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Schwartz Center outlines six principles to change health care workplace culture


Physicians and other clinicians are dealing with burnout, moral injury, mental health stigma, and more. Health care leaders need their input to craft long-term solutions.

Earlier this year, the nonprofit Schwartz Center for Compassionate Healthcare announced its inaugural Healing Healthcare Initiative (HHI) to provide solutions that improve workers’ well-being, “so they can focus on delivering equitable, compassionate patient care.” Six institutions around the country will combine six principles with evidence-based resources, tools, and support for staff members.

Schwartz Center outlines six principles to change health care workplace culture

Beth Lown, MD
The Schwartz Center for Compassionate Healthcare

“The health workforce right now is just exhausted,” said Beth Lown, MD, chief medical officer for The Schwartz Center, founded by the late Kenneth B. Schwartz, a health care attorney and nonsmoker who died of lung cancer in 1995. The center’s mission is to put compassion at the heart of health care through programs, education, and advocacy, and it has more than 600 member organizations in the United States, Canada, Australia, and New Zealand.

A primary care physician, Lown sat down with Medical Economics to discuss HHI and what compassionate care means for doctors, other clinicians, administrators, and patients.

Leaders in the health systems and Schwartz Center supporters hope to change the culture for medical workers and for patients with solutions that integrate six principles: diversity and equity; inclusion, voice, and choice; mental health and well-being; psychological and physical safety; team cohesiveness and collaboration; trust and trustworthiness.

Lown emphasized mental health and workplace resources available through The Schwartz Center’s website, and the continuing “Compassion in Action” webinar series available for workers, managers, and administrators to learn more.

This transcript has been edited for length and clarity.

Medical Economics: Most of our readers, unfortunately, are all too familiar with burnout among physicians, other clinicians, and their support staff. In your own words, can you explain some of those causes and the scope of the problem?

Lown: The health workforce right now is just exhausted. They're stretched thin, they're burned out at best and at worst, anxious, depressed, and suffering from traumatic stress, and I don't use those phrases lightly. Burnout is an occupational syndrome. It occurs when work or organizational demands exceed available resources. We know that burnout preceded the pandemic, but it was certainly exacerbated by it, 60% of health workers now are reporting burnout. The Commonwealth Fund’s International Health Policy survey was of primary care physicians, this published late last year and it said that 54% of primary care docs are experiencing emotional distress or have reported it since the beginning of the pandemic, but only 11% of them sought professional help. The Schwartz Center is working with other groups really to reduce mental health stigma and the fear of professional repercussions if you disclose mental health issues. I think this is really, really important. It's very, very worrisome that 29% of PCPs are planning to stop seeing patients regularly the next one to three years. And this is really, really alarming, especially given the predicted shortage of physicians and of PCPs.

To get back to what you said about the causes, they're different for different kinds of health workers. I think for most physicians, it’s administrative and regulatory burden, inadequate support, ever increasing workload, and also moral injury from being unable to provide the care that patients need. For PCPs, it's also low reimbursement, never ending charting, preauthorization, things like that. And among employed physicians it’s loss of autonomy.

But honestly, I think there's more to more to think about here. There's more at play. Physicians, especially primary care physicians, are trying to survive in a system that simply does not prioritize the values and the mission that motivates them, which is providing person-centered, high quality, compassionate care for the patients and the families they've known and loved over the years.

Medical Economics: Can you explain the Healing Health Initiative?

Lown: Schwartz center launched the Healing Healthcare Initiative in January this year. It's a senior leadership team education and support program for organizational change. And the purpose of the program is to guide health leaders to reimagine and prioritize well-being in the workplace for themselves and their health workers in order to enable them to provide equitable and compassionate care for patients.

The two primary goals of the program are, first, to provide the resources and information that can guide the creation of compassionate cultures and positive work environments. And also to provide support and safe space for leadership reflection, team building, and honest conversation. You know, leaders are just desperately trying to address burnout and disengagement. But much of this work is occurring in silos and without involving the workforce to co-create the solutions. So HHI is all about bringing senior executive and clinical leaders together and involving health workers to really develop a deep shared understanding of workers’ needs and to begin to develop comprehensive, long-term strategies that will really leverage the collective strength across the organization. And this is really what we need to ensure that everybody can thrive.

Medical Economics: How do you how do you get everybody under the same umbrella, so to speak, to join in, to work toward a common solution?

Lown: That's why we're starting with the leadership teams in HHI. Because really, the umbrella has to be opened by leadership. You know, it has to be open so that people can feel that there's a pathway, a pathway and a roadmap that they actually had some voice in co-creating in order to get on board with creating solutions. And that's exactly what HHI is designed to do.

Medical Economics: With the six different systems that were selected, they're in different geographic locations around the United States. Could you talk about that balance of creating a program that will work within an organization, and then finding certain practices or principles that might transfer and that other organizations and health care leaders could learn from?

Lown: The six key principles are universally applicable, but it's up to each team and each organization to tailor what's going to be best for their organization, their needs, and their workforce. So we provide the principles and examples of promising practices. And what we want is for people to share that across the cohort. We'll make that available to the public as well. And we'll continue to collect information and data so that we can continue to push out and offer solutions that people have found to be effective.

Of course, it's a one-year pilot, we don't expect necessarily to see immediate outcomes, which is why we are going to continue to be in touch with all of our organizations as we always are within our membership, and offer promising practices to everyone over a period of time. So the answer is yes, and. We have the framework, and each team will create what's right for them. And again, you know, we've asked them to do this in collaboration with a swath of their health workforce.

Medical Economics: You talked quite a bit about primary care physicians. What message would you like to say to them?

Lown: Well, I think that the key principles that we're really trying to hold out for everybody – these are applicable everywhere, from big city hospitals to the smaller practices. Everyone has a role to play in improving the health of our nation, and everyone needs these six key principles to thrive. So I would love to just have them take a look at that and they can use these as a roadmap to create solutions to everyday practice issues.

There's more I want to say, though, to my fellow primary care physicians. I would say, to remember to be compassionate with yourself. If you want to sustain your compassion for everybody else, just do more of whatever feeds your soul and your sense of purpose. And don't worry alone, build a supportive community around you. And please, if you are experiencing anxiety, depression, or anything else, please get the help that you need.

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