Measuring wellbeing — The ROI of resiliency

Health systems around the country are coming to grips with the problem of burnout among their doctors, nurses and other staff members. While the extent of the problem varies among health systems, the vast majority is experiencing the problem in some form and deploying strategies to address it.

Wellbeing strategies

The best strategies to promote wellbeing and reduce burnout address both the causes and symptoms of burnout. They identify ways in which the practice environment in a health system diminishes wellbeing and contributes to burnout. And, they dedicate resources to eliminate the ways that technology, operational processes, organizational design and organizational decision-making create hassles for doctors and nurses.

Organizations also address the culture of the health system to ensure that the organizational values doctors and nurses experience in carrying out their work are consistent with the values that they desire to bring to patient care—including teamwork, open and honest communication, trust, compassion, empathy, caring and concern.

Finally, strategies to address burnout equip doctors and nurses with skills that allow them to manage the stress of their personal and professional lives. One effective approach is to train the skill of wellbeing to increase resiliency, focus and emotional health with the ultimate goal of restoring joy to the practice of medicine.

Reliable measurement

Health leaders are sometimes reluctant to spend time and resources to reduce caregiver burnout and increase resiliency because they are uncertain about how — or whether it is even possible — to measure the success of their efforts. With the reality of competing priorities and ever-tighter budgets, they appropriately want to know, before they invest, that they will get some return on their investment — that the work will yield meaningful and tangible results in areas that are important indicators of their health system’s success.

The good news is that wellbeing can be measured. Scientifically validated measurement tools have been created by some of the most reputable organizations and experts in the field of neuroscience, positive psychology and organizational behavior. These instruments can establish a baseline for wellbeing and measure improvement on both an individual and aggregate basis.

An example of this kind of an assessment tool is the one developed by Life Cross Training, a Chicago-based company that is currently applying its wellbeing-training program in health systems across the country. Life XT developed its Human Assessment Tool in collaboration with experts at the University of Chicago, Harvard University, the University of Wisconsin at Madison, Kellogg University and Stanford University over the past five years. The HAT generates an overall wellbeing score and breaks that score down into 13 discrete areas, including: resilience to stress, energy level, engagement, focus, emotional health, happiness, satisfaction with relationships and productivity. Scientifically validated across hundreds of thousands of users, this tool allows an organization to reliably and quantifiably measure improvement in wellbeing over time.

Extending the reach of wellbeing measurement

Much like an engagement score, a wellbeing score has value in and of itself. Even greater value comes from leveraging wellbeing scores to achieve other health system improvements. Clinical literature has established that reductions in burnout correlate positively with improvements in turnover and retention, patient experience, safety, error rates and clinical quality. So, the next step is to correlate improvement in wellbeing with the other metrics that are important indicators of health system success.

Health systems have already begun to make these correlations and are seeing positive results. For example, under the leadership of Ronald Paulus, MD, Mission Health System in Asheville, N.C., has adopted a comprehensive strategy to address caregiver burnout. Mission Health is working to improve individual wellbeing and is doing so in ways that are bringing positive results to their operations. Mission Health now knows that for every one percent increase in retention across their staff they save $7.5M. By correlating improved wellbeing with higher retention, they can quantify the benefit of wellbeing investments to their bottom line.

For health systems concerned about the need to score “quick wins” to persuade skeptics of the importance of wellbeing investments, the lowest hanging fruit is improved retention. With nurse turnover at an average of 19 percent across the nation and the average cost to replace a nurse at $59,000 targeting nurse turnover is an obvious choice. Physician turnover, while usually lower than nurse turnover as a percentage of the employed physician population, is arguably even more costly given the revenue impact of a lost physician. So, measuring physician retention is also an early candidate for demonstrating the impact of wellbeing improvement investments.

After targeting retention, the next likely area of focus is patient experience. Direct correlations between wellbeing improvement strategies and enhancing the patient experience are sometimes harder to make given the other “noise” that can affect the correlation between the two. But, with the right implementation approach, a reliable correlation is feasible. The importance of patient experience to reimbursement and competitive advantage makes this an obvious area to begin.

In order to get the maximum benefit from wellbeing improvement strategies, and to allow for easy measurement of results, health systems should also carefully consider how they implement their wellbeing strategy. Discrete operating units where a population can be easily defined and measured should be at the top of the list—a floor of nurses, a clinical department or an ambulatory practice site are among the top candidates to start this work. Further targeting those units where engagement scores are lowest or turnover is highest will also maximize the likelihood of achieving early success and quantifiable ROI.

The case for moving forward

It is now clear that improvements in wellbeing can be measured, quantified and correlated to improvements in the areas in which health system leaders are being held accountable—cost, quality, safety and patient experience. This makes wellbeing improvement not only the right thing to do, but the smart thing to do as well. Health systems should have confidence that they can measure and achieve ROI in wellbeing with the same rigor as their other investments.

Our health systems depend on people—doctors, nurses, technicians, housekeepers. Each step in the care delivery process depends on an individual, a human being, to make it work. We have historically underinvested in the very people we depend on to deliver the results our patients deserve. Now, we are reaching a crisis point in our country’s health system. To underscore the magnitude of the problem and the gravity of this underinvestment, some of our best health system leaders recently called doctor and nurse burnout a “public health crisis.” It’s time we begin to invest in our human capital—it’s the next great innovation for our health systems to pursue.

 

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