Nemours Children’s Health’s Chief Well-Being Officer Talks About Caregiver Well-Being
Leaders at the Wilmington, Delaware- and Jacksonville, Florida-based Nemours Children’s Health have led that pediatric health system forward as a pioneer along numerous dimensions. And one area of particular interest has to do with how to nurture and support clinicians and other professionals working inside their health system on a day-to-day basis, during these stress-filled, highly pressured times.
And a key practical step that Nemours’ leaders made two-and-a-half years ago was to appoint Maureen “Mo” Leffler, D.O. as the organization’s chief well-being officer in July 2020. As Nemours has explained on its website, “In this role, Dr. Leffler leads the organization’s mission to improve well-being for all associates, by developing and implementing a strategic approach to well-being. During her tenure, she has launched the Nemours Center for Associate Well-being, reinvigorated, and expanded the Peer Support program, broadened the scope of resources available to support the emotional and mental health needs of Nemours associates, and directed targeted clinical team assessments and systems-based interventions. Dr. Leffler has played a major role in the organization’s COVID-19 response, leading the Enterprise PPE Task Force and Enterprise COVID-19 Leadership Group. Prior to her current role, Dr. Leffler served as a physician liaison on the Patient Experience team since 2018, supporting her colleagues in improving the care they provide by demonstrating the relationship between clinician engagement and the patient experience. Dr. Leffler works with the Accreditation Council for Graduate Medical Education (ACGME) as the Course Director for the Chief Resident Leadership Training Program and served as the co-chair of the ACGME’s National Task Force on Well-being responding to the COVID-19 pandemic. She continues to lead the ACGME National Well-being Community calls.”
The announcement last year also noted that “Dr. Leffler earned her medical degree from the Philadelphia College of Osteopathic Medicine. She then completed a residency in Pediatrics and fellowship in Pediatric Rheumatology at Nemours/Thomas Jefferson University, where she proudly served as chief resident and later became a faculty member and Assistant Professor of Pediatrics in the Division of Rheumatology at Nemours Children’s Health.”
Late last year, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed Dr. Leffler regarding her role and her perspectives on healthcare professionals’ well-being. Below are excerpts from that interview.
You had been scheduled to co-present late last year with chief well-being officers from Children’s Mercy and Children’s Hospital of Philadelphia, at a recent conference. What was the focus of those planned sessions?
The presentations were an opportunity for chief well-being officers to help level-set the CHA community around well-being, what well-being is, and how it figures into the Quintuple Aim, and about burnout as one measure of well-being, and what we know about it. We wanted to focus on the idea that this is not an individual situation, but rather, a system-wide problem.
And what does the well-being team look like at Nemours?
We have a full-time coordinator and three people dedicating 2.5 FTEs to running the peer support program. It is actually three people with 0.25 time each dedicated to this. And I have a new full-time psychologist in Florida dedicated to supporting our employees, and am trying to hire a full-time well-being psychologist in the Delaware Valley. I myself am based in the Delaware Valley. And I report to our organization’s chief human resources officer.
What is your read of the well-being of healthcare professionals in this moment? Many are concerned that longer-term burnout and dissatisfaction could actually end up impacting patient outcomes.
I appreciate that you’re bringing that question about the intersection of patient outcomes and healthcare worker well-being to the surface. It’s often overlooked, and is one of the key elements. I was a patient experience liaison, and I took that job believing that caregivers would help us improve patient experience, as defined by quality, safety, equity, outcomes.
How do you see all of this from a 40,000-feet-up view?
We don’t differ from other pediatric healthcare systems, where we’re seeing at least 50 percent of our associates expressing at least one element of burnout; so we’re seeing high levels of burnout and exhaustion. And the majority of our associates are still satisfied with their jobs, which speaks to the fact that people can find tremendous meaning and satisfaction, while at the same time experiencing burnout.
Clinicians are trained to work through exhaustion, but eventually, it catches up with them, correct?
Yes, there is good literature about the fact that some of the very things important to high-quality care, can be a double-edged sword. For example, we have a culture of perfectionism in medicine, which can be a driver of burnout when we make inevitable mistakes. We have a culture that has normed emotional exhaustion, and has stigmatized vulnerability and self-compassion. We’re culturally driven to be compassionate, but do not prioritize compassion as a cultural norm.
As everyone knows, patient care organizations are continuing to struggle with deepening staffing shortages in numerous areas—most notably in nursing, but also in a whole range of other areas. How are you supporting clinicians through this time of shortages?
I think the staffing question is huge. You can think about it at every level of our system. First and foremost, staffing shortages and patient volume in pediatrics are overwhelming our system. A regular shift requires existentially more work, so people are tired. And that level of stress and exhaustion puts them at risk for stress injury, PTSD, and chronic fatigue and anxiety. So first, we need to help clinicians and staff self-identify issues. They need good communication within their team. At a broader level, we have to recognize that this level of chronic stress is not sustainable. It’s costly in terms of the bottom line, in terms of the impact on our healthcare workers, and on patients. Improve retention, change staffing models, and make it desirable to continue to be a part of medical care.
So when you’re speaking with people who daily manage and lead front-line clinicians—meaning people like chief nursing officers, chief residents, and so on—how are you activating them, and what are you communicating to them?
Two major things: in addition to being aware of the problem and the resources and integrating well-being/burnout into all their decision-making, we know that leadership behaviors directly impact the people who report to those leaders. So as leaders, we have the opportunity in our decision-making to impact the people who work for us, and to learn to know the people who work for us, and if we can get our team members doing what they care about the most for 20 percent of the time, based on research, we can reduce burnout. We also know that if we an create a culture where self-care is prioritized, and our team adopts a personal growth-based mindset, that’s called self-prioritization. I think it’s also really important to place a value on the investment lens. Not everything will be measured in a zero-sum return-on-investment way. When we invest a little bit more in staffing models, slightly different staffing models, different EHR models, documentation support, there is a value that comes from those investments that may be hard to measure. So, value in return on investment, changes in behaviors, and things like prioritizing self-care, self=prioritization, and protecting 20-percent time spent on valued priorities. And listening to your team is important.
At our Healthcare Innovation Summits, we regularly discuss the topic of EHR [electronic health record] optimization, and its role in reducing burnout among both physicians and nurses. EHR optimization and documentation support have emerged as major issues; what do those issues look like at Nemours and across pediatric healthcare right now?
What works well is when clinical staff have options, because there’s no single solution. So, providing options and helping clinicians to learn about them, try them, and get support from them, is ideal. So, some clinicians have found an AI documentation tool to be a game-changer, life-changing, and others have found it unusable. Scribes have worked extremely well for some clinicians and not others. So we want to create a diversity of tools for needs, and be flexible. And that goes across the board for well-being efforts; we won’t flip a switch and see burnout go away.
With regard to EHR optimization and burnout, is there anything that you’d like to say specifically to CMIOs?
One thing that’s been really helpful is having physician liaisons between the informatics team and the frontline clinician staff; they’re two different languages, ways of thinking; it’s like having bench researchers, clinical researchers, and translational researchers. That’s an example of a role that we love to think about the value in that investment. When you put somebody like that in position and they’re really available, they improve documentation, chart closure, and decrease stress. It has a long-term positive impact; and there are physicians who love that role, and it brings them joy and satisfaction, and decrease those really challenging conversations that sometimes happen. For CMIOs, I would urge that they recognize that there’s a huge gap there. Check out the AMA’s [American Medical Association’s] website; they’re promoting a slightly different variable on time spent on documentation that’s not purely pajama time. Steps Forward Program, well-being program, and they have a whole EHR optimization program.
How does this landscape look like for you over the next couple of years?
I have the privilege of serving in this role that cares for healthcare providers, and I do it because I care very, very deeply about it. And leaders across the country who have stepped into this position, share that same calling. I think it’s a very, very hopeful sign that we have more CWOs across the country, which says we’re investing in leadership and infrastructure in this area. Step forward would be our ability to influence regulatory and payer groups in a way helpful to healthcare worker well-being, and how we can decrease cognitive load and task-switching, and outcomes that matter. I’m hopeful, and there are wonderful people working across the world on this. People liken this to the quality and safety movement, and how every healthcare organization has a chief quality officer.
