LIKE JUST ABOUT EVERY other division of hospital medicine in the country, the one at Michigan Medicine (the academic enterprise that includes the University of Michigan at Ann Arbor) has had a wellness committee since December 2018. After all, the issues of physician wellness and burnout have gained prominence, and the costs and chaos associated with high turnover are well-known.
But—again, like many other wellness committees—the one set up by Michigan Medicine’s hospital medicine division has until now been fairly low-key, says hospitalist Jason Ham, MD, a committee member. None of the committee co-leads has dedicated time carved out to organize wellness activities, nor were their colleagues clamoring for more get-togethers than the occasional social event the committee organized.
“During the committee’s early days, our focus was blurry,” says Dr. Ham. Committee work ranged from providing nutritional support and publicizing key resources to arranging get-togethers.
“Wellness is one of those frontiers where, if you invest just a little bit more, the payout multiplies.”
~ Jason Ham, MD
But that was before coronavirus, which has pushed clinicians far beyond what they’ve previously faced. During the pandemic, he explains, clinician wellness has suffered due to the stress of treating the virus and the fears of becoming infected and transmitting it to family, among other concerns. It’s now clear that clinicians need extra support and attention.
When the wellness committee was first formed, Dr. Ham says he mistakenly viewed it as “plain and boring.” That’s not to say he didn’t think the committee’s mission wasn’t important. But unless you’re personally burning out, he says, doctors under normal circumstances tend to not spend a lot of time worrying about wellness at work.
“At work, you think about your schedule, your census, the meetings you need to attend, how accurately you’re billing and the new hospital initiative on washing hands,” he says. “Traditionally, wellness is what’s left over.”
But as the pandemic hit, covid patients began to be flown in. “All of a sudden, the helicopters made the academic center look like a beehive,” says Dr. Ham. “We maxed out at around 350 coronavirus patients.” His regular job—running the observation unit—evaporated because “no chest pains were coming in.”
To help colleagues during the early part of the pandemic, the committee started out simple, bringing in snacks and organizing an educational series on wellness techniques, including breathing exercises and meditation. “We wanted people to know,” says Dr. Ham, “that we were looking out for them.”
Several members of the committee began partnering with intensivists to cover a covid ICU, and frontline workers—hospitalists as well as those in the ED and ICU—had an amplified sense of anxiety and fear. “We recognized that this level of anxiety really needed some type of support,” he notes. That’s when the wellness committees quickly pivoted to provide a forum for peer-to-peer support.
Sharing a unique experience
The committee’s first innovation was a Zoom meeting it called “Community Check-In,” held every other week in the evening. Dr. Ham has been facilitating the check-ins, which are designed to function like a virtual water cooler to gather around.
“We came up with some ground rules for faculty and staff because we didn’t want the check-ins to become complaining sessions about our schedules,” he says. “We start off talking about things we’ve come to appreciate and then move into concerns.” Each person is invited to participate but doesn’t have to.
The first few check-ins allowed group members to vent their stress and fears around caring for covid patients. Those sessions, Dr. Ham recalls, featured tears, laughter and a great appreciation of one another.
“We acknowledged this unique experience that others outside of health care couldn’t relate to.”
Interestingly, the check-ins have evolved over time, moving away from expressions of concern to discussing the important work everyone is doing in the hospital as well as the impact of the George Floyd killing and the ensuing protests.
One check-in was held later in the evening so that colleagues could get together after children were in bed. While that session attracted fewer participants, it allowed them all to talk about the challenges of home-schooling and of finding child care. The committee continues to tailor check-ins to more specific concerns and groups, including a virtual happy hour for women in medicine.
Identifying pressure points
The academic center has also stepped up, says Dr. Ham, to extend several levels of support to clinicians and staff. For those who “just need somebody to talk to who understands, a Community Check-in will do nicely,” he points out.
But that’s not appropriate for someone suffering from depression, and avenues have been set up through the health system’s wellness office for those who need more intensive support. In addition, Michigan Medicine’s office of counseling and workplace resilience has set up a 24/7 schedule of social workers who are being deployed to hospital floors.
That office also launched a peer-to-peer program— named COMPASS—to train hospital medicine faculty to recognize and respond to stress among colleagues who are experiencing adverse events or other distressing clinical encounters. All those levels of support are highlighted during each Zoom check-in as well as in division meetings and on the hospitalists’ Facebook page.
Dr. Ham also authored a letter to providers’ friends and family, explaining the impact of treating covid on clinicians and noting that they may be more emotionally distant at home. To further find and alleviate the pressure points hospitalists are under, the committee this spring also began crafting “a detailed survey,” he says, that faculty will be incentivized to take once a year.
The survey will delve into faculty and staff satisfaction, burnout, work-life balance, and job retention—and how the committee could best support those as well as the needs of a very diverse group. Committee members hope to use the results of the anonymous survey to plot their future direction and to understand how diversity and inclusion affect wellness and retention.
Dr. Ham has also come to appreciate the benefits of “bumping up wellness committee work just a bit,” he says. “Wellness is one of those frontiers where, if you invest just a little bit more, the payout multiplies.”
Phyllis Maguire is Executive Editor of Today’s Hospitalist.Published in the August 2020 issue of Today’s Hospitalist