The Exec: New CMO of Texas Children's Pediatrics Focused on Physician Well-Being

Texas Children's Hospital and its physician group have stepped up efforts to promote physician well-being since the coronavirus pandemic, according to this CMO.

Sapna Singh, MD, the new CMO of Texas Children's Pediatrics, has several years of experience in leading physician wellness efforts.

Singh has been a physician at Texas Children's Hospital since 2011, and she started as CMO of Texas Children's Pediatrics in October. Singh has served as medical director of physician wellness at Texas Children's Pediatrics since October 2022 and has been the chair of the Texas Children's Pediatrics Engagement and Wellness Committee since October 2021.

With 350 physicians, Texas Children's Pediatrics is one of the largest pediatric medical groups in the country.

Discussions about improving physician well-being at Texas Children's Pediatrics began in 2016, but the coronavirus pandemic galvanized the effort, according to Singh.

"Not only in our organization but also across the country burnout and moral injury increased during the pandemic," Singh says.

The Engagement and Wellness Committee was formed in 2021.

"It was comprised of physicians in the organization who had a desire to help work on improving the culture and efforts to improve wellness and engagement for our clinical teams," Singh says. "The key was not only the establishment of the committee but also partnering the committee with our leadership team."

The committee strengthened the relationship between senior leadership and the clinical staff, Singh explains.

"We moved away from what sometimes felt like a disconnected relationship between senior leadership and the clinical side of the organization," Singh says. "We tried to bring those two groups together and to work together. We have brought that partnership to fruition."

The first step to boosting physician wellness efforts was "simply asking" what physicians needed, according to Singh.

"Oftentimes when wellness initiatives are put together, there is an assumption of what is needed. Instead, we asked the physicians and the clinical teams what they needed," Singh says. "We began conducting a well-being index survey about three years ago."

Singh says she has been involved in multiple well-being initiatives over the past three years.

"A lot of what we have done in terms of our wellness programs has been off-loading work that does not directly impact patient care," Singh says, "but adds to physician burnout and adds to work physicians do outside of clinical hours."

Managing electronic in-box messages for physicians has been a focal point.

"We receive hundreds of thousands of in-basket messages as an organization every year, so it is an incredible amount of work, and we tried hard to off-load some of this work for our physicians," Singh says. "We had nurses triage questions. Now, we are working on AI to help us with the responses."

Clinical documentation in the Epic electronic medical record has been another area where work is being off-loaded from physicians, according to Singh.

"It takes a lot of time to check all of the boxes and complete clinical notes," Singh says. "We have initiated a pilot to use an AI virtual scribe, so some of our physicians are using AI technology that writes their clinical notes. Their documentation is largely done by the time they walk out of the exam room."

There have been training efforts to improve physicians' skillsets, Singh explains.

"For many physicians, burnout is not just a matter of the work we are doing," Singh says, "but also work that we feel helpless about."

For example, there is a training program with The REACH Institute for any physician who wants to get training in psychiatric care in the primary care setting.

"When we came out of the pandemic, many children were suffering with mental health issues," Singh says. "There was little we could do to improve resources for these patients, so we improved our own training. More than 200 of our physicians took the training, which helped us to help patients in real-time."

There have also been efforts to improve communication with physicians and other clinical team members, according to Singh, including an initiative to add anonymous feedback links in Epic.

"If you are in front of your computer and there is a 'pebble in your shoe'—a constant occurrence that keeps coming up—you can click on a link and send an anonymous message to me as the chair of the Engagement and Wellness Committee or the president of Texas Children's Pediatrics, Daniel Gollins," Singh says.  

Anonymity is an important aspect of the feedback links, Singh explains.

"Clinical team members can freely express their concerns," Singh says. "They can reach people at the top of the leadership team who can address these concerns."

Sapna Singh, MD, is CMO of Texas Children's Pediatrics. Photo courtesy of Texas Children's Pediatrics.

Promoting patient safety and care quality

In addition to physician well-being, Singh's top priorities as CMO of Texas Children's Pediatrics include focusing on patient safety and care quality.

"The biggest thing I look at is making sure the teams that need to be involved in quality and safety are all talking with each other," Singh says. "When it comes to quality and safety in the clinic, we need our quality and safety teams engaged with not only the clinical staff members but also making sure that physicians know their role in ensuring quality and safety."

Physicians play a pivotal role in patient safety and care quality, according to Singh.

"When we discuss needle sticks, vaccine errors, or fall prevention, these are things that sometimes people assume will involve educating the nursing staff," Singh says, "but I take the position that physicians need to know about these things as leaders of the team to reinforce, educate, help spread awareness, and emphasize why these things matter."

To foster patient safety, clinical staff must feel safe to speak up when there are safety concerns or a medical error occurs, according to Singh.

"The focus cannot be placing blame on a person," Singh says. "Having worked in medicine for more than 20 years, I know that anyone is capable of making a mistake on any given day."

At Texas Children's Pediatrics, discussions about quality never stop.

"Quality is embedded in every conversation, and it is the hallmark of what we want people to think of when they think about Texas Children's Pediatrics," Singh says. "No matter which clinic they go to, and no matter which physician they see, the high standard of quality care is going to be the same."