Patty de Vries. Patty is the Director of Strategic Projects for the Stanford Medicine Well MD Center. She is presently building working relationships with hospitals and university programs, and generating networking support for current and upcoming projects.
In this Expert Interview, AdvancingWellness CEO Mari Ryan discusses with Patty de Vries burnout and the employee well-being model Stanford created to respond to this issue for physicians and employees.
Mari Ryan: Welcome to the Workplace Well-being Essentials series. I'm Mari Ryan. I'm the CEO and founder of Advancing Wellness. It's my pleasure to welcome you to this expert interview where we explore topics that impact employee well-being. My guest today is Patty de Vries. Patty is the Director of Strategic Projects for the Stanford Medicine Well MD Center. She is presently building working relationships with hospitals and university programs, and generating networking support for current and upcoming projects.
Patty’s background at Stanford is as a prior manager of Healthy Steps, the employee wellness program for the 10,000 employees of the Stanford Healthcare and Stanford Children’s Health. In addition, she has a continuing role as the Director of Stanford Health Promotion Network, a 65-member organization, including companies such as Cisco and Apple, which share best practices and resources on worksite wellness and well-being.
As a former national class athlete, a nine-time Stanford NCAA All-American in track and field, national collegiate Olympic weight-lifting champion, and participant in the 1988 Olympic trials, as well as a health entrepreneur, as an owner of a 100+ employee company, she looks forward to using her fitness, business, and organizational skills to improve physician health at Stanford.
Patty and her husband have four grown children, ranging in age from 19 to 26. She enjoys hiking and gardening, and spending time with her family in the Santa Cruz mountains. Patty, I’m so excited to have you here as my guest today.
Patty de Vries: Thank you so much for having me. I’m excited to share some of our work at Stanford Hospitals and Stanford University. I wanted to start with sharing a little bit about what our situation was at Stanford. Our physicians, although not as burned out as national average – physicians across the country are burned out at a rate of 54% -- we have found our burnout rates are 28% for our male physicians, and 38% for our female physicians. Using a different scale; I want to make that clear that it’s not the same Maslach Burnout Scale that is often used across the country, but I want to talk a little bit about the drivers of burnout and what’s happening, not only for our physician population, but what we’re learning impacts all of our employees across the university.
Certainly, a loss of control over work, inefficiencies of the work environment, implementation of much more technology where there’s a learning curve, and different processes being used in different areas of the organization, increased complexity of work, and certainly the demand for more measurement of our time and energy.
Burnout has been described in three components; as emotional exhaustion, interpersonal disengagement, and a lack of personal accomplishment. I’m sure many of the folks who are listening have felt maybe one or two of those, not necessarily all three, but when you feel all three of those, that’s when you literally feel you have run out of fuel to go on in your day-to-day work environment.
Our vision at Stanford went beyond just trying to reduce the incidence of burnout. We do want to reduce the burnout, but more importantly we want to go beyond that. Our vision our vision is professional fulfillment for all employees.
The way the Well M.D, Center and Dr. Mickey Tropple have defined professional fulfillment is having happiness or meaningfulness, self-worth, self-efficacy, and satisfaction at work. I’m sure all of us would love to get up every day and have those things, and have that meaning in our lives.
We developed a conceptual framework around it; it was published in The Catalyst, and it contains three important areas in order for us to get professional fulfillment. The data and the domains were based on the survey data from 2013 and in 2016, where we saw that professional fulfillment had decreased in our physician population, and our burnout had increased.
I’d like to share with you the definitions of each of these areas and some of the things we are doing at Stanford to impact those in a positive way.
Mari Ryan: That’s great. Let’s explore this model a little bit because it sounds like based on the business issue – your business issue of burnout, certainly has a lot of ramifications. Patient care, costs, turnover, and satisfaction, certainly, among the workforce, but patient care, I would think, would be an important element.
Take us through, if you would, the model and what the elements are, and how you define each of these.
Patty de Vries: Great. Certainly, professional fulfillment is multi-dimensional. What we found, and we tied professional fulfillment back to well-being for our employees, not just our physicians, but across the organization, we are finding this model resonates.
The first piece of it is personal resilience, which has been the traditional wellness model. It’s how an individual eats, thinks, sleeps, moves – all of those things that we’ve been looking at and we know that 70-80 percent of disease is caused by an individual’s choices. We are learning more and more that those individual choices are impacted greatly by the other two domains.
At Stanford, we have a long tradition of having great resources for employees to increase their personal resilience. We’ve got world-class athletic facilities, we offer biometric screenings, incentives and events through our Be Well program for all of our faculty and staff, we offer over 1000 classes per year, fitness classes and healthy living classes, and that’s in addition to the athletic department fitness classes as well.
We have a phenomenal array of activities and offerings for that domain of personal resilience. We don’t want to say in any way, shape or form that those things aren’t important, it’s just that what we’re learning is that there are other things that greatly impact our well-being.
Those things that we found from the survey include additional things, such as low self-compassion. Sleep-related impairment, which is one of the traditional wellness pieces, was also highlighted as being impactful. Learning that not having enough sleep for just one night is equivalent to a blood alcohol level. So, we are looking at those types of things and helping our employees understand that it is not a badge of honor to come into work with two, three, or four hours of sleep, that it is important if we are going to have successful physicians and employees, they need to be getting the sleep they need to be healthy.
Under the culture of wellness, we define that as organizational values and actions that promote personal and professional growth, self-care or compassion for ourselves, our colleagues, and our co-workers and our patients. We learned that leadership support was identified as the key ingredient to this, is the kind of leadership that your immediate supervisor or your boss creates to create that culture of wellness. We can have the CEO, C-Suite, any of the leaders tell us this is important, but if your boss snarls at you when you try to leave your workspace to go for a walk, that brings on a whole different importance to that leadership piece.
We have an added focus on leadership looking at the areas of inclusiveness, appreciation and support while still having the high expectations that we need at Stanford, and at your organization as well. We don’t want to let go of the high expectations, but how can we create those high expectations while still being inclusive, appreciative and supportive of our team members.
We also looked at the Harvard Business Review on what leadership skills individuals look for, and people want somebody who inspires and motivates others, that display high integrity and honesty. They still need to drive for results, but how do we do it in a way that supports the individual. That’s what we found was really important under the culture of health.
We’ve also found that psychological safety is a huge piece of this. There is a lot of work done by Amy Edmundson. The term was first coined by Edgar Shein back in the ‘60s, but even in 1993 one of the key things that he talked about is with psychological safety, individuals are free to focus on collective goals and problem prevention, rather than focus on self-protection and shutting down for that reason. So, that’s another piece of it, where at Stanford we are looking to adjust our work and culture so that people do feel psychologically safe.
We try to create those opportunities for psychological safety through a couple of the different programs, including wellness-infused team training, some of the topics are practical self-care tips, the strengths finder, where we go in and we work with teams to look at how to honor other people’s strengths, positivity in the workplace. We created a grant program to allow people to let us know what they would like within their work environment, and certainly, the champions’ network that is mean to support all of our individual contributing [indecipherable - 0:11:59.2] on our team.
One of the things to talk about, this management, the struggles with management, is we are looking to go across the whole enterprise, Stanford Hospital, the university, and all the clinics. We have about 32,000 employees now across those entities, and we call that our enterprise right now. One of the ways that we are bridging that gap is we are looking at management practices. We have a professor here in our business school, his name is Jeffrey Pfeffer, he has written some great books, including one called Dying for a Paycheck. So, we are bringing our H.R. director from the university together with our CEO from the Children’s Hospital, and our Chief Wellness Officer, together in August to dive into what makes a work environment either positive or negative in those management practices that bring that together.
Mari Ryan: There is no doubt in an organization of this size that there are going to be challenges and successes in rolling out this type of a model. Can you talk a little bit about what you’ve seen as both the successes and the challenges of rolling this out across your organization?
Patty de Vries: Certainly. The successes have been at the top of the C-Suite because for the first time since I’ve been in wellness, since 1995, I have a model and a way of putting personal resilience in that traditional wellness piece into the broader organizational goals.
Our leaders see this as important and the final domain is the efficiency of practice, and I’ll go into that in just a moment. Our C-suite executives and our Chief Operations Officer and quality officers, and those people within our organizations see that as a key piece. So, we’re supporting their organizational goals, and at the same time we are acknowledging the individual contributor.
So, when I present this model to whether it is the janitorial staff, or the groundskeepers, or the leaders in the organization, all of us want professional fulfillment. It puts the individual in the center of the model, but it puts all the resources within the university and the healthcare system around the outside working together. That, I think, is what is important about this model, is that it does resonate from the top of the organization, down to the individual contributor, who wants to come to work every day and be professionally fulfilled.
Ruggle*, has been, I think, sharing the model across the organization with so many silos of people. I share this whenever I do a class, whenever I teach our employees or do a team training, I share this model and across the board it has really resonated. I think that’s the biggest challenge, getting the terminology down.
Patty de Vries: Going into the inefficiencies of practice, or efficiency of practice, we’ve defined that as workplace systems, processes and practices that promote safety, quality, effectiveness, positive interactions, and work-life balance. We’ve adjusted those terms a little bit; we don’t use the patient terms within the university setting, but they do know that it’s transferable.
We all know that we’ve had frustrations, and I like to talk about the frustrations with inefficiencies of practice because when you think about somebody within your organization that is employed to support functions of your group, and if that person is not professionally fulfilled, they most likely don’t get things done on time, and/or they are not accurately done, and there is frustration that is involved in that.
We all are impacted when somebody is not professionally fulfilled; we’re impacted when somebody is not engaged in their job, and that’s one of the key pieces. What we are trying to focus on is tackling the tough topics. For us, under efficiency of practice with the physicians, the main thing was the electronic medical records and the struggles our physicians have on that. Our dean of our medical school is tackling that tough topic. In June he had a national symposium where he brought leaders from across the country in to talk about what we can do to streamline that, and what pieces of the electronic medical record were developed as more a covering of our backsides instead of adding value to our patients.
What we are literally looking to do is looking at leadership to tackle some of these big issues that as a wellness team we are not going to be able to tackle. This is a problem on a national scale. With the electronic medical records, it has not eased the burnout of physicians, and in fact it has added a great deal of it. Epic has what they call “pajama time” where physicians are spending 32 hours a month in their pajamas – as the way they say it – doing the work that they can’t get done in a normal day. They are struggling with Saturday nights, Sunday nights, and they have records that show the peaks in those off times where our physicians are spending a lot of time doing that type of work. That’s a piece of it where we need our leaders, and including our dean of our medical school, tackling.
Across the organization, even the three domains, personal well-being, culture of wellness, and efficiencies of practice, sometimes what we call operational excellence, is that we want people to collaborate across the organization, and you can do this in your organization as well, is to collaborate and look for ways to come together, to contribute to the culture of wellness by being a positive role model for the rest of your team, and then cultivating personal resilience. Of course, in my world you need to celebrate successes as well.
Mari Ryan: We always need to celebrate success; that’s an important part of who we are as human beings and being able to reinforce for everyone that the work we are doing is valuable and important, and that we share that success together. That’s great – love having that piece in it.
Patty de Vries: Absolutely, and that’s it, that’s what we have done at Stanford. For me, as I transition into a new role at Stanford, for me, all of these things are important, but we need to be kind to those around us as well. For me, it’s the best piece of a wellness program is to make sure that we are treating people with respect and kindness.
Mari Ryan: Absolutely, foundational for everything that we do. Patty, if our audience wants to learn more about you and the work you are doing, how can they get in touch with you?
Patty de Vries: Certainly, they can email me. My email address is firstname.lastname@example.org, and I’d love to hear from them. We are encouraging others to use this model, we think it is adaptable to any organization, and we hope that it is something that will bring value and allow you to create a more positive work environment for yourself and your employees.
Mari Ryan: Thank you, I appreciate you introducing this model. I’ve already introduced it to some of my clients, especially those in healthcare, in a hospital system, and found that it resonated for them as well. So, thank you for taking the time to be with me today, and to share your experience and your fabulous model for how to be thinking in a holistic way about the health and wellbeing of your workforce. Thanks, Patty, appreciate your being here.
Patty de Vries: Thank you very much for the opportunity, Mari.
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