HCA Healthcare Focusing on Workplace Environment to Improve Resident Well-Being

While individual interventions for residents such as resiliency initiatives are important, HCA Healthcare believes creating a supportive workplace environment is crucial.

At health systems and hospitals, burnout among physicians and residents is a national problem.

A study published by Annals of Medicine and Surgery found that burnout among residents may be linked to long work hours, high educational demands, lack of autonomy, a high level of work-home interference, a shortage of benefits, and insecurity about the future.

To combat burnout among residents, HCA Healthcare is training clinical leaders and medical faculty to create a supportive workplace environment for the health system’s residents.

The health system’s research on resident well-being and assessment of external research has determined that resident well-being is grounded in five factors: efficiency of practice as defined by job demands versus available resources, autonomy, belonging, competence, and whether the workplace environment supports a sense of meaningful work.

"We did a study last year with 2,029 residents and found that we could predict burnout with those five pillars," says Gregory Guldner, MD, vice president of academic affairs at HCA Healthcare.

HCA Healthcare has defined these five factors as follows:

• Efficiency of practice: Making the practice of medicine for residents as efficient as possible is a function of hindrance job demands and challenge job demands. An example of a hindrance job demand is a broken piece of equipment in an exam room. An example of a challenge job demand is asking residents to speed up and see more patients.
   
• Autonomy: Residents should feel a sense of endorsement in the work that they do. It is not about freedom or lacking supervision. It is the sense that what a resident does throughout their day is chosen volitionally. They feel they do work is done because they have the choice to do it or because their supervisors endorse what they are asking residents to do.
   
• Belonging: Residents should have a sense of feeling understood and accepted by their coworkers and supervisors.
   
• Competence: For residents, competence has two elements. First, it is a sense of mastery—that a resident can do and affect things in their workplace environment. Second, it is a sense that there is an opportunity for growth—that there is a pathway to grow.
   
• Meaningful work: Faculty members should encourage residents to step back and reflect on the impact of the care that they are providing. For example, if a resident is involved in a procedure that provides life-saving care, a faculty member should tell the resident that they have played a meaningful role in saving a life because of the resident’s training and involvement in care.

Although HCA Healthcare has initiatives that provide residents with resources to help boost their well-being and resiliency as individuals such as therapy and coaching, addressing the workplace environment through the lens of these five factors is essential to reducing resident burnout, according to Guldner.

"We are much more interested in how we work with leaders, faculty members, and the C-suite to create a work and learning environment that supports resiliency," Guldner says. "Our research shows that one of the best ways to support an individual’s resiliency is to create a work and learning environment that addresses psychological needs."

Gregory Guldner, MD, is vice president of academic affairs at HCA Healthcare. Photo courtesy of HCA Healthcare.

Training clinical leaders and medical faculty

HCA Healthcare has a workshop program to train clinical leaders and medical faculty to promote a supportive workplace environment for residents.

"We bring in our faculty, program directors, directors of graduate medical education, and other leaders to work with our organizational psychologists," Guldner says. "This is a change from how you build a resilient person, which is great and important, to how you build an organization with a supportive environment."

Part of the workshop curriculum involves training faculty on how to communicate with residents to support autonomy as opposed to just telling residents what to do when they are providing care.

"With autonomy, our residents may have supervisors say, 'Just do this.' That is a common scenario in graduate medical education," Guldner says. "That approach does not make residents feel they have a lot of ownership or autonomy. We teach our faculty to say things like, 'What do you want to do?' If a resident wants to admit a patient to the hospital and that seems reasonable, faculty member will say, 'If that is what you want to do, let's do that.'"

A focal point for the workshops is self-determination theory, which is an organizational well-being theory.

"We talk about how the ways you behave and the ways you set things up in the environment with policies and procedures support autonomy, belonging, and competence," Guldner says.

In addition, the workshops train clinical leaders and faculty to identify hindrance job demands and address them quickly. Guldner cites the example of a broken otoscope in an exam room.

"From a workplace standpoint, if a resident is in an exam room caring for a child with an earache and the otoscope is broken that is a hindrance job demand," Guldner says. "They have to stop what they are doing to find a working otoscope. Those are exactly the type of things that we want to address quickly because there is a direct connection between hindrance job demands and workplace burnout."