How Will This Toolkit Help Me?
This toolkit offers a blueprint for crafting a well-organized Listening Campaign, provides a framework to prioritize and execute improvement initiatives, and sheds light on strategies to overcome common challenges in engaging leaders and physicians, fostering active involvement in improvement work.
More than half of all physicians in the United States are experiencing professional burnout, which affects the experience, quality, and safety of care patients receive. Burnout can have devastating effects on physician well-being—forcing some to leave the profession altogether.1- 5 Health care organizations increasingly seek to measure and quantify physician burnout with surveys such as the Mini-Z or the Maslach Burnout Inventory.6- 8
While surveys can help highlight general areas of concern and monitor trends over time, they often do not provide the personal narratives behind the issues that are so key for generating effective changes. Individual physicians and physician groups need a systematic yet practical process to voice their stressors and propose improvement ideas so they will feel heard.
One method to solicit, process, and act on clinician feedback is to develop a Listening Campaign, which comprises 1 or more Listening Sessions between a physician facilitator and a group of practicing physicians.
A Listening Campaign is a detailed process similar to LISTEN-SORT-EMPOWER that accomplishes several goals (Figure 2).
Seven STEPS to Successfully Carry Out a Listening Campaign
Engage Leadership and Choose Physician Facilitators
Plan the Listening Session(s)
Facilitate a Listening Session to Create a Wish List
Share the Ranked Wish List With Participants
Create a Summary Report to Share With Key Stakeholders>
Implement Changes to Fulfill Wishes
Follow Up With Participants
STEP 1 Engage Leadership and Choose Physician Facilitators
Congratulations, your organization has decided to embark on a Listening Campaign: a journey to tackle burnout by optimizing system efficiencies. As the physician champion for this campaign, you are spearheading the program at the organizational level or within your local team (eg, department, clinic, or practice group). A champion should be respected amongst peers and viewed as a positive, engaged leader within the organization. It is preferable, but not essential, to have an already established role in well-being at the organization.
As you create a plan, engaging organizational leadership and identifying motivated physician facilitators are the first STEPS.
![—Sarah Richards, MD, University of Nebraska Medicine]()
In many ways, this is the most important step. Getting buy-in from both physician and administrative leaders is key and requires a well-planned and thoughtful approach.”
—Sarah Richards, MD, University of Nebraska Medicine
Engaging leaders early in the process improves participation and support throughout the campaign. Figure 3 shows 5 tips to improve your engagement efforts.
Listening Campaign Presentation for Leadership ( Sample Follow-Up Email To Leaders ( As you choose your facilitators, think about individuals (typically physicians) with an interest and/or a formal role in supporting physician well-being. It is helpful for facilitators to have excellent communication skills given that they will be the point person for sharing information between key leaders and stakeholders. They should also possess exceptional listening skills and have a positive attitude.
STEP 2 Plan the Listening Session(s)
The physician champion should meet with the physician leader to plan the Listening Session. The champion and leader may want to include other facilitators.
STEP 3 Facilitate a Listening Session to Create a Wish List
Ideally, schedule the Listening Session at a time when the physician group regularly meets, such as during a faculty meeting, to encourage attendance. The group leader may or may not attend depending on what is best for their group. A smaller department could successfully conduct a Listening Session over a dinner meeting.
The Listening Session fits best into a 45-to-60-minute timeframe; however, it can be completed in 30 minutes if more time is unavailable. Remember that the Listening Session agenda may need to be truncated for a shorter session (Table 2).
Before the Listening Session
Send the proposed agenda and any suggested questions to the group approximately 1 week before the session so the participants have some time to reflect and prepare.
During the Listening Session
It is ideal for planning for 2 individuals to conduct the Listening Session. While one facilitator is presenting, the other can take notes, pass out materials, and gather completed worksheets or wishes. There is no set role for the facilitators. They can work together to determine how the responsibilities will be shared.
The presentation is organized into 5 to 7 sections depending on how much time the group has allotted for the session (Table 2).
Listening Session Example Presentation ( Introduction and Purpose
To kick off each Session, facilitators give a brief introduction and review of the purpose. Let the group know that you (the Listening Session facilitator) will assist with goal setting and action items after the session. You will support the local team members (physicians, leaders, administrators, etc.) in accomplishing their goals, but you are not there to “solve the problem” or “lead the project.”
Large Group Discussion
To set a positive tone for the Session, ask the group to share anything they think openly is going well—both individually and as a department or division—and take notes to document the participants' responses.
Common responses to “What is going well?”
Strong sense of teamwork—physician–physician, physician–advanced practice provider, physician–nurse, physician–non-clinical staff, etc
Empathetic and supportive leader(s) (“They value my opinion,” “They really listen, “They advocate for us”)
Joy and meaning in practice ("I make a meaningful difference in the lives of my patients”)
Next, share specific examples of potential topics contributing to professional burnout, including known systemic factors (ie, excessive workload, administrative burden, workflow distraction, time pressure, control over schedule or workload). At this time, the physician facilitators could share a personal example, such as “the most stressful part of my job as a hospitalist is when my patient is ready for discharge to a skilled nursing facility, but they are stuck in the hospital for days or even weeks due to factors outside of my control.”
Individual and/or Small Group Activities
Depending on the time available, physicians may be asked to do only an individual activity or an individual activity paired with a group activity.
Each physician is asked to silently reflect and complete an individual reflection worksheet for the individual activity. The questions on the worksheet are designed to elicit specific factors that contribute to both a positive and negative work experience.
Individual Reflection Worksheet ( For the group activity, physicians are partnered to “pair and share,” in which they discuss their individual reflection sheets and brainstorm possible solutions for the issues. They are asked to record any ideas on the reflection worksheet. For example, a primary care physician's biggest stressor is that they don't feel like they get to spend enough time with their patients. During a brainstorming session, one partner recalls hearing that expanding the medical assistant (MA) role can give physicians more time with patients.
One Wish and Rating Activity
After the individual and small group activities, each participant writes down 1 “wish” that would most improve their work experience on a lined 3x5 index card. The rating process is a way to see which wishes are most likely to improve the work experience for the most people and to help prioritize where the group should focus first.
The room layout determines the process for rating the wishes. There are 2 possible processes:
The facilitators collect the cards, shuffle them, and then place them face down on tables around the room. Participants stand up and walk to a card near them. They review the wish on each card and consider how they would rate it before flipping it over to write down their score. Wishes are rated on a scale of 1 to 10, with 1 = this would not enhance my professional satisfaction at all and 10 = this would definitely enhance my professional satisfaction. Participants keep going until they've rated all the cards.
If the room is not set up so that participants can easily walk around, another option is to shuffle the cards, hand them out to seated participants, and then ask the participants to rate their wish and pass it to the person to their left.
Collect wish cards for data entry to provide a ranking of perceived impact for the wishes.
Evaluation and Next Steps
It is important to let the group know what to expect after the session concludes. The group will receive the wishes and their rating order within about 1 week, a copy of the formal report in the coming months, and will be invited to a report-out session approximately 6 to 9 months after the Listening Session. At the end of the session, consider asking for feedback about the Session itself.
Listening Session Evaluation Form (
STEP 4 Share the Ranked Wish List With Participants
After the Listening Session, facilitators should compile a summary of the wishes gathered and calculate their average rating (Table 3). Communicate this summary in a brief email to the group leader so they can review the wish ratings first and have the opportunity to process the results and help determine the best timing for sharing the wishes (eg, before an upcoming team meeting instead of after). Shortly after the group leader has reviewed the wishes, the facilitator(s) should send a recap of the session and the collected wishes. In the email, include mention of the forthcoming report of the “what's going well” discussion and analysis of the individual reflection exercises so that participants know that their time was valued and will lead to meaningful changes in the practice.
Sample Recap and Summary Email (
STEP 5 Create a Summary Report to Share With Key Stakeholders
A Listening Session “summary report” contains all the valuable information from the Session to share first with the group leader, then senior leadership and other key stakeholders. The report should reiterate the findings of the wish rating, highlight takeaways from the “what is going well” discussion, and include a summary of the individual reflection activities.
Summarizing and identifying common themes in individual reflection responses can be the most challenging and insightful. At our organization, a team member uses a content analysis matrix template to place open-ended responses into the following broad categories: the best part of the day, barriers, and worst part of the day. Categories that represent similar concepts are further collapsed (eg, “interacting with my colleagues” and “working with our team”). Include the counts for these categories and representative quotes in the report.
A typical summary report is organized as follows:
Overview (ie, the date of the session, number of attendees, results of the initial large group discussion about what is going well, and general themes)
Positives
Ex. Participants were asked, “What are the best parts of your job?” Of the 15 responses, 9 mentioned…
Negatives
Ex. Participants were asked, “What gets in the way of the best parts of your job?” or “What are the worst parts of your day?” Of the 15 responses, 12 mentioned…
Potential solutions
Opportunities (prioritized wish list)
Priority items by category and next steps
Session evaluation results
There is flexibility in which components are included based on how long the Session lasted. Not all reports will have 7 sections.
After reviewing the results in the report, devise a plan to work with senior leadership to implement key changes (STEP 6).
STEP 6 Implement Changes to Fulfill Wishes
This STEP will undoubtedly be the most challenging and will not look the same in any 2 organizations. When working with organizational leaders to implement change, choosing what to tackle and where to start is always hard.
A matrix such as the example shown in Figure 4 can be helpful. Starting with “high feasibility, high impact” is optimal, but perhaps “high feasibility, low impact” can be another easy win to boost morale. For items determined to be low feasibility, it is crucial to share why and if or when the thing may become possible in the future. This is important because physicians may not be aware of the resources required to make changes that they believe would greatly enhance their professional satisfaction (eg, providing a full-time scribe for all physicians, hiring more clinical team members during a staff shortage, etc).
For example, many of the issues identified in our Listening Sessions were operational in nature at our organization. Therefore, we presented the high-level results of each Session to the Chief Operating Officer and their leadership team every quarter. During these meetings, vital operational leaders sought additional clarity, brainstormed solutions, and helped identify the next steps. Depending on the topic, meetings were also often held with the Chief Transformation Officer, who oversees the EHR, the Chief Medical Officer, and/or other members of the organization's senior leadership team. One of the most common next steps for an initiative was to invite a specific stakeholder to physician group meetings to transparently share information with physicians about the history and state of the identified issue(s), answer questions, and facilitate the subsequent actions on the topic.
STEP 7 Follow Up With Participants
Setting up a follow-up meeting is essential to touch base with the physicians who participated in the Listening Session. The purpose of the follow-up meeting is to:
Revisit the issues identified during the session
Provide a status update
Identify any additional next steps for the group
We followed up 6 to 9 months after the initial session at our organization.
Conducting a Listening Campaign will guide the prioritization of work to improve process efficiency for physicians to help reduce burnout. Listening Sessions intend to facilitate conversations with physicians to identify systemic factors that negatively affect work experience, allow for group-specific ranking of these factors, and connect physicians and leaders to participate in improvement work. As you begin your Listening Campaign, we encourage you to continue to assess systemic inefficiencies with an open mind, ready to hear feedback from physicians.
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