Interview with Gaurava Agarwal, MD, on training physicians to advance well-being with effective pilot interventions at a system level. To learn more on this topic, review the related toolkit.
Learn more about practice innovation strategies by visiting stepsforward.org.
Gaurava Agarwal, MD, director of physician well-being, Northwestern Medical Group
Jill Jin, MD, MPH, senior physician advisor, 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. Jin: My name is Jill Jin and I am a physician advisor with the AMA and an editor for STEPS Forward, as well as a practicing internist at Northwestern. I have with me today, Dr. Gaurava Agarwal, who is the author of the STEPS Forward module Scholars of Wellness. So, Gaurava thank you so much for taking the time to speak with me today.
Dr. Agarwal: It's my pleasure. Thanks for having me.
Dr. Jin: Of course. Do you want to start by giving a quick introduction of yourself, your background and your current position?
Dr. Agarwal: Sure. So, I am an occupational and organizational psychiatrist. And that basically means that I focus in on workplaces and workers and how they can work together to achieve kind of optimal performance. And my specialization is in health care professional wellness. And thinking about the broad spectrum for physicians; particularly in terms of prevention, in terms of treatment of physicians, and identification of symptoms in physicians as well. My current role is the director of physician well-being for Northwestern Medicine’s medical groups. And I am responsible for working with about 2,000 physicians in our organization.
Dr. Jin: You are the perfect person to speak to us about wellness today. So, tell us a little bit about the Scholars of Wellness program at Northwestern.
Dr. Agarwal: Sure. I'll tell you a little bit about kind of what the background was in terms of why we started it and what the unmet need was that we felt that we were trying to meet with the creation of it. So, as you know, well, there are lots of organizations that have come out with the idea that the best way to deal with the burnout epidemic is really through addressing the organizational drivers of burnout. STEPS Forward has been really instrumental in helping people figure out what are some of the ways they can address those drivers. But you know, it seemed to me that while everyone kind of had this sense of what needed to be done, it also was difficult for lots of organizations that weren't really prepared to commit these huge amounts of resources and create all the infrastructure that we would hear for some of the vanguard institutions.
And I kept hearing from my colleagues on the ground, that they had these simple ideas that they wished they could implement. They thought that those ideas would make a big difference. And yet, I kept seeing that there was this disconnect between what everyone seemed to want to know and what was actually being done. And so, I said, you know, what's the reason for this disconnect? And I started to think about, you know, what knowledge and skills were needed for a local person to be an effective wellness change agent. And it started to become clear that part of that disconnect was that a lot of physicians lack, frankly, some of those key skills and knowledge to make effective sustainable improvements. It's just not what we focus on in medical school and residency. There's plenty to learn and this is just some of those skills that we didn't have a chance to know a lot about.
And so, with the Scholars of Wellness, we wanted to bridge that gap, and at its core, it's a faculty development and training program that creates these wellness champions, that have these three buckets of knowledge and skills that we think are needed. And that's really understanding how process and quality improvement works. What's the evidence around well-being? And two, how does change management, change leadership work? And it's really designed to help people move past these kind of wellness committees and councils, that are really full of well-meaning and interested people but really trying to create the team of empowered and educated physicians who can actually create positive change.
Dr. Jin: Yeah, yeah. Got it. That is so important. And you're right. We get no training on that through our medical training. So, in the module you go through, you know, the steps that you took or that one should take to develop the Scholars of Wellness program to get to what you just described. And, you know, we won't go through all the steps in this video, but I'll just go through the list of eight steps here for our readers and listeners.
So there are the eight steps that you talk about are: One, establish a DYAD leadership team with a physician wellbeing expert and a project manager. Two, approach leadership for buy-in and funding. Three, select scholars via a broad application process. Four, pair scholars with a process improvement coach and a well-being coach. Five, create and deliver curriculum. Six, focus on dual-core objectives, faculty leadership development and implementing pilot interventions. Seven, implement accountability points. And eight, the final step is you use the identify, develop, scale, sustain model to harvest the results of the program. So each of these steps are further described in the module itself. And I know it's impossible to kind of summarize that all quickly, but what would you say are the key features in this process in creating a successful Scholars of Wellness program?
Dr. Agarwal: Sure. I think for us, it really does come down to people and I know that's a little cliche, but we really are selecting people that are passionate about this, that are open-minded, willing to learn and willing to serve. I can't say that strongly enough. This really has to be about a servant mentality where you want to do something to remove those pebbles in the shoes for yourself and your colleagues. It can't be really about, you know, your agenda or your pet project. It really is listening to your colleagues on the ground. What are the little things that could make their lives better so that you can start gaining momentum and helping develop those people with this relationship?
This DYAD, as you mentioned, there's two different coaches that each of our faculty physicians get. One is a well-being coach, which I help serve. And one is a coach in the project management, performance improvement division, to really help get these projects on the ground, make sure that they have ways to be sustained. I think two is really having expertise, right? So having a strong methodological approach that really utilizes the evidence base in wellness, utilizes process improvement, methodology, we use the DMAIC methodology and it's really helping to teach best practices around change management. And then finally, I think having an environment there really is shared accountability and commitment to really making that local work unit better. And I think having those three key features really allows us to be successful.
Dr. Jin: Are there any final pearls of wisdom that you want to give to organizational leaders who are interested in starting up their own Scholars of Wellness program?
Dr. Agarwal: Yeah, I think what I would say is, as you think about why we should be doing this right. To me, it's always the moral case and to me, it's the right thing to do to care about our people. But I think also really highlights that there's a business case, that there's a performance case, in that, for us to be able to provide the best care for our patients, we really do have to take care of our clinicians and that this program is really about making an investment in the development of a team that is action-oriented, has a shared vocabulary, that's hopeful and collaborative in helping people reach their full potential. So, it's not about this one-and-done pilot or this couple of classes that people take. It's really you are investing in the development of people and that investment is going to pay dividends for years. And that's what I love about the program.
Dr. Jin: Thank you so much for all that wisdom. Thank you. As a clinician who works at Northwestern, where there's such a great wellness program and such great wellness leadership.
Dr. Agarwal: Thank you for this opportunity. I really appreciate it.
Speaker: Thank you for listening to this episode from the AMA STEPS Forward® podcast series. AMA 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.