The Well-being Impact of Northwestern Medicine's Scholars of Wellness Program

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Tom Haederle
In recent years, American health care has become acutely aware of the importance of well-being, personal and professional, among care providers. Top quality patient care is easier to deliver for physicians, nurses and other team members if they're operating at the top of their game. Chicago's Northwestern medicine has created an innovative program to elevate the importance of provider well-being across the entire organization,

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Tom Haederle
department by department. Its Scholars of Wellness program has been expanded to bridge and create connections across professions by bringing advanced practice providers into the group. Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. Northwestern Medicine's Scholars of Wellness program focuses on teaching and understanding of what well-being is and how it can be woven into the culture of an organization at the local or departmental level.

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Tom Haederle
In this podcast, two experts from Northwestern join the AHA’s Elisa Areaspacochaga,, vice president of Clinical Affairs and Workforce, to discuss the difference the Scholars of Wellness program is making and how it could be adopted almost everywhere.

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Elisa Areapacochaga
Thanks, Tom. I'm Elisa Arespacochaga, vice president for Clinical Affairs and Workforce. And today I'm joined by Dr. Gaurav Agarwal, vice President and Chief Wellness Executive at Northwestern Medicine and director of Faculty Wellness at Northwestern University. And Samantha Saggese, physician assistant in the Division of Nephrology and Hypertension at Northwestern Memorial Hospital. Really excited about today's conversation. Talk about well-being, the work that this team has done through the Scholars of Wellness program and the expansion to working with their APP colleagues.

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Elisa Areapacochaga
So just to get us started and introduce yourselves a little, I'll start with you, G, if you could just tell us a little bit about yourself and your role.

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Gaurava Agarwal, M.D.
Sure. Thank you and great to be with you again, Lisa. Again, Gaurav Agarwal, everyone just calls me G. I serve as our chief executive. I'm a psychiatrist in organizational well-being and leadership coach by training and I've had a chance to lead our well-being efforts at Northwestern Medicine. First, starting with our physicians, frankly, before the pandemic started, and then through the pandemic and over the last year or so, taking over this role of chief executive that looks over the well-being of our entire workforce.

00;02;35;24 - 00;02;36;25 Elisa Areapacochaga And Sam.

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Samantha Saggese
Thank you, Elisa. Thanks for have me on the podcast today. It's a real honor. I first joined Northwestern as a student actually back in 2017. I moved to Chicago from the Boston area, and then I joined the Division of Nephrology on their inpatient consults service in 2019, and I met G through my participation in Scholars of Wellness this past year.

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Samantha Saggese
My project, which we'll talk a little bit about, was focused on peer support for advanced practice providers. And coming up, I will be serving as the Office of Well-Being APP liaison for Northwestern Medicine.

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Elisa Areapacochaga
Wonderful. And congratulations.

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Samantha Saggese
Thank you.

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Elisa Areapacochaga
G, let's start with you. I know you've had a lot of success with the Scholars Wellness Program. I know you've spoken at HRA conferences and others, and it's allowed you to create this, for lack of a better term army of wellbeing champions across the organization. Can you give us just the quick thumbnail sketch of the program and how you've started to spread that now outside of the physician community and particularly to APPs?

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Gaurava Agarwal, M.D.
Yeah, absolutely. Scholars of wellness is our flagship program. It's sort of the engine that runs our Office of Well-Being program for the reasons you stated. I remember when someone first came to me and said, Hey, you know, we'd like for you to think about wellness. And I said, Me and who else? Because I said that that doesn't seem like a very effective plan, because I really do believe that if we define wellness as really providing a superior work environment to the people that work at our organization, you know, in my view, wellness has to be locally led because those folks know how their departments divisions work for the best and they know how

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Gaurava Agarwal, M.D.
they want to provide the best patient care for their patients. And so we have to listen to them about those sorts of issues. Where we can help them, though, so that they're actually effective, empowered change agents around wellness, is to really provide them with the skills and knowledge that we think you need to be able to craft a work environment that is optimal.

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Gaurava Agarwal, M.D.
And what we sort of reflected on was these sort of three buckets. One was we do need to understand the science of well-being and how well-being really does work in particularly the health care setting, but in work settings in general. You have to understand how to do process improvement in project management if you're going to make changes in the actual workflows and work environments.

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Gaurava Agarwal, M.D.
Those systemic drivers of well-being that we're well aware are at the root of health care professional fulfillment. And number three, and something that we have found is the secret sauce is you have to have some understanding of how change management and change leadership will work. When you are working within a system and we felt that those were oftentimes lacking in our clinicians because that's frankly what we did not spend time learning in our training.

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Gaurava Agarwal, M.D.
So we wanted to be able to provide a curriculum and professional development program that provided those three sets of skills. And to do that in a setting where people would actually apply those skills in real time to a project of their choosing. So as we all know, you don't learn something until you actually put it in practice and see how it works in the real world.

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Gaurava Agarwal, M.D.
And, and by doing that, we think that helps consolidate folks knowledge and really create a lot of momentum, both as leaders and through these pilot projects that they stand up for Northwestern.

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Elisa Areapacochaga
That's awesome. And you reminded me of something my father always used to say to me whenever I said, Oh no, I totally understand it. He would say, All right, explain it to me. And then when I couldn't explain it, you'd be like, All right, let's go over it again. So I love that you make it very real and actionable.

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Elisa Areapacochaga
And in the moment of, let's learn this skill, now let's go use it. Understand how it works. So continuing on that theme, what do you think has made this expansion of this work ... you had a lot of success with physicians in expanding it, to now the APPS and looking to really look at the overall well-being of all of your team.

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Elisa Areapacochaga
How has that been successful and what do you think has been the winning strategy there?

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Gaurava Agarwal, M.D.
Yeah, I think for us, when when we were charged with moving from looking over the well-being of physicians to the entire workforce, we sort of had a decision to make and that was how do we continue to be effective without feeling like we have to boil the ocean? Because I find that that's usually where people fail or they begin to really create stuff that is pretty frankly superficial and people don't feel us then.

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Gaurava Agarwal, M.D.
And so we wanted to say, okay, how can we find a group of folks that we really want to do a deep dive on and better understand their drivers? Because, you know, as a doc, I sort of feel like I understand physicians, but I was well aware that I wasn't sure what the actual drivers of professional for them were for our APPs.

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Gaurava Agarwal, M.D.
But what I did know was our organizational data and national data, which showed that APPs were struggling. And so I said, Well, this seems like a group of individuals that has some similarities to our physician drivers is frankly small enough that I could actually do a deep dive and that we had partners that were ready to allow us to to engage with them and, you know, really welcomed us with open arms.

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Gaurava Agarwal, M.D.
I think those three factors were really key in the change management part of this. We were also lucky enough to receive an all in grant to help with this expansion of the Scholars of Wellness. And that really allowed us, you know, the networking resources, the financial resources to expand the program to our APPs across our 11 hospitals.

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Gaurava Agarwal, M.D.
And then, you know, the first thing we did was really connect with our APP directors. We have three of them at Northwestern Medicine, and like I said, they began to explain to us the leadership infrastructure that we have for APPs. How would we begin to select and recruit our scholars and our APPs and which projects were really high need and that had sort of been on the back burner in some cases.

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Gaurava Agarwal, M.D.
And they said, you know, we'd love to have your expertise, help us actually launch these programs that we know our APPs are are yearning for. And I think all those factors really led to a very successful expansion last year. And this year we're going to continue on with our program, with our APPs across the system and actually frankly, add our pharmacists as well.

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Gaurava Agarwal, M.D.
And I think I'll finish with one point is, you know, as we start thinking about workload and how workload continues to explode post-pandemic, you know, it started to occur to me that we really only have two options because the workload isn't going to get less, I don't think. We really have technology which, you know, I hope hope serves us well.

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Gaurava Agarwal, M.D.
But I'm always nervous to rely solely on technology to save us. And if it's not technology, then it's teamwork. And we had to figure out how to create high functioning teams. And we thought that one way that we could do that was by beginning to have cross collaboration or collaboration with a program like this, where people can really begin to get to know each other, work with each other, and begin to understand what drivers each one is facing.

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Elisa Areapacochaga
You know, absolutely. I think the the more you can break down those barriers between people and get them started working on a project, giving them a purpose and and a shared goal is a great way to start building some of that teamwork. And certainly the demographics would back you up with 10,000 baby boomers retiring a day. I don't think we're going to see any decrease in the number of patients being served.

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Elisa Areapacochaga
So, Sam, let me turn to you. And as one of the most recent graduates of the Scholars of Wellness program, can you talk a little bit about your experiences? A participant in one of the first to the APP class of participants and maybe focus on what you found most meaningful of the work?

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Samantha Saggese
You know, for me, SOW was obviously wellness - we call it SOW - was such a unique experience because it allowed me to finally take off my clinical hat for a little while where I spent so much energy on the patient well-being and try on a new hat, really focusing on provider and colleague well-being. And when I talk to other colleagues and to friends about this program that I participated in, it really takes almost no explanation as to why it's important.

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Samantha Saggese
You know, it's no secret that work like this is really essential in today's climate. And for me personally, I loved learning the science behind employee well-being. I thought it was fascinating. I also thought it was just such a cool opportunity to make connections with colleagues and departments that I rarely get to overlap with, especially for me working in internal medicine subspecialty.

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Samantha Saggese
I don't often overlap with certain surgical specialties and anesthesia and really get to get fresh perspectives from people all around the hospital. And what I found so meaningful about this work is really understanding that it doesn't take huge sweeping changes to improve the day to day experience for colleagues, you know, getting a big pay bump or improving employee benefits.

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Samantha Saggese
This is obviously going to improve well-being. But for the vast majority of us, this is not within our sphere of influence. And so what we do have influence to change are the small things or the pebble in the shoe, as G likes to call it. And these things really can make life better for all of us. And I got this opportunity to hear what other people are doing in their divisions, and it just set off alarm bells for me to bring back to my own division.

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Samantha Saggese
And so I've already started to kind of copy and paste some solutions that other scholars have implemented, like QR codes that lead to quick abbreviated feedback forms for trainees or a straightforward survey to collect and organize provider vacation requests. And I'm trying to bring these back into my own division and see how we might be able to incorporate them.

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Elisa Areapacochaga
That's awesome. Yeah. Sometimes it's the smallest changes that can make a difference for people. So let's talk a little bit about how this has and I don't know if this is something you planned from the beginning or not, but how it's helped really benefit that relationship between your APP colleagues and the physicians they work with and how it's improved those relationships.

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Samantha Saggese
Yeah. So as she mentioned, this was the first year that we had a blended class of scholars, so including both APPS and physicians working side by side and learning side by side. And at Northwestern it's commonly APPS and physicians really are already working side by side as colleagues in the clinical setting. And so this was unique in that it kind of mirrored that in a professional development settings. Within our APP community

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Samantha Saggese
at Northwestern, we have a ton of enthusiasm for advancing our professions and expanding opportunities for APPS to grow in their careers. But oftentimes these opportunities are specific to APPS and we're not commonly blending with physician colleagues during these professional development series. And so being able to learn from one another and really feel as though we're all moving through the experience together was truly unique.

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Samantha Saggese
And while there is a fair amount of overlap between drivers of fulfillment for APPs and physicians, there are some nuances that I feel like said APPS apart, but maybe most physicians aren't aware of. And so specifically the experience of an APP may have at their place at work can just really vary greatly depending on the environment. And so for me personally, I realized over my years of being a provider that I'm very lucky that the physicians I work with have been supportive of my development from day one.

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Samantha Saggese
And through this I grew as a provider and I built trust with my colleagues. And now I can say that within my field I'm practicing near the top of my license. However, for a lot of other APPS, roles can sometimes be loosely defined, and this is a huge source of stress. And physicians who may just not be familiar with an APP or what they're capable of might use them in roles that are more akin to a resident or a scribe.

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Samantha Saggese
And so not practicing to our full scope can feel demeaning to a provider and really leave APPS feeling like their skill set that they work so hard to attain is just not being appreciated. And so, you know, for me personally, I was probably the least tenured provider at the table during this this class. And so sometimes I feel intimidated among more senior APPs, let alone among some of my physician colleagues.

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Samantha Saggese
But the group dynamic honestly just put me at ease. It showed me that this is a community of providers that really was invested in learning from one another, regardless of background or years of experience. And so I really feel like representation for APPS and this sort of environment is essential to promoting a culture of mutual respect between APPS and physicians and really we were all just there to learn from one another.

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Elisa Areapacochaga
That's awesome. G, let me ask you to throw in your thoughts from the physician perspective. You know, are were there any places where you saw, oh, this is really benefiting our ability to better work with and partner with our APPS?

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Gaurava Agarwal, M.D.
Yeah, You know, I mean, I think for me I was nervous actually. Our initial thought was to create a separate program, one for physicians, one for APPs, because I didn't know if one of the things I love about the program having run it for a few years is physicians sort of let down their hair and talk openly about their struggles.

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Gaurava Agarwal, M.D.
I didn't know if they would go back into the sort of doctor mode if the APPS were there and sort of buttoned up, and I didn't want that because I really do think that is a huge part of our success. But as we sort of played with it a little while, they said, you know, I think it'll be okay.

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Gaurava Agarwal, M.D.
I think, as Sam said, we work a lot together with APPS and I think we'll be able to do it. And I think the teamwork benefit outweighed the risk, if you will. And so when it happened, it was it seems obvious now. It was it was great. And I have a story from it that that sort of was our "Aha" moment.

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Gaurava Agarwal, M.D.
I think it was, I think it was month two, when we actually had an anesthesiologist in a CRNA name class. And I said, you know, a project I'm interested in working on is when we have M&Ms or we have grand rounds. I don't know if you all noticed, but no one asks us what happened. I was the one doing the institution in the room, but everyone asked the anesthesiologist or they asked the resident about the case.

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Gaurava Agarwal, M.D.
Yet I was the person actually in the case doing the work, and you should have seen the looks on people's faces around the table where the docs were like, Oh my God, what are we doing? Like, this is just is so obvious, but not to us and be able to hear that story and to see the looks of like, we got it, we have to be better.

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Gaurava Agarwal, M.D.
These are the moments that make people feel like they belong somewhere, that make people feel valued. We talk about recognition and appreciation all the time, but recognition and appreciation aren't about thank you's that are about knowing that I matter and that I'm here and and I add value. So for me, that was clear what we were trying to do.

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Gaurava Agarwal, M.D.
And you know, if I can share some data, we actually looked at this pre and post and on all these metrics, both APPS and physicians reported nearly 30% increase in understanding what the other was dealing with from a professional fulfillment perspective. And also they each felt better understood by the other. They said, you know, I really am beginning to believe that physicians now get what we deal with or I'm beginning to understand, or I believe that APPS understand what we're dealing with.

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Gaurava Agarwal, M.D.
And so we're really proud of that data. In some ways, I think that accomplishes some bigger picture of the type of environment we're trying to create.

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Elisa Areapacochaga
That's fabulous. I just love that it's built that connection. So, Sam, let's come back to you. Tell me just really quickly a little bit about your project to bring the and I know this is something Northwestern has worked on, bring that peer support to the APPS, because I know that it's something Northwestern and G and I have talked about it before, but I didn't realize it

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Elisa Areapacochaga
was focused on the physician community at Northwestern, not beyond that.

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Samantha Saggese
Yeah, absolutely. So just to recap, so peer to peer is our peer support program that we have at Northwestern. It's confidential, it's voluntary, and it's meant to be utilized after a provider experiences a medical error, a near miss, an adverse patient outcome. And through this program a colleague is referred either by another colleague, by a manager or by risk, or they can self-refer and it's to receive emotional support from a trained peer supporter.

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Samantha Saggese
You know, the conversation has really focused on how the provider's coping. It's not meant to dissect talent error occurred. It's not an M&M. We know from the literature, it's been cited over and over that there are just significant negative psychological effects that are felt by provider hours after and during a medical error. And there tends to be a focus in the literature around how these experiences affect physicians and nurses.

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Samantha Saggese
And while they haven't really focused too much on APPS, it's not a stretch to assume that we experience similar negative emotions after these events. So through my project, we were able to survey advanced practice providers at Northwestern and we found that events are occurring at similar rates and APPs adds to the published data for physicians and nurses and APPS do experience these identical negative emotions, anxiety and depression and avoidance after enduring a medical error.

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Samantha Saggese
And so then my project focus on expanding P2P our peer support program to APS. And now we have over 20 APPs that have been trained in providing emotional first aid to their colleagues after errors. I really feel like this is essential to rebuilding provider integrity after these events and as health care providers, for all empathetic by nature, we're a natural caregivers and unfortunately, medicine at its core can often promote a culture of perfectionism and blame

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Samantha Saggese
after these events, whether they're big or small. And so our goal with P2P is to cause a cultural shift of some sort into acceptance and understanding that at the end of the day, we are only human, and a single negative event doesn't negate all the positives the provider brings to the table. And what we found is the training process itself can just be an asset to the emotional well-being of the supporter.

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Samantha Saggese
Regardless if these conversations ever take place. Just knowing that they built these skillsets can really improve the well-being of people who just volunteer to do the supporting, as well as knowing that this program is in place and it's available to those who might need it in the future.

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Elisa Areapacochaga
That sounds amazing. I love that you're continuing to bring that to more colleagues because I'm not a clinician, but I can imagine the challenge that it must be and the sense of isolation that it comes with from my previous conversations. I want to thank you both so much for joining me today and for sharing your work. And I hope Sam come back and tell us about how your new role goes in a little bit as your take on the role of the APP liaison in the Office of Well-Being.

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Samantha Saggese
Absolutely. I look forward to it.