How Sanford Health keeps pressing on to prevent doctor burnout

When Sanford Health measured well-being and physician burnout in 2022, they found that the levels remained little changed from what they had been in 2019, despite very intentional, nationally recognized systemwide efforts to bring more joy to practice.

That outcome was, naturally, disappointing. But after speaking with the AMA organizational well-being team about their survey findings, leaders at the Sioux Falls, South Dakota-based health system realized their numbers told a different story.

Sanford Health—a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine—is a physician-led health system that includes 46 hospitals, over 300 clinics, nearly 3,000 clinicians,  and more than 200 Good Samaritan Society senior care locations in 26 states.

After completing the AMA Organizational Biopsy^® (PDF) last year, 49.7% of respondents at Sanford reported burnout. While that that was up from 43.1% in 2019, it was lower than the overall AMA 2022 national benchmark of 53%. Yet 74.2% reported feeling satisfied with their current job, which was higher than the 2022 national benchmark of 69%. On top of that, 48.9% reported job-related stress, compared with 47.5% at Sanford in 2019 and 55% nationwide.

The AMA benchmarking report—which is exclusive data to the AMA that is not published anywhere else—reflects 2022 trends on six key performance indicators: job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization and total hours spent per week on work-related activities (known as “time spend”). It comprises aggregated data from nearly 14,000 physicians and non-physician providers representing health systems with whom the AMA surveys on an annual basis.

Heather Spies, MD

“When we reflected on our results and met with the AMA, we actually felt reassured that we stayed the same despite the pandemic, the budget stressors and all the different things that have impacted health care tremendously since 2019,” said Heather Spies, MD, an ob-gyn and physician director of clinician experience and well-being at Sanford Health. “We’ve shifted focus to that to say: OK, we’ve held our ground and at least held things steady through some really trying times.”

“We still want to keep improving things because we want our clinicians to be well and we want to figure out ways as an organization to support them,” Dr. Spies said. “But overall, for our results from 2019 to 2022 we held stable and that was a little bit better than the national benchmark.”

For Sanford’s 2022 Organizational Biopsy, there were 519 total respondents, 268 of which were physicians who mainly represented family medicine, pediatrics, anesthesiology, and obstetrics and gynecology.

Here are some of the ways Sanford Health continues to innovate in its efforts to improve well-being and reduce physician burnout.

While Sanford Health used its enterprise all employee survey—which is done every six months—to gauge clinician satisfaction and obtain feedback in 2023, Dr. Spies emphasized the importance of completing surveys when available.  

“Even though it’s one more thing to do and everybody’s time is super valuable, we literally go through every single comment,” she said. “Then we are blasting out information to our department chairs and our physician-executive councils and asking them to spread the word to all the clinicians that we are listening to what they say in the surveys. If you take the time to do the survey, we’re actually going to read it. We’re going to pay attention to it.”

“Real-time feedback is so important. People want feedback. Sometimes things that people give feedback on we can’t change right now, but at least being able to speak to why is important,” Dr. Spies said.

“We have an awesome partnership with the AMA. First of all, we now have given all of our physicians in our entire health care system the benefit of AMA membership,” Dr. Spies said. Additionally, “whenever we have anything that we’re working on, we reach out to people in the AMA and they’re always very supportive and responsive.”

For example, Sanford Health formed a council to promote physician well-being. At annual retreats held the last two years, the council has “collaborated with team members at the AMA to come and give an update on national trends and then where Sanford Health sits in relation to those national trends,” she said. The council’s “members have found a lot of value in that.”

“It gives them things to speak to too as they’re advocating for well-being in their different areas,” Dr. Spies said, noting that the AMA will also connect them with other physicians, leaders or health systems doing great work with well-being.

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.

For midcareer physicians who were “doing just fine,” leaders still know the importance of transparent, timely and authentic communication. The same goes for physicians who are doing amazing things or doctors who are struggling. How can you check in with them and give them the tools they need?

“We want everyone to be at the best that they can be. … If you don’t have those check-ins regularly with your direct team or leader, that could be something that gets lost,” Dr. Spies said. “Over the last couple of years, we’ve implemented annual check-ins for every clinician and it’s still evolving.”

Every year, a designated hour is set aside for physicians and their leaders to meet and get to know each other better—not to discuss a performance review.

“What we’ve found is that … people are getting to know each other, and they may have worked together for a few years and not ever had that designated time,” she said. “The hope is that people continue to see the value and look forward to them.”

In 2021, Sanford Health launched the Reaching others, Innovating and making an impact, Strategizing to support and sustain the organization, Elevating and empowering others, Serving our colleagues and communities (RISES) leadership development program. Each cohort includes 25 clinicians who have been nominated and selected by a committee, which is “a big honor and we’re recognizing them as valuable leaders and investing in them,” Dr. Spies said.

The second cohort began in 2023. There are six sessions per year for two years that are curriculum based. The third year of the program involves impact projects.

“It’s very intentionally laid out so that we are incorporating all aspects of medicine and being a leader in medicine. But with that we have a through line of well-being and being an authentic leader,” Dr. Spies said, noting “every single session starts with a wellness check-in as a group of 25. It’s considered a safe space for all the clinicians from all the different regions of Sanford to come together.”

“Then we start with what you have put into practice from our last session. … And we actually have them write it on a sticky note and we put it up on a board. Then we talk through some of the things,” she said. “At the end of every session, whatever they learn that day they commit to what their leading practice is going to be over the next month until we meet again.”

The first cohort is in year three and implementing projects in the health system’s four regions. The projects “must be something they can do in one year that will impact the culture, well-being and efficiency in practice,” Dr. Spies said, noting that the projects will be presented to the next cohort.

“The goal of RISES is to have these groups network with each other and really get to know each other and lift each other up,” she said. “But then, also, as we overlap a little bit from each cohort—to continue to build more and more relationships.”

At Sanford Health’s recent annual retreat, the AMA provided Jennifer Bickel, MD, chief wellness officer from Moffitt Cancer Center to speak on recognition and feeling valued, “and the Joy in Medicine™ Health System Recognition Program has been a huge part of that,” Dr. Spies said, noting this includes “the road map of the tools that we can use and the six core areas that we want to focus on.”

The AMA has connected Sanford Health leaders with “people who have been at the gold level and tried things, proven them to be effective, so that we can then learn from them to continue moving forward in that journey,” she said.

This year, Sanford Health earned gold-level recognition, moving up from its bronze status in 2021.

“Sometimes when you’re in the everyday work of it, you feel like things aren’t moving fast enough,” Dr. Spies said. “It was really rewarding when we actually sat down to consider and reflect on all the things we’ve done since 2021—we have added or enhanced a lot of things.”

“This only means that we have more work to do. We have to stay committed to all of this. We have to make it even better,” she said. “This type of work is always going to be changing because the environment and the culture of medicine is constantly changing.

“But I love it because it’s a challenge. It keeps us accountable, and it continues to keep us in touch with all the people who have the same passion for it and are doing well with it,” Dr. Spies added, emphasizing “it’s just a huge honor to know that we can continue to collaborate in those groups.”