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Featured topic and speakers
The AMA Joy in Medicine™ Health System Recognition Program has recognized Ochsner Health for the third time in 2023. Nigel Girgrah, MD, PhD, chief wellness officer at Ochsner Health joins to discuss the evolution of Ochsner's organizational well-being program and its strategic framework for the future. AMA Chief Experience Officer Todd Unger hosts.
- Register for the 2024 Joy in Medicine™ Health System Recognition Program informational webinar.
- Download AMA Joy in Medicine guidelines (PDF).
- What is the AMA's Joy in Medicine™ Recognition Program? Find out.
- Learn more about the AMA Health System Program.
- Hear more from Dr. Girgrah on the STEPS Forward® podcast and learn how Ochsner's shift to a culture of well-being began.
Speaker
- Nigel Girgrah, MD, PhD, chief wellness officer, Ochsner Health
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. The AMA recently unveiled the list of organizations recognized by the AMA Joy in Medicine Health System Recognition Program for 2023. Today, we're talking with one of the only 10 organizations to achieve gold-level recognition this year. With me is Dr. Nigel Girgrah, chief wellness officer at Ochsner Health in New Orleans.
I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Girgrah, let me start by saying congratulations to you and everyone at Ochsner for all your hard work.
Dr. Girgrah: Well, thank you, Todd. It's great to be back. And I just have to emphasize that workforce well-being is a team sport. You know, I've got a great team. Our team is called the Office of Professional Well-being. I've benefited from fantastic executive sponsorship, great colleagues and also benefited from some terrific mentorship with other CWOs and some of the thought leaders, actually, at the American Medical Association.
Unger: Well, all your work and the teamwork that you refer to is really paying off because this is the third time that Ochsner has been recognized by the AMA Joy in Medicine Recognition Program—first in 2019 and then a second time in 2021. And since then, I'd love to know, what are some of the improvements that Oschner has made to its well-being program?
Dr. Girgrah: Yeah, well, I think we benefited since the last Joy in Medicine Recognition from receiving a $2.9 million grant from HRSA. And that's allowed us to sort of roll out—experiment with some initiatives around supporting our mental health needs for our workforce, some initiatives around resilience.
And I think that's really helped. But I think more than the actual initiatives, just witnessing the culture change here at Ochsner. I mean, when you see other large business units at Ochsner, like pharmacy, like IT, rolling out major initiatives to improve practice efficiency, decrease inbox work, I mean, that's cultural alignment.
When you start witnessing boardroom discussions around workforce well-being, well-being featuring on department meeting agendas, an openness with our executives to talk about mental health struggles, that's culture change. So I think more than the initiatives, I think just witnessing the improvements in an overall culture of well-being has been fantastic.
Unger: And that's so important with any kind of change. It's the culture change that sometimes can be the most difficult. And what I hear you talking about is momentum that comes from the kind of wins that you see from one department that seem to spread to the other, so congratulations because I know that kind of culture change is so hard. And that comes at a pretty difficult time because in the middle of this, of course, is the pandemic.
You certainly saw your fair share of cases of COVID-19. Did the pandemic give you any insight into what was working well with your well-being efforts and maybe what still needed more work?
Dr. Girgrah: Yeah. Yeah, I mean, you know, necessity is the mother of invention so it really forced us to be more balanced in our portfolio of offerings. So Todd, pre-pandemic, our strategic areas of focus were heavily weighted around practice efficiency, promoting teamwork, leadership development.
Nothing wrong with that. That was, I thought, a solid strategy. But with the pandemic—and we were a big hotspot—we had to react, adapt. So we had to certainly start to focus on crisis support, getting down Maslow's hierarchy of needs, focus on resilience offerings for individuals and teams, thinking about how do we support the mental health needs of our workforce?
And we really needed to get more upstream, more on-demand when reaching our employees. And thinking about how to reach them outside the traditional employee assistance program. And Todd, we also had to rethink and broaden the scope of our activities.
So again, pre-pandemic, our scope was just around our employed physicians and APPS. Again, nothing wrong with that. But I think the pandemic illustrated to us that you can't think of one segment of the sort of overall health care delivery ecosystem in isolation.
So the well-being of your nurses impacts the well-being of your APPs and physicians. The well-being of your medical assistants plays a big role in the overall well-being of your health care delivery team. So I think with the pandemic, we had to sort of had to broaden our focus to embrace all 38,000 employees.
Unger: That's no small feat. I'm curious, Dr. Girgrah, when you talk about—I mean, those are bigger ambitions. There's more complexity, a richer program. How has that affected the team that has to oversee both the strategy and execution of these efforts? Has that had to grow to be able to do that?
Dr. Girgrah: Yes, our team has grown. I think back in 2019, we were a team of about three full time FTEs. I want to say we're around eight FTEs. But Todd, I have to emphasize that whether you're a team of three, whether you're a team of eight, whether you're a team of 20, this kind of office has to be an office of influence and collaboration.
So eight FTEs can't be responsible by themselves to impact the overall well-being of an organization that has 38,000 employees. But adding FTEs, adding project managers has allowed us to take on more complicated projects that require bringing different stakeholders together, chartering a project, building a business case, developing a guiding coalition.
So it has allowed us to do a lot more in the practice efficiency space. Adding FTEs has also given us some capabilities to align with our nursing well-being activities. And then I mentioned the HRSA grant. We had to hire some folks to help us manage and implement the grant. So our team has grown.
Unger: You know, one of the things we talked about earlier was this issue around culture change. And related to that is kind of the sustainability, I think, of any program that you attempt to implement. And I wanted to get your perspective on how Ochsner has been able to keep the commitment to physician well-being so strong for so long when I'm sure you're always operating in a context of change, whether it be the pandemic or executive leadership, whatever that is. How do you keep it going?
Dr. Girgrah: Well, that's a great question. I think it really starts with executive sponsorship and commitments. And honestly, when I took on this role, I equivocated a little bit because I wasn't sure back in 2018 and 2019 whether there would be that consistency and that commitment.
But you know, it's been there for the past five years. Certainly, I think having a framework to work with, like the Joy in Medicine Recognition Program has been very helpful as well.
Unger: Let's talk a little bit about that. Number one, the framework of the Joy in Medicine Recognition Program. Number two, other tools that the AMA brings to the table, like the AMA Organizational Biopsy, that are there to help health systems improve physician well-being. Talk to us a little bit about how Ochsner's partnership with the AMA has helped you this past year.
Dr. Girgrah: Sure, I'm happy to. And it's helped us in a in a number of ways. But I mentioned the Joy in Medicine Recognition award. I think that's a framework or a roadmap. I think of the Latin expression, sine qua non. It's necessary, but not sufficient. So it doesn't guarantee that you're going to have success, but I think without a framework like that and assessing the six organizational competencies around well-being, it's going to be harder to make longterm change.
So but outside the Joy in Medicine Program, the AMA has the STEPS Forward® website, where there are all sorts of great modules to help you sort of guide and build your strategy around workforce well-being. It's certainly helped me.
You mentioned the Organizational Biopsy. I think Ochsner health was the first system to pilot that Organizational Biopsy. But with the Mini-Z, we've had the opportunity for five consecutive years, year over year, to use that survey to benchmark ourselves against other organizations, not just in terms of the primary measures of success like reducing burnout, increasing job satisfaction, but really taking a look at the drivers of burnout to the extent that you can measure culture.
Can you measure perceived leadership, the sense of equity in the workplace, workflows? So all those things have been enormously helpful as we as we build our strategy. And then I think the mentorship that the AMA has been able to provide my colleagues at Ochsner.
So I think of Chris Sinsky and Nancy Nankivil, but also folks like Michael Tutty and Marie Brown. I've benefited significantly from their mentorship and their insights. And really, the AMA has allowed us to connect with other organizations throughout the country that are going through a similar journey in terms of rolling out their workforce well-being programs.
Unger: Dr. Girgrah, I'm curious, what's on tap? How do you take a great program forward?
Dr. Girgrah: Yeah, so that's something I've been thinking a lot about lately. So I'm going to date myself, but I think about James Carville and the strategy back in 1992 when he was building Clinton's presidential bid plan. And that was, is the economy stupid? And I think for us, it's workflow.
It's been great to develop programs around resilience and mental health. Those will continue to be essential. But what I'm hearing loud and clear from our employees is, let's get back to fundamentals, practice efficiency and workflow.
So I think another step that I think is going to be necessary over the next two years is we, I think, have a nationally recognized, solid, evidence-based system strategic framework around workforce well-being. How do we build some agility and decentralize those activities?
I mean, the drivers of burnout in primary care in one of our community facilities is going to be different than what's driving burnout in surgery at our flagship hospitals. So how do we develop local empowerment, local ownership to build local programs that support the workforce well-being?
So I think, getting back to your question, I think refocusing our efforts around workflow and practice efficiency and then taking a solid, centralized strategy and beginning to decentralize it and make it more agile.
Unger: Very, very smart. I love to—the focus on workflow and practical, it reminded me, when you were talking about that, of something that comes from the STEPS Forward body of knowledge there about getting rid of the stupid stuff, like in any organization—
Dr. Girgrah: That's a great module, yeah.
Unger: It really is. It's just kind of like, you know, people kind of work in situations where they're just—they can make a change. And so what you're saying is kind of recognize it, change the workflow and then decentralize some of that too. It's just amazing. Dr. Girgrah, thank you so much for joining us. And congratulations again to you and the entire team at Oschner.
The 2024 application cycle for the AMA Joy in Medicine™ Recognition Program opens on January the 12th. And you want to be a part of that. So learn more about the program and how your organization can apply at ama-assn.org/joyinmedicine.
That wraps up today's episode and we'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today and take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
