Physician burnout continues to plague the medical profession. But amid the relentless demands of the health care industry, the Confluence Health system in Central Washington is taking bold steps to implement innovative strategies to cut stress, enhance work-life balance and foster a culture of support. And these efforts are being noticed.
In 2021, Confluence Health received bronze-level distinction from the AMA Joy in Medicine™ Health System Recognition Program, which is designed to spark and guide organizations interested, committed or already engaged in improving physician satisfaction and reducing burnout.
Confluence Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
This year, by following the program’s framework, Confluence Health earned silver and were among the 72 health systems, hospitals and medical groups that were recognized for their active dedication to physician well-being. The health system has 15 clinics and two hospitals throughout Central Washington, with more than 300 physicians and 170 nonphysician providers.
Receiving silver-level recognition “shows our dedication to physician well-being. It’s not just something that I’m doing. It’s something that has had support throughout the organization,” said Makrina Shanbour, MD, a hospitalist and director of provider well-being at Confluence Health in Wenatchee, Washington.
“The Joy in Medicine program provides a great road map for developing a program. It’s been helpful for us to see what the next steps are and what other organizations are working on,” Dr. Shanbour said. “It has provided a nice road map for us from the beginning and also looking forward at what we may aspire to.”
Additionally, “the AMA STEPS Forward® toolkits have been really helpful and provide a tangible way to implement a new project,” she said, adding that “we’ve really appreciated the support of the American Conference on Physician Health. We’ve sent people there almost every year since it started and that’s been really inspiring for our people to see that other organizations are working on similar things and there’s so much great collaboration there.”
Here are some ways Confluence Health has reduced physician burnout and made well-being a priority.
Train up staff to support physicians
Confluence Health’s burnout rate dropped from 46.4% in 2021 to 37% in 2023. That is below the nationwide burnout rate of 53% that was reported by the AMA’s Organizational Biopsy®.
The COVID-19 pandemic assuredly drove up stress levels in the health system, “but we’ve worked on trying to band together and keep community,” Dr. Shanbour said.
“One of the biggest impacts has been to decrease in-basket burden and there’s been a huge strategy for how to do that—utilizing the team to offload some of the messages,” she said. “Out of the in-basket messages that are patient question requests, 70% of those are managed by staff. Only 30% go to the physician and that has decreased the amount of in-basket time significantly over the last couple of years.”
A key to this decrease has been through medical assistant training.
“We found that during COVID there was such a shortage, and they were hiring people and doing new training every week, but they weren’t getting the amount of training that they had previously,” Dr. Shanbour said. “Our clinical development team has gone back to retrain and bolster the training for our medical assistant staff, which has really helped.”
The medical assistants and nursing staff do so much to “cover and decrease the burden, specifically of the in-basket. That’s something that we’ve been celebrating recently,” she said, noting “we have also done a big campaign to re-educate our patients about using the patient portal and what appropriate use is. That’s also been helpful.”
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Focus on leadership development
Leadership assessment and support was defined as a priority to help physicians and address the concern of a “disconnect with leadership.” That’s when Confluence Health decided to hire a medical director of provider leadership development—a position that had been created prior to the COVID-19 pandemic but left vacant.
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“It was funded by our health system, and we realized, especially looking at the leadership piece of the Joy in Medicine application, that we weren’t doing the best service for our leaders,” Dr. Shanbour said. “That was a huge gap in our program, and we felt like it was important to develop that.”
With this position filled, the leadership academy was launched and that included 60 physician leaders, which was well attended and earned great reviews. It helps to bolster leadership assessment, training and communication. Another group will be put together to continue the leadership academy.
“We’re also planning some small leadership groups to help support each other and work on projects together,” she said.
Address staffing shortages
“Staffing shortages were probably the leading cause of burnout across our organization,” Dr. Shanbour said. “What we noticed was that MAs were the most burned-out group in our organization, followed by nursing and then physicians.”
“Going and talking with our people all across the organization, we found that staffing didn’t just mean that we didn’t have enough staff. … It also meant that the staff that we had weren’t trained well for the position that they were in, or that they didn’t have the cross-training ability.
“We also noticed that there was a lot of need for standardization of workflows, which would make it easier for staff, especially when they’re having to work across different departments. So, we’ve been thinking about—and working on—some standardization projects,” Dr. Shanbour added. “And some of them are really simple, like putting the consent form in the same place before a gastrointestinal procedure.”
“We had another department that worked on standardizing the rooming procedure for urology, and they had significant improvement in the happiness of the staff in that department,” she said.
“This is a team effort. There's not one person or one department that can make this work,” Dr. Shanbour said. “I really appreciate my team, which includes my CMIO, our director of physician leadership and our CMO and support from our board, including the Confluence Health Board and the medical group board. I couldn't do it by myself.”
