Physician Health

How Ochsner Health created culture to support physician well-being

Andis Robeznieks , Senior News Writer

Hitting “send” on a letter going out to 34,000 co-workers may never be a stress-free moment—particularly if the letter shares highly personal reflections on one’s own mental health.

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Nigel Girgrah, MD
AMA member Nigel Girgrah, MD, PhD, a transplant hepatologist and chief wellness officer at Ochsner Health in New Orleans.

But AMA member Nigel Girgrah, MD, PhD, has no regrets over sending out the letter two summers ago, especially after it received an overwhelmingly positive response and helped spur engagement with his colleagues over the value of self-care and reaching out for help when needed.

“I did not know what was going to happen,” said Dr. Girgrah, a transplant hepatologist and chief wellness officer at New Orleans-based Ochsner Health—an AMA Health System Program member.

“I didn't know whether the state licensing board would come knocking at my door,” he added. “It felt a little risky. But I think it was the right thing to do—certainly at that time and for our employees.”

Dr. Girgrah, who is also the medical director of the Liver Transplant Program at Ochsner, shared his story during “Creating a Culture that Supports Well-Being,” (Apple Podcasts | Spotify), an AMA STEPS Forward® podcast.

New Orleans, one of the nation’s first pandemic hotspots, had been going through another COVID-19 surge and Dr. Girgrah was dwelling on the anniversary of the loss of his son from cancer. Due to travel restrictions and a knee injury, he was unable to use his normal coping mechanisms—traveling to see friends and family in Canada or exercising.

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This led to the letter in which he acknowledged seeking help. The letter’s response led to a realization.

“My ‘aha!’ moment was that everybody has their version of this story,” Dr. Girgrah said. “Historically, that letter, we call it the ‘Chief Wellness Officer Message,’ had been a somewhat sterile report about things that we were doing in the office.

“But I shared a little bit about myself and then I talked more broadly about the issue of mental health in the health care sector and the response was overwhelming,” he added. “It was the most-opened executive letter with many lengthy responses and people saying that they were now going to reach out for help.”

Dr. Girgrah recalls that, while he had received support in advance from key members of the executive team about the theme of the message, he was still a bit worried about a negative reaction from Ochsner leadership. Instead, it has led to these leaders adopting a “more vulnerable-but-authentic” communication style and speaking “more intentionally about mental health.”

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Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.


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Four-pronged approach

In the podcast, Dr. Girgrah described how Ochsner has moved to address and maintain the mental health of its physicians, health professionals and staff.

Measure the state of staff mental health. Ochsner performs an “organizational biopsy” through the use of an expanded Mini Z well-being index—a 10-item Zero Burnout Program survey—to identify drivers of professional fulfillment and assess issues such as depression or post-traumatic stress disorder at granular department and service-line levels. With the help of the AMA, Dr. Girgrah said, this has led to annual measurement of the burnout levels of physicians and other staff with the ability to benchmark Ochsner against other systems.

Education and awareness raising. This includes talking about mental health “more broadly,” Dr. Girgrah said. Ochsner also has an office of professional well-being that is “determined to help our workforce and employees find the resources they need to avoid disengagement, reclaim joy and find harmony.” Physicians and staff have access to webinars around personal and professional well-being, including 90-minute sessions on resiliency, nutrition, mindfulness and post-traumatic growth.

Destigmatize mental health. Internally, this has meant having system leaders be more open and sharing what they are going through regarding mental health, which “creates an environment that’s more permissive for employees to seek help earlier,” Dr. Girgrah said.

Discover why health system leaders should be open and authentic on burnout.

Looking upstream to solve burnout. There was a need to go beyond being reactive and developing crisis-coping mechanisms and reduce frequency and severity of stressors. In addition, a resource group was formed where women physicians could come together to talk about the unique stressors they face. Dr. Girgrah noted that Ochsner has been willing to take an experimental approach in this area and uses the plan-do-study-act process to scale interventions that work and eliminate those that don’t.