Recognizing that it’s OK to not be OK, leaders at Sanford Health System made building a culture of well-being a top priority even prior to the emergence of COVID-19. But when the global pandemic hit, the work they were doing to reduce physician burnout and elevate well-being never faltered. Instead, the pandemic helped accelerate it.
“The pandemic allowed us to identify blind spots that we had in the overall strategy,” said Luis Garcia, MD, a surgeon and president of Sanford Health System in Sioux Falls, South Dakota. A physician-led health system, Sanford Health includes 46 hospitals, more than 200 clinic sites and employs more than 1,500 physicians and over 1,100 advanced practice providers.
“One of the things that surfaced from the pandemic was clinician support groups. These were groups of clinicians who would meet without any agenda, just to support each other,” said Dr. Garcia. “As a result of that, we subsequently developed a formal Clinician Wellness Council. The council meets with specific agenda items that inform the overall strategy around clinician well-being.
“What started as a group that was interested in finding short-term solutions during the pandemic has really transformed into a well-organized strategic team that helps define the long-term solutions for clinician well-being for our organization,” he added.
During a recent interview, Dr. Garcia discussed his role in establishing a culture of well-being at Sanford Health System and the importance of teamwork.
AMA: Since Sanford Health doesn’t have a chief wellness officer, as president of the medical group with the Office of Clinician Experience reporting directly to you, what is your role in ensuring the well-being of your organization?
Dr. Garcia: My duties and responsibilities include leading and representing all our clinicians. Indirectly, I am responsible for the success of their practices. We pay attention to the support that our clinicians need to deliver excellent medical care. But in addition to the professional support, equally important, we need to support them as individuals. In the individual part, that's where the clinician well-being factors in.
At Sanford Health, we have really elevated the conversations about the importance of supporting our clinicians as human beings. And we have developed a very comprehensive strategy that outlines different tactics to support our clinicians in the clinical practice, but also as individuals.
AMA: What work is included in that strategy?
Dr. Garcia: We tend to concentrate on what happens during the time that you're at work and while you are in the four walls that comprise your clinic or your hospital. But one of the things that we forget is that clinicians—just like anybody—are human beings. And as human beings, we can bring stressors from work to home and stressors from home to work.
In the last year and a half with the pandemic, those stressors have really become much more pronounced to the point of pushing our clinicians into a tipping point. So, our strategies emphasize on that relationship.
We have different strategies to support clinicians who are new to our organization, those who already have an established practice inside Sanford, and for those who are planning retirement.
Our strategies also encompass the life of our clinicians outside of work. We are interested in learning how can we support them and their families, how can we support work-life balance, and how can we support their engagement in their communities.
One of the things that Sanford does well is support community involvement. We invest heavily in every community where our clinics and hospitals are located, and we try to encourage our clinicians to get involved as community leaders, not only in the clinical setting.
AMA: What are some ways your clinicians have gotten involved in the community?
Dr. Garcia: Clinicians are leaders by nature, and we encourage them to expand their leadership outside of the clinical setting. We have clinicians who have become board members, some hold public positions, or become involved in academic organizations or nonprofits in the community.
Our CEO recently declared that Sanford will protect the time of every employee that chooses to get involved in community work. As an employee of Sanford—independent of rank—you have a day per year that would be fully compensated for involvement in community projects.
AMA: What are the different strategies for new physicians, established doctors, and those nearing retirement?
Dr. Garcia: Our overall strategy is comprehensive. An example for new clinicians is the development of a strong new provider orientation and onboarding program. We know that the highest turnover rate is in the first couple of years of joining a practice. The reason why most of the clinicians leave, is because either they didn't feel integrated into the culture of the organization or did not adapt to the community where they live.
During the onboarding process, our clinicians engage in a very intentional and proactive process where they meet on a regular basis to discuss topics of relevance to their clinical practice, but also topics relevant to the culture at Sanford Health.
The onboarding program has the intention to make our new clinicians feel supported, welcomed and integrated into our culture in a more intentional manner. Our clinician turnover rate is 7%, which is lower than the national average. And in part, it's because of examples like this.
One of the things that we don't learn in medical school is finances or long-term planning. We recently developed a program that offers financial guidance to any new clinician that joins our organization, and we are planning to extend that program to clinicians that are considering retirement. A financial advisor meets individually with our clinicians to discuss available tools and options to prepare for retirement.
As a clinician-led organization, it is also important to us to offer high-quality leaders a path for growth. When we think about succession planning, we need to grow our own through internal leadership-development programs.
One example is called Sanford RISES. Every couple of years, 25 of our clinicians start a three-year leadership development program. This offering is for those that are the rising stars that would become the future leaders of the organization.
AMA: Your health system also wants physicians and other health professionals to retire at Sanford. How do you ensure that that happens?
Dr. Garcia: The reality is that it's not one initiative that does it all. It's not one day, one program, or one conversation. But it is truly a series of actions that eventually define our culture. If you think about it, when we talk about loyalty, about engagement, about value or legacy, those are driven by culture, and culture cannot be defined overnight.
The conversations that we have are recurrent and about culture. The initiatives that we develop are dynamic initiatives that get implemented over time. And ultimately, it is about feeling that you, as a member of the Sanford family, are providing an impact in people's lives that goes beyond the meaning of whatever career you have.
And that sensation of being part of something bigger and bringing value to those in need is really what drives our culture, making a difference and responding to the trust that our patients and our communities are putting on us. That's truly what drives our clinicians, and we feel proud of that.
AMA: What are your hopes for well-being for the next year?
Dr. Garcia: What excites me into the future is that all will get better and to be able to work with phenomenal human beings. If you think about it, the reason why people continue to stay in health care is because they have a calling, because they have a mission, because they have a talent to help others and that they want to continue to share, despite the adversities.
That calling is not going to be taken away by anybody. That's who we are as clinicians, as nurses, as employees of health care. And we will continue to do that. Why? Because our patients need us, because our patients trust us, and because we want to have that impact in our communities.
So, I am hoping that in health care, we get a little bit of a break in 2022. But at the same time, I'm very excited because I am working with the best kind of human beings.
