In tackling physician burnout, don’t be afraid to use the “TWord”

As the field of medicine continues to battle a national burnout epidemic that only intensified with the emergence of COVID-19, leaders at Sanford Health say one key to unlocking physician well-being is focusing intently on physician experience.

A strong commitment to the experience they have has led to improvements for both physicians and Sanford Health, a physician-driven health system based in Sioux Falls, South Dakota, that includes about 1,500 physicians, 1,300 nonphysician providers and 45,000 employees working throughout the Midwest. And they are seeing evidence of the usefulness of their efforts.

“Health systems that are focusing on this work are starting to really pay attention to the connection between decreasing burnout and better quality of care for patients,” said Heather Spies, MD, an ob-gyn who is the physician director of clinician experience and well-being at Sanford Health. “If we focus on that, we know we're going to get buy-in from leaders and support to strengthen our approach and strategies to strengthen the clinician experience and reduce burnout.”

“Ultimately, we all went into medicine because we want the best care for our patients—that's what we truly care about. But we also are human beings, and if we don't take care of ourselves as physicians, we're not going to be able to provide that quality of care,” Dr. Spies said during an education session at the 2024 AMA Annual Meeting in Chicago.

Sanford 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.

For a road map, Dr. Spies said, Sanford Health follows recommendations from the AMA Joy in Medicine™ Health System Recognition Program. The AMA program empowers health systems to reduce burnout and build well-being so that physicians and their patients can thrive.

As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

“We partner closely with the AMA on a lot of the work that we've been doing to combat burnout,” she said, noting a large part of this has been aligning their goals with the AMA program, then using that framework to intensify its efforts in improving the physician experience.

“We applied for the AMA Joy in Medicine at the bronze level, just to get in the door, get committed to it, start working forward, and then in 2021, were recognized with a bronze award. We worked our way up following that road map to the gold level in 2023,” Dr. Spies said.

Dr. Spies said Sanford Health wants to improve every stage of a physician’s experience, no matter where the person might be in their career.

“We really look at the strategy of looking at the lifetime of engagement of all of our physicians and advanced practice providers,” she said. “From the minute they step through the doors as a medical student, or maybe even working at Sanford in some way, shape or form, all the way through their clinical practice and into succession planning and retirement, we really look at how can we capitalize on every opportunity to support clinicians along their way.”

Sanford Health has invested in its well-being efforts, creating a “robust clinician experience team” that includes Dr. Spies’ physician leadership, a full-time administrative co-director partner, a clinician well-being council created in 2020 and an organizational formal strategic plan. Sanford Health has also grown its well-being department.

“As people have seen that it's important that we're committed to this and that we devote resources to this, we have actually expanded to a full time clinician experience liaison in each of Sanford’s four main regions, as well as adding an executive assistant to cover our big geographical footprint over the last few years,” she said.

Dr. Spies also said leaders constantly ask themselves how the decisions they make affect well-being.

“We want the clinician experience and well-being portion to be in the center of everything we do,” she said. “We've evolved to a place where I really think a lot of the things that we're working on, we're remembering to keep that at the center.”

There are four building blocks Sanford Health uses: collaboration, communication, leadership development and recognition.

Collaboration can be particularly key to alleviating burnout because when physicians have help from colleagues, their burden becomes less onerous and work overload, a known driver of burnout, can be more easily avoided.

“That's one of the things that is absolutely crucial that we're looking at to address the challenges that we're facing in health care,” Dr. Spies said, naming several ways leaders survey clinicians about their challenges.

“A lot of these specific things are assessing team function. We're asking for barriers to teamwork: What's getting in the way and what can we do differently to help support that collegiality? Are they feeling like they're psychologically safe and that they're supported in their teams?” she said.

Sanford Health uses the “TWord” component of the AMA Joy in Medicine guidance to help with this. It helps identify how often teamwork is used in creating orders—called TWord. The more often teamwork is used in ordering, the higher the T-word ratio and the better for the physicians involved.

“We've been starting to dig deep into—especially primary care specialties that notoriously are doing the most work outside of work hours, or pajama time—how we can start implementing more teamwork orders,” Dr. Spies said, adding that she often has a nonphysician provider in her clinic to help shoulder the workload.

“We're trying to help share the way we do things operationally in our clinic with my family medicine, internal medicine and pediatric colleagues in this work to say, ‘How can we move that forward for them?’” she added

The last piece of the puzzle, Dr. Spies said, is measuring progress.

“As we've been doing this work to reduce burnout, we all need to find ways to determine whether we’re making a difference,” she said.

In-house surveys and AMA’s Organizational Biopsy^® data provide helpful insights, and they’re seeing a “steady increase” in physicians’ well-being, she said, noting that from 2022 to 2024, there has been an improvement.

“We feel like the things that we have focused on … are moving the needle in the right direction,” Dr. Spies said. “We're going to continue to measure this so we can hopefully continue to use data-driven solutions.”

Learn more about how Sanford Health keeps pressing on to prevent doctor burnout.