Physician Health

Q&A: Establishing a culture where physicians can feel whole again

Sara Berg, MS , News Editor

When T. Ruth Chang, MD, MPH, became the chief people officer at Northwest Permanente in 2018, she realized that—at the end of the day—health care is about people taking care of other people. While her title is chief people officer, the professional role is similar to a chief wellness officer in that well-being is a key part of the organization’s people strategy. But for Dr. Chang, it’s also about looking at well-being more holistically to support the people.

AMA Moving Medicine Podcast

AMA Moving Medicine highlights innovation and the emerging issues that impact physicians and public health today.

T. Ruth Chang
T. Ruth Chang, MD, MPH

“I'm really looking holistically at our people strategy pillars, which are wellness, equity, inclusion and diversity, talent acquisition, and professional leadership development,” said Dr. Chang, a family physician at Northwest Permanente, a member of the AMA Health System Program. “An inclusive, safe environment is a foundation to wellness. It's not just about personal resilience, but it's creating a culture where people can be whole.”

In an interview, Dr. Chang discussed her role as chief people officer, her personal burnout story and well-being plans for 2022.

AMA: What are some ways that you create a culture for people to be whole?

Dr. Chang: It's engaging in conversations and really measuring ourselves as well. ... That's very important data for us in seeing how our teams are responding. Are they getting the resources that they need to do their job? Do they feel like they can have safe, open conversations with their teammates, with their leaders, with our senior leadership team?

AMA: What were your systemwide goals for well-being prior to the pandemic?

Dr. Chang: We had the opportunity to really establish that vision, borrowing from the Stanford WellMD model. We adopted the key strategy of thinking about wellness. So, it's not just about personal resilience, but it's about building cultural wellness and optimizing our practice—the efficiency and efficacy of practice—ultimately to bring joy at work. And we've been thinking about wellness holistically in that sense.

We saw that we had opportunity to build up programs for people to work on their own personal resilience, but we know that that's not enough. And so how do we move into the space around optimizing our practice? How do we help people be more effective and efficient in their workdays and make sure they're optimally supported in their work?

Then that third piece around the whole culture is examining our habits around work and taking time off. We've had some really explicit conversations around, for example, when you go on vacation, please don't check email—the basic things that we just needed to call out for each other.

Related Coverage

4 questions leaders can ask to show pandemic-weary doctors they care

AMA: Have you had to adjust your well-being plans?

Dr. Chang: Yes, absolutely. With the pandemic, it was very much about crisis communication and crisis management. So much of it was having to be reactive. We knew that our people were working such long hours and taking care of so many sick patients and a portion of them dying takes an emotional toll. It was very much that we were working to heal, working to process the trauma, working to help create space where people could just have a chance to talk to each other and debrief.

One of the things we did was what we called the COVID debrief sessions. We designed a series of questions and then taught our leaders how to facilitate those discussions within their departments. We had over 75% of the chiefs and physicians in charge report back that they did conduct those debrief sessions within our medical group.

We had the whole system debrief around the one-year anniversary of when COVID hit our region and then we hosted a series of facilitated group discussions. We had over 14 sessions over the summertime and continue to perform debriefs in response to surges. We feel like people would have the most benefit during the time of surges or stress on the system.

AMA: What is your high-level strategy for changing the culture of well-being at your organization?

Dr. Chang: The culture starts from the top and I'm super excited about our new president and CEO of the organization. Leong Koh, MD, has been very clear that wellness is the foundation of our organization. He has expressed his vision that now is the time for healing, and we really have to think about what we need to do to heal through all the challenges that we faced, how we continue to build a very engaging and inclusive environment, and how we build community.

We all feel so disconnected right now. Using [the online] Teams [platform] is wonderful, but it's not the same as if we were sitting down at this big table and having this discussion in person. Our doctors, administrators and clinicians feel that it's hard to stay really connected and have a strong sense of community when we are just working in a two-dimensional world.

AMA: How do you try to create some of that community during these times?

Dr. Chang: We've gotten creative thinking about how we can encourage people to gather, even if it's online. One simple, but powerful example is a book club. We've used our professional development team and they've helped us organize a monthly book club. People who are interested can sign up, get copies of the book, and then they gather and discuss it.

We've also started a healthy living movie club. It is for those who are interested in watching documentaries around lifestyle medicine, and then gathering and discussing what they learned and what they thought was interesting or what advice they would end up sharing with their patients.

We're really trying to build community any way that we can. And at times when we've had lower case counts of COVID, we have also said to teams that if they want to gather outdoors in small groups, they are welcome to, but keep it safe and keep it small.

Related Coverage

A boost for doctors’ well-being? Bring back the physician lounge

AMA: Have you found that sharing your burnout story can help others too?

Dr. Chang: Absolutely. I’ve shared the story of when I first stepped into this role. It was the year that my cousin, who was 32 years old, was diagnosed with metastatic ovarian cancer. She had just graduated from medical school and started chemotherapy and treatment for stage four ovarian cancer.

I knew that time was short. I don’t think that she understood that. Ultimately, I took care of her on home hospice for two weeks before she died. Then the morning that she died, I was planning on going to clinic that afternoon because I’m a family doctor and that’s what I do. I had a full schedule of patients, and I was ready to go to clinic, but my friend who was the director of wellness at the time called me and said, “How can I support you?”

I asked her to cover my meetings that morning and then she said, “Well, then what are you doing this afternoon?” I said I have clinic and she said, “No, you don’t.” We had this exchange and she finally said, “I give you permission to cancel clinic because you need to take care of yourself. You need to take care of your family right now.”

Ultimately, that was my big aha! moment of, oh my gosh, life happens to all of us and yet we all have such a strong sense of duty to our patients that we can’t see that for ourselves. So sometimes we have to press pause and say we’ve got other things we must attend to.

The beauty of working in a large medical group is knowing that my patients will still be really well cared for by my colleagues. Part of that is being able to let go of my own guilt of cancelling clinic and being able to recognize I am human too. I also need time to cry, and I need time to grieve.

AMA: What are your well-being plans for 2022 and beyond?

Dr. Chang: Continuing to think about how we foster an inclusive, psychologically safe environment—how do we build this culture of wellness? And it's really one conversation at a time from our senior leadership level and then continuing to engage with our leaders and our core clinic.

Then the third piece is for us to just manage, come what may. We don't know when this pandemic is going to end and it's hard to predict. At the same time, I would say our medical group has been so strong in these almost two years of the pandemic so I'm confident that we will be able to handle whatever is around the corner.