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September 22, 2017

Case Study: Stanford Medicine Seeks to Understand Burnout Through Measurement

Article by: Lola Butcher, Hospitals and Health Networks 

The goal is to develop national benchmarks to help health systems gauge and lessen physician burnout

When Stanford Medicine started focusing on physician wellness, leaders knew they needed to get a handle on the scope of the problem within the academic medical center and among the approximately 300 community physicians in its University HealthCare Alliance.

Stanford’s first Physician Wellness Survey, conducted in 2013, found that 26 percent of participating physicians reported a symptom of burnout. That could have been cause for celebration; the national physician burnout rate was 46 percent in 2011, according to Mayo Clinic researchers.

“But when we took it to our boards and to our CEOs and our dean, they all said: ‘This is still way too high. We can’t have a quarter of our doctors burned out,’” says Bryan Bohman, M.D., chief medical officer, University HealthCare Alliance.

In response, the Stanford University School of Medicine, Stanford Health Care and Stanford Children’s Health jointly created the WellMD Center to focus on physician wellness and help to lead a national movement to address burnout. The Stanford Medicine WellMD Center conducted its second Physician Wellness Survey in 2016.

The challenge

Although a consensus definition of physician burnout — emotional exhaustion, depersonalization and low sense of accomplishment — has emerged in recent years, there is no consensus about the best way to measure and assess burnout.

Some health systems use physician engagement as a proxy for burnout and expect a physician-engagement survey to provide the insights into physician well-being that they want, says Bohman, who previously served as the center’s acting director.

“Those survey tools are more about ‘Are you happy with this organization?’ and ‘Will you refer to the right doctors within the organization?’” he says. “Those are all important things, but we are focusing more on ‘Are you feeling well?’ and, “If not, what are the reasons that might be contributing to that?’”

Creating and fielding the survey

Mickey Trockel, M.D., director of scholarship and health promotion, spearheaded the development of the survey in 2013 and modified it in 2016. The survey, which focuses on both burnout and professional fulfillment, is designed to correspond to Stanford’s Physician Wellness Model. It includes questions that seek to evaluate several domains:

          Culture of wellness

  • Perceived appreciation.
  • Personal/organizational values alignment. 
  • Peer supportiveness.
  • Perceived support from leadership.
  • Control of schedule.

          Efficiency of practice

  • Efficiency of the electronic health record.
  • Perceived negative EHR experience.

          Personal resilience

  • Self-compassion.
  • Sleep-related impairment.
  • Meaningfulness of clinical work.

 

The most recent survey, conducted last fall, was distributed to physicians by email, and it took about 15 minutes to complete. The survey had a 54 percent response rate.

Overcoming challenges

Stanford has encountered problems that are common with surveys.

Validating results

Fewer than half of physicians participated in the 2013 survey, prompting a question about whether the results were trustworthy.

“People were going to say that the only physicians who responded are, depending on your perspective, the ones that aren’t burned out or the ones who are burned out,” Bohman says.

Anticipating a low response rate to the first survey, the research team identified a random sample of 250 physicians. The team used small cash incentives — “and we really hounded them,” Bohman says — to ensure that a higher percentage (65 percent) completed the random sample. Responses from the sample group then could be compared with the responses from physicians who voluntarily participated without incentives.

“This was a lot of work, but it was worth it,” Bohman says, because the strong similarity of responses in both groups boosted confidence in the accuracy of the combined results.

Incentivizing participation

In 2016, the WellMD Center used an incentive to encourage physicians to participate in a second survey: Each academic department that achieved 60 percent participation received $25 per person to be used for a wellness-related project or event.

Though participation in this second survey (54 percent) was somewhat higher than the first, the incentive program was probably more work than it was worth, in Bohman’s opinion.

Bohman uses a different incentive approach with the 350 community providers in University HealthCare Alliance, which is the medical foundation of Stanford Medicine. The UHA physicians can earn up to 10 percent over their base salary through the incentive program to encourage specific behaviors. A portion of that incentive — equal to about $2,000 for most physicians — is allocated for physician wellness activities. Each physician can earn that if the survey response rate in his or her group exceeds 80 percent and the physician participates in a groupwide exercise to identify and implement a way to improve physician wellness.

“That means that you are getting paid to take care of yourself and also to report on your own wellness,” Bohman says. “We get 97 to 98 percent response rate that way.”

That high response rate assures Bohman that he has valid data, and it allows him to analyze the effect of various interventions. Survey responses are confidential, but Bohman can see whether the physicians who completed a given intervention — for example, training on the EHR system — showed improved wellness or professional satisfaction.

Next steps

Stanford eventually plans to field the Physician Wellness Survey for all physicians — academic and community — either annually or every other year, Bohman says.

Beyond that, the WellMD Center and the Risk Authority Stanford — a consulting firm created from the institution’s hospital risk management department — have recruited 10 health systems to create a Physician Wellness Academic Consortium. Consortium members are working to further develop the Physician Wellness Survey for broader use across the country and create benchmarks that allow organizations to gain a better understanding of their own survey results. 

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