Penn Medicine Princeton House Behavioral Health. To date, more than 300 Princeton Health physicians and employees have used Penn COBALT. Early in the pandemic, the Medical Staff Executive Committee began periodically using the Mayo Clinic Well-Being Index to help uncover the risk of distress and burnout among the medical staff, which comprises more than 1,370 physicians. The Well-Being Index is an online, validated self-assessment tool invented by the Mayo Clinic that measures six dimensions of distress and well-being in just nine questions.
In addition to the use of the Well-Being Index and the changes implemented in response to the periodic surveys, Princeton Health also promotes and encourages the use of Penn COBALT, a digital platform launched by Penn Medicine to give physicians and other employees access to mental health and wellness content, including the Mind on Mental Health podcast. In this session, Dr. Gronczewski will discuss the why, the what, the how, and what’s next for these programs.
Shereese Maynard, MS, MBA, Co-Owner, HIT Like A Girl Pod
Craig Gronczewski, MD, Chief Medical Officer, Penn Medicine Princeton Health
Case Study - Penn Medicine’s Multifaceted Approach to Workplace Wellness and to Supporting Physicians and Reducing Physician Burnout
Shereese Maynard: So first of all, I am so excited to talk to you about this particular project. I've been following Penn Med for a long time, and I think what you guys did with Cobalt and at the time at which you did it, fascinates the heck outta me. I'm obsessed. So I'm so glad to have you here today. Thank you so much for coming.
Craig Gronczewski: Thank you. My name's Craig Gronczewski. I'm the Chief Medical Officer of Penn Medicine, Princeton Health, and I'm also excited to be here. And we've been doing a lot of work on physician burnout. I am a practicing emergency physician and I've heard about burnout my whole career before I went into the field and I didn't, I, you know, I heard that emergency medicine is a burnout field, and I never really understood what that meant.
I thought it was just, ER physicians felt like they weren't making enough money or putting too many hours and, and we've learned so much more. So I'm, thank you. I'm happy to be here.
Shereese Maynard: So for those of us who don't know, not me because I'm obsessed, but for those who don't know, could you explain to our audience a little bit about Cobalt and the project you guys were involved in?
Craig Gronczewski: Well, our project is to address workplace wellness physician burnout and resiliency among our, our staff. Penn Cobalt was a part of that project and something we tapped into. So I'll speak about Penn Cobalt. So Cobalt is a digital platform to support mental wellbeing. It was it came out of the Penns Center of Innovation, David Ash promoted by a dean Lisa Bini.
And it, it is really a a digital platform designed for real-time mental health support for practitioners, for other staff to get them connected with a need based on a triage assessment of, of, of their individual needs that could be from a podcast or wellness apps to group support to individual one-on-one psychotherapy.
It's been very successful. It was a collaboration with United Health. It's deployed throughout the system of 40,000 employees. Princeton Health is where I'm from, is 3000 employees and additional 1400 members of the medical staff. And we've had about 10% of our workforce utilize Penn Cobalt.
Shereese Maynard: That's amazing. So could you tell us a little bit about the method you guys used to for this project and why you chose it?
Craig Gronczewski: Well, for us at Princeton Health, it was easy to tap into. We had started around second half of 2019, our medical executive committee, medical staff leaders. We were talking a lot about physician burnout.
It was coming up in our monthly leadership meetings and we organized our efforts around that. We, we designed a project. We started with the physician. Task force on physician burnout. And, and, and I think from the start there, one thing that went well was. We didn't tap into just the physicians who were concerned and, and caring about this, but nursing leaders, administrative leaders.
So we really tapped in the support. We started with trying to understand the issues and from that we really wanted to do a couple things. One, we wanted to better understand how physician burnout or moral dis world injury was impacting. Our workforce, our medical staff. So we wanted to figure out how to measure it.
Like we've been hearing about it, we've been hearing people tell their stories, their own individual experiences, what they've been hearing other institutions have been doing to favorably impact efforts against it. But we didn't really know the scope of that problem at Prince. So we wanted to measure that.
And secondly, we really were careful not to try to reinvent the wheel. And a part of that was to tap into our system a larger system. And that's really where it led us to some of the efforts that were system-wide that we could tap into.
Shereese Maynard: That makes sense. So you guys took on, this was a huge undertaking and you did it during the pandemic, which is amazing to me.
How were you able to prioritize your efforts in such a trying time for all of us?
Craig Gronczewski: So we, I think we had the unique experience for us is that there was, I, I think a fortuitous intersection between our project and efforts surrounding. Physician wellness and burnout. So we created, we really established a project around it in late 2019.
We also did identified a department, our labor and delivery unit that seemed to have higher levels, reports of issues related to physic and burnout. So from medical staff leadership, medical executive standpoint we began tackling burnout in those two areas. So we created a project. Task force.
We created a scope of work and timeline, and that was end of 2019. And then here comes 2020 and Covid is around the corner. And we knew physician burnout was a serious issue before the Covid pandemic. The pandemic absolutely amplified all those issues and then some. And so it really, that intersection really gave us the the platform to really energize and accelerate some of our efforts.
Mm-hmm. , it really changed our priorities in many ways. Some of the things in addition to, so we, how we prioritize that we, as part of our agenda and our covid medical staff huddles we always had on the agenda. Workplace wellness. So, and, and during the, the, the, the covid pandemic, the peak of that, we had some real unique issues.
I mean, there was obviously distress and anxiety. Fear of the, of the virus, of getting sick protocols constantly changing. You know, it was Unique and challenging, uniquely challenging times. So we wanted to, one, make sure that everyone had awareness of all the resources and tools out there.
We also it was clear to us that some of the suffering that was occurring from the stress of the pandemic and the workload and what was going on at. It was important for us to get more boots on the ground support for the, for the, for the staff. So one thing we did was we retained a, a psychologist who rounded with our chaplain services.
So we had huddles on frontline rounds daily. And one thing we morphed our huddles into was just not operational huddles, protocol driven huddles, but it was always about how are you feeling, what's going on? And for example, in the emergency depart, was a critical frontline area for us in managing the early pandemic.
We had a an ER physician who got very sick. He contracted the virus ended up in I C u, was on a ventilator was placed on an imminent death condition and was on a ventilator 90 days. Thankfully he survived outta the hospital. You know, you know, love him dearly and, and glad he, he's, he's recovered from that.
But I'll tell you when that was occurring, when. Colleague is going through that and we're already afraid and fearful of the virus that's impacting that, that kind of feeling comes into the workforce every day. So one thing we did was we huddled daily, we brought a chaplain to our huddle and we were very vulnerable about how we're feeling.
So we real, we, to me, I think what changed in how we prioritized wellness during the pandemic is, We were very open about discussing it, and I think also it was the first time in my career that our staff felt comfortable about openly discussing how they feel. And I don't know if it's destigmatizing the issue, but people were feeling the obvious need to, to, to discuss that.
And that really leveraged not only real time efforts, but also allowed us the opportunity for our staff support services to pull people on the. How they're asked, how they're feeling, set up group sessions make sure they are aware of all the resource and tools provided.
Shereese Maynard: So you spoke about the challenges you guys had, and I know you had some really specific goals.
So in your opinion, what do you think went really right with this?
Craig Gronczewski: I think efforts to, to communicate that. Mm-hmm. , I think to allow our staff and the courage to speak up with how they're feeling and us from an administration standpoint to have the courage to listen and all of us together to try our best to do something about it. And I don't wanna represent that we've figured out.
how to, you know, how to cure yourself, physician burnout, . But we are in a much better place in, in combating it mm-hmm. and having a systematic approach , to ensuring our efforts are productive. But I think for us was just, it was deeply communicating with our staff and engaging with them and really understanding, like just doing something about it that was very tactical in nature, for example , and, and not, not stopping.
Mm-hmm. . So I mentioned labor and delivery was a, was a unit that was I think under some distress. During the pandemic one of the things that come up there, the call rooms were under construction and construction. completely suspended. So now we have some obstetricians who have to be up all night delivering babies and midwives and they don't have a call room to sleep in.
Right? And so that was very distressing and it's very tempting to take on the approach. Well, there's not much we can do about it. Construction is suspended, but once. It's resumed, we can get around to it. We followed through. So we had a visitor lounge that was now empty cuz we're allowing visitation.
So what if we converted that lounge into the, not a call room, but a break room. So we can put computer stations there, we've put lounges there, we can pull curtains. So it's not a qual room, but it's maybe the next best thing is a temporary fix. Also identifies alternative areas where they could. And then also assure them that reprioritize our construction schedule.
So absolutely day one, when the governor allows us to resume construction, we have moved that to the top of the list, but then also not finishing there. So when we finally constructed, as we're constructing the six call rooms for a 10 bed mother baby delivery unit, and understand that we deliver about six babies a.
and then hearing about, well, are six call rooms enough? What about when our midwife covers? We had a identifying, we have a system where we have multiple private practices and we are asking if we can have a number of call rooms that frankly outnumbered the number of babies we're delivering. So having those conversations with our practices, and again, it's bidirectional, like how are we all.
A part of what's impacting how we feel about the work environment and for that as an example, is that practice model that each practice independently represents to the organization. Is that a sustainable, is that contributing to some of the burnout? So we have multiple practitioners from multiple groups coming in, having to be on call, staying up, delivering babies, and.
Is there some different model? So we made a signif. So based on those conversations we explored and eventually implemented a Labis model. I'm not saying that's the right fit for every organization, but for us that was a solution to work with the providers better, understand their work demands, what their issues were, what's contributing to bird burnout, and.
Obstetricians. It's, it's, it's, it's oftentimes the, the schedule managing home life, your private practice running into the hospital and it's an intense job. So laborist model was, was a poten a solution for us to now two obstetricians on shift can manage those six deliveries, plus additional. And then the individual practitioners from different groups don't necessarily be, need to be in the hospital up.
Every night. So it, it was just incremental really having those conversations to understand what the issues are being represented, but also to better understand them and communicate with the practitioners and then really execute and do something about it together.
Shereese Maynard: Okay. So here's a good one.
What did you learn that you think other organizations could greatly benefit from? Because hopefully we'll see these, this modeling every. My hope .
Craig Gronczewski: Yeah, I think one, it's, it's, this issue is here to, it's here, here to stay. There's not, it's not going away. It's, the workforce is incredibly valued to healthcare.
There's a staffing crisis out there. This is gonna penetrate administrative decisions going forward. It's not going. And I think also, I think one of the things we learned early on when we were promoting awareness for physician burnout and addressing physician wellness and resiliency and we are bringing other stakeholders at table administration, nursing staff, hr, et cetera.
There's a sensitivity around that, which we learned is it's, this is not just a physician. There are some unique features to physician burnout. Physicians don't corner the market on burnout. This is a healthcare wide industry, so you need to partner and accept that this is a, a more, it's a broader issue.
So I mean, that's something where we pivoted. We did pivot from working on physician burnout and really broadening it to the workplace environment. And that shift really I think got everyone to embrace and get more on board with the in.
Shereese Maynard: That brings up an interesting question for me, for the administration.
What kind of change did you see there? Did you, was it a huge difference? Because that's where we usually see the, the pushback. .
Craig Gronczewski: We had a, we had significant administrative changes during that time several months after the Covid pandemic. It made an impact to addressing this. One thing I personally, I think leadership is very important.
Mm-hmm. in, in combating this and accepting this and prioritizing it.
Shereese Maynard: Okay. So If you're thinking about long term where we want all of these studies to go, where do you see it going? Like, do you see every institution looking at this as a framework or what's your hope?
Craig Gronczewski: That's a really good question. I think you know, back to our earlier earliest, one of our early assumptions with our project was to not reinvent the wheel. I think one, I, we need to, we need to do, continue to explore the data and evidence to quantify the levels of burnout and the impact where it is, you know, for us it was.
That department of ob gyn. Other aspects was there was a there was a disparity. Women, our women, our female physicians had higher distress scores, our middle-aged career physicians. So I think going forward we use need data and evidence to help quantify the scope and levels of the problem. And I think we need to.
Ground our interventions on things that work, evidence-based work. We also have to accept that there's not just one tool or resource that will solve this and nothing will solve it quickly. This is an ongoing, sustainable effort that will extend past all our careers and And accept that it's just not one thing.
A hot yoga class is not gonna solve this. A, a meal on a table is not gonna solve it. These will all help, but we need con long, ongoing, comprehensive, collaborative support and we need to be better listeners of what the issues are. Again, the courage to listen and the courage to allow our staff to speak up and do something about it.
Shereese Maynard: That's amazing. So the data that you guys were able to extract from this study, it's a lot of it. Is it widely available?
Craig Gronczewski: There's a lot of data, I mean, on, on physician burnout and workplace burnout. So our data that we collected the tool we used, we used a, a wellbeing index that was developed by the Mayo Clinic.
It's a validated tool. It's a nine question. Tool. Our data is not published. It's kept internally. But what is available and why? One of the reasons why we, what, what is helpful in measuring is the benchmarking. Mm-hmm. . So the, the benchmarking of all participants across the country that have used this broken down by specialty and other demographic features that is available as part of the survey data.
Shereese Maynard: Oh, okay. Thank you.