To achieve Silver-level recognition from the AMA’s Joy in Medicine® Health System Recognition Program, Washington Permanente Medical Group embarked on a six-year journey to revamp its structure, processes and tactics.
The movement in recognition levels called for “changes in our scaffolding and how we approach the well-being work,” said Mary Pan, MD, a family physician and chief wellness officer for Washington Permanente Medical Group.
This relates not just to how programs are implemented, but also to the broader cultural work at the organization.
“The Silver recognition means that this dual approach can be impactful,” Dr. Pan said.
Washington Permanente Medical Group (WPMG) 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. Located in the Pacific Northwest, the group has over 1,260 clinicians, including physicians, physician assistants, midwives, mental health specialists, osteopaths, and optometrists. This includes 550 specialists across 26 disciplines, including oncology, neurology, orthopaedics, emergency medicine, cardiology, pediatrics and women’s health.
Looking back on the work, Dr. Pan emphasized that expanding the team was a major part of boosting its Joy in Medicine Program status.
“When we reimagined the wellness work in 2020, we didn't necessarily have the personnel resources—an empowered team who are really passionate about this work—to innovate, implement programs, and scale the effective programs we were developing,” she said.
Starting from Bronze-level recognition, WPMG had laid the foundation, but it was really the expansion of those resources and spreading that important culture change that made the difference, according to Dr. Pan.
Prioritizing well-being initiatives
Deciding which well-being initiatives to prioritize was the “million-dollar question,” said Dr. Pan. “We connect directly to our frontline clinicians and staff in areas where we see the most need, and we look at the evidence-based initiatives that have been successful, either in our organization or in others that we can learn from.”
It's always most important to get the input and buy-in from the people who are closest to the work, she said. This involves sharing data with them and saying, “Does this resonate? Does it make sense? What looks right here? What doesn't? What are we missing? And what are your ideas on how to improve this?”
WPMG is fortunate to have a cultural advisory group that enhances this process. Comprising frontline physicians, leaders and staff, the group serves as a focus group across the organization, including wellness. Their feedback is invaluable prior to scaling any initiative.
"If we're creating things that we think the data says we should do, but for whatever reason it doesn't resonate with people or it's not what they really want, then it's not going to be effective,” said Dr. Pan.
Gathering meaningful feedback
Like many other health organizations, WPMG has used two tools to measure burnout and related drivers: the Mini Z and the AMA’s Organizational Biopsy®. Dr. Pan explained how the group has become more intentional in how it gathers meaningful feedback without creating survey fatigue.
“As we revamped our survey process, we spent hours working together across different leaders to get buy-in and really choose the most essential, actionable questions,” said Dr. Pan. “We wanted to ensure that they're evidence-based, [using] validated measurements like the Mini Z, so that's fairly important.”
WPMG leaders discussed expanding the survey to every 18 months or every two years to give time to implement changes and see the impact of measurable data, she said. Instead, they decided to survey people every year, focusing on actionable questions.
“If we are implementing a particular wellness initiative, then we may use a shorter questionnaire, like the Mini Z, to gauge its impact in between that one-year mark,” Dr. Pan explained.
On measuring success beyond burnout rates, WPMG looks at more than just the burnout rate. The level of engagement, trust in the organization, leadership alignment scores and culture are all important.
As the leader in physician well-being, the AMA provides organizational solutions that help physicians and health systems optimize practice efficiency, reduce burnout, and rediscover the Joy in Medicine.
Bringing back the dinner dance
Culture is often more challenging to measure over time. It’s difficult to move the needle on this metric and make it visible. This is because there are so many other factors that are out of your control, such as the healthcare environment, financial pressures, leadership changes or broader organizational changes.
“But when we look at that, we look at sustainability of practice,” Dr. Pan said. “We want to see those improve year over year.”
Initiatives that bring people together—either through commensality groups, Schwartz Rounds, coaching or in-person wellness-centered leadership training—have had the biggest impact on cultural change.
“It's really been amazing to see how just connecting people, virtually or in person, can make such a huge difference,” said Dr. Pan.
WPMG also revamped its recognition program, led by its HR leadership.
“A big part of it was really focusing on local people being chosen by local people,” she said. “They redid the district awards, a staple that existed prior to the COVID-19 public health emergency.”
Getting to Gold means reducing stress
To strive for the next step, WPMG’s aim for Gold-level recognition from the Joy in Medicine Program, Dr. Pan emphasized the importance of reducing workflow stressors to improve practice efficiency. This involves using tools such as ambient documentation technology while also embedding physician well-being into leadership decision-making.
"Of course, we've got the ambient scribes and those capabilities to allow clinicians to really focus on the patient,” she said. “But moving forward, having all leaders continue to use that well-being lens for policy and decision-making within the organization is really what we need to move to that next level.”
WPMG has also expanded upon its popular wellness-centered leadership program, a “2.0” iteration of the original program, to its colleagues at Colorado Permanente Medical Group. The second iteration acknowledges that leadership training is not just a one-and-done program.
“We want people to continue to build those skills, bringing clinician well-being front and center for those leaders and giving them practice using those new skills and information with their teams,” Dr. Pan said, emphasizing that “we want to support that journey.”
Looking at the remaining challenges in getting to Gold, Dr. Pan pointed to the many changes that have taken place at the organization, such as with leadership.
There's always the potential that new leadership can really be a benefit in moving things forward. But it's not just about individual leaders, Dr. Pan noted. Changes in organizational structure and leadership can move the work forward. The hope is that new leaders bring new ideas and that organizational changes benefit all the things we're working toward for physician well-being, she said.
Leveraging the quintuple aim pillars
Physician well-being gained a lot of recognition and visibility during the COVID-19 public health emergency. But it is imperative to keep well-being front and center, said Dr. Pan.
One area of interest is expanding upon the “quintuple aim,” a framework that incorporates five pillars: improving population health, improving experience of care, advancing health equity, improving workforce well-being, and lowering per capita cost.
Having a seat at the senior leadership table so each area of the quintuple aim can wholly own physician and other health professional well-being, makes a difference, said Dr. Pan. There’s a lot of talk about how this work affects quality, access, patient satisfaction and affordability, but this can't be just implemented through siloed programs and initiatives.
“Really working together to support our people to take great care of patients in a sustainable way for our clinicians is the only way we can accomplish real change," Dr. Pan said.
Thinking about the entire arc of this work, there are things that can happen right away, and there are also things that take a lot of time, she continued. Ultimately, it’s about the long arc, the long game of the work.
"I'm encouraged by the people on our team at WPMG … who do this work with hope and persistence and who are committed to making change over time,” said Dr. Pan.
AMA STEPS Forward® offers real-world solutions to common challenges in healthcare today. Explore a variety of innovative, physician-developed resources designed to help prevent physician burnout, optimize workflows, improve well-being and enhance patient care.
