When it comes to physician well-being, leaders at the nation’s largest health system say they’ve learned that efforts need to focus on the larger picture, shifting away from simply supporting individuals and toward changing the organization itself for the better.
“We have a fantastic benefits package, with several well-being partners that do a wonderful job of individual psychological skills-building,” said Gregory Guldner, MD, MS, vice president of academic affairs for HCA Healthcare’s graduate medical education program. “If you need help with those kinds of things, we have it available. But we’ve found we can make a much bigger impact—especially scalable—by trying to create optimal work environments.”
Dr. Guldner joined Christopher J. Ott, MD, chief medical officer of physician services in HCA Healthcare’s Clinical Services Group, and the AMA in a Becker's Hospital Review webinar to discuss the underpinnings of the organization’s innovative and successful physician well-being efforts.
HCA Healthcare is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Here is how HCA Healthcare has taken an evidence-backed approach to addressing physician well-being at a vast scale, one grounded in established psychological theories that reveal how best to help doctors and their care teams thrive.
Create a framework for positive change
HCA Healthcare, based in Nashville, Tennessee, serves patients at 190 hospitals and 2,400 other sites of care, with more than 44,000 active and affiliated physicians, including about 16,000 employed physicians and nonphysician providers and more than 5,400 residents. Implementing changes throughout such a vast network presents challenges, among them how to identify strategies that work throughout the system.
As a result, HCA Healthcare adopted the Job Demands-Resources psychological theory as a cornerstone. One of the theory’s core concepts is that there are two types of job demands—ones that present stimulating challenges and others that present hindrances—with opposite effects on physician burnout. The theory focuses on improving physicians’ workplaces by removing hindrances rather than just helping them build their skills in resilience and self-care.
“The Job Demands-Resources theory suggests that high job demands combined with a lack of job resources can lead to burnout and negative health outcomes, while high job resources can promote work engagement and positive outcomes,” Dr. Ott said. “We actively manage processes to achieve operational excellence at the individual practice level. Our goal is to bring patients and clinicians together in an efficient, effective manner. When we remove barriers that impede this goal, we see less burnout and higher job satisfaction.”
Practically speaking, that means that HCA Healthcare undertakes a systematic approach to finding and then addressing hindrance job demands—the "pebbles in the shoe" that contribute to physician frustration and burnout. Examples of “hindrance” demands might include broken equipment or EHR inefficiencies.
Removing those pebbles not only improves efficiency and patient care but also positively affects physician well-being and perceptions of feeling valued, a known protectant to burnout.
Self-Determination Theory serves as another key component of the organization’s well-being strategy. As explained by Drs. Ott and Guldner, the core concepts of basic psychological needs and pillars of this theory are autonomy, belonging, competence and meaningful work, or what they call “deep meaning.”
HCA Healthcare leaders are taught to foster autonomy and inclusion in decision-making among physicians, to cultivate a sense of belonging through supportive team environments and intentional connection, and to support feelings of competence by providing growth and development opportunities and fostering a sense of mastery.
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Find autonomy whenever possible
Physicians can’t always make every decision about their jobs, but if organizations want to keep them and keep them happy, they’ll find ways to prioritize the physician voice and include them in the decision-making process, making it clear why this is intentional and key to physician satisfaction and patient care.
“When you're making corporate and operational decisions, anything that's going to impact the physician's medical decision-making or affect their patients, you have to ask why you're making the change, and then you have to have an explanation as to why you're limiting their autonomy,” Dr. Ott said.
He continued that in years past, some organizations and insurers have done a poor job of finding the “why” in the wake of an emphasis on patient satisfaction. Ultimately, limiting a physician’s autonomy should only occur after careful consideration and evidence-based research, Dr. Ott said.
“The ‘why’ has to be a better outcome for the patient, a better outcome for the system as a whole and a better outcome for you as an individual providing care in that direct interaction with the patient,” Dr. Ott said. “If any of our operators are going to make a decision that's going to impact the autonomy of a physician, they better have a ‘why’ ready on hand, and one that's defensible. If you don't, I recommend not going down that road.”
Be intentional about impact
There is powerful meaning in the way that physicians can change their patients’ lives for the better, said Drs. Ott and Guldner, and that meaning can be accessed in intentional ways.
“We teach our faculty members to be very specific about drawing out meaning,” Dr. Guldner said. “If you're a resident and you are working with a patient, and you put in a central line or maybe even more dramatic than that, a transvenous pacemaker or something. It’s not uncommon in graduate medical education for someone to simply say ‘good job’ and walk away. And that's not very supportive of competence, per se, so we teach them to do a little more.”
Instead, he said that they encourage faculty members to relay contextual meaning to the residents. For example, by sharing, “‘I want you to pause for a second and think about Mrs. Brown, who came in with a heart rate of six and was nearly terminal. Through your competence and ability to put in this line, you as part of a team were able to save her life.’ That deliberateness is dramatically important. We've just seen that as being so foundational.”
The interesting part of the interaction, Dr. Guldner noted, is that it helps the faculty member as much as it does the resident to reflect on the impact of their work and their care for patients.
Systemic change to unlock real results
Workshops for faculty and administrators at HCA Healthcare also focus on supporting autonomy, belonging, competence and meaning. Drs. Ott and Guldner said that, of course, good benefits and individual support programs complement the systemic workplace interventions. But they said that for real change to occur, they must go hand-in-hand.
“In terms of barriers, the biggest one I see is probably around this inertia that's been there, that well-being is something that's an individual responsibility, that well-being means lectures or computer modules or something to help you build resilience and grit and mindfulness,” Dr. Guldner said. “Those things are great. I'm not at all saying they're not helpful. They very much can be, but there's a whole other world out there, which is how do you create a work environment that is actually supportive?”
Use data to target organizational challenges
HCA Healthcare measures the impact of its well-being initiatives and has seen reductions in burnout and improvements in satisfaction and retention, leading to figures that outperform and are well below national averages.
Dr. Guldner said well-being surveys from 2023 showed HCA Healthcare beating the national average on eight of 12 questions and tying on the other four, and in the 2024 and 2025 academic years, topping the national figures in all 12 categories.
Ongoing data collection and analysis helps to refine the strategies, Dr. Ott said, pointing out that surveys have shown that frustrations with EHRs and inadequate staffing are huge drivers of job dissatisfaction. He said that HCA Healthcare uses its metrics to push for changes that will make concrete improvements to the work lives of physicians and other health professionals.
“Always pushing our EHR companies to give us a better product and not to overlay it with too much complexity makes the clinician’s day much better,” Dr. Ott said, acknowledging that the staffing component doesn’t always come easily for financially taxed organizations.
“Making sure that your staffing works well, that's a huge challenge in places where there isn't a lot of margin left,” he said. “It's something you have to focus on. You have to figure it out.”
Through the considerations, Drs. Ott and Guldner said that driving these successes at HCA Healthcare are leadership commitment and a system-wide effort to embed well-being into the organization’s culture.
“It's great for individuals to have healthy, supportive things happening outside of the workplace—with diet, nutrition, exercise and all of that,” Dr. Guldner said. “But let's focus as an organization on, how do you create a workplace environment that supports well-being?”
