If at first you don’t succeed, try, try again. So says the proverb, and for physician leaders at Allegheny Health Network the age-old wisdom has again proven true.
In a testament to unwavering commitment and dedication to reducing physician burnout, Allegheny Health Network emerged victorious in its pursuit of well-being recognition after an initial setback. The Western Pennsylvania health system, on its first try, fell short on the criteria for bronze-level recognition from the AMA Joy in Medicine™ Health System Recognition Program in 2022.
The program is designed to spark and guide organizations interested, committed or already engaged in improving physician satisfaction and reducing burnout. As AMA President Jesse M. Ehrenfeld, MD, MPH, noted in a Leadership Viewpoints column, “Joy in Medicine is the standard by which our nation’s best health systems should be judged because it recognizes those taking the right steps to care for their physicians, as well as patients.”
Physician leaders at Allegheny, understanding the value of the program, refused to be disheartened and redoubled their efforts to achieve the coveted recognition.
Their efforts paid off.
By following the program’s framework and road map, Allegheny Health Network earned silver-level distinction from the AMA. The health system has 14 hospitals and over 200 primary- and specialty-care practices in more than 300 clinical locations and offices with about 2,600 physicians and 21,000 employees.
Like other health systems, Allegheny Health Network (AHN) has seen fluctuating physician burnout rates since beginning to survey in 2019. That inaugural year, 47% of physicians reported burnout, dropping to 44% in 2020 and 2021. Along with the rest of the country, AHN saw a spike in burnout rates in 2022 to an all-time high of 52%. This mirrors the nationwide burnout rate of 53% that was reported by the AMA’s Organizational Biopsy®.
But in 2023, Allegheny saw their physician burnout rates drop back down to 46%. Allegheny Health also surveyed burnout rates among all 22,000 employees, including nurses and nurse managers. These groups saw similar fluctuations, with nurses reaching an alarming burnout rate of 67% in 2021 and dropping to 44% this year.
“My hat’s off to the AMA because when the decision was [that] we didn’t meet the requirements for bronze-level recognition, we had a phone call and discussions about why, which was really helpful,” said Thomas P. Campbell, MD, MPH, an emergency medicine physician and chief wellness officer for Allegheny Health Network.
“It was helpful because we learned how to do a better job at submitting our data and programs clearer, and more concisely meeting the application requirements,” Dr. Campbell said. “The other thing we really fell short on that made us not eligible for the bronze level was our teamwork data—at the time we were doing an engagement survey and it had teamwork questions on it, but they were very vague.”
“During our discussion with the AMA, several things happened. We realized we had some data in our wellness survey because we have more questions than most, which is a good and bad thing,” he said. “But we also realized we do the Agency for Healthcare Research and Quality [AHRQ] culture of safety survey that also has a lot of teamwork data in it. And the AMA team said there were domains within that survey that could be used, so it made us rethink, go back and look.”
Here are some steps Allegheny Health Network took to achieve silver-level recognition from the AMA.
There’s an AMA road map to help
“What was really helpful to me during the second application was the road map that the AMA created,” Dr. Campbell noted. “Having the road map, having examples of what other people did in those categories, was really helpful. It got my wheels spinning about what we were doing and how we fit in and where our gaps were.”
“The road map has been revised for 2024, so that has been fun to see again, and it will be our guide to get to gold for 2025,” he said, noting that “reading it again, we have some of it completed already.”
For example, “one of the things that is for gold recognition is to have a strategic plan that’s signed off. We sort of did it backwards,” Dr. Campbell said. “We started with a strategic plan that our senior leaders signed off on to get their buy-in, but it’s not until you get to a gold level that you have to have a strategic plan. So that was nice for us.”
Attend drop-in “office” hours
What also helped was the AMA’s drop-in hours, which allow health systems to discuss the Joy in Medicine program with staff and ask questions about the application for recognition.
“I always had a lot of questions for the AMA team. I got a lot out of it. I brought up some questions that also made them think a little bit as well about how they can refine some of their information and questions for the data,” Dr. Campbell said. “We had good discussions, but through both the road map and the drop-in hours, I kept looking at the bronze and the silver and I thought we were doing everything that would meet silver requirements despite not meeting bronze the year before.
“So, I had that discussion with them too and It was very helpful to hear that if I submit a silver level and only have enough for bronze criteria that I wouldn’t get penalized and get nothing at all,” he added. “That was so helpful and that’s what happened. I submitted. They had one question about teamwork, and I created an Excel spreadsheet that showed the domains of teamwork.”
“Because I used questions on our AHRQ culture of safety survey as well as our wellness survey, I was able to say here are the questions, here’s who got surveyed, here are the results and this is why I think they fit in the domain,” Dr. Campbell said. “And they liked that.”
Remove mental health questions
There were other areas of work that have also helped improve well-being at Allegheny Health Network.
For physicians, “one big thing we finally got off the table last year—that I’ve been working on for a couple of years—was getting all of the behavioral health questions off our applications and reappointment applications,” Dr. Campbell said. “We finally did that last year and that was a big achievement.”
But “a lot of people still don’t know. That’s my continued effort—to keep letting people know that those stigmatizing questions are off of there,” he said, noting “we’re working to get the questions off of our state licensing because Pennsylvania isn’t there yet. So, we’re advocating for that and working with the Lorna Breen Foundation to get that done as well.”
Not having questions about past diagnosis and treatment for mental health conditions on credentialing or employment forms will be a requirement for organizations to earn AMA Joy in Medicine Health System Recognition in 2024.
Learn more about how to properly word physician employment and credential applications with this AMA issue brief on confidential care to support physician health and wellness (PDF).
Put well-being leaders in departments
“The other thing we have is a physician wellness leader in each department,” Dr. Campbell said. “We have a cabinet meeting once a month of all the wellness officers and annually they pick something they would like to work on based on our survey.”
Each leader will “look at their department and specifically pick a program to work on. Then monthly we talk about how it’s going and what they’re doing,” he said. “That’s been a big improvement in the past two years for me to spread out and create the culture we want to create with wellness in mind.”
Let people speed up compliance trainings
“We always hear about survey fatigue and all the essential education that residents and physicians have to do annually is a pain,” said Dr. Campbell. To address this “a lot of that essential education went into a concentrated three-month period when they had to do it all instead of spreading it out throughout the year.”
"We heard from our physicians and employees that they would rather have all of the essential education sessions concentrated in one period and get it done for the year rather than spread out over four or five periods during the year,” he said, adding that “since many of the required trainings were repeated information, they wanted to have a ‘pass out’ option with questions that they could answer to show they knew the information and not have to review training material that did not have new information, such as hand hygiene, fire safety, etc.”
“In addition to that, you could pass out of the course. So, if you could answer the questions and you had a 90%, you didn’t have to take the whole course. That was a big win,” Dr. Campbell said, noting that the option applies to nearly all the required trainings.
“But that was a big win for everybody,” he added, emphasizing that “it takes a team.”
“Like any effort to change culture, progress requires all to row in the same direction,” Dr. Campbell said. “Much of our success has been from leadership support and collaboration with departments such as Human Resources, Enterprise Equitable Institute, Information Technology, Behavioral Health Institute, and many others.”
