Northwest Colorado Health; Craig, CO
Diana Hornung, Chief Medical Officer

• Leadership embraced supporting workforce as a focus area; included Joy in Work in strategic plan.
• Used Executive Leadership and Physical Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout as framework.
• Providers given 20% of time for clinical area of interest, administration, teaching, or other activities.
• CMO meets 1:1 with providers and provider group regularly; executive leadership joins provider group quarterly.
• Mindfulness and team-sharing included in meetings; mindfulness strategies supported by behavioral health consultant.
• Conducts yearly all-staff survey, which includes questions on burnout.
• Financed through general budget per strategic plan.

Henry J Austin Health Center; Trenton, NJ
Kemi Alli, CEO

• Included Joy in Work in health center’s strategic plan, and holds twice yearly Joy in Work staff retreats.
• Increased opportunities for staff to talk with senior leadership, receive recognition, and socialize.
• CEO is champion, supported by leadership team, including Directors of: Transformation, Quality, Media and Communications, Electronic Medical Record Clinical Applications, and the Chief Medical Officer.
• Skill-building for senior leadership team; plan to expand to mid-management and care teams.
• Systems changes led by Process Transformation Committee.
• CEO sees role as providing resources that help staff do their best work; increased and diversified revenue stream by adding retail pharmacy and more private donors.

Oregon Primary Care Association; Portland, OR
Irma Murauskas, Sustainability Director

• Maintain ongoing relationship with Clinical Leaders Peer Network, used Quality Improvement approach to support leaders in addressing workforce burnout, a topic raised by Clinical Leaders Peer Network.
• Engaged executive leadership through CEO/CMO dyads in Executive Leadership Peer Network.
• Clinical Leaders Peer Network meets two to four times per year and participated in one-day retreat on workforce well-being.
• Developed workforce well-being action plans and piloted baseline assessments of well-being and burnout.
• Validation of workforce well-being as an important issue, in early stages of assessment with action plans being implemented; enhanced perceived value of Primary Care Association.
• Work to achieve consensus on shared metrics for network monitoring of workforce well-being and burnout.

Caring for the Care Team

Compassion Fatigue. Canadian Family Physician, 2013.
Case discussion which includes definitions and multiple strategies to manage the stress of being involved in emotionally demanding patient and family situations.

Intervention to Promote Physician Well-Being, Job Satisfaction, and Professionalism: A Randomized Clinical Trial. Journal of the American Medical Association (JAMA) Internal Medicine, 2014.
Facilitated small group discussions for physicians improved meaning and engagement in work and reduced depersonalization, with sustained results at 12 months.

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Resources From Federal Partners

STAR² Center: Solutions Training and Assistance for Recruitment and Retention
A project of the Association of Clinicians for the Underserved (ACU), which has a National Cooperative Agreement (NCA) with HRSA.

Community Health Center, Inc.
This HRSA-funded NCA provides webinars and learning collaborative on advancing team based care.  Learning collaborative incudes learning sessions, in person QI training, coach mentoring and access to web based tools and resources.

National Association of Community Health Centers Leadership Development 
The National Association of Community Health Centers (NACHC) is a HRSA-funded NCA that provides leadership development training and coaching for health center executive leaders. The Clinical Leadership Self Directed Training tool helps clinical leaders assess their professional competencies, identify their learning gaps, and create a self-directed learning and development plan.

Organizational and Systems Changes

Executive Leadership and Physician Well-Being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings, 2017.
Clear recommendations on how organizations can make change to promote workforce engagement. Helpful table that compares assessment tools. 

IHI Framework for Improving Joy in Work: White Paper. Institute for Healthcare Improvement, 2017.
Similar information and approach as in article above; includes business case for investing in joy in work.

The Business Case for Investing in Physician Well-Being. JAMA Internal Medicine, 2017.
Outlines steps to address burnout. Identifies critical ingredients, including prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level.

Implementing Optimal Team-Based Care to Reduce Clinician Burnout. National Academy of Medicine Discussion Paper, 2018.
Describes features of successful health care teams, reviews evidence that links high-functioning teams to increased clinician well-being, and recommends strategies to optimize team-based care.

Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness and Personal Resilience. NEJM Catalyst, 2017.
Three-pronged and inter-related approach to improving physician well-being; can be applied to all staff.

Physician Burnout and Higher Clinic Capacity to Address Patients’ Social Needs. Journal of the American Board of Family Medicine, 2019.
Correlated levels of physician burnout with clinic’s capacity to address social needs. Very applicable to health centers.