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    Conceptualizing Programs to Support Faculty Well-Being

    Chantal Brazeau, MD
    Assistant Dean for Faculty Vitality
    Rutgers New Jersey Medical School

    Effective faculty programs on well-being should address the many dimensions of professional fulfillment. Using a conceptual model of professional fulfillment or well-being can help plan a balanced menu of activities and guide a comprehensive approach to faculty well-being programs.

    An important aspect of program development is measuring the burnout and professional well-being of faculty on a regular basis. Initial survey results can help prioritize faculty needs and program selection. Follow-up surveys can assess the evolution of faculty as programs are implemented. Survey design falls outside the scope of this toolkit, but excellent resources about surveys on burnout and well-being can be found in the National Academy of Medicine website.1

    Appropriate conceptual models recognize the important impact of the work environment and health care system on professional fulfillment. These include models by Stanford University2 and the National Academy of Medicine.3,4

    For simplicity, this guidance will focus on the Stanford model, which consists of a “wheel” with three domains of professional fulfillment: personal resilience, a culture of wellness at work, and efficiency of practice in the clinical environment. To make this model applicable to basic science faculty, “efficiency of practice” can be changed to “efficiency of research.”

    A comprehensive program on well-being should therefore include activities along the three domains:

    Personal resilience: This includes events to engage faculty in activities or discussions about topics that support resilience: relaxation training, mindfulness, nutrition, sleep, work-life integration, and stress management. These are frequently the first type of activities planned because they can be easier to organize. It is important not to limit faculty programming solely to activities on personal resilience so as to not give the message that faculty need to “deal better” with the stress of a “dysfunctional” system. Such a message is counterproductive and can breed resentment or discontent in faculty.

    Culture of wellness: In a culture of wellness, leadership understands the need for professional fulfillment, and congruence exists between the faculty goals and school leadership’s goals and visions. Faculty feel they can voice their opinion and that it is considered. There is a sense of community and collegiality. A faculty affairs (FA) professional can engage chairs and leadership in discussions about faculty well-being and encourage leadership attributes associated with less burnout.5 Creating opportunities for collegiality, peer support, or diverse affinity groups to discuss stresses unique to particular faculty attributes or life cycle (new parent, women, minority group) can foster a culture of wellness. A systematic review of interventions by West et al. can help provide ideas for programming.6 Faculty mentoring or coaching programs can be helpful.7 It is important to plan initiatives at various times of the day to accommodate the schedules of several faculty. It is also important to avoid planning well-being activities only after-hours or on weekends, which further reduces the time faculty can spend with their families and friends; the irony of such timing is typically not lost.

    Efficiency of practice or research: This is often the most difficult to plan because how well the practice or research laboratory “flows” might not be under direct control of the faculty or even of the FA professional. The same applies to work related to clinical documentation, the electronic health record, or any research- or patient-related administrative tasks that can pose challenges to achieving professional well-being. In this case, the work of the FA professional can take the form of advocacy in interactions with other school leadership involved in clinical care, information technology, and research to help reduce administrative burdens on the faculty.

    A powerful aspect of a faculty well-being program is to create opportunities for faculty to have a voice in creating their professional environment. One example is to have “faculty wellness champions,” “ambassadors,” or similar faculty representation from each department. Such champions are guided by the FA professional to be the designated department leader on well-being and are educated about the conceptual model chosen by the school and any information pertinent to their role. For example, the representative may be provided with school survey results about burnout or AAMC Standpoint™ Survey reports. Champions, with the support of their chairs, are then tasked to facilitate discussions about well-being in their departments following the selected conceptual model. This gives faculty a voice and also respects differences in needs of departments.

    Using the Stanford University model, for example, the champions can lead their colleagues in a brainstorming session where they discuss what they can do in their department to increase the culture of wellness, collegiality, and community or initiatives to improve the efficiency of their clinical practice or research laboratory. Such initiatives are often not costly and can be very simple but powerful. This has been likened to removing the pebble in the shoe: removing the little things that are bothersome and don’t seem like much in isolation but can accumulate and hurt at the end of the day. A simple example is the realization through faculty discussion that the location of a printer in the clinical or research office is inconvenient to all and changing its location can make the day go more smoothly. Faculty might suggest ways to alter the patient sign-in process to facilitate clinical flow. Many suggestions for the clinical office can be found on the AMA STEPS Forward website.8 The site even includes a calculator to indicate how much time an intervention can save the clinician. It can be amazing to hear the variety of ideas faculty propose if a clear message is given that talking about well-being is part of the school’s culture.

    Faculty discussions can also be used to elicit suggestions for the school about problems common to all departments or that require more central resources. Champions can be charged to collate these suggestions and bring them to the FA professional. It is important to give the message that well-being is being addressed both school-wide and within departments so faculty do not feel it’s all up to them to “fix” the work environment. Chairs of departments are important conduits, as they have access to both their faculty and school leadership; their support is crucial. 

    References

    1. Dyrbye LN, Meyers D, Ripp J, Dalal N, Bird SB, Sen S. A pragmatic approach for organizations to measure health care professional well-being [discussion paper]. NAM Perspectives. Oct. 1, 2018. https://nam.edu/a-pragmatic-approach-for-organizations-to-measure-health-care-professional-well-being.
    2. Bohman B, et al., Physician well-being: the reciprocity of practice efficiency, culture of wellness and personal resilience. NJEM Catalyst. August 2017. doi:10.1056/CAT.17.0429.
    3. Brigham T, Barden C, Legreid Dopp A, et al. A journey to construct an all-encompassing conceptual model of factors affecting clinician well-being and resilience [discussion paper]. NAM Perspectives. Jan. 29, 2018. https://nam.edu/journey-construct-encompassing-conceptual-model-factors-affecting-clinician-well-re….
    4. National Academies of Sciences, Engineering, and Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press; 2019. https://doi.org/10.17226/25521.
    5. Shanafelt TD, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432-40.
    6. West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet. 2016;388:2272-2281.
    7. Dyrbye LN, Shanafelt TD, Gill PR, Satele D, West CP. Effect of a professional coaching intervention on the well-being and distress of physicians: a pilot randomized clinical trial. JAMA Intern Med. 2019;179(10):1406-1414.
    8. American Medical Association. AMA STEPS Forward. https://edhub.ama-assn.org/steps-forward. Accessed Feb. 20, 2020. 
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