How Ochsner Health develops leaders ready to battle burnout

AMA News Wire

How Ochsner Health develops leaders ready to battle burnout

May 16, 2023

Before the pandemic, AMA member Nigel Girgrah, MD, PhD, chief wellness officer at Ochsner Health in New Orleans, and other members of his team learned about a leadership program in North Carolina that led to a rise in engagement scores—a measure of interaction and interest in an organization—from the 50th percentile to the 95th at that health system.

Dr. Girgrah decided to attend. On the first day of the leadership program, there were chairs set up in circles, and on each seat was a box of Kleenex. “I was nonplussed, to say the least,” said Girgrah.

But he gave it a chance, and the leadership program was so life-changing that even Dr. Girgrah’s wife commented on the difference she saw in him. That’s why Dr. Girgrah decided to implement what he learned at Ochsner Health.

Addressing the heart of leaders was to be the next major focus in a well-being strategy for Ochsner, a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

“At a high level, our strategy for well-being is anchored around five strategic pillars and we’ve tried—to every extent possible—to make this evidence-based,” said Dr. Girgrah, who is also a transplant hepatologist and medical director of the Ochsner Multi-Organ Transplant Institute.

These are the five pillars for well-being, according to Dr. Girgrah:

• Practice efficiency.
• Leadership development—both developing curricula and measuring leadership quality.
• Organizational culture.
• Resilience.
• Mental health.

“This personal leadership program is one of many things that we’re experimenting with at Ochsner,” Dr. Girgrah said. “The program aligns nicely with three of those five strategic pillars—leadership development, organizational culture and resilience.”

The leadership program pilot required pulling physicians away from campus for three days, and this was followed by a one-day capstone.

“It’s very intensive work and it’s all about the idea that you can’t manage others until you’re managing yourself,” said Dr. Girgrah.

By following the five pillars of the well-being strategy, Ochsner has seen improvements in key performance indicators this year, measured through a voluntary survey completed by 892 respondents at Ochsner. The respondents were 60.2% physicians along with 25.8% nurse practitioners, 8.1% physician assistants and 5.9% other nonphysician providers—all key roles at Ochsner.

After completing another AMA Organizational Biopsy™, job satisfaction rose from 73.2% in 2022 to 75.1% in 2023. There was also a drop in burnout, from 47.4% to 44%. That compares with a 54% rate of burnout nationally, which is based on data from AMA assessment of health systems across the country. Job stress also dropped from 51.2% to 48.8% over the past year.

In addition, Ochsner Health has seen fewer respondents saying they plan to cut back the number of hours they work. That rate of “intention to reduce hours” fell from 31.4% to 29%—which compares with a 36.4% rate nationwide. Intent to leave within two years also dropped from 33.4% to 31.2% compared to 40.5% at the national level.

When it came to measuring burnout and improving well-being, Ochsner chose the AMA because of one key factor: trust.

AMA burnout experts Nancy Nankivil and Christine Sinsky, MD, “made themselves available before I knew there was any formal partnership with the AMA, and they were very generous with their time,” Dr. Girgrah said. But it is more than just using the Organizational Biopsy to measure burnout. It’s about following the Joy in Medicine Health System Recognition Program Road Map (PDF) too, which provides program criteria, resources, cases examples and submission samples.

These AMA burnout experts have been working with Ochsner since 2019 on their well-being journey. This year marks Ochsner’s fifth year in a row surveying about burnout.

“It’s great to be able to measure our progress over five years, and measure against national benchmarking,” Dr. Girgrah said. 

With this focus on leadership, here are some of the ways Ochsner Health is improving the well-being of its physicians and other health professionals.

As part of the Organizational Biopsy, Ochsner canvassed leaders from several different areas of the institution. One question queried respondents about their trust that leaders will keep them safe and found a slight rise from 78.3% to 78.5%.

Overall, though, only 72.6% felt their specialty leader—for example, a chair of their department—supported them in their work. This is an ongoing area for improvement at Ochsner, hence the leadership program that launched in 2020. So far, 11.7% of respondents have participated in the personal leadership program. Ninety-six senior leaders have completed the program, which is now open to all physicians and nonphysician providers at Ochsner.

The leadership program is meant to take a hard look at who you are, “to understand how the experiences that you’ve had in your life—even your childhood—have shaped your belief systems and developed your biases,” said Dr. Girgrah. The goal for individual participants is to eventually develop a plan and a commitment to that plan to try and change actions. And it’s tough. It’s pretty intensive.”

Initial Organizational Biopsy survey “data suggests that there’s a nice correlation with some of the outcomes that Ochsner wants,” Dr. Girgrah said, noting “training will be ongoing.” “We’re going to be offering an annual two-hour booster program—a sort of maintenance program—for those who went through the leadership training,” he explained.

Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.

And with far too many U.S. physicians experiencing burnout, the AMA has resources that prioritize well-being and highlight workflow changes so doctors can focus on what matters—patient care.

“We’ve made a commitment to bring more of the rank-and-file physicians to the program to see whether it’s making a difference,” he added, noting when you compare the first leadership program cohort against other chairs or more senior leaders, there was lower burnout, and more of a sense of being valued by the organization.” These numbers saw a slight decrease from 57.6% in 2022 to 56.2% in 2023. That is still better than the national comparison of 45.8%.

Additionally, working internally with Ochsner Leadership Institute, curricula was developed for all leadership levels. This includes physicians and other health professionals who may not have a formal leadership level title but take on additional roles and responsibilities in their departments to lead the care teams.

There will also be additional leadership courses, but the question Dr. Girgrah asks is, “How do we measure the impact of these courses on not just the leaders that go through it, but their direct reports? We want not just quantitative data, so we need to be doing focus groups with the direct reports.”

Ochsner is a gold recipient of the AMA Joy in Medicine™ Health System Recognition Program, which “validates that we’re heading in the right direction,” Dr. Girgrah said.

“As we’ve progressed from a non-medalist to a bronze to a gold, there has been a correlation in terms of hard outcomes in not just burnout, not just joy in medicine score, but some of the other secondary measures of burnout that we try and track as well,” Dr. Girgrah said.

To keep physicians and other health professionals in their roles full-time, respondents noted they needed enhanced workflow efficiency, less documentation and work outside of work, and fewer EHR hassles.

“Other business units are rallying around the inbox-volume ideas,” Dr. Girgrah said. “To hear our leaders say their two-year goal is to reduce inbox messages by 30% ... is really gratifying. We’ve done a lot of work in the last year around primary care inbox management and we’re starting to see a lot of gains in that area.”

For example, Ochsner established a pharmacy refill center, which has safely removed 70% of medication refill requests from primary care physicians’ inboxes. The “ask a question” button has also been removed from the bottom of all test results, reducing test related questions by half to two-thirds.

Additionally, Ochsner has changed “the patient messaging menu to steer many things away from ‘ask the provider’ and started asynchronous e-visits which has the benefit of reducing messaging thread,” Dr. Girgrah noted.

Almost two years ago, Ochsner had a highly publicized assault of one of its nurses.

“I’ve done a number of focus groups with our nurses—not just our nursing leaders, but front-line nurses—and when you open things up to Q&A, about eight of 10 questions were: What are you doing for my personal safety?” said Dr. Girgrah.

Ochsner’s response to the assault was in helping Louisiana lawmakers draft legislation making patient mistreatment of caregivers a felony act. It recently became law.

The legislative victory is “a great example of Ochsner being an influencer within the state,” Dr. Girgrah said.

In addition, Ochsner’s leadership has long advocated for the removal of questions about mental health from the state board’s licensure-application process, and finally this year that change was enacted.

While the overall trends are encouraging, Dr. Girgrah and his colleagues aim to help hard hit specialties make greater progress in reducing physician burnout.

“When you drill down on departments that I’m really worried about—primary care, internal medicine—and look at the ongoing day-to-day stress that they’re feeling, there’s a lot more work to be done,” he said. “It’s nice to celebrate what’s going on from a 30,000-foot level, but you’ve got to recognize that there are large pockets within your organization that are really still struggling.”

“That’s why this year we’re trying to identify high-impact areas—high-impact being either levels of burnout or the level of influence they have on other areas of the organization—and really target them,” Dr. Girgrah said. “For example, in our general internal medicine group, 60% have burnout. They’re suffering the most with inbox volume. So, there’s a lot more work that needs to be done to enhance their professional satisfaction.”