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Featured topic and speakers
What is a physician wellness program? Why do physician well-being programs matter? Do you need a chief well-being officer? How do you scale a physician wellness program?
Our guest is Gaurava Agarwal, MD, chief wellness executive at Northwestern Medicine. AMA Chief Experience Officer Todd Unger hosts.
- The AMA is your powerful ally in patient care. Join now.
- Improve physician well-being in your organization through the AMA Joy in Medicine™ Program Health System Recognition Program.
- Start a Scholars of Wellness program in your health system:
- Discover more resources from the AMA, the leader in physician well-being (PDF)
- Join the AMA's new physician well-being group on Facebook.
- Learn more about the AMA Health System Program.
Speaker
- Gaurava Agarwal, MD, chief wellness executive, Northwestern Medicine
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. Northwestern Medicine's Well-Being Program has earned Gold Level Recognition in the AMA Joy in Medicine™ System Recognition Program. And today, we're talking about the journey that it took to get there with the Chief Wellness Executive at Northwestern Medicine, Dr. Gaurav Agarwal. I'm Todd Unger, AMA's chief experience officer. Dr. Agarwal, it's great to have you in the studio today.
Dr. Agarwal: Thank you for having me, Todd.
Unger: For those of you who might not know, the AMA Joy in Medicine Program recognizes health systems that have reduced burnout in their organization and provides them with a roadmap to improve physician well-being. Dr. Agarwal, congratulations on your 2023 Gold Level Recognition in the AMA Joy in Medicine Program. How does it feel to be recognized for all your efforts?
Dr. Agarwal: It was a great, great achievement and we were really thrilled to be recognized in this way. I will say, I think for us, it was the validation that we're on the right track. I definitely believe that we have work to do. It's not a mission accomplished sort of situation, but to know that we're on the right track and to have some sort of benchmarking against other health care systems in the country was really validating.
Unger: Well, let's talk a little bit about your journey, because there's a lot that goes into being recognized. Tell us about some of the key being efforts that you and the system have been making?
Dr. Agarwal: Yeah, I mean, for me, I think when you go on this journey, you have to think about top-down and bottom-up impact. And so for top-down impact, we were really blessed to have really senior leadership support our journey, support these initiatives. In fact, our first physician CEO was our executive sponsor from the very beginning on this journey and really said, "Hey, this is the right thing to do and we want to support you. We want to support an office of well-being to make sure you have the resources and the team that can really help you achieve this goal."
And it really became a part of our central mission statement for Northwestern, and that was a new addition. We also wanted to make sure that the people on the ground felt us, and we really wanted to have bottom-up impact and bottom-up influence. And we created a program called Ignite that helped operationalize the surgeon general's workplace mental health framework. And that really allowed us to get scale and well-being at scale is really the challenge for a place like ours—11 hospitals, 41,000 employees. To be able to make an impact at scale in this program really allowed us to make sure that the entire workforce had an opportunity to be involved in a program to increase their knowledge about well-being and what professional well-being is all about.
Unger: I want to talk a little bit more about that. This is actually the third time that you've been recognized by the Joy in Medicine Program. You've had a program in place the first time was in 2019 for that recognition. You're talking about scale.
I'm curious, how has your program changed since 2019? That's now, jeez, five years ago? Is scale kind of the defining change in this. What goes into that?
Dr. Agarwal: Absolutely. You wouldn't believe it. I mean, we started with a program that included 10 physicians. And my scope was only physicians at that time. And now we're responsible for all 11 of our hospitals, all 41,000 employees, both clinical and non-clinical. And so I would say that scale is the defining change in the work that we've done, and that has come with additional resources, additional responsibilities, but trying to make sure that we are offering relevant wellness initiatives to all sorts of different workers is really a challenge.
As a physician, I sort of knew what physicians were asking for what they needed. But to have to learn about all these different job families has been really the challenge, but also the fun of the last five years.
Unger: Well, to know that there is kind of top level support and also, as you say, from the ground up physicians inputting and being part of this process, it must have a huge impact on physicians. Can you tell us, say, a story or any kind of example of where that impact is being recognized?
Dr. Agarwal: Yeah, I mean, I think for me, we try to have data drive us. And so when we look at even the last couple of years, even the last two years, what we've seen is that the burnout has reduced amongst our physicians by roughly 25%. But potentially even more impactful to us is we, like many health care systems, have seen a gender gap. We saw our female physicians with higher rates of burnout than our male physicians.
Through the last two years, we've been able to reduce that gender gap by two-thirds, 66%, while helping both male and female physicians reduce their burnout. And for me, that has got crystallized at the individual level through one of our scholars of wellness who had experienced this burnout herself and became a coach. And she then became a participant in one of our programs called the Scholars of Wellness, and we were able to sort of take that passion she had to use coaching skills and help our female physicians. And she created a group coaching program for our young physician moms. And that experience, that success allowed her to then become our office of well-being coaching lead.
So she's providing coaching opportunities for every physician trainee at Northwestern and now is going to have additional coaching responsibilities in the primary care world, which we all know is a challenging specialty where there's a lot of wellness challenges. And I believe coaching was going to make a difference there as well. So I love seeing her get a chance to follow her passions and also take that passion and be able to serve our colleagues.
Unger: That's a great story. You mentioned the term 'scholars of wellness.' This is a key part of your program. Can you tell folks out there a little bit more about what that is?
Dr. Agarwal: Yeah, this was a program that started it all. This was a program that I was talking about. It started with 10 physicians at the first hospital that we did it on. And it sort of came out of a lot of wellness committees when we first started this work. That sort of was what led to me initially being identified as someone who might want to do this work.
And what I always tell people is most of the wellness committees I felt like didn't do very much and I couldn't figure out why. And then I realized there's a certain set of skills and knowledge that it takes to be able to make change at an organizational system level. And we're just not trained in some of those skills as physicians.
I also knew that when people said, "Hey, think about being the lead of physician well-being and now think about being the lead for the entire workforce." I said, "Me and what army?" And so I realized that I needed to be able to have a multiplier effect. I needed to train the trainer.
And so Scholars of Wellness is our professional development program. It's to create wellness change agents at the local level that can be extensions of our office of well-being and really take the lead on those local unique drivers of well-being that only someone in those local departments and divisions can know. And it's been wildly successful for us.
We've been able to expand that program from only including physicians to now, including APPs, advanced practice providers, and also being able to include our pharmacists this year. And it really has created a lot of teamwork and collegiality where we all get to learn about our different drivers of well-being and how we can support each other.
Unger: That's, again, a great story. And I'm curious if you're going to advise other folks out there that are in different parts of their journey on building physician well-being programs, now that you have so many years under your belt, so to speak, what areas of concern would you point out? What advice would you give them?
Dr. Agarwal: Yeah, I think for me, I'm not a big believer in boiling the ocean. I've encouraged people, even though our scope was the entire workforce and we have initiatives to try to address the entire workforce, we do deep dives in certain job populations based on need, based on our data. And that really allows us to make sure that we truly understand what are the drivers that this group is experiencing.
We have a chance to really be felt by the local leaders and the local workforce, so it's not just sort of an inch deep, a mile wide. We really want them to know we're here. We're in it for the long haul. We really want to understand what's going on and what would be useful to improving your work environment. So for me, I have found that to be really successful.
I do think the Scholars of Wellness is a great program to kick off your efforts because again, no one's going to be able to do it themselves. You're going to need a team. You're going to need your extenders that really can help you understand what are the true needs on the ground. And thanks to you all, we were able to publish the Scholars of Wellness on the AMA STEPS Forward with a really pretty step-by-step guide on how you might want to start your own program in your local areas.
Unger: If I heard one theme kind of coming through in yours, it's really about getting to scale—
Dr. Agarwal: Yeah.
Unger: —starting small, building those folks that can be extensions of the work of you and your immediate team, and then spreading out from there. That's a huge accomplishment.
Dr. Agarwal: Thank you very much. I really do think that is something that I hear in a lot of my talks. At the end in the Q&A, people say, you know, I don't really think I can get started unless my CEO is on board. I really just don't know if I've got the support.
And what I always say to people is, you'll be amazed. I'm a big believer in small wins and just getting some positive momentum, demonstrating value, demonstrating that you can execute on what you say you're going to do. And that tends to increase people's circles of control and influence. And I'm living proof of that.
Unger: Success breeds success—
Dr. Agarwal: That's right.
Unger: —is what I always say to my team here. You are Northwestern's first ever Chief Wellness Executive. What prompted that decision to create that role at Northwestern? And would you recommend that other health systems follow suit?
Dr. Agarwal: Yeah, I mean, I think our journey started before the pandemic. There was some foresight, hey, this is where the puck is going, as we like to say, and we need to make sure that we understand how to execute and advance the quadruple aim. That was sort of the discussion we were having. But then the pandemic, I think, really gave us an opportunity to show value and say, hey, you know, the things that we did before the pandemic in preparation have really allowed us to respond differentially.
And then during the pandemic, that trust we had built allowed us to be in the conversations to take on the entire workforce. And the entire workforce had, as you know, tons of needs. And so again, being able to show value during those times I think led to people saying, you know, this is really important work and it requires dedicated focus. And so while I'm biased, I do believe having someone that can have that dedicated leadership that creates the organizational strategy and then executes on that organizational strategy is very likely to help accelerate your work in the space.
Unger: Well, you're lucky that you were out ahead of the pandemic. I know that didn't help things and those problems just remained afterwards. So you definitely were skating to the puck, which is very nice. Good Chicago illusion.
Dr. Agarwal: That's exactly right.
Unger: Last question for you. As you look ahead in the year to come, what's the big goal?
Dr. Agarwal: Yeah, I think for me, we use a term called marbling. And so if you think about steaks, right, what makes a really good steak is—
Unger: Now, you're talking my language right now.
Dr. Agarwal: —is if the fat is really marbled into the meat, right? And that's what we talk about is, is well-being can't be an initiative or an office that sits in the corner and it's just sort of a thing. It really has to be marbled within operations. It really has to be marbled in the character of who we are as a health care system.
And I think we've done a good job of marbling, but I think there's continued work there to be done as we convert well-being into an operational metric. And so we're trying to use data to drive this next phase of, what does it really take to create a superior health care environment?
My dad was a coal miner. And so what I always tell people is I'm not interested in making stronger canaries. I'm interested in making healthier coal mines. And what we are here to do is to identify what we call those work determinants of well-being that are responsible for healthy coal mines. And that's what we want to advance.
Unger: I love that. It's just a great metaphor first in marbling. And then just creating the healthier environment, really terrific. Dr. Agarwal, thank you so much for being here. Congratulations to you and your team. We're looking forward to seeing what you do next.
If you're a health system leader and you want to learn more about the AMA's Joy in Medicine Program to help you improve physician well-being, visit ama-assn.org/joy and join the more than 70 health systems we recognized last year alone for their well-being efforts. That wraps up today's episode and we'll be back soon with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please 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.
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