Interview with Tait D. Shanafelt, MD, chief wellness officer at Stanford Medicine, on what you and your organization can do before, during and after a crisis to increase the likelihood your workforce will cope and even thrive. For a deeper dive on caring for your workforce during a crisis, review our toolkit.
Tait D. Shanafelt, MD, Chief Wellness Officer, Stanford Medicine
Christine Sinsky, MD, Vice President of Practice Transformation, American Medical Association
Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today. Solutions that help put the joy back into medicine. AMA STEPS Forward® program is open access and free to all at stepsforward.org.
Dr. Sinsky: Well, hello. It's my pleasure today to be speaking with Dr. Tait Shanafelt, chief wellness officer at Stanford Medicine. Dr. Shanafelt is also the associate dean at the Stanford School of Medicine and the director of the Stanford WellMD Center. We are very pleased to have Dr. Shanafelt, as an author of four of our STEPS Forward modules. So, Tait thanks so much for taking the time to share your wisdom with us.
Dr. Shanafelt: Thanks, Chris. Great to be with you today.
Dr. Sinsky: You were in your position as chief wellness officer at Stanford for two, three years prior to the pandemic and then the pandemic hit. And I know you did some really important work at Stanford in terms of listening sessions. And I wonder if we can start by just learning what you did and how you did it, and then what you learned.
Dr. Shanafelt: I guess it began, you know, across our team, we have a number of very experienced seasoned hands individuals who have been engaged in studying and implementing change to improve physician well-being for 20 years. But we recognize very quickly in the initial days of the pandemic, that this was a different challenge and that if we simply recycled the strategies that had been proven effective in the past, we probably were not going to be really addressing the true needs that our physicians, our health care team was dealing with now. So, we, in that first week of the pandemic, initially had eight listening sessions, you know, groups of six to eight, professionals. We would have separate sessions for physicians, nurses, advanced practice providers, residents and fellows. And to really just get a sense of what are you dealing with now? What are your biggest concerns? What specific things do you need? And, really to just have a conversation around those things and to listen.
What was revealed very quickly is how unique some of the needs were based on people's age, their own health conditions, their family's challenges, their partner's career, the specialty they were in. Some folks were in harm's way, worried about inadequate PPE and lack of knowledge about how to care for patients with infection. Others were, in a sense, having their elective surgeries canceled and being told to stay at home. And those groups were dealing with very different challenges. So, understanding both the unique needs and the diversity of them. We learned so much from those sessions that allowed us to not only shape our response as a WellMD center, but we actually collated the learnings and shared those. And those shaped the entirety of the organizational response for all of Stanford; chief nursing officer teams, our HR teams, our executive leadership teams, on how we supported our people. And were so valuable that we ended up having nearly 40 of those sessions over the first several months.
And what was, again, striking is how dynamic the needs were. And what the needs were in the first two weeks were completely different than what they were a couple weeks later. And they really shifted quite dramatically, week by week, month by month, those first several months, before then kind of reaching a point of stability in many of the needs.
But again, I think just an example of the importance both in acute changes like the pandemic, but even in the longer-term journey we're on of engaging our physicians, our health care workers, to get their input on what things we should be prioritizing, what ideas they have and specific suggestions on how we could help.
Dr. Sinsky: What are you thinking, what do we need to do to think about the post-crisis care for our workforce, for the events that may surface three, six, nine months down the line as the crisis, hopefully, subsides and we may have some PTSD to deal with?
Dr. Shanafelt: So, it's a great question. Sort of forward-looking, the aftermath of the pandemic and its impact and how do we think about recovery. And I think it's important, at least I keep fresh in my mind, that we're really dealing with this acute, on-chronic stressor and that we had many challenges, structural problems, inefficiencies, administrative burden, that physicians were dealing with, predating the pandemic. None of those things have, you know, fully disappeared. Some of them might have temporarily improved, but, you know, the long-term change we need is, we're going to still have to deal with those things. And then we have all of the challenges of the pandemic. And again, so multifaceted, just the exhaustion, the emotional distress, the moral distress of watching patients die alone, not having the resources we need to deliver care in the way in which we are accustomed. Feeling like we're maybe no longer giving the best possible care that we could in the past.
These dimensions of moral distress that many physicians have had to deal with of choosing between their professional responsibilities, the needs and safety of their family; just a host of these different challenges that impact, again, different specialties, different physicians in different ways. And so, there clearly is going to be one component of just needing to create space for people to have breaks, rest, recharge. You know, we've had discussions that none of our, many of our physicians, our leaders, had no breaks over the holidays. This has been a peak for us, and that you know, we are going to need sort of winter holidays in July, truly, of really being able to create time away that is just sort of making up for breaks people haven't had.
I think there'll be needed space for reflection, lessons learned that hopefully are things we can take forward. You know, what efficiencies did we gain? What unnecessary burdens did we sort of set aside because it was just a focus on what mattered, that we can take forward with us? And I think we all have, as organizations, identified blind spots, elements of our culture that really served us well. And where were elements of our culture, where there was, you know, something that held us back or frictions between groups or units or silos, that held us back? And so I think, how do we as leaders create that space that again is not an autopsy that looks at everything that went wrong, but is more what opportunities did we identify that we could, you know, position ourselves to be a better organization going forward? And that some efficiencies we learned that we should carry forward and then, just attending to our people. And I think there'll be a need to really think about what types of breaks, time away, acknowledgment, psychological support, emotional support, do we need to provide people to process? Because I think we've intentionally said now is not the time to necessarily go through all the processing because we're still just having to step forward and just deal and care for large volumes of patients.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA's STEPS Forward® program is open access and free to all at stepsforward.org. STEPS Forward can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA STEPS Forward® podcast series, stepsforward.org.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.