For CMOs, Prioritizing Physician Wellbeing Includes Reducing Stigma

WellSpan Health is discontinuing the practice of asking new medical staff probing questions about their mental health status.

A primary concern in physician wellbeing is reticence among clinicians to seek help, especially when they are experiencing emotional or mental problems.

Traditionally, healthcare organizations have asked questions about mental health on credentialling and licensure documents, which raises concern about stigma for healthcare professionals.

However, WellSpan Health has been honored for removing stigmatizing questions from staff credentialling and licensure documents.

Any healthcare organization wants to know that a provider is competent and capable of providing care, but that desire should not extend to prying into people's mental health history, says Anthony Aquilina, DO, executive vice president and chief physician executive at WellSpan.

"We do not need to know your personal history, especially when it comes to mental health because that is the kind of thing that has led to stigma," Aquilina says. "It can bias people if they think you are getting mental health care."

It is inappropriate to focus on people's mental health history, according to Aquilina.

"On a credentialling document, we would not ask you whether you have ever had a heart attack," Aquilina says. "So why should we ask you whether you have had mental health problems?"

WellSpan received an award from the Wellbeing First Champion Challenge program in part for changing a particular credentialling question.

The original question was as follows: At any time in the past 10 years, have you been hospitalized or received any kind of institutional care for physical or mental problems?

The new question is worded differently: Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?

"What's important is that we assess competency and capability," Aquilina says. "There are ways to do that without causing people to react in a way that makes them concerned about their livelihood."

Anthony Aquilina, DO, is executive vice president and chief physician officer at WellSpan Health. Photo courtesy of WellSpan Health.

Promoting healthcare worker wellbeing

WellSpan is making a robust and multifaceted effort to boost the wellbeing of physicians, nurses, and allied health professionals.

"At WellSpan, we have the benefit of having several physician leaders and other leaders who are dedicated to the wellbeing of our provider workforce," Aquilina says. "One of our emergency room physicians is the immediate past president of the Pennsylvania Medical Society. The theme for her presidency was all about restoring joy in the practice of medicine."

Physician wellbeing is a top concern at WellSpan. The health system has a wellness program led by a physician, who partners with a psychologist. They use a multifaceted approach to addressing physician burnout.

"We measure physician burnout, and we understand where we stand as an organization," Aquilina says. "In our most recent measurement of physician burnout, we posted a decrease in our physician burnout percentage last year."

Last year, 34% of WellSpan physicians reported experiencing some level of burnout. Nationally last year, about 50% of physicians reported experiencing some level of burnout.

WellSpan is focusing on eliminating or mitigating nonproductive work for physicians such as spending inordinate effort in the electronic health record and devoting time to insurance company requests for peer reviews.

To reduce documentation burden, the health system has adopted artificial intelligence ambient listening technology that records a conversation between a clinician and a patient, then produces a clinical note for the electronic medical record.

The health system is offloading work that physicians have been doing that other staff members can tackle. For example, advanced practice providers can provide care for minor complaints such as upper respiratory infections, uncomplicated urinary tract infections, and sore throat.

At WellSpan York Hospital, the health system has launched an initiative called Code Lavendar to help all staff members who struggle with emotional and mental distress.

"It is a response team for staff members who are feeling high levels of stress, emotional distress, or mental trauma," Aquilina says. "Code Lavendar is a private way for staff members to get help."

Emergency rooms at WellSpan's hospitals also have areas where clinicians and nurses can go if they feel stressed.

"It gets them away from work for a short period of time," Aquilina says. "We call those areas Zen Dens."

Lastly, WellSpan is trying to discourage doctors from taking work home with them.

"We are focused on reducing pajama time," Aquilina says, "[which is] when doctors are working at home on computers when they should be spending that time decompressing and enjoying life with their family."