoy working with the people we work with every day? Then, really, efficiency of practice—what does it look like to get through the day? Are there pebbles and rocks in my way that are making it really hard for me to finish my day? Or are those things swept away so I can get through the day and enjoy my patients?
Interviewer: Wonderful conversation. Thank you so much for showing up and talking about wellness.