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WellMD Center Status Report March 2017 Mary Lou Murphy, MS Patty de Vries, MS Mickey Trockel, MD, PhD Maryam Hamidi, PhD Bryan Bohman, MD
WellMDCenterStatusReportMarch2017
MaryLouMurphy,MSPattydeVries,MSMickeyTrockel,MD,PhDMaryamHamidi,PhDBryanBohman,MD
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TableofContentsEXECUTIVESUMMARY..............................................................................................................................................2WELLNESSFRAMEWORK.................................................................................................................................................................2LONGITUDINALASSESSMENTOFPHYSICIANWELLNESS..........................................................................................................2TESTINGPHYSICIANWELLNESSINTERVENTIONS......................................................................................................................2BUSINESSCASEDEVELOPMENT.....................................................................................................................................................3NATIONALPHYSICIANWELLNESSADVOCACY............................................................................................................................32017-2018WELLMDSTRATEGICPRIORITIES.........................................................................................................................4
BACKGROUND..............................................................................................................................................................5CURRENTSTATE.........................................................................................................................................................6ECONOMICIMPACTOFBURNOUT...................................................................................................................................................6
WELLMDCENTERWORK..........................................................................................................................................7WELLNESSFRAMEWORK.................................................................................................................................................................7DefinitionofProfessionalWellness.......................................................................................................................................7Mission...............................................................................................................................................................................................7Vision..................................................................................................................................................................................................7ConceptualModel.........................................................................................................................................................................7LeadershipEngagementandAccountability...................................................................................................................8CommunicationandPublicRelations..................................................................................................................................9OrganizationalInfrastructure................................................................................................................................................9MeasurementandScholarship.............................................................................................................................................11Support,CollegialityandAppreciation.............................................................................................................................12
ESTABLISHINGANATIONALROLE......................................................................................................................16PHYSICIANWELLNESSACADEMICEVALUATIONCONSORTIUM............................................................................................16NATIONALPHYSICIANWELLNESSCONSORTIUM.....................................................................................................................16JOYINMEDICINE-RESEARCHSUMMIT.....................................................................................................................................162016INTERNATIONALCONFERENCEONPHYSICIANHEALTH(ICPH)..............................................................................16
MOVINGFORWARD..................................................................................................................................................17LOCALLY...........................................................................................................................................................................................17NATIONALLY...................................................................................................................................................................................17
CONCLUSION...............................................................................................................................................................19ACKNOWLEDGEMENTS...........................................................................................................................................20ORGANIZATIONALSUPPORT........................................................................................................................................................20THEPHYSICIANWELLNESSCOMMITTEE..................................................................................................................................20WELLMDSTEERINGCOMMITTEE/ADVISORYCOUNCIL........................................................................................................21WELLMDCENTERPARTNERS.....................................................................................................................................................21
APPENDICES...............................................................................................................................................................24APPENDIXA:WELLMDTEAM....................................................................................................................................................24APPENDIXB:2016PHYSICIANWELLNESSSURVEYEXECUTIVESUMMARY......................................................................25APPENDIXC:PEERSUPPORTPROGRAM...................................................................................................................................26APPENDIXD:MEDICINEANDLITERATURE...............................................................................................................................27APPENDIXE:MINDFULNESSBASEDSTRESSREDUCTIONFORPHYSICIANS.......................................................................28APPENDIXF:COMPASSIONCULTIVATIONCOURSE.................................................................................................................29APPENDIXG:BRIEFCOMPASSIONTRAININGINTERVENTIONFORPHYSICIANWELL-BEING........................................30APPENDIXH:PUBLICATIONS.......................................................................................................................................................31APPENDIXI:2016INTERNATIONALCONFERENCEONPHYSICIANHEALTH(ICPH)ABSTRACTS................................33
REFERENCES...............................................................................................................................................................35
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EXECUTIVESUMMARYIn2015,theDean’sTaskforceonPhysicianWellnessrecommendedacentralorganizingstructureforStanfordphysicianwellnessactivities;theestablishmentoftheWellMDCenterfollowedinJune2016.ThisstatusreportprovidesasnapshotofthecurrentstateofphysicianwellnessatStanford,reviewstheCenter’sactivitiesoveritsfirstseveralmonthsandoutlinesourgoals.WellnessFrameworkTheWellMDCenterhasdevelopedarobustconceptualframeworktoguideitsstrategicplanning,wellnessinterventions,measurementtoolsandscholarship.OurwellnessmodelidentifiesthreedomainsthatareessentialtoachieveProfessionalFulfillment,including:CultureofWellness,EfficiencyofPracticeandPersonalResilience.Stanford’smodelisbeingsocializednationallyandhasbeenadoptedbyotherorganizationstoguidetheirphysicianwellnessefforts.OurarticlepublishedintheNewEnglandJournalofMedicineCatalystdescribesthemodelinmoredetailsanditisservingastheorganizingframeworkfortheAmericanConferenceonPhysicianHealthoccurringthisfallinSanFrancisco.LongitudinalAssessmentofPhysicianWellnessTheWellMDCenterteamrecentlycompletedthe2016PhysicianWellnessSurvey.OurlongitudinalsurveydatarevealthatStanfordMedicine,likethenation,isexperiencingadeclineintheprofessionalhealthofourphysicianworkforce.Amongthosewhotookoursurveyinboth2013and2016,burnoutincreasedfrom26%to39%,whilehighprofessionalfulfillmentdeclinedfrom24%to14%.Oursurveywasdesignedtoelucidatethedriversofburnoutandprofessionalfulfillmentandtoemploymetricsthatareresponsiveenoughtobeusefulinassessingtheeffectivenessofinterventions.Validationstudiestodatehavebeenverypositiveandwehavebeguntobuildanationalconsortiumofleadingmedicalcentersthatwillbeadministeringoursurvey,contributingtoadditionalvalidationwork,andprovidingbenchmarkingdata.SurveyoutcomesarebeinganalyzedatthedepartmentanddivisionleveltohelpidentifybestpracticeswithinStanfordMedicineandtounderstandwheretobestdirectourimprovementefforts.TestingPhysicianWellnessInterventionsDuring2016,theWellMDCenterdevelopedorimprovedprogramsthatofferimmediatewellnesssupporttotheStanfordphysicians.Center-sponsoredwellnessprogramsincludingLiteratureandMedicine,Mindfulness-BasedStressReductionforPhysicians,CultivatingCompassionforPhysiciansandPhysicianPeerSupportprovidedover200physicianswithopportunitiestoimprovetheirpersonalresilienceskills,spendtimeconnectingwith
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colleaguesandreceivepeersupportasrequested.Eachoftheseprogramsiscurrentlybeingevaluatedforefficacy,effectiveness,efficiencyandscalability.BusinessCaseDevelopmentTohelpestablishthebusinesscaseforphysicianwellness,theWellMDteaminvestigatedthefinancialimpactofburnoutonStanfordphysiciansandfoundoutthatburned-outphysiciansaretwiceaslikelytoleaveStanford.Atcurrentratesofburnout,by2018about90physicianswillhaveleftStanfordattributabletoburnoutwithaneconomiclossofupto$84,000,000inrecruitmentcostsalone.TheWellMDCenterhassubmittedamanuscriptforpublicationtoapeer-reviewedjournalaboutthesefindingstoassistotherorganizationslookingtomakethebusinesscaseforphysicianwellness.NationalPhysicianWellnessAdvocacyWhilethereismuchthatcanandshouldbedoneatthelocalleveltoimprovephysicianwellness,manyofthedriversofburnoutrequireanationalapproach.Examplesincludeincreasinglyburdensomedocumentationrequirementsfrompayers,theprofusionofuncoordinatedandunalignedqualitymetricsfromwell-intentionedqualityorganizations,andfundamentalusabilitychallengesincurrentEHRs.Thus,itisimportantfortheWellMDCentertodevelopinfluenceatthenationallevel,andoverthepastyeartheCenterhasestablisheditselfasathoughtleaderinthephysicianwellnessfield.WellMDCenterexpertiseasconsultants,speakersandadvisorsisfrequentlyrequestedontopicsrelatedtophysicianwellnessandprofessionalfulfillment,includingmeasurement,peersupport,andphysicianwellnessprogramdevelopment.TheCenter’sfacultyhavedeliveredovertwentypresentationsoutsideStanford,includingpresentationsatnationalACGMEandAAMCmeetingsaswellasattheInternationalConferenceonPhysicianHealth(ICPH).Stanfordrepresented25percentoftheabstractsatthiseventandover30individualsattended.Inaddition,theWellMDteamhasactivelyworkedwiththeAmericanMedicalAssociationandtheMayoClinictodevelopanationalconsortiumonphysicianwellness.During2016,thisconsortiumheldbothaResearchSummitandaCEOCoalitionmeeting.Stanfordphysicianwellnessleaders,BryanBohman,MickeyTrockel,MaryLouMurphyandRebeccaSmith-Cogginsparticipatedinthedesignandimplementationofthesesuccessfulmeetings.UpcomingmeetingsinthisseriesincludeaStakeholders’Conference(EMRvendors,payers,qualityorganizations,etc.)andaCMO/COOConference,bothco-chairedbyWellMDleaders.
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2017-2018WellMDStrategicPrioritiesTheCenter’sthreeoverarchingprioritiesforthenext18-24monthsinclude:
1. CultureofWellness:Leadershipengagementanddevelopmenttoassistinthedevelopmentofaculturethatdemonstratessupportandappreciationforphysiciansandprioritizestheirprofessionalhealth
2. EfficiencyofPractice:Wellnessadvocacyforprocessimprovementsthatfacilitateefficiencyofphysicians’practicewhilehelpingallmembersofthehealthcareteampracticeatthetopoftheirlicensure
3. PersonalResilience:Creationofprogramsandtoolstopromoteandevaluateself-compassionandimprovedsleepquality,workingtowardprecisionhealthforStanfordphysicians
Specificprogramswillbedevelopedbasedonfeedbackfromourreviewsofthesurveydatawithdepartmentleaders,operationalleadersandfocusgroups.OurWellMDteamhasalreadybegunmeetingwithdepartmentanddivisionleaderstoanalyzetheirindividualdepartmentphysicianwellnesssurveyfindings.Inaddition,wewillworkwithbothschoolandhealthsystemleaderstodesigninterventionsaimedatimprovingthecultureofwellnessthroughoutStanfordMedicine,workwithinformaticsandoperationalleaderstoimproveefficiencyofpractice,andworktoidentifyeffectivepersonalresilienceinterventionswhilemakingthoseresourcesmoreaccessibleforourphysicians.Ournationalimpactwillbeadvancedthroughmultiplepublicationsinprocess;thecontinuedactivitiesofthePhysicianWellnessConsortium;andtheinauguralAmericanConferenceonPhysicianHealthinSeptember2017hostedbyStanford,theMayoClinicandtheAMA.
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BACKGROUNDStanford’smorethan3000physicianscareforovertwomillionpatientsannually.Thesededicatedprofessionalsstrivetoprovideanoptimalpatientexperienceandachievethehighestqualitycare,whilesimultaneouslyfacingincreasingproductivityanddocumentationdemands.Manyphysiciansperceiveminimalcontrolovertheirworkscheduleandpracticeenvironment.Additionally,theyexperiencesignificantconflicttryingtosimultaneouslyadvanceourStanfordtriplemissionofclinicalcare,discoveryandeducation.Thesestressorscanleadtoanxiety,sleepimpairment,emotionalfatigue,depressionandburnout.Ofspecialimportanceinthisregard,our2400facultyphysiciansserveasteachers,mentorsandrolemodelsforover1,200housestaffandnearly500medicalstudents.OurcommitmenttoaddressphysicianwellnessbeganoversixyearsagowiththeformationofamedicalstaffcommitteedevotedtounderstandingandpromotingPhysicianWellness.Initiallythecommitteefocusedongeneratingawarenessofthiscriticalissue,designingasurveytooltomeasurebaselinephysicianwellnessanddevelopingarobustwebsitetoassistourphysicianstoassesstheirownhealthandidentifylocalresourcestosupporttheirwellness.Our2013PhysicianWellnesssurveyfindingseventuallyledtotheDean’sTaskforceonPhysicianWellness.TheTaskforcerecommendationsledtotheestablishmentoftheWellMDCenterinJune2016,withfive-yearfundingfromthemajorenterprisepartners,includingtheSchoolofMedicineandbothhealthsystems(StanfordHealthCareandStanfordChildren’sHealth).ThisreportgivesanoverviewtheworkoftheWellMDCenterteamsinceitsformationinJune2016.
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CURRENTSTATEEvenasphysicians’professionalwellnessisincreasinglyrecognizedascriticallyimportanttothedeliveryofoutstandinghealthcare,nationalsurveydatashowthatphysicianburnoutincreasedfrom45%in2011to54%in2014.Unfortunately,thoughnotsurprisingly,ourownsurveydatarevealthatStanfordMedicineisnotimmunefromthepressuresthathaveresultedintheseconcerningfigures.Amongthosewhotookoursurveyinboth2013and2016,burnoutincreasedfrom26%to39%andhighprofessionalfulfillmentdeclinedfrom24%to14%.Femalephysiciansreportedhigherburnoutratesthanmalephysicians(39%vs28%)andlowerratesofhighprofessionalfulfillment(13%vs20%).Toensureahealthyandhighlyproductivefacultyworkforce-onethatcanachievethepreeminencethatStanfordMedicinestrivesforinallthreeofitsfundamentalmissions-itisclearwemusttakestepstoaddressthedeterminantsofburnoutandprofessionalfulfillment.EconomicImpactofBurnoutBurned-outphysiciansaretwiceaslikelytoleaveStanford.Ofthosewhoreportedburnoutin2013,21%leftwithintwoyears,morethantwotimesthedeparturerateofthosewhoreportedlowsymptomsofburnout.Atcurrentratesofburnout,wewouldpredictadepartureattributabletoburnoutof88physiciansby2018.Basedonlocalandnationaldata,thiswillresultinaneconomiclossofupto$88,000,000inrecruitmentcostsalone.Thisdoesnotincludeopportunitycostswhenresearchandclinicalprogramsaredisrupted,orthecostsofreducedproductivityandqualityassociatedwithburnout.Onahumanbasis,attendingtothedecliningwellnessofourphysiciancolleaguesisclearlytherightthingtodo.Webelievethesedataonburnout-attributablerecruitmentcostsarejustthetipoftheicebergwhenitcomestotheeconomicimpactofphysicianwellness,meaningthatitalsomakesexcellenteconomicsensetoinvestintheseefforts.
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WellMDCENTERWORKWellnessFrameworkTheWellMDCentercreatedaguidingframework-includingmissionandvisionstatementsaswellasanoperationaldefinitionofprofessionalwellness-toserveasthefoundationforitsstrategicplanningandgoalexecution.DefinitionofProfessionalWellnessProfessionalwellnessisnotsimplytheabsenceofburnoutbutapositivestateofphysical,mentalandsocialwell-beingcombinedwithasenseofprofessionalfulfillment.MissionTheWellMDCenterwascreatedtoimprovetheprofessionalwellnessofStanfordMedicinephysiciansandtheassociatedwellbeingoftheirpatients,theirtrainees,andthemembersofthemedicalteamstheylead;andtobeanationalleaderinthisfield.VisionTocreateapreeminentStanfordMedicineculturethatpromotesorganizationalexcellence,collaboration,andself-carewithagoalofprofessionalfulfillmentforallmembersofourcareteams.ConceptualModelTheCenterhascreatedaconceptualmodelwiththreeprimarywellnessdomainsthatmustbeaddressedtoensureoptimalphysicianwellnessandachieveprofessionalfulfillment.
• CultureofWellness • EfficiencyofPractice• PersonalResilience
Acommitmenttoaddressallthreedomainswillenhanceourabilitytounderstandthedeterminantsofburnoutinourpopulationandhelpguideoureffortstoimproveprofessionalfulfillment.ThisreportisorganizedaroundtheWellMDCenter’sworkineachofthemodeldomains.
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CULTUREOFWELLNESS
CultureofWellnessconsistsoftheorganizationalworkenvironment;thevaluesandbehaviorsthatpromoteself-care,personalandprofessionalgrowth;andcompassionforourselves,ourcolleaguesandourpatients.TheWellMDCenterdeliberatelychosetofocusahighpercentageofitseffortsinthisdomainforthefirstyearbecauseimbeddingwellnessintothefabricoftheStanfordMedicinecultureisacriticalfirststep.Keysuccessfactorsaddressedinthefirstyearincluded:
• Leadershipengagementandaccountability• Communicationandpublicrelations• Organizationalinfrastructure• Measurementandscholarship• Support,collegialityandappreciationmechanisms
LeadershipEngagementandAccountabilityResearchshowsleadershipengagementisessentialtobuildingasuccessfulphysicianwellnessprogram.TheWellMDteamexaminednationalbestpracticesforleadershipengagementandidentifiedtheMayoClinicasatopperformerinthisarea.InJune2016,MayoClinicphysicianwellnessexpertTaitShanafeltspenttwodaysconsultingwithStanfordleadersandfaculty.Dr.Shanafeltpresentedattwograndroundswithapproximately150attendees.Healsohadlunchwithseveraldepartmentchairstoreviewhisresearchontheimpactofleadershiponphysicianburnoutandsatisfaction.Dr.Shanafeltemphasizedleadershipresponsibilitytoensureahealthyworkingenvironment.Toprovidedepartmentchairsanddivisionchiefswithfeedbackregardingtheirleadershipsupport,theWellMDteamincluded(aftergettinginputattheCouncilofClinicalChairs)theMayoLeadershipquestionsinour2016wellnesssurvey.
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CommunicationandPublicRelationsWellMDWebsiteWellMD.stanford.eduisconsistentlythe#1websiteonGooglesearchfor“physicianwellness”.IthousesinformationaboutourWellMDCenteraswellasawealthoflocalandnationalresourcesandinformationforourmedicalstaff,traineesandthepublic.Duringthe5yearsofthewebsite’sexistence,thereturnvisitorratehasincreasedfrom2%to35%,meaningpeopleappreciateitsresourcesandcomebackformoreinformationandhelp.Wehaveover1800visitstoourwebsitemonthlyandinDecember2016,59countriesaroundtheworldaccessedourwebsite.Thewebsitenotonlyisawonderfulresourceforinternalstaff,ithascreatednationalattentionforourWellMDCenter.Manyrequestsforconsultationandsupportcomeviathewebsite.WellMDNewsletterOurmonthlynewsletterissenttoapproximately3000individualsincludingmedicalstaff,housestaff,medicalstudents,leadershipandpartners.Itshowcasesourwellnessprogramdevelopments,recentwellnessresearch,acalendarofeventsandnoteworthyannouncements.InternalPresentationsDuring2016,toincreasetheawarenessandunderstandingoftheimportanceofphysicianwellness,WellMDstaffandPhysicianWellnessCommitteemembersconducted35presentationsprovidinginformationtoapproximately1300physiciansandstaff.OrganizationalInfrastructureWellMDStaffTheWellMDCentercurrentlyhasabudgetedstaffof3.75FTEs:
• CenterPhysicianDirector(0.5FTE,vacant)• AdministrativeDirector(1FTE)• StrategicProjectsDirector(.75FTE)• DirectorofScholarshipandHealthPromotion(.5FTE)• AssociateDirectorofScholarshipandHealthPromotion(1FTE)
(seeAppendixAformoreinformationonWellMDstaff)Our2016nationalsearchtofilltheDirectorpositionwasunsuccessfulinsecuringacandidate.Recruitingahighly-qualifiedindividualiscriticaltothesuccessoftheWellMDCenter.Pending
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recruitmentofourpermanentdirector,Dr.BryanBohmancontinuestoserveinaninterimrole,thoughhisotherdutiescurrentlydonotallowfora0.5FTEWellMDcommitment.Dr.TaitShanafelthasagreedtoconsultwithusaswedevelopourstrategicplanandhisexpertisewillbeespeciallyhelpfulaswebegindepartmentlevelwork,asMayohasconsiderableexperiencewiththisapproach.PhysicianWellnessCommittee(PWC)Themembersofthismedicalstaffcommitteespanthephysiciancareercontinuum,bringingtogetherindividualsfromacrossthemedicalcenteranduniversitywhoarealreadyworkinginthewellnessarena,alongwithnewmembersinterestedinadvancingphysicianwellnesspracticesandresearch.Inscholarlymonthlymeetings,membersshareandlearnaboutcurrentwellnessprogramsandresearchaswellexplorenewopportunities.Topicscoveredthispastyearincluded:MedicineandLiterature,PeerSupport,BecomingSavvyElectronicHealthRecord,EducationEnvironment,WritingOpportunitiesforPhysicians,BestPracticesinPhysicianWellness,NewandImprovedPhysicianWellnessSurvey,etc.(seeAcknowledgementsforafulllistofPhysicianWellnessCommitteeMembers)WellMDSteeringCommittee/AdvisoryCouncilTheWellMDSteeringCommitteeguidestheworkoftheWellMDCenteralongwithitsstrategyandoperationaltactics.(seeAcknowledgementsforafulllistofSteeringCommitteeMembers)WellMDPartnersTheWellMDCentersupportswellnesseffortsthroughoutStanfordMedicineandtheUniversityCommunity.TheCenterisactivelycollaboratingwiththefollowingprogramstocreateacultureofwellnessforallteammembers:
• HealthyStepstoWellnessforallhospitalemployees• UniversityHealthcareAlliancewellnessprogram• AdvancePracticeProvider(APP)wellnesstaskforce• StanfordChildren’sHospitalresiliencytaskforce• BeWellUniversitywellnessprogram
OfsignificanceisourrelationshipwiththeUniversityHealthCareAlliance’sProviderWellnessprogram.TheWellMDCenterteamcontinuestomeetwiththeUHAWellnessLeadershipteammonthlytoalignprogramsandsharebestpractices.UndertheleadershipofDr.RachelSeamanandAndreaHausel,theUHAprogramhasembracedtheCenter’sModelandworkscloselywiththeCenterteamtoupdatethesurvey,analyzedataandcreateproviderspecificprograms.
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MeasurementandScholarshipMeasurement-PhysicianWellnessSurveyInFall2016,theWellMDCenterinconjunctionwiththePhysicianWellnessCommitteeconductedoursecondPhysicianWellnesssurvey.Thissurveyaddedseveralnewsectionsincluding:
• LeadershipSupportScale• Self-Compassion• ElectronicHealthRecord• WellnessInterventionStrategies
FiftyfourpercentofStanfordPhysicians(vs.35%in2013)participatedinthesurveyandthefindingsarepresentedintheAppendixB.Theseresultswillguideourstrategicplanningandimplementationforthisnextyear.Measurement-ValidationSurveyPrecedingthelaunchofthe2016PhysicianWellnessSurvey,astudywasconductedtovalidateournewmeasuresofphysicianburnout,professionalfulfillmentandwellness.Ouraimwastodevelopmetricsthatareshort,reliable,valid,andsensitivetorecentchangessothatwecanefficientlyassesscontributingfactorstophysicianwellnessandtheimpactofinterventionstoimprovewellness.Weareintheprocessofdraftingamanuscriptforpublicationinapeer-reviewedjournalwithdetailedresultsofourvalidationstudy.Scholarship-HealthforHealersResearchGroupThisgroupmeetsonthefirstTuesdayofeverymonthandbringstogetherresearchersandcliniciansthroughoutStanfordwhohaveaninterestinwellness.TopicstodateincludephysicianwellnessandEHR,sleepimpairment,self-compassionanddoctor-patientrelationships.ThismeetinghasresultedinformationofcollaborativeteamstoaddressEHRresearch,aswellastodevelopinterventionstoreducesleep-impairmentinphysicians,residentsandfellows.GrantsWehavereceivedonegranttostudywaystoreducesleep-impairmentinphysiciansandtotestasleephealthimprovementprogramformedicalstudents.WewereawardedagrantfromThePhysicianFoundationforourupcoming2017AmericanConferenceonPhysicianHealth.Wehaveappliedforonegranttoassesstheassociationsbetweenmentorshipandphysiciantraineewellness,andarepreparinganothertoassesstheeffectsofengagingincontemplativepracticesonphysicianwellness.PublicationsTodatetherehavebeenelevenpeerreviewedphysicianwellnessarticlespublishedbyStanfordauthors.Theseincludepublicationsinpeer-reviewedjournalsaswellasinformationalarticles.
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AppendixHcontainsalistofcurrentpublicationsalongwithlinkstoabstractsandpostersacceptedatnationalmeetings.Support,CollegialityandAppreciationBothour2013and2016surveyfindingsdemonstratethatphysicianswhofeelappreciatedaremorelikelytoexperiencehighlevelsofprofessionalfulfillment.During2016,theWellMDCenterhostedseveraleventstoshowappreciation,offersupportandfostercollegiality,including:
• TwodaysofeventswithDr.TaitShanafeltfromMayoClinic• ValidationSurveyLuncheons• InternationalConferenceonPhysicianHealth(IPCH)ReceptioninBoston• IPCHWellnessResearchEventatStanford• PrimaryCareAppreciationLuncheonatHoover
PosterPresentationEventinAtrium MonthlyPhysicianWellnessMeeting GratitudeLunchatHoover
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EFFICIENCYOFPRACTICE
EfficiencyofPracticereferstoworkplacesystems,processes,andpracticesthatpromotesafety,quality,effectiveness,positivepatientandcolleagueinteractions,andwork-lifebalance.Thecenterhasonlybeguntoaddressthiscriticaldomainandplanstodevotemoretimeandresourcestothisareain2017.Wewillfocusinitiallyonassessingphysicians’experiencewithourelectronichealthrecord(Epic)anditsimpactontheirdailywork.InSeptember2016,theWellMDCenterhostedajointStanford/PackardCMIOmeetingtoexplorethealignmentofinitiativesandresourcestoimprovetheusabilityofEpicinbothhealthsystems.Asaresult,threesetsofEHRquestionswereagreeduponforinclusioninthe2016PhysicianWellnesssurvey:
1. Rateyourexperience(satisfactionandcompetence)withEpic2. Howoften/welldoesEpichelpwithpatientcommunication,locationofpatientinformation,
efficientordering,andcarecoordination?3. ChallengeswithEpic,including:physicianorders,patientfacetime,leveragingEHRtasksto
others,workvolumeInaddition,EfficiencyofPracticesstrategiesthatwereratedhighlyinour2016surveyareshownbelow.Thesesurveyresultswillhelptoguideandprioritizeourcontinuedworkwithhealthsystemleaders.
37%
40%
46%
65%
66%
One-on-oneEPICcoaching
ImprovedEPICrapid-responsehelp
Documentationassistance(e.g.scribes)
Physicianinvolvementindecisionsregardingsupportstaff
Empowerphysicianstore-engineeerclinicalprocessandflows
EFFIC IENCY OF PRACTICE STRATEGIES RATED H IGHLY
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Onemethodthatdeservesconsiderationtoempowerphysiciansinthere-engineeringofclinicalprocessandflowsistheUniversityHealthCareAlliance(UHA)ModelClinic.TheUHAmodelclinicengagespracticingphysicianstoincreaseefficiencyofpracticebyredesigningandstreamliningworkflowsandcareprocesses.In2016UHA’smostadvancedmodelclinicpractice,AffinityFamilyPhysicians(AFP),showedthegreatestimprovementsinprofessionalsatisfactionandburnoutwhilealsoshowingsubstantialimprovementinemployeeengagement.
Webelievetheseresultsillustratethevitalimportanceofimprovingefficiencyofpracticeifwearetohavemeaningfulandsustainedimpactsonbothproviderandcareteamprofessionalwellness.
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PERSONALRESILIENCE
PersonalResilienceconsistsofanindividual’sskills,behaviors,andattitudesthatcontributetophysical,emotional,andprofessionalwell-being.Stanfordalreadyhasmanyexcellentpersonalresilienceprogramsandresourcesinplace.Thechallengestotheirutilizationinclude:
• Physicians’lackofawarenessoftheresources• Lackofproximityofandafter-hoursavailabilityofresources(e.g.exerciseandsleepareas
andhealthyfood,educationprograms)• Lackofscheduleflexibilitytoutilizetheseresources
Thesechallengeswillneedtobeaddressedtooptimizephysicianhealthandresilience.ThispastyeartheWellMDCenterimplementedfourwellnessprogramsthatprovidedover200physicianswithopportunitiestoimprovetheirpersonalresilienceskills,spendtimeconnectingwithcolleaguesandreceivepeersupportasrequested.AdescriptionofeachoftheseprogramscanbefoundinAppendixCthroughAppendixG.
• PeerSupportProgram–Revisedin2016• LiteratureandMedicine• Mindfulness-BasedStressReductionforPhysicians• CultivatingCompassionforPhysicians
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ESTABLISHINGANATIONALROLEOverthepastyear,theWellMDCenterhasestablisheditselfasanationalandinternationalleaderinthefieldofphysicianwellness.WellMDCenterexpertiseasconsultants,speakersandadvisorsisfrequentlyrequestedontopicsrelatedtophysicianwellnessandprofessionalfulfillment,includingmeasurement,peersupport,andphysicianwellnessprogramdevelopment.TheCenterfacultyhavedeliveredovertwentypresentationsoutsideStanford,includinginvitedpresentationsatnationalmeetingsoftheACGMEandAAMC,aswellassixpresentationsandworkshopsattheInternationalConferenceonPhysicianHealth.PhysicianWellnessAcademicEvaluationConsortiumTheWellMDCenterinconjunctionwiththeRiskAuthorityhasestablishedaPhysicianWellnessAcademicConsortium(PWAC)tosupportthephysicianwellnessevaluationandneedsassessmentinacademicinstitutions.Theconsortiumisactivelyrecruiting10academichospitalsinafreeopt-inprogram.ThePWACkickedoffwiththefirstexternalsurveyfora2000physicianhospitalontheeastcoastinDecemberof2016.WhilethisisthefirstPWACmemberoutsideoftheStanfordsystem,therearemanyotheracademicorganizationsthatweplantosupportthroughourcollaborationwithTheRiskAuthority,with6activerequestsforstartingthisprocessand7additionalrequestsataninitialrecruitmentstage(13activerequestsasofJanuary2017).NationalPhysicianWellnessConsortiumThispastyearStanfordMedicine,alongwiththeMayoClinicandtheAmericanMedicalAssociation,foundedanationalconsortiumtoaddressthephysicianburnoutcrisis.In2016,thefoundingmembersheldaCEOconsortiumtowhichitinvitedseniorleadersfromvanguardorganizationsacrossthecountry.Theseleadersspentthedaytoexploringwhatweknow,sharingbestpractices,anddiscussinghowtoinfluencethenationallandscapesuchthatphysicianswillbeabletoreconnectwiththejoyofpracticingofmedicine.StanfordCEODavidEntwistlehadaconflict(hisfirstSHCBoardmeeting)butStanfordwasrepresentedbyMaryLouMurphy,whohelpedorganizetheevent.JoyinMedicine-ResearchSummitWellMDalsoparticipatedinthecreationofthefirstnationalPhysicianWellnessResearchSummitin2016.Dr.MickeyTrockelco-chairedtheevent,whichwasattendedbythirty-fivenationalandinternationalscholars.Thepurposeofthesummitwastocraftaresearchagendaaroundissuesofburnoutandprofessionalwell-being.2016InternationalConferenceonPhysicianHealth(ICPH)The2016,ICPHwasheldinBostonandStanfordhadthelargestcontingent(33individuals)ofanyorganizationinattendance.Werepresented25%ofallacceptedabstractswithelevenpostersandsixpresentations(seeAppendixI).Duringtheevent,wehostedareceptionattendedbyover60individuals,enablingourphysicianstonetworkandsharetheirideaswithworldleadersinthephysicianwellnessfield.
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MOVINGFORWARDLocallyOurStanfordsurveydatasupporttheneedtoaddressallthreewellnessdomains-cultureofwellness,efficiencyofpracticeandpersonalresilience-toreversetherecentdownwardtrendinphysicianwellness.Wewilldevelopandprioritizepotentialinterventionsbasedonthenationalliterature,ourownsurveydatashowingcorrelationsbetweenwellnessandvariousdrivers,thepreferencesexpressedbyoursurveyparticipantsforspecificinterventions,andinputfromupcomingfocusgroupsandleadershipdiscussions.CultureofWellnessProfessionalfulfillmentwashighlycorrelatedwithleadershipsupportinoursurvey,andover60%ofsurveyparticipantsidentifiedleadershipsupportforimprovingphysicianwellnessandprofessionalsatisfactionasveryorextremelyhelpful.BeginninginFebruary2017,theWellMDteamwillmeetwithdepartmentchairstoreviewtheirindividualfindingsandhelpdevelopwellnessstrategies.Additionally,wewillholddepartmentalandsystem-widefocusgroupstoinvolveourfacultyinthedesignofspecificinterventions.Wewillexplorewaysforleadersandpeerstoeffectivelycommunicatetheirappreciationandsupportofourfaculty,alongwithwaystobetterhighlighttheappreciationsooftenexpressedbyourpatients.EfficiencyofPracticeSurveyparticipants’experiencewithEpicaccountedforsignificantvarianceinprofessionalfulfillmentandburnout.Therefore,akeystrategyinthisdomainwillbetocontinueourworkwithinformaticsleaderstoimproveEpicusability.Wewillalsopartnerwithhealthsystemoperationalleaderstofindopportunitieswherecaredeliveryredesigncanhaveapositiveimpactonphysicianwellness(asitappearstohavedoneinUHA).PersonalResilienceWhenaskedtorankpotentialinterventions,surveytakersidentifiedmindfulnessandself-compassioninitiativesalongwithhealthyfoodaspriorities.Sinceself-compassionandsleepqualitywerealsohighlycorrelatedwithprofessionalhealth,theWellMDCenterwillcontinuetoexpandourmindfulnessandcompassionprograms,withaneyetomethodologiesthatarescalableandlessdemandingoftime.Wealsohopetodevelopcognitive-behavioraltherapyofferingstoimprovesleepquality.Wewillpartnerwithoperationalleaderswithanaimtoprovidehealthyfood24/7alongwithaccesstoimprovedsleepandexercisefacilities.Nationally2017AmericanConferenceonPhysicianWellness(ACPH)Stanford(throughtheWellMDCenter)isleadhostoftheinauguralAmericanConferenceonPhysicianHealth,tobeheldOctober12-13,2017inSanFrancisco.TheAmericanMedicalAssociationandtheMayoClinicarecollaboratorsandco-hostsforthisconference,whosethemeis“CreatinganOrganizationalFoundationtoAchieveJoyinMedicine”.
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Theconferencewillfocusonstructuringhealthcareorganizationsandsystemsofcaresothatphysicianscanprovideoutstandingpatientcarewithoutburnout.Thismeetingwillshowcaseresearchintowhatorganizationscandotohelpcombatburnoutandpromoteprofessionalfulfillment.Itwillalsoprovideaforumtohighlightinnovativemethods,supportsystemsandeducationalprogramsthatsupportphysicianhealth.Thisscholarlyeventisexpectedtodrawanaudienceof350-400physicians,academics,students,physicianhealthresearchers,administrators,educators,andconsultants.AMAJoyinMedicine2017CMO/COO/CXOConferenceAsafollow-uptothe2016JoyinMedicineCEOmeeting,theAMAishostinganApril2017conferenceforC-Suiteoperationalleaders,withthepurposeofbringingthesehealthcareleaderstogethertosharestrategiesandgeneratenewideasonhowtobesttosupportphysicianwell-beingattheorganizationallevel.Thesediscussionswillformthebasisofacallforactionthatwillbeusedtoraiseawareness,supportadvocacyefforts,andultimatelyspurnation-wideactionbyleadinghealthcareorganizationstoimprovephysicianwell-being.Stanfordcontinuestobeinvolvedinaleadershiprole.BryanBohmanisco-chairingtheplanninggroupandMaryLouMurphyiskeymemberoftheplanningteam.
AMAJoyinMedicine2017StakeholderConferenceAnotherfollow-uptothe2016JoyinMedicinemeeting,co-chairedbyMickeyTrockel,willbringtogetherindividualsrepresentingprofessionalsocieties,EHRvendors,qualityandsafetyorganizations,regulators,andpayers,withthegoalof1)increasingawarenessoftheimportanceofphysicianwellnesstoeachstakeholder,2)facilitatingcollaborationsacrossstakeholdergroups,and3)helpingallstakeholderrepresentativescreateandimplementanactionplanspecifictotheirroleincomprehensiveeffortstoimprovephysicianwellness.
The Stanford WellMD model is being recognized nationally as a useful guide for efforts to promote professional wellness and Joy in Practice.
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CONCLUSIONWeatStanfordhavetheopportunity,capability,andcompellingvisiontocreateaninnovativeandcomprehensiveprogramthatwillestablishusastheforemostinternationalleader,bothacademicallyandoperationally,inpromotingphysicianwellnessandprofessionalfulfillmentasastrategyforexcellenceinclinicalcareaswellasresearchandteaching.Thesupportnecessarytomovethisprogramforwardissmallcomparedtothepotentialimpactonourclinical,educationalandresearchmissions.Withoutthatsupport,manyofthecurrentphysicianwellnesseffortsatStanford,dependentastheyareonextraordinaryindividualvoluntaryefforts,arelikelytowitheraway,leadingtodisappointmentratherthantheenergizingengagementthatwebelievewillensuretheultimatesuccessoftheseefforts.TheStanfordWellMDCenterhasestablishedamodelforphysicianwellnessandisbecomingaleaderinthisevolvingfield.Thisreportoutlinesourrecentactivitiesandpresentsacredibleroadmaptowardourgoals,includingthedevelopmentofsystemsandprocessestosustainandadvanceourcurrenteffortswhilebuildingthefoundationforexpandedeffortsinsubsequentyears.During2017theprimaryfocusoftheCenterwillbetoworkwithdepartmentanddivisionleaderstounderstandtheirphysicianwellnessfindingsanddesigninterventionstoimprovetheCultureofWellnessintheirareas.Additionally,theCenterwillfocusonhowtobestimproveEfficiencyofPracticeacrosstheenterprise.PersonalResilienceactivitieswillcontinueandbeexpanded.The2017inauguralAmericanConferenceonPhysicianHealth,aswellastheongoingseriesofAMAJoyinMedicineconferences,willshowcaseStanford’scommitmentandleadershipintheincreasinglyvitalfieldofphysicianwellness.TheWellMDCenterlooksforwardtocontinuedsupportfromleadershiptoaccomplishitsgoalsandmakeadifferenceinthelivesofourphysicians,staffandpatients,bothlocallyandnationally.TheSurgeonGeneralhasstatedthatphysicianburnoutisanationalhealthcarecrisis.Developingaresearchandoperationalprogramtocombatthisthreattoourmission-andtothenation’shealth-isexactlythekindofinnovativeworkthatStanfordexiststoundertake.
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ACKNOWLEDGEMENTSOrganizationalSupportTheworkoftheWellMDCenterwouldnotbepossiblewithoutthesupportof:Dr.LloydMinor,DeanoftheStanfordUniversitySchoolofMedicineDavidEntwistle,CEOStanfordHealthCareChrisDawes,CEOStanfordChildren’sHealthNormRizk,ChiefMedicalOfficer,StanfordHealthCareDennisLund,ChiefMedicalOfficer,StanfordChildren’sHealthLindaBoxer,ViceDean,StanfordSchoolofMedicineMarciaCohen,SeniorAssociateDean,MedicalEducation,StanfordSchoolofMedicine
ThePhysicianWellnessCommitteeWesAlles,PhDLauraBachrach,MDSumitBhargava,MDBryanBohman,MDTaraCornaby,MDMagaliFassiotto,PhDBruceFeldstein,MDCharelleFernandez,MSBennyGavi,MD
JacquelineGenovese,MASuzanneGokel,MDMargaret Govea,MSMaryamHamidi,PhDGregHammer,MDStephanieHarman,MDNatalyaHasan-Hill,MDAndreaHausel,MPH,RDAnitaHonkanen,MD
JoeHopkins,MDBobHorowitz,MDNawalJohansen,MDLaurenceKatznelson,MDEmiLesure,PhDManuelaKogon,MDJohnMark,MDRebeccaMiller,MDDanMurphy,MD
CenterOrganizationalChartDean
SCHCEO SHCCEO
DirectorofStrategicProjects
AdministrativeDirector
DirectorofScholarship&Health
Promotion
AdvisoryCouncil
AssociateDirectorofScholarship&Health
Promotion
CenterDirector
SHCCMOandSADClinicalAffairs
SCHCMOandAssociateDean
WellMD
PhysicianWellnessCommittee
WellMD
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MaryLouMurphy,MSCarolineOkorie,MDLarsOsterberg,MDRaviPrasad,PhDJochenProfit,MD,MPHPattydeVries,MSZakiaRahman,MDKristenRaj,MD
GeoffreyRiley,MDAmeliaSattler,MDRachelSeaman,MDKellySkeff,MD,PhDRebeccaSmith-Coggins,MDMarciaStefanick,PhDHariseStein,MDSonooThadaney,MBA
MickeyTrockel,MD,PhDEvaWeinlander,MDDanaWelle,DO,JDMarkWelton,MDLouiseWen,MDAmandaWheeler,MD
WellMDSteeringCommittee/AdvisoryCouncilTheWellMDSteeringCommitteeguidestheworkoftheWellMDCenteralongwithitsstrategyandoperationaltactics.Thecommitteemembers:Marisa(Mimi)Albert,MPH,ProjectManageroftheDean’sTaskForceBryanBohman,MD,WellMDCenterInterimDirectorPattydeVries,MS,WellMDCenterDirectorofStrategicProjectsMaryamHamidi,PhD,AssociateDirectorofScholarshipandHealthPromotionMaryLouMurphy,MS,WellMDCenterAdministrativeDirectorChristySandborg,MD,ChairoftheDean’sTaskForceRebeccaSmith-Coggins,MD,PhysicianWellnessCommitteeCo-ChairMickeyTrockel,MD,PhD,WellMDCenterDirectorofScholarshipandHealthPromotionDanaWelle,DO,JD,PhysicianWellnessCommitteeCo-ChairWellMDCenterPartnersTheStanfordWellMDCenterandthePhysicianWellnessCommitteebothactasagentsofchangewiththeirownprogramsaswellasameansforsupport,networkingandcollaborationbetweenvariousdepartmentandinstitutioninitiatives.HereisanoverviewofCenterandCommitteeconnectedwellnessprogramsforphysiciansandtrainees.AdditionalwellnessopportunitiescanbefoundthroughoutourWellMD.Stanford.eduwebsite.CommunityBuilding
• Literature&MedicineDinnerSeries(JacquelineGenovese,BennyGavi)• MedicineandtheMuseProgram(AudreyShafer)• MedicineandtheMuseSymposium(ShailiJainandJacquelineGenovese)• MusicandMedicineEvents(JacquelineGenovese)• StanfordMedicineMusicNetwork(JacquelineGenovese)• Writer’sWorkshops(JacquelineGenovese)• PegasusPhysicianWriters(HansSteiner)• 3GoodThingsProjects(JochenProfit)• SchwartzCenterRounds(SaraNikravan,TorreySimons)• WomenFacultyNetworkingGroup(BonnieMaldonado)• MedicalStaffGala(OfficeoftheChiefofStaff)• HealthforHealersResearchGroup(MickeyTrockelandMaryamHamidi)
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Education• WellnessExpertGuestSpeakers(MaryLouMurphy)• MindfulnessSubcommittee(LarsOsterberg,TaraCornaby)• MindfulnessClassforPhysicians(TaraCornaby)• CompassionCultivationClassforPhysicians(LarsOsterberg)• BriefCompassionTrainingforPhysicianWell-being(BobHorowitz)• Healer'sArtforMedicalStudents(BruceFeldstein)
Communication
• Website(HariseStein)• MonthlyNewsletters(HariseStein)
MedicalStaffSupport
• MedicalStaffPeerSupportProgram(HariseStein)• MedicalStaffLitigationSupportProgram(HariseStein)• AcademicBiomedicalCareerCustomization(MagaliFassiotto)• TimeBankingSystem(MagaliFassiotto)
HousestaffSupport
• HealthConnect24/7PhoneLine(MickeyTrockel)• HouseStaffPeerSupportProgram(HariseStein)• InitiativesforHealthandWell-Being(LaurenceKatznelson)• SpecificDepartmentPrograms• AnesthesiaPRIMEProgram(TaraCornaby,RaviPrasad)• SurgeryBalanceinLifeProgram(RalphGreco)• PediatricsHumanismandWellnessProgram(LauraBachrach)
MedicalStudentSupport
• OfficeofMedicalStudentWellness(MargaretGovea)• MedicalStudentLifeAdvisingOffice(RebeccaSmith-Coggins)• RespectfulEducatorandStudentMistreatmentCommittee(RebeccaSmithCoggins,James
Lau)• EducatorsforCare–E4C(LarsOsterberg)• Ears4Peers(RebeccaSmith-Coggins)• ReflectionRounds(BruceFeldstein)
http://med.stanford.edu/researchandevaluation/rathmann/fellows.html• EthicsandHumanitiesScholarlyConcentration(AudreyShaferandMarenGrainerMonsen)• MedicalStudentSleepProject(SaraConnollyandMickeyTrockel)
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CollaborativePrograms• UniversityHealthCareAllianceProviderWellnessProgram(RachelSeaman,AndreaHausel)• BeWellwellnessprogramforUniversityEmployees• HealthImprovementProgram(HIP)(WesAlles)• HealthyStepsProgram(CharelleFernandez)• FacultyEngagementCommitteeatLPCH(ChristySandborg)
Measurement
• PhysicianWellnessSurvey(MickeyTrockel)• SHALA-StanfordHealthandLifestyleAssessment(WesAlles)• PhysicianWellnessQualitativeResearchProject(IrisSchrijver)• PediatricFellowWellnessSurvey(CarolineOkorie,SumitBharagava)• BarrierstoResidentWellness(LindsayBorg,MickeyTrockel)• Multi-OrganizationResidentWellnessSurvey(MickeyTrockel)• EMRStudywithUniv.ofNMandUniv.ofMinnesota(NancyMorioka-Douglas)
AdditionalCollaboratorsChristopherSharp,KelleySkeff,YumiDiAngi,BonnieHalpern-Fisher,ChangLeeTzielan,NancyMorioka-Douglas,YanivKerem,NataliePageler,LindsayStevens,andMichaelKimwhowereinstrumentalindesigningtheEMRquestionsforthe2016Survey.EmiLesure,PhDisaSocialScienceResearcherwhowasinstrumentaltooursuccessinvalidatingourPhysicianWellnessSurveyandlaunchingourcollaborationwithTheRiskAuthority.
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APPENDICESAppendixA:WellMDTeam
BryanBohman,MDInterimDirectorDr.BohmaniscurrentlyservingasinterimleaderfortheWellMDCenter,whileanationalsearchisunderwayfortheDirector.Heischargedwiththeoversightofallphysicianwellness/burnoutpreventionefforts.HisprimaryfocusistoestablishtheCenterasakeycontributortophysicianandstaffprofessionalfulfillmentacrossStanfordMedicineaswellasacenterofscholarshipandresearch.MickeyTrockel,MD,PhDDirectorofScholarshipandHealthPromotionMickeyTrockelisaclinicianscholarwholeadsStanford’sPhysicianWellnessSurveystoguidedevelopmentandevaluationofendeavorstoimprovephysicianwellness.HealsodirectstheCenter’saffiliated“HealthforHealers”researchgroupandprovidesconsultationtoscholarstohelpthemdeveloptheirphysicianwellnessresearch.MaryLouMurphy,MSAdministrativeDirectorMaryLouMurphyistheAdministrativeDirectorfortheWellMDCenter.SheoverseestheCenteroperations,finances,communicationsandpublicrelations.Additionally,shedevelopsandimplementsnewprogramsandsystemstoimprovephysicianfulfillment.PattydeVries,MSDirectorofStrategicProjectsPattyDeVriesoverseesthedesignandadministrationofCenterstrategicprojectsandprograms.Additionally,sheservesasourlinktohospitalanduniversitywellnesseffortsduetoherexperienceoverseeingtheHealthyStepsprogramforStanfordChildren’sHealthandStanfordHealthCareemployeesandhersupportingrolewiththeUniversityBeWellteam.
MaryamS.Hamidi,PhDAssociateDirectorofScholarshipandHealthPromotionMaryamHamidiservestheAssociateDirectorofScholarshipandHealthPromotion.Sheisresponsibleforresearchprojects,dataanalysisandmentoringphysiciansintheresearch.
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AppendixB:2016PhysicianWellnessSurveyExecutiveSummary
The2016StanfordPhysicianWellnessSurveyResultsEvenasphysicians’professionalwellnessisincreasinglyrecognizedascriticallyimportanttothedeliveryofoutstandinghealthcare,1surveydataindicatethatphysicianburnoutnationallyhasincreasedfrom45%in2011to54%in2014.2TheStanfordPhysicianWellnessCommitteeconducteditssecondPhysicianWellnessSurveyinthefallof2016witha54%responserate.Thissurveywasdesignedtoassessburnoutandprofessionalfulfillment,alongwiththeirdeterminants,andtohelpidentifygapsincurrenteffortstoimproveprofessionalwellness.
2016KEYFINDINGS
BurnoutOverall,34%ofStanfordPhysiciansreportedoneormoresymptomsofburnout(emotionalorphysicalexhaustion).Ofphysicianswhoparticipatedinboth2013and2016surveys,datashowsa13%increaseinburnoutoverthreeyears.Femalephysiciansreportedsignificantlyhigherburnoutrates(39%)thanmalephysiciancounterparts(28%).Similartoour2013data,ourburnoutratesarehighestamongourClinicalEducatorsandMedicalCenterLines.Thisisproblematicbecausethesephysiciansdeliverahighpercentageofourdirectpatientcare.Lowself-compassionandsleep-relatedimpairmentwerethestrongestdeterminantsofburnout.
ProfessionalFulfillmentProfessionalfulfillmentwasassessedwithafour-itemscaleincludingself-efficacy,worksatisfaction,happiness,andself-worth.Only14%ofStanfordPhysiciansreportedhighprofessionalfulfillmentascomparedto24%in2013.Thisrepresentsa10%declineoverthreeyears.Femalephysiciansreportedlowerratesofhighprofessionalfulfillment(13%vs.20%).Culturalfactorswerethestrongestdeterminantsofprofessionalfulfillmentandincludeperceivedappreciation,personal/organizationvaluesalignment,andpeersupportiveness,allofwhichwererelatedtoperceivedleadershipsupport.
Figure1.Changesinburnout(n=265)andhighprofessionalfulfillment(n=272)ratesfrom2013o2016
EconomicImpactofBurnoutDatashowsthatburned-outphysiciansaretwiceaslikelytoleaveStanford.Ofthephysicianswhoreportedburnoutin2013,21%leftwithintwoyears,morethantwotimesthedeparturerateofthosewhoreportedlowsymptomsofburnout.Iftheburnoutratesremainunchanged,therewillbeadepartureofupto88physiciansby2018attributabletoburnout.Basedonnationaldatathiswillresultinaneconomiclossofapproximately$88,000,000inrecruitmentandopportunitycosts–notincludingthecostsofreducedproductivityandqualityassociatedwithburnout.
ImprovingPhysicians’ProfessionalWellnessSurveydatasupporttheneedtoaddresscultureofwellness,efficiencyofpracticeandpersonalresiliencetoreversetherecentdownwardtrendinphysicianwellness.TheWellMDCenterwillfocusonthefollowingdata-driveninterventions.
CultureofWellnessBecauseover60%ofphysiciansidentifiedleadershipsupportforimprovingphysicianwellnessandprofessionalsatisfactionasveryorextremelyhelpful,wewillfocusonimprovementinterventionsintheseareas.BeginninginFebruary2017,theWellMDteamwillmeetwithDepartmentChairstoreviewtheirfindingsanddevelopwellnessstrategies.Additionally,wewillholdfocusgroupstoinvolveourphysiciansinthedesignofspecificinterventions.Wewillcontinuetocreatemechanismsforrecognitionandappreciationbybothleadersandcolleagues.EfficiencyofPracticePhysicianexperiencewiththeelectronicmedicalrecord(EMR)predictedsignificantvarianceinprofessionalfulfillmentandburnout.Therefore,ourprimarystrategyinthisdomainwillbetoworkwiththeInformationTechnology(IT)departmentleaderstoimprovetheefficiencyoftheEMR.Additionally,wewillpartnerwithoperationalleaderstoexaminetheimpactofcaredeliveryredesignonphysicianwellness.PersonalResilienceThehighestratedpersonalresilienceinterventionswerefree,healthy,andconvenientlylocatedfoodandstrategiestopromoteacompassionategrowth-mindset.InitialevaluationofprogramssponsoredbytheWellMDCentersuggestsmindfulnessandcompassioncultivationbothimproveprofessionalfulfillment.Self-Compassiontrainingprogramsarecurrentlybeingdeliveredandevaluated.ItistheWellMDCenter’sgoaltoaddressbothorganizationalwellnessandindividualresiliencystrategiestopromoteprofessionalfulfillmentforallmembersofourcareteams.1. WallaceJE,LemaireJB,GhaliWA.Physicianwellness:amissingqualityindicator.
Lancet.2009;374(9702):1714-1721.2. ShanafeltTD,HasanO,DyrbyeLN,etal.ChangesinBurnoutandSatisfactionWith
Work-LifeBalanceinPhysiciansandtheGeneralUSWorkingPopulationBetween2011and2014.MayoClinicproceedings.2015;90(12):1600-1613.
26% 24%
39%
14%
BURNOUT HIGHPROFESSIONALFULFILLMENT2013 2016
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AppendixC:PeerSupportProgramProgramDirector,Dr.HariseSteinreceivedherMDfromDartmouthafterattendingStanfordasanundergraduateandasanOb/Gynresident.SheispresentlyanAdjunctClinicalAssociateProfessorinOb/Gyn.HarisehasbeeninvolvedwiththePeerSupportProgramfromitsinception,writingtheprogrammanual,servingasapeersupporttrainer,andbecomingtheDirectorinMay2016.
ProgramDescription:Adverseclinicaleventshappentoallclinicians.Theaftermathcanbeverychallengingandleadtoasenseofisolation.Ourconfidentialandlegallyprotectedprogramconsistsof40volunteercliniciansfromStanfordHealthinmultiplespecialtiesandlevelsofexperience(14faculty,11fellows,11residents,4UHA),theyhavebeentrainedtolisten,offerperspective,stressself-care,andprovideresourcestothesephysicians.TheprogramcanbeactivatedbyoversightgroupssuchasSafety,QualityorRisk;bymanagersordirectors;byphysiciansconcernedaboutacolleague;andbyself-referralbyemailingmedpeersupport@stanford.edu.Findmoreinformationat:http://wellmd.stanford.edu/get-help/peer-support.htmlDataCollectionandAnalysis:2016datashow2-9referrals/month(onparwiththeHarvardprogramof4-5/month).Involvedphysiciansarecontactedbyemail,andresultingstatsshowabout50%donotrespond,25%respondandsaytheyaredoingokbutappreciatetheconcern,and25%opttotalkwithasupporter.Thisisusuallyaone-timeeventoverthephone,rangingfrom15-60minutes.ParticipantFeedback“Justhavingsomeoneneutralcheckinspecificallyaboutmywellbeingwascomforting...Ifeltincrediblysupportedanditwasnicethattherewerenotsecondarymotivesbehindthesupport(i.e.datagathering).”
“Greatadditionforourphysicians,asweoftenfeeltheneedtosortthroughtheseissuesalone.”ConclusionWehavereceivedverypositivefeedbackaboutthisprogram,andeventhoughcliniciansmaynotopttoutilizeit,theyareappreciativethatitisavailable.
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AppendixD:MedicineandLiteratureJacquelineGenoveseJacquelineGenovese,CourseLeader,hasaMaster'sDegreeinMedicalHumanities,andistheAssistantDirectoroftheStanfordMedicineandtheMuseprogram.Shecoordinatesevents,workshopsandeducationalinitiativesformanygroups,includingmedicaltraineesandveterans.
BennyGaviProgramDirector,Dr.BennyGavi,isaClinicalAssistantProfessorinMedicineandpastDirectoroftheStanfordHospitalistProgram.HehasextensiveexperienceandinterestintheLiterature&Medicineprogram,previouslyatHarvardandpresentlyatStanford.TheStanfordLiterature&MedicineDinnerandDiscussionseriesisdesignedtoprovideanopportunityforphysicianstocometogetherandshareamealwhilediscussingworksofliterature.Itispartofanationalprogramfosteringthemedicalhumanities,joiningotherparticipatingacademicorganizationssuchasHarvardandtheUniversityofChicago.Theprogramfacilitatorsencouragetheexplorationofthechallengesandrewardsofbeingadoctor.Ledbyaskilledmedicalhumanitiesfacilitator,theLiteratureandMedicineseriesprovidesasupportiveenvironmentforcandidandthoughtfuldiscussionamongphysician.Todateover80physicianshaveparticipatedintheprogram.Attendeeshavebeenhighlyappreciativeoftheopportunitytointeractwithandlearnfromcolleaguesofdifferentages,backgroundsandspecialties.Participantquotesincluded:“It’sgratifyingtoheartheperspectiveofdoctorswithtraininginotherareas,”and“theprogramwasagreatwaytoengageyourcoreasaphysicianandshareitwithyourcolleagues.”Timecommitment:2eveninghoursonceamonthfor6months
"TheLitMedprogramwasagreatwaytoengageyourcoreasaphysicianandshareitwithyourcolleagues."
-SteveAsch,MD,ProfessorofMedicine
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AppendixE:MindfulnessBasedStressReductionforPhysiciansProgramDirector:TaraCornaby,MDisaClinicalAssociateProfessorintheDepartmentofAnesthesiology,DirectorofByersSurgeryCenter,andCo-foundingDirectoroftheAnesthesiaResidentWellnessProgram.SherecentlycompletedafellowshipinIntegrativeMedicineandhastaughtmindfulnesstophysicianssince2010.CourseLeader:MarkAbramson,DDS,isafacultymemberoftheStanfordIntegrativeMedicineCenter.HehasledtheStanfordMindfulness-BasedStressReductionprogramfor20years,teachingmedicalandcommunitygroupsthroughtheSchoolofMedicineandthroughtheHealthImprovementProgram(HIP).ProgramDescription:Physiciansattendedeightweekly,two-houreveningsessionsandanoptionalalldaySaturdayretreat.Thisexperientialprogramtaughttheprinciplesofmindfulnessandtheirapplicationtoeverydaylifeandhelpedparticipantshowtorespondmoreeffectivelytostressors.Theclasswascustomizedtoaddressthepersonalandprofessionalchallengesfacedbyphysicians.SixteenphysicianscompletedtheSpring2016courseandtwelvephysicianscompletedtheFall2016course.DataCollectionandAnalysis:Pre-interventionandpost-interventionsurveysmeasuredvariablesincluding:mindfulness,self-compassion,emotionalexhaustion,interpersonaldisengagement,andoverallburnout.Statisticallysignificantresultsfromthespringcourseshowedincreasesinself-compassionandmindfulbehaviorsanddecreasesinoverallburnout,emotionalexhaustion,andinterpersonaldisengagement.Fallcoursesurveysarecurrentlybeinganalyzed.ParticipantFeedback:Participantslikedbeinginasmallgroupwithotherphysicianswhounderstoodoneanother’sstressorsandthatthecourseinstructorswerefellowdoctors.Theyrequestedon-going,flexiblemindfulnessgroupmeetings.Conclusion:Physiciangroupmindfulnesstrainingprogramshavebeenshowntosignificantlyincreasemindfulbehaviorsandreduceburnout.Thiswellreviewedprogramsuccessfullyreproducedthosemeasuresinacost-effectivemannerthatcanbescaled,asneeded,toaccommodategrowingphysicianinterest.
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AppendixF:CompassionCultivationCourseProgramDirector:LarsOsterberg,MD,MPH,isanAssociateProfessorofMedicineatStanfordSchoolofMedicine;Co-directorofStanfordMedicineTeachingandMentoringAcademy.LarsservedastheProgramDirectorforboththespringandfallCompassionCultivationCourse.
ProgramInstructors:MonicaHansonisaninstructorfortheCenterforCompassionandAltruismResearchandEducation(CCARE),MonicapilotedtheCompassionCultivationTraining(CCT)programwithmilitaryveteransinthePaloAltoVAHealthcareSystem.KellyMcGonigal,PhDisahealthpsychologistatStanfordUniversityandaleadingexpertonthemind-bodyrelationship.Sheco-authoredtheCompassionCultivationTraining(CCT)course.Herpopularprograms—including“TheScienceofWillpower”and“TheScienceofaCalmedMind”—addressthepsychologicalscienceofpersonalhealthandhappiness,aswellasorganizationalsuccessProgramDescription:TheprogramwasdeliveredbyCenterforCompassionandAltruismResearchandEducation(CCARE)facultyatStanfordUniversitySchoolofMedicine.Theprogramincorporatedscience,inputfromcontemplativescholars,mindfulnessmeditationandotherpracticesinan8week,2hr.weeklyclass.Thisofferingwastailoredforthechallengesfacedbyphysicians.Twenty-sixpeopleattendedthecourseswehaveofferedsofar.DataCollectionandAnalysis:Toevaluatetheprogramwesurveyedparticipantsusingavalidatedquestionnaireoncompassionmeasures,burnoutmeasuresandassessmentofmindfulnesspractices.Tenparticipantscompletedbothbaselineandweek-eightquestionnaires.Results:Participantsreportedincreasesinself-compassion,self-confidenceandmindfulbehaviors.Theyalsoreporteddecreasesinoverallburnout.Conclusion:Compassioncultivationtrainingprogramscansignificantlyincreaseself-compassion,mindfulbehaviorsandreduceburnout.Challengeswerefacedinphysiciancompletingtheprogramsduetothecommitmentrequired.
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AppendixG:BriefCompassionTrainingInterventionforPhysicianWell-BeingProgramDirector:BobHorowitz,MDattendedStanfordMedicalSchoolanddidhismedicineresidencyatSantaClaraValleyMedicalCenter(VMC).Hejoinedtheirprimarycaredivisionandpracticedtherefrom1983-2014.Bobhasbeenalong-timemeditatorandisespeciallyinterestedincompassionmeditationpractices.ProgramDescription:DevelopedinconjunctionwiththeStanfordPreventionResearchCenter,thisphysicianwell-beinginterventionfocusedonprovidingaconvenientself-compassiontrainingprogramforproviders.Twenty-six
physiciansfromfiveStanfordprimarycareclinicsattendedeightweeklythirty-minuteskill-buildingsessionsdeliveredon-siteattheirclinicsduringworkdays.Theyweretaughtexercisesthatcouldbeperformedinsecondstoafewminutesduringstressfulmoments.Overallprogramattendancewasseventyfivepercent.
DataCollectionandAnalysis:Participantscompletedpre-andpost-interventionsurveysmeasuringempathy,self-compassion,andself-efficacyforskillslearned.Statisticallysignificantincreaseswereobservedforself-compassionandself-efficaciesformindfulbreathing,recognizingcommonhumanityandevokingself-compassion.ParticipantFeedback:Participantslikedtheconvenienceandbrevityofthetraining,andparticularlyvaluedself-compassionasatechniquetoimprovetheiroverallwell-being.
• “ItwasamazingandtherewerethingsthatIwillrememberandalwaysaffectmyviewpointofmyselfandmypractice.”
• “Theprogramisuniqueinprovidingshorteffectivetoolstomakeclinicflowmoresmoothly.”Conclusion:Thisbriefcompassion-trainingprogram,emphasizingconvenienceforphysicians,wasfeasibleandappearedtoimprovemeasuresandskillsofself-compassion.Thisprogramisanattractiveandpotentiallypowerfultargettoimprovephysicianwell-being.
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AppendixH:PublicationsThefollowingpublicationsarebasedonresearchdoneatStanford(aloneormulti-center),frommembersandpartnersofthePhysicianWellnessCommitteeandtheWellMDCenter.In2016therewereelevenphysicianwellnessrelatedarticlespublishedinpeer-reviewedjournals.Ourwebsitenowhasalinktotheabstractsofthesepublications.PeerReviewedArticlesEvaluation
• Pathologyinthemedicalprofession?takingthepulseofphysicianwellnessandburnout.SchrijverI.ArchPatholLabMed.2016Sep;140(9):976-82.PMID:26828114
Impact
• BurnoutintheNICUsettinganditsrelationtosafetyculture.ProfitJ,SharekPJ,AmspokerAB,KowalkowskiMA,NisbetCC,ThomasEJ,ChadwickWA,SextonJB.BMJQualSaf.2014Oct;23(10):814-22.PMID:24742780
• Burnoutintheneonatalintensivecareunitanditsrelationtohealthcare-associatedinfections.TawfikDS,SextonJB,KanP,SharekPJ,NisbetCC,RigdonJ,LeeHC,ProfitJ.JPerinatol.2016Nov17.[Epubaheadofprint]PMID:27853320
Interventions
• Canartsandcommunicationprogramsimprovephysicianwellnessandmitigatephysiciansuicide?GenoveseJM,BerekJS.JClinOncol.2016May20;34(15):1820-2.PMID:26926683(pdf)
• Anexplorationofkeyissuesandpotentialsolutionsthatimpactphysicianwellbeingandprofessionalfulfillmentatanacademiccenter.SchrijverI,BradyKJ,TrockelM.PeerJ.2016Mar10;4:e1783.PMID:26989621
Leadership
• Womeninacademicmedicine:measuringstereotypethreatamongjuniorfaculty.FassiottoM,HamelEO,KuM,CorrellS,GrewalD,LavoriP,PeriyakoilVJ,ReissA,SandborgC,WaltonG,WinklebyM,ValantineH.JWomensHealth(Larchmt).2016Mar;25(3):292-8.PMID:26555562
• Reducingimplicitgenderleadershipbiasinacademicmedicinewithaneducationalintervention.GirodS,FassiottoM,GrewalD,KuMC,SriramN,NosekBA,ValantineH.AcadMed.2016Aug;91(8):1143-50.PMID:26826068
32
Housestaff• Well-BeinginResidency:ASystematicReview.JournalofGraduateMedicalEducation:
KristinS.Raj(2016)December2016,Vol.8,No.5,pp.674-684.• Emotionalintelligenceasapredictorofresidentwell-being.
LinDT,LiebertCA,TranJ,LauJN,SallesA.JAmCollSurg.2016Aug;223(2):352-8.PMID:27182037
• Burnoutinpediatricresidentsovera2-yearperiod:alongitudinalstudy.PantaleoniJL,AugustineEM,SourkesBM,BachrachLK.AcadPediatr.2014Mar-Apr;14(2):167-72.PMID:24602580
• Well-beinginresidency:asystematicreview.RajKS.JGradMedEduc2016[epubaheadofprint]pdf
• Exploringtherelationshipbetweenstereotypeperceptionandresidents'well-being.SallesA,MuellerCM,CohenGL.JAmCollSurg.2016Jan;222(1):52-8.PMID:26616033
• Promotingbalanceinthelivesofresidentphysicians:acalltoaction.SallesA,LiebertCA,GrecoRS.JAMASurg.2015Jul;150(7):607-8.PMID:25992632
• Therelationshipbetweengritandresidentwell-being.SallesA,CohenGL,MuellerCM.AmJSurg.2014Feb;207(2):251-4.PMID:24238604
• Thediscriminatorypatientandfamily:Strategiestoaddressdiscriminationtowardstrainees.WhitgobEE,BlankenburgRL,BogetzAL.AcadMed.2016Nov;91(11AssociationofAmericanMedicalCollegesLearnServeLead:Proceedingsofthe55thAnnualResearchinMedicalEducationSessions):S64-S69.PMID:27779512
MedicalStudents
• Zerotolerance:implementationandevaluationoftheStanfordmedicalstudentmistreatmentpreventionprogram.Smith-CogginsR,ProberCG,WakefieldK,FariasR.AcadPsychiatry.2016Apr19.[Epubaheadofprint]PMID:27093963
Commentary
• Maintainingwellnesscriticalfortraineesandcliniciansinmedicalsubspecialties.KatznelsonL,TrockelM.EndocrineTodayNov2015.(article)
• Invinciblecaregivers.Welle,D.MGMAConnectionNov2015.(article)
33
AppendixI:2016InternationalConferenceonPhysicianHealth(ICPH)AbstractsSeptember18-20,2016Boston,MAMoreinformationoneachabstractcanbefoundat:http://wellmd.stanford.edu/content/dam/sm/wellmd/documents/2016-ICPH-pub.pdfICPHPosters
• CultivatingaCultureofSelf-Awareness,CompassionandCommunitythroughDevelopmentofaNovelAnesthesiaResidentWellnessProgrambyTaraCornaby,RaviPrasad,NatalieHasan-Hill&EmilyRatner
• ItSustainsMe:HowPhysiciansDrawSatisfactionandOvercomeBarriersintheirPracticesbyAmyWeil,LarsOsterberg,ElizabethRiderandWilliamBranch
• FindingJoyintheHayStack:WellMDWebsiteandNewsletterbyHariseStein• EvaluatingtheEffectivenessofaPhysicianWellnessLiteratureandMedicineProgramby
BennyGavi,JacquelineGenovese,MickeyTrockelandMaryLouMurphy• Planning&AssessingWellnessInterventionsPhysiciansCreateforThemselves:Resultsofa
PromisingNaturalExperiment.UHAPhysicianWellnessProgrambyAndreaHausel,MickeyTrockel,RachelSeamanandBryanBohman
• BurnoutintheNeonatalIntensiveCareUnitSettinganditsrelationtoHealthCare-AssociatedInfectionsbyDanielTawfik,J.BryanSexton,P.Kan,PaulSharek,CourtneyNisbet,JosephRigdon,H.Lee&JochenProfit
• AssessingBurnout&ProfessionalFulfillmentamongPediatricSubspecialtyFellowsbyCarolineOkrie,MickeyTrockel&SumitBharagava
• BriefCompassionTrainingInterventionsforPhysicianWell-BeingbyBobHorowitz,MickeyTrokel,TiaRich,S.KimandMarciaStefanick
• SleepHealthinMedicalStudents:ACross-SectionalStudybySaraConnolly,MickeyTrockel&RebeccaSmithCoggins
• WhatdowemeanbyPhysicianWellness?ASystematicReviewofitsDefinitionandMeasurementbyKeriBrady,MickeyTrockel,ChristineKhan,KristenRaj,MaryLouMurphy,BryanBohman,ErikaFrank,AlanLouieandLauraRoberts.
• IdentifyingHousestaffBarrierstoSelf-Care:MentorshipMattersbyLindsayBorg,KeriBrady,JieLi,NancyPiro,AnnDohn&MickeyTrockel
ICPHPresentations&Workshops
• FindingYourBlissbyDanMurphyandArtieWu• ATimeBankingSystemtosupportworkplaceflexibilitybyMagaliFassiotto,Yvonne
Mondanado,CarolineSimard&HannahValentine• Theidealgaslounge:Boostingresidenthappinesswithempowermentandcommonspace
improvementsbyTaraCornaby&AdamWas• ExperiencingJoyinMedicinebyRebeccaSmith-Coggins&BruceFeldstein
34
• AddressingHouse-StaffPhysicianProfessionalFulfillmentandBurnoutbyMickeyTrockel,StewartBabbot,BardiaBehravesh,GregUnruh,BradPoss,EllenMarrow,BrianFlahery,MarkLinzer,RosemaryQuirk,CarolineOkorie,SumitBhargava
• AnInnovativeProgramtoAddressBarrierstoHealthfulEatinginAnesthesiaResidentsbyNatalyaHasan&SandraSacks
35
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