Wellness: A New Kind of Best Practice

As physicians, our practice goes beyond merely what we do at the microscope or in the clinical laboratory. It’s well known that patient satisfaction is constructed on a foundation of healthcare provider wellness and satisfaction. When providers are engaged and happy, the result is safer and more efficient encounters with our patients. But is that how we always feel? And if not, what can we do to ensure that our patients (be they cells on a slide, blood in a test tube, or human beings in a hospital) are receiving our best care?

A dangerous situation

Data on physician burnout in the United States overwhelmingly points to a national crisis. Being a physician is, in fact, considered a risk factor for suicide – with an incidence rate previously reported as 1.8 times the national average (1)(2). Pathology, unfortunately, is no exception to this rule; the burnout risk for pathologists is reported at about 42 percent (3). Not many departments of pathology and laboratory medicine address this issue, and even fewer pathology residency programs offer formal resilience training to help those at risk alleviate the strain. The burnout dilemma takes a multidimensional form: it involves the individual, the group, and the system. In the case of pathology, this means the individual pathologists, the laboratory or department, and the hospital or institution.

The burden extends to all colleagues in the laboratory and the healthcare arena; although the individual burnout statistics may be different for nurses, technologists, laboratory scientists, or clinicians, the fact remains that it is a systemic issue with no single easy solution.

There is hope, though. Wellness and resilience can be taught, and groups and institutions can put formal training into place to help those who work there to weather the storm. In our department at Loyola University Medical Center, we are approaching the issue with our residents using a comprehensive tri-dimensional strategy. Our goal? To provide them with tools to maintain the joy, humanity, and satisfaction of practicing pathology and laboratory medicine throughout their careers.

The tri-dimensional approach involves strategies for the institution, the group, and the individual. At the institutional level, we try to improve working conditions for all physicians. The administration at Loyola and at the Gottlieb Memorial Hospital plays a key role in this. In our case, the “group” refers to pathology department trainees (residents, fellows, rotating observers, and students). We spend time with them brainstorming ideas to better our department, and then – most importantly – we act on those suggestions. We already have requested several changes (such as new microscopes to make work easier and more comfortable), and we intend to continue developing and passing on new ideas. And, finally, we all have responsibility for our own individual wellbeing – so we’ve started a series of Wellness Talks to teach our trainees about different approaches to stress and burnout, including physical and mental health, mindfulness techniques, and more.

Talking about wellness

Initially, we conducted a survey of our pathology residents that indicated an overall need for wellness and resiliency training. After some discussion as to the best approach, we settled on monthly talks (including a free lunch!), which we supplement with additional education.

I organize the talks myself, but the residents drive them. Each meeting starts with a moment to celebrate and be grateful for something, followed by a short talk on a specific subject, such as burnout symptom recognition, suicide prevention, physical health, the benefits of sleep, or the effects of gratitude on mental health. After the didactic portion of the meeting, we move into action items and brainstorm what we can do next to improve the department’s wellbeing. We accomplish a lot with each session, but I think the biggest driver of attendance is that the attendees feel free to express their opinions in a non-judgmental environment. Because I want to respect the confidentiality of what is discussed at the meetings and give people a space to express themselves freely, only our trainees are invited to attend – and I make it clear to them that everything we discuss is private, except for action steps that they permit me to bring up with the people who can enact change.

Based on the success of these talks, we are now in the process of formalizing a wellness curriculum that will focus on stress prevention, management, treatment, and professional and life purpose. Our ultimate goals are to increase wellness among our pathology residents to prepare them for a high-stress environment before entering the workforce, and to increase their ability to bring the tools they have learned to their new workplaces.

Anonymous responses to the six-month and one-year surveys on Loyola’s wellness talks.

Tips and tricks

We have implemented a number of initiatives to assist our residents, many of which are applicable to all of our colleagues. What can other institutions take away from our approach?

• Ensure that your residents have access to sessions with trained resilience coaches. We provide this service in addition to standard psychological help, an Employee Assistance Program, a Care for the Care Giver Program, and chaplaincy services.
• Have a portal on your internal network that allows your staff members to access wellness and resilience resources, such as those named above. At Loyola, our residents and faculty can find these programs by tapping into our website’s Resilience Page, so accessing them is quick and convenient.
• Foster a successful mentorship program within the department. This can focus on partnering new residents with those further along, or it can include all of your faculty members. Our institution pairs first-year residents with senior residents in first-time rotations, and each resident chooses a faculty mentor during their first year.
• Provide opportunities to learn mindfulness and meditation techniques. We discuss and practice those techniques during the wellness talks, so people receive regular refreshers and can ask for assistance if needed.
• If you are able to provide discounts to other resources, such as your institution’s fitness center (or even a nearby gym or wellness facility), this can create opportunities for your colleagues to pursue wellness on their own time. For instance, pathology residents at Loyola receive discounted admission to the school’s Fitness Center.
• Stay abreast of how well your initiatives are working and how your faculty and staff are feeling. We conducted a brief pulse survey to identify one positive, one frustration, and one thing that needs to be changed at the beginning of our study, then ran separate wellness surveys at the six-month point and after one year. Results showed a significant trend toward better individual stress control and a more positive overall environment.
• Consider working with other departments to develop an institutional resilience resource. This grants easy search access to volunteer activities and interdepartmental networking – activities that contribute to many people’s overall wellness.

There is no one-size-fits-all solution. Each one of us may have a different way of achieving balance and managing the multitude of demands in our personal and professional lives. But remember: we don’t have to travel this path alone. Together, we can create an environment where our personal goals and our love for medicine can coexist and thrive.

Marisa Saint Martin is Assistant Professor of Pathology at Loyola University Medical School, Maywood, Associate Director of the Residency Program, and Laboratory Medical Director at Gottlieb Memorial Hospital, Melrose Park, USA.