Investing in yourself by participating in the Well-Being Index (WBI) is now easier than ever, thanks to the newly provided WBI Sign Up Access Codes for each entity. The WBI is a confidential 9-question self-assessment of your stress and well-being. Take or re-take the Well-Being Index multiple times per year to track your score over time. Click here to see your special code.
The well-being of our physicians, providers, nurses, and all employees is an important topic of discussion for the UNC SOM and Health Care System and is the primary focus of the System-Wide Well-Being Program.
Well-Being Program Progression
Very recently, there was an article published in the New York Times, by Dr. Danielle Ofri, a noted physician and author at New York University. Her piece highlights the personal sacrifices health care professionals make to ensure their patients continue to receive high-quality care in spite of ever-increasing workplace demands and administrative burdens. Ofri’s article poignantly describes the growing pressures on physicians and nurses to see more patients each day as well as the extensive time spent documenting in the EHR. The combination results in many providers being forced to engage in “pajama time”, ie, time spent completing EHR tasks in the evenings or other off hours. In addition, these administrative burdens creep in to academic time that decreases research productivity and time spent teaching. These significant administrative burdens cause burnout and distress for the provider and worse outcomes for patients.
UNC has taken a serious stance against physician burnout that began with formally adopting the Quadruple Aim in 2016 and the subsequent creation in July 2018 of the System-Wide Well-Being Program. An initial first step of this program has been to measure the stress of our workforce to identify the areas that are most distressed and develop targeted interventions.
Over the past year, we have invited all faculty, employees and learners across the UNC SOM and HCS to sign up for the Well-Being Index to track their workplace stress levels. We have begun to prepare reports and disseminate the information to leadership, which is informing intervention efforts.
Please see below for a detailed account of the interventions and initiatives underway to address physician, provider and employee stress and burnout.
About Practice Quality and Innovation’s Quality & Clinical Implementation Coaches
Practice Quality and Innovation’s Quality & Clinical Implementation Coaches support the SOM clinics and providers through strategically aligned projects such as Patient Engagement, Organizational Goals, and the Primary Care Improvement Collaborative. These goals provide improvement to our patients lives by focusing on improving outcomes for preventative measures. The quality coaches are lean six sigma trained and have worked with clinics to improve items such as throughput and workflow. The clinical implementation coaches focus on meeting measures via Epic, workflow improvements, and efficiency.
New initiative identifying and providing resources to providers with high rates of after hours EPIC use (pajama time)
As of Monday, we are working with ISD to develop a new initiative focused on identifying and providing resources to clinic providers with a higher than average time spent in Epic@UNC after scheduled clinic hours. These resources will include a number of different elements (at-the-elbow coaching and consults for EMR personalization and optimization, assessment of work-flow related issues, clinic staffing and scheduling, etc.). We welcome your suggestions on additional resources that we can provide.
Distribution of Well-Being Index (WBI) data to leadership to promote awareness, facilitate increase in resources, and guide decisions that may impact well-being.
The Well-Being Program team members are gathering data, measuring indicators of stress, and distributing reports to leadership so that we can identify the areas that are most stressed and aggressively follow up in real time with appropriate interventions to those who need it.
Human Factors Engineering Care Re-Design projects
The Division of Health Care Engineering (DHE) is leading an innovative program using a human factors engineering approach to identify work-related processes that can lead to frustration and contribute to burnout. The 2018 work with the Hospitalists at UNC Medical Center and UNC REX was highly successful and is now expanding to include Cardiology and Oncology at UNC Medical Center and Rex. Follow-through on action items from the hospitalist pilot continue.
Improvements in Laboratory Services at UNCMC—an example of an issue identified and how this is being addressed:
During the care redesign project with the UNC Hospitalist group, we learned that certain processes involving laboratory services at UNCMC required change to improve efficiency and decrease frustrations. This is being actively addressed with the following improvements now in place: Read more
Ongoing ISD increased support and enhancements
To support the system-wide Well-Being initiative, ISD has established a strong, collaborative partnership with the System-Wide Well-Being Program led by Dr. Samantha Meltzer-Brody.
Ongoing Support from Faculty Practice Embedded Epic Support
Team-Based Care and Documentation
Emotional Support Program
The Integrated Emotional Support Program connects healthcare professionals with emotional support resources, with a specialized focus on providing resources after adverse patient events, and unexpected patient outcomes. The program has also started a new initiative with workplace safety to proactively reach out to faculty and staff who have been verbally or physically assaulted by patients and visitors.
Expansion of SOM Wellness Committee to include representatives from all Departments
This year, the School of Medicine has launched a new Well-Being Committee to liaise with and complement the System-Wide Well-Being Programs efforts and ensure representation across all SOM Clinical and Basic science departments.
A toolkit of best practices that can be tailored as appropriate to meet the specific needs of individual teams at each entity is currently under development. If you would like to be a participant in this effort by contributing ideas and disseminating information to help adopt and share best practices across the system to enhance work culture and relations, contact the Well-Being team today!
In summary, the complexity of health care delivery requires ongoing vigilance of the Well-Being of all physicians, nurses, and staff involved in delivering patient care and performing other vital missions (research and teaching). The UNC System-Wide Well-Being Program is committed to working together to make things better. Please email us with questions or suggestions at Well-Being@unchealth.unc.edu.