How AHN's Wellness Program Is Improving Well-Being of Clinicians, Nurses

The burnout rates for Allegheny Health Network physicians and nurses are below national averages. Here's how its CMO did it.

At Allegheny Health Network (AHN), a six-year journey to improve the well-being of physicians, advance practice providers, and other staff is generating positive results.

There are three primary reasons why CMOs should be concerned about clinician well-being, says Donald Whiting, MD, CMO at AHN and president of Allegheny Clinic. Promoting well-being is essential for retention of clinicians, clinician well-being has been linked to the overall quality of patient care, and well-balanced clinicians perform their jobs better than clinicians who are struggling with well-being, Whiting says.

"As the CMO, you want your clinicians to come to work and put all of their energy toward taking care of their patients," Whiting says. "To do that, you need to address both the basic and advanced needs of your clinicians."

About six years ago, Thomas Campbell, MD, MPH, proposed creating a physician wellness program to Whiting. At the time, Campbell was serving as chairman of emergency medicine at AHN. He is now vice president of wellness at the Pittsburgh-based health system.

"I wanted to launch a physician wellness program because I had been doing research on burnout," Campbell says. "Dr. Whiting wanted to include more than just physicians, so our decision was to create a program for physicians, residents, advanced practice providers, and nurses. The intent was to grow the program to include all employees."

After launching dozens of wellness initiatives, AHN has made significant progress in boosting staff well-being. In recent years, physician burnout has trended 10 percentage points lower than the national average. In 2023, AHN earned recognition from the American Medical Association for demonstrating a commitment to promoting clinician well-being through proven efforts to address work-related stress and burnout.

"For our physicians as well as our nurses, we have been below the national averages for burnout," Campbell says. "In national surveys, there has been physician burnout as high as 62%. Our highest burnout rate for physicians has been about 52%."

To promote clinician well-being, CMOs and other leaders need to start with understanding the environment clinicians are in and the stressors that they are facing, Whiting says. "When we launched our well-being program, we started by surveying our physicians and advanced practice providers in several categories around the components of Maslow's Hierarchy of Needs. There were specific questions about safety at work, hours of work, the ability to take time for meals, and the respect of peers."

Well-being interventions

AHN began its efforts to promote clinician and nurse well-being by focusing on "low-hanging fruit," Campbell says.

• The health system's first annual wellness survey indicated that many clinicians and nurses were not aware that they could reach out for behavioral health help. Leaders publicized the fact that behavioral health services were available to all employees through AHN's Employee Assistance Program, which also was made available to non-employed independent clinicians.
• AHN's internal behavioral health group created a 24/7 help line for employees. "That was a great success, and it has continued since the beginning of our wellness program," Campbell says. "It is a foundational program."
   
• The early annual wellness surveys found that some basic needs were not being met. Staff members were not taking meal breaks and they were getting dehydrated from not taking a break to drink water. "We made a big push among physicians, residents, and the nursing staff to get people focused on meal breaks," Campbell says. "Our parent organization, Highmark, gave us a grant to create water stations in our hospitals at convenient locations."
   
• The annual wellness survey found female clinicians had higher burnout scores than male clinicians, which matched national data. There were cultural responsibilities impacting female clinicians such as the need to get children to school in the morning, so the health system implemented flexibility for start times and job-sharing capabilities.

Over time, after the low-hanging fruit had been grabbed, AHN began tackling more challenging aspects of promoting well-being, Campbell says. "We are working on initiatives that are much more difficult such as creating a caring culture to care for each other. We are trying to find ways for people to still take their breaks despite staffing shortages. We are trying to make sure physicians can take their vacations without checking patient messages in their electronic in-boxes."

Some AHN well-being initiatives launched during the coronavirus pandemic have become permanent.

"We now have 'decompression rooms' that people can go to when they are stressed out. These are quiet rooms with massage chairs and resources for people to reach out if they need help," Campbell says. "We also created another 24/7 help line for people in the emergency department and critical care. In addition, we started a peer support program for physicians and nurses so they could get help when they were at the end of their rope—if they were hesitant to reach out to a clinical professional, they could reach out to a peer."

In recent years, AHN has launched several new and innovative well-being initiatives.

The health system hired a wellness officer for each institute on the medical staff, Campbell says. "These wellness officers are my panel of experts for fields including surgery, obstetrics-gynecology, family medicine, and internal medicine. Almost all of these wellness officers have gone to programs on burnout and completed Stanford Medicine courses on well-being."

Last year's AHN wellness survey found improvement in the burnout scores related to electronic health record work, Campbell says. "We asked specific questions about the in-box because we knew that was a driver of burnout. What we found was that burnout from the EHR in-box got better for our physicians but a little worse for our advanced practice providers. What I think happened is that some of the work got pushed to the APPs, and now they need help."

For the clinician resident group, AHN has posted a couple of recent successes, Campbell says. "For example, the residents have complained that they have a lot of administrative tasks and other things that make their life difficult such as interruptions in their workday. Instead of equipping them with pagers, we got them cellphones, so they could be reached by text, which is less disruptive than a page, especially when they are at home. We also have provided healthy food in the resident lounges."

For the APPs, AHN has launched several initiatives because they are critical to getting work done, Campbell says. "We created an APP council, so their voices would be heard. In addition, every hospital medical staff executive committee has an APP representative, so their voice is heard in those forums. They have become more integrated with the leadership of the institutes."