Health Care Transformation Begins With Its People

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Tom Haederle
Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications. Supporting clinician well-being is at the forefront of workforce strategies across hospitals and health systems. It makes sense. Clinicians need to be able to perform at the top of their game to provide the best patient experience, contribute to the health of your organization, and establish a positive, long lasting impact on their work lives.

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Tom Haederle
Join us to hear how Kaiser Permanente and Mass General Brigham are using innovative workforce approaches, including performance coaching, to give clinicians the resources and skills needed to thrive professionally and personally. Today's podcast is brought to you by Valor Performance.

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Elisa Arespacochaga
Hi everyone. I'm Elisa Arespacochaga, vice president of Clinical Affairs and Workforce with the American Hospital Association. The workforce challenges facing the health care field have emphasized the importance of addressing well-being at a system level and building a workplace culture that supports it. With me today, I have leaders who are doing exactly that. Joining me today are Dr. Mary Wierusz,

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Elisa Arespacochaga
chief wellness officer with Kaiser Permanente, Washington Permanente Medical Group, and Dr. Lee Park, chief patient experience officer with Mass General Brigham. And Sara Milby, CEO and founder of Valor Performance, to share their experiences in building organizational well-being and supporting their teams. So let me start here to sort of set the stage with all of you for our discussion.

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Elisa Arespacochaga
As you all have probably heard me say, workforce challenges are not new to health care. COVID really just put a highlighter pen on some of the challenges that we faced. The field continues to look for new ways to address both the challenge of keeping and helping their team members thrive. So, Dr. Wierusz and Dr. Park, I'm going to ask you and Mary, I'm going to start with you.

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Elisa Arespacochaga
What are you seeing as the biggest challenge, the across the field that you really have to make a priority to be able to move forward with your workforce?

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Dr. Mary Wierusz
Thanks for that question and thanks so much for having us today. I do think one of the biggest challenges across health care right now is really maintaining an engaged and energized workforce in the face of competing priorities.And so looking at that issue holistically, and that really means equipping individuals, which we've sort of done in the past, looking at health care worker well-being, but also teams, organizations and really the system as a whole to embrace change and different ways of thinking around how we might deliver high quality care while maintaining meaning in medicine.

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Dr. Mary Wierusz
And that may take some innovative strategies to address the health care worker shortage.

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Elisa Arespacochaga
Absolutely. And Lee, your thoughts?

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Dr. Lee Park
So I think COVID, you know, we all haven't been through a global pandemic. So there was that. I think there were a lot of changes through COVID that we weren't necessarily anticipating. So there is a lot of workforce shortages, not just among physicians, but among support staff. I think health care's faced a lot of financial challenges that we haven't faced in the past.

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Dr. Lee Park
And I think COVID globally actually was a very challenging situation for patients, for providers, for everyone. We have a lot of challenges with how patients are their, conduct in our offices and things, and those are things we hadn't faced before. We also had some delays in care: the emergency rooms, you know, are overflowing. So I think that COVID might have exacerbated some things, but it also created some new challenges for us that we hadn't faced in the past.

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Dr. Lee Park
And that has made well-being really tough in the last couple of years, I think, for everyone.

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Elisa Arespacochaga
Absolutely. I think we have seen a real splitting of what that priority list looks like into three really strong priorities around supporting both the team, making sure that we can keep everyone safe and how to best do all of that with the financial pressures that hospitals face. So I really appreciate your setting the stage for us, and I think this is something the next question I'm going to ask and Lee, I'll start with you, because I think it's so important to highlight and really underscore the connection again between the well-being of your clinical team in particular and the impact on the patient experience and outcomes, as well as the entire culture of the organization.

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Elisa Arespacochaga
We want people to want to come to work. And honestly, I've never met a clinician or anyone in health care who didn't want to do their very best for their patients. But how do you see all of these factors that are swirling, really impacting that connection?

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Dr. Lee Park
I mean, I think at the end of the day, most of us went into health care so we could help patients, right? In order to help patients, You know, we want to do that at the best of our ability. And that's really when we are personally, professionally fulfilled and we're not burnt out. There are a lot of factors that go into that, too.

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Dr. Lee Park
Some of it is like me personally, where am I? There are organizational factors that go into it. There are systemic factors like larger health, health care items. So I think the the link is just I mean, it seems like it's not hard to put together. Like if you're doing well no matter what you're doing, whether that's, you know, in your personal life or your professional life or whatever, you're going to be doing better in that space.

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Dr. Lee Park
And there are a lot of links to workforce well-being, professional fulfillment and burnout to, you know, better quality outcomes, let people make less mistakes and things like that. But at the end of the day, it just seems like, you know, we want to make sure that our workforce feels that we care about them and so that they can take the best care of patients that they can because that that's that's our ultimate goal, I think, for everyone.

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Elisa Arespacochaga
Absolutely. Mary, from your perspective.

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Dr. Mary Wierusz
Yeah, I absolutely agree. I think, you know, studies have really shown that patient experience and quality suffer when clinicians are burned out or lack before professional fulfillment and meaning in their work. And so how far we can enable that is important. And we know it's all connected. We need to have a culture that's high and trust and community and collegiality in order to really enable all clinicians to take the best care of our patients.

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Elisa Arespacochaga
Absolutely. And Sara, let me ask you to jump in here because I know that one of the things we have spent at the AHA a lot of time helping, particularly clinical leaders, but others think about is really to some extent adopting an athlete's mindset towards their career that this is not even a marathon. This is a, you know, one of those marathons where you run, you know, thousands of miles instead of 26.

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Elisa Arespacochaga
It is a career in health care needs to be sustainable. And to do that effectively, you have to address some of these challenges. And I know your work has focused on leadership and performance coaching and how you do that. And you've taken a lot of lessons from the athletic world. And I'd love for you to tell us a little bit about how that works and how it's different from other tools to develop your team.

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Sarah Milby
Sure, happy to. I think you hit on one of my favorite words around sustainability. And so for Valor, we think a lot about sustainable high performance. And it's really important to acknowledge that at least the coaching with Valor, it is a strategy to reward, invest, value and develop rising leaders. It's a way to build leadership capacity. It's not a punitive one.

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Sarah Milby
And look, the best of the best athletes have coaches in their corner and we just bring a lot of those principles to reward, invest and develop rising leaders in various different arenas of high performance. Our work within health care is a key strategy to help ensure that some of the leaders are also getting that energy management. Having a sounding board, especially third party, there's the psychological safety where you're able to actually discuss things, to navigate choices and priorities, navigate all the competing demands on people's schedules.

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Sarah Milby
And because it's also digital, it's a way that people can do it any time, anywhere to accommodate just the crazy schedules that people have. So that's the work that we do and we have the pleasure of, you know, you think about nodes of change, you head on and Mary hit on system, organization, team, individual, and we believe that you really do need to support the individuals as they navigate all the changes, as well as critical nodes of teams like leaders that are going to have a ripple effect and eventually cascade across the organization and culture.

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Elisa Arespacochaga
I couldn't agree more. I think there's a lot of value in really helping leaders have that that extra bandwidth and gas in the tank to really start to make the change they need. But Mary, let me turn to you and ask you, you know, how does performance coaching fit into the work you're doing in your organization to really improve the entire organization's well-being?

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Dr. Mary Wierusz
Yeah, our strategy has included building coalitions of wellbeing, collaborators and cultivating a culture of well-being. I think, as Lee mentioned previously, you know, COVID really brought particular challenges. And one of the things that we found throughout was that in particular our women clinicians were particularly impacted and really wanted to focus on, as Sara said, building up leaders in that particular group within the organization.

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Dr. Mary Wierusz
So we did partner with Valor to focus on a cohort of women leaders, women with leadership, potential and really focus on on that. And performance coaching in general really equips individuals to grow themselves. And as I mentioned, community and collegiality, equipping, wellness centered leadership. And that's what we found with partnering with our and coaching.

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Elisa Arespacochaga
That's great. And Dr. Park, tell me a little bit about how you've used performance coaching in your organization.

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Dr. Lee Park
So I think we just did a little differently. We weren't as focused on leaders specifically, although we have the same data that shows, you know, female physicians have higher rates of burnout and lower professional fulfillment. And that's been true for a number of years. You know, we use the Stanford model in terms of the three areas of well-being.

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Dr. Lee Park
So cultural wholeness, efficiency of practice and personal resilience. So coaching really fell into the personal resilience bucket. And I just want to say it's like one piece of a larger thing that has to happen. It can't just be coaching. We looked at what our sites had done successfully and coaching was one of those things. I think the goal is to really help physicians who haven't really been trained on personal resilience, like we actually are very resilient people to get through like med school and residency and everything else, but you have to have a pretty high level there.

00;11;09;25 - 00;11;27;25
Dr. Lee Park
But I think often as physicians, we don't have a ton of self-compassion, right? We're not sure how to navigate leadership. There are these things that we haven't necessarily been trained to do. So we looked at coaching as a way to sort of shore up and support a number of people that way and the way that we approached it was we sort of led it up to the person and the coach to make the goal.

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Dr. Lee Park
So it wasn't specifically about leadership, but it could have been like, Hey, I need to find more time to see my kids. It could have been, Hey, I need to figure out how to do this academic promotion or, Hey, I just got into this leadership position. Like, how do I build up my team? Know we're still gathering data on exactly how people have used it.

00;11;45;15 - 00;12;07;07
Dr. Lee Park
And it may be different across our campuses versus the community hospitals. But again, it's like one component of a number of items that hopefully when you put together, it addresses a number of things. Whose well-being is it? We don't want people to think like, I have to be personally resilient and that's how I want to be. Well, there are other things that we have to do as a system in the practices and, you know, other components to that.

00;12;07;07 - 00;12;27;26
Dr. Lee Park
But it's one piece where we felt like there was good support. There's some evidence on this, you know, that coaching can help some of these areas. And it's one of the things that we wanted to try and pilot. So we're in a pilot phase with this. We're gathering some information on what people used it for and also does it change outcomes in terms of professional fulfillment, burnout and intent to leave?

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Dr. Lee Park
So we'll see where that lands, but that's where it fit in for us.

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Elisa Arespacochaga
I'm really glad you emphasized that point because it is one piece. It's the groundwork that can help create that space for being able to address what are the efficiencies we can bring because the people doing the work are the ones who can help you identify that. And how do you think about, you know, really those system level activities that can make it more fulfilling place to work?

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Elisa Arespacochaga
Well, if you don't have enough time to, you know, go to the bathroom in a day, you're not going to have time to think of those things. Mary, anything you want to add from your perspective and then, Sara, I'm going to ask you to jump in as well as what you've seen across the country.

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Dr. Mary Wierusz
Yeah, absolutely. I would agree with Lee. I think, you know, it is one component and you know, we also use the Stanford professional fulfillment approach and we know that this is a national movement for a reason. The National Academy of Medicine and there's so much attention. Our surgeon general as well has has addressed this issue with an advisory.

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Dr. Mary Wierusz
And so it really is an approach that we can invest in at the organization, at the national level, that individual patients even can really address this as well because it impacts them. So I think it is important to recognize that it is one component. As Lee said, it's not just on the individual, but it is something that we also want to support the individual as we move towards making those systemic changes.

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Elisa Arespacochaga
Thanks so much. Sarah, you get the opportunity to see at a national level with the multiple organizations that you work with. How do you see people using performance coaching to really kick start and drive forward their organizational efforts?

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Sarah Milby
Yes, and a couple of things I want to just build on that Lee and Mary shared as well. I completely agree. Coaching needs to be part of a suite of solutions. It is not a panacea because it is a systemic and sometimes organizational issues that need to change and and you need to invest in the talent that is navigating those environments.

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Sarah Milby
And so you cannot wait for everything to be resolved at the system level to support the workforce. And the beauty of having a tailored solution, as Lee mentioned, where one individual is going to work on something different from the next individual, but it also be scalable, like with MGB, where we can go across MGB wide is a benefit and I think a huge value that we have the privilege of being able to see different systems, hospitals and health systems across the country.

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Sarah Milby
A couple of things that we found in our data, I mean, pertinent to this conversation, we have seen in our data a reduction of many of our organizations, also leverage Press Ganey, for instance. And so we have seen and correlated to a reduction in intent to leave. We've also started to ingest some of our own information and data where Elisa I know you're privy to cognitive load and some of the Nassar task index work, and we've incorporated that into some of the Valor experience to see a baseline midpoint and final.

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Sarah Milby
How are people experiencing their work? And no one is going to be surprised to hear the high mental cognitive load of clinicians. And we see an impact in people's confidence to navigate confidence and coping mechanisms, to navigate that mental cognitive load and better behaviors in their response. Not as much like anger in response, for instance, as one of the data points that we found.

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Sarah Milby
So we're seeing some really promising outcomes with a lot of our organizations. I think the point that I feel very passionate about is we often are talking about the transformation that has to happen in health care. And some of that we just need to acknowledge needs to happen at the individual level and helping people adapt to change is going to be a critical strategy in actually executing on a lot of broader strategies for health care transformation.

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Elisa Arespacochaga
Thanks so much, Sarah. And I think there's yeah, really starting with what can we do to support the teams individually so that they can make a health care system that really works for their patients or the work that they're doing. Mary and Lee, I'm going to ask, as you've been doing this work, what guidance would you give your colleagues in incorporating performance coaching, in thinking about their well-being and workforce strategies, in supporting their team members to be able to to move forward?

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Elisa Arespacochaga
And Mary, let me start with you. Of, you know, what? If one of your colleagues called you, what would you say? What advice would you give them?

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Dr. Mary Wierusz
I think it's so important to recognize that this is a proven investment in your people. I think as Lee mentioned, there's a lot of competing priorities right now at organizations. And, you know, finances and resources is definitely one of them a reality. But our people are our greatest asset, and especially in the health care workforce situation right now.

00;17;37;21 - 00;17;54;28
Dr. Mary Wierusz
And so it really is an investment in people and at expanse to their teams. You know, if people are if we're investing in individuals, whether it be around their leadership behavior or around their individual resiliency, it makes a big difference to the to the organization as a whole.

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Elisa Arespacochaga
And Lee.

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Dr. Lee Park
I would say a few things.

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Dr. Lee Park
One, as we kind of discussed, like there's not going to be one intervention that will solve all problems. So, you know, making sure that coaching is like a piece of something else that's going on for coaching itself. I think the valuable lessons for us was there are it's not a one size fits all. And so we actually did a pilot with a couple of different arms. We did some group coaching, we did the performance coaching and then we actually faculty coaching as well.

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Dr. Lee Park
So we're trying to look at how do those three different kinds of coaching work or not work. We actually pivoted away from group coaching because it wasn't successful for a number of reasons. And then I think talking to other organizations, there's so many people who are trying to do this and there's so many people that we can learn from.

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Dr. Lee Park
So we talked to a number of folks in terms of like, how did you do it? Did this work for you? And every organization is going to have its own nuances. Some of us are bigger than others. We have like academics, some people don't. But there's a lot of learning that you can do from the group or you don't have to reinvent the wheel.

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Dr. Lee Park
I think often in well-being things can feel very nebulous as to what are we trying to impact and just making sure, you know, to Sarah's point, like we're looking at professional fulfillment, burnout and intent to leave and thinking through like how do these interventions or changes impact some of those things?

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Dr. Lee Park
Because again, just getting it back to like the patient, at the end of the day, what we're trying to do is keep our workforce well so that we can take better care of patients and have better patient outcomes. And so just kind of making sure that we keep an eye on the prize and really think through what the goals are so that we're all moving towards the same thing.

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Dr. Lee Park
As I said, I think sometimes in the past things have been kind of nebulous and so making sure we know what we're aiming for. So I would say like it has been great in terms of the coaching pilots that we've been doing, we're still learning and we really hope that this is something that can be sustainable where people feel like we're investing in them and, you know, can help us take better care of patients.

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Elisa Arespacochaga
Thanks so much for that. And Sarah, let me close with you and just ask, you know, when people call you up and say, okay, can you fix this doc for me or can you fix my dysfunctional team, what is the advice you give in terms of where it fits in the grand scheme of your work?

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Sarah Milby
I have many responses to that question if someone was going to have that over. So a couple of things. One is and it actually builds from what we were saying, we like to be really thoughtful on the leading indicators and lagging indicators as it relates to measurement and metrics of success. And again, coaching, third party coaching, scalable coaching, the digital components that people do self-directed.

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Sarah Milby
You have to have people who are opting in to that experience. It cannot be thrust upon, it cannot be forced. And so now look, we're often oversubscribed when we rolled out with partners because there is such a demand for this type of offering. That said, this is not a we will solve the problem, you know, children. This is let's invest in the future of our organization by investing in the development of our rising leaders. And you won't be surprised that not only do we get positive information from the individual who feedback from the individual who receives coaching, but it is then validated by when we've done other 360s to get.

00;21;21;15 - 00;21;43;15
Sarah Milby
And how is the team seeing the impact of that individual? So we do have impact on how people are showing up and some of their behaviors, absolutely. But the framing matters, communication and making sure and this is something that we're pretty hands on with a lot of our partners, that it is framed as a congratulations because we're investing in you.

00;21;43;15 - 00;22;04;07
Sarah Milby
And B, we want you to see this as a support mechanism for your personal and professional growth. This is not we're really worried about you,  frankly, we've been discussing this a lot behind your back. This is much more of an investment. And that's why, by the way, we have over 90% of participants say they feel more valued by their organization when they've received Valor.

00;22;04;09 - 00;22;20;09
Dr. Lee Park
Can I just add one thing? I do think it's very important that Sara said we framed our coaching program is this is not remediation at all and we're very like separated that out. We thought it was really important to do that and the nominations came from leadership. The way that we did it again, just is like a recognition thing.

00;22;20;09 - 00;22;39;23
Dr. Lee Park
But I do think you need to be very careful about how you frame coaching, because a lot of people when we first started were like, Wait, did I do something wrong? Like why am I getting put into this program? And we wanted to make sure we we kept it out of the remediation in that bucket and very much into the fact that, hey, this is for your growth and your know your leadership or however you want to do it.

00;22;39;26 - 00;22;45;02
Dr. Lee Park
And I think that's really important when people are thinking about any kind of coaching program.

00;22;45;05 - 00;23;04;15
Dr. Mary Wierusz
Yeah, we we took that approach as well. And I think it's important also because and saying what coaching is and what coaching is not, I think there's a lot of misconception around that as well. So I think if you are implementing a program to really define that and make sure that there's understanding broadly around how coaching can be beneficial.

00;23;04;18 - 00;23;09;29
Sarah Milby
I think that also I'm going to build on that because it also goes to this word trust again.

00;23;10;01 - 00;23;37;03
Sarah Milby
And we love when some of our partners have internal coaches and there's value in having the psychological safety of a third party who also can cross-pollinate from other organizations as well. And there's such value in that from just the innovation that has that can be generated. But I just wanted to double click on that word trust that we of course, want in our organizations.

00;23;37;03 - 00;23;48;19
Sarah Milby
And we need to acknowledge that sometimes people need that safe space to have conversations about what they're navigating at work and in life that a well-trained and professional coach can provide.

00;23;48;21 - 00;24;15;05
Elisa Arespacochaga
Absolutely, wonderful conversation. And I really appreciate the work that you all have done and continue to do to frame this as the positive that it is. As you said earlier, Sarah, no professional athlete would think to go to any competition without their coach and without their support team. And I'm glad to hear that our clinical teams and our colleagues understand the value that that can bring to their own experience.

00;24;15;05 - 00;24;38;29
Elisa Arespacochaga
So Mary, Lee, Sarah, thank you so much for joining me today and sharing your insights and your thoughts in the work that you're doing to learn more about Valor Performance and the work that Sarah is able to do with her team, please visit their website at www.valorperform.com/health care. And again, just my sincere thanks for all the great work that you all do.