Behind the Gold: The People Powering Joy in Medicine

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In this special Well-Being at Michigan Medicine podcast with Dr. Elizabeth Harry, leaders across emotional support, clinical efficiency and faculty development reflect on Michigan Medicine’s achievement of gold status in the AMA’s Joy in Medicine Award. Drs. Jodie Eckleberry-Hunt, Whitney Begeman, Greta Branford, and George Mashour share how programs like COMPASS peer support, confidential counseling, AI-driven documentation tools and robust leadership development strengthen well-being across the institution. Their insights highlight systemwide commitment, innovation and continued investment in reducing burnout, fostering resilience and empowering faculty and clinicians to thrive.

Transcript

Dr. Elizabeth Harry:

Welcome to Well-Being at Michigan Medicine, and today, we have a special podcast, the Joy In Medicine podcast. We're so excited to announce that Michigan Medicine was given gold recognition from the American Medical Association, and today, we get to dive into the people and the programs driving well-being across Michigan Medicine that help make this possible. So today, I'm joined by three remarkable leaders whose efforts span emotional support, clinical efficiency, and system-wide transformation. We have Dr. Whitney Begeman, a clinical psychologist with Office of Counseling and Workplace Resilience. Whitney leads initiatives that provide confidential support or promote psychological safety for our physicians. We have Dr. Greta Branford, who's the Associate Chief Medical Officer for Ambulatory Care and the Senior Medical Director for UMMG. She's also a faculty lead for the Office of Well-Being and a forefront of reducing administrative burden and enhancing clinical workflows through innovation and technology.

We also have Dr. Jodie Eckleberry-Hunt, a board-certified health psychologist, executive coach, author, and nationally recognized keynote speaker with over 20 years of experience bringing refreshingly down-to-earth approach to healing and blending cognitive behavioral mindfulness-based strategies with healing and authenticity. So I'm so excited to have you all three here. Welcome. And let's start with the big picture. Peer support is a cornerstone of emotional resilience and one of the things that we are asked to explain how we're supporting in the AMA application. Jodie, would you tell us a little bit about the COMPASS program and how it supports clinicians after adverse event?

Jodie Eckleberry-Hunt:

I would love to. I am so thrilled about the COMPASS program. I am newer to Michigan Medicine, and COMPASS was already up and running before I got here. I do feel like it's important that y'all know a little bit about COMPASS. It stands for compassionate peers and stress support and COMPASS was originated around the end of 2019 by my predecessor Dr. Kelcey Stratton, who is now Chief Behavioral Health Strategist for UHR. In many ways, Kelcey was ahead of her time, but right before COVID, they piloted the first group of peer support trainees and it was a step-by-step process lockstep with patient relations and clinical risk. And the first group of peer supporters were physicians who were trained to provide peer support to other physicians who had been named in litigation. And because we know that being named in litigation is one of the most stressful experiences a physician can have professionally, and so it can be very isolating and lonely and having somebody to talk to is just a great resource.

So serendipitously, that training happened right before COVID hit. And when COVID hit, there was an explosion in terms of interest in peer support across the healthcare system. And so Kelcey in lockstep with the trauma-informed advisory group and patient relations and clinical risk were able to scale COMPASS to access from nursing project managers, anybody within Michigan Medicine. So I think that's the point that I really want to emphasize that presently COMPASS is available to anybody within Michigan Medicine. There are a couple of things that I just really want to highlight. I am very honored to be able to be one of the new co-leads of COMPASS, and I would say that there are two prongs of it. One is the sort of official prong where we get notification from clinical risk regarding providers who have been named in litigation, could be any provider or somebody who was involved in a large-scale adverse event.

We reach out to those individuals confidentially and just say, "Hey, we see you. We're here if you need anything." And the peer support list is also available on the COMPASS website should somebody want to go and see who is on that list. But we try to match people based on their preferences in terms of the specialty. Then we also train peer supporters to provide more informal peer support within their unit, division, department area. And so I could probably spend a whole hour talking about COMPASS, but I'm sure you're thinking wrap it up, Jodie, so I'll have a chance to maybe mention it a little bit more later. But it is an absolute jewel within Michigan Medicine.

Dr. Elizabeth Harry:

And Jodie, can people reach out to COMPASS to get support if they feel like they would like it after a particular event?

Jodie Eckleberry-Hunt:

There are so many ways to access COMPASS. Providers can send an email to COMPASS, we hear from patient relations and clinical risk. But even if you are a... Let's say that you're a physician in practice and you're concerned about a colleague, you can contact COMPASS and we can just reach out and people don't have to respond. And again, because it's an OCWR program, it is confidential. And I think it's important to mention that a lot of physicians maybe are a little bit concerned about counseling and reaching out in that way, but they are interested in talking to a peer supporter. And there's a whole part of our training focused on confidentiality. And again, because it's an OCWR program, it is confidential. We don't keep records. And I also must say that in working with patient relations and clinical risk way back when Kelcey was in consultation with the general counsel at Michigan Medicine who advised all along the way that these conversations are not subpoenable, there are no records kept. So it is, we try to make it as safe as possible.

Dr. Elizabeth Harry:

Well, I love that. And you speak something to how we've tried to reduce stigma and reduce barriers around seeking help. What other steps has OCWR or the office in general taken to create confidential support and to try to reduce the barrier or the stigma to reaching out?

Whitney Begeman:

I'd be glad to talk about that, Liz. Core to OCWR's work is that all of our services are confidential and we have our own internal electronic health record that only our team has access to. Secondly, I think a real gift to us is that counselors intentionally do not formally assign a diagnosis which assists with reducing stigma and helps to invite physicians to seek support in care, and that we aren't required to assign a diagnosis, also allows for our counselors to support physicians with clinical as well as subclinical concerns, including matters related to job satisfaction and burnout. So when folks are reaching out related to those concerns, we might think about it as professional work type counseling as opposed to clinical counseling.

Even still, regardless of what matters somebody is reaching out to address, our records are internal only to us, and that extends to our after hours crisis support team as well. Because that team is an extension of our office and functions with the same level of confidentiality, records are only available within OCWR, and we will use those records to ensure the highest level of continuity of care following a crisis call so that when somebody does call during off hours, we want to be able to follow up with them the next day to connect and invite additional support, whether that be a leader consultation or to establish counseling services.

Dr. Elizabeth Harry:

It's amazing all the steps that have been taken in really thoughtful proactive steps to try to create this confidentiality, reduce this concern around stigma and really respond when anyone at Michigan Medicine is struggling. Another huge pillar around the AMA joint medicine gold criteria is prevention and prevention of stress and prevention of things that create distress, and some of that can be in the EHR. So Greta, I'm curious, what inspired the launch of initiatives like In Basket 360 and Ambient AI documentation support?

Greta Branford:

Yeah, thanks, Liz. It has been well established for many years that burnout and provider turnover are increasing. And this was actually supported by our own KLAS Arch collaborative survey that we did in 2021 and 2023. This problem is not only for the providers who are experiencing these problems, but it actually extends to the whole healthcare system and the patient. Provider burnout is actually linked to worse patient safety and worse patient outcomes. And so also, if you think about it, if you have more turnover of providers, there's fewer providers and fewer appointments for which the patients can be scheduled into, which is a big problem for our organization right now. And finding replacement providers is a hard task, hard to do.

It's costly, cost between a half a million and a million dollars per provider to replace that provider who leaves. And so leaders are rightly concerned about this as much as the workforce themselves. And so it was a no-brainer. But in terms of where to start, that wasn't a big mystery either because if you walk and talk to any provider, they pretty much are always going to say that their notes like keeping their notes for the visits and dealing with the in-basket volume and the time you have to spend answering messages from patients and dealing with lab results, those are the two biggest pain points and sort of time sucks in our day. And so that is where we saw change first.

Dr. Elizabeth Harry:

And you talked about the notes a little bit. Can you share how DAX Copilot's being used in clinical settings and what impact it's had on cognitive load or burnout among our providers?

Greta Branford:

Yeah, it's very exciting tool. So this tool is transforming how providers and actually now even Allied Health staff are documenting their visits. DAX Copilot is an ambient documentation product, and basically I just take my phone into the exam room. It has a special Epic instance installed upon it so that it doesn't actually stay on my phone. It goes through a cloud directly to Microsoft, and I let it listen during a patient visit and after getting consent from the patient and then the LLM, which is large language model or this GPT type technology, it creates a note for me that's formatted in the way that we are used to writing our notes. It knows how to do that. It knows how to leave out the small talk or the interruptions. It knows what symptoms and medications typically go with which diagnoses and the like. And then we can also go back to see the written transcript and recall something if it seems different than what we remember from what the note states.

It isn't perfect. We still need to go back and make edits, but it's even better than most people's human scribes that we've had in the past. It gives us a solid head start and not having to type our notes during the visit is huge. It decreases the cognitive load, it allows us to connect with the patients better. We don't have to be typing and looking things up in the EHR while we're trying to carry on a conversation. And just knowing that something is collecting all of that data and the whole conversation for us to look at later relieves us from having to do multiple things at once and trying to get all that all on paper. So it's really a huge benefit to us. We have done some surveying of our providers before and after our first 515 licenses and it was overwhelmingly positive. I've been collecting these positive comments from emails and chats and texts from users since February.

We're actually up to 1,400 users now or so. My collection of love for DAX is up to seven pages long. So providers are reporting, they can go be with their family, they can go on a date night with their spouse. We've had people say that I was going to think about retiring, but I might not retire now, after all, I think I can go a few more years maybe. We're still trying to analyze the objective data from the HR, but the trend overall looks really positive. We're seeing statistically significant improvements in cognitive load, burnout, work-life balance and those kinds of things. And so we're super excited about that. We're also waiting to do the objective data analysis, as I mentioned from the EHR statistics. It'll be exciting to get that back. And then additionally, we're doing some research on what the patients think of it, and that also seems to be pretty positive so far. They like having a more face-to-face interaction with the provider, not having to interact with the computer as much during the visit. So that's super exciting.

Dr. Elizabeth Harry:

It is really exciting. I have to say, as a primary care provider, I've had a lot of patients comment on that, that they really appreciate the ability just to be present and I've really appreciated that. So let's pull on this data thread a little bit more. And Whitney and Jodie, how do you measure, assess and measure access to care OCWR's overall usage? How are things going in OCWR and what sort of trends are you noticing?

Whitney Begeman:

Well, what I can say is in terms of our work, all of our work in OCWR allows us to join with individuals and groups. And through those experiences, we learn about the pressure points, the challenges, and the stressors within the organization. And then it's through our counseling workplace resilience and leadership teams consulting and collaborating with each other, we're able to draw from that knowledge and awareness to be agile and strategic with evolving our services and programming, including partnering with teams to develop group interventions specific to their unique needs and challenges. And I think probably Jodie also can say something about COMPASS in this regard in terms of how we use these kinds of experiences and data toward reducing burnout.

Jodie Eckleberry-Hunt:

So one of the ways that we're refreshing COMPASS is we are getting regularly quarterly support group meetings for peer supporters on the calendar, and they're bringing forward trends that they're seeing in their units. Denise Ervin is the nurse leader who is my co-lead on COMPASS and I are actively talking, also about diving into some research to look at. I was just at the CHARM, the National Peer Support Group meeting last night, and they were talking about return on investment, measuring the return on investment in peer support. And that is something submerging that I would love to kind of get in on. But I will also add one of the great parts of my job is I get to do a lot of outreach. I do a lot of lectures, evaluate all those lectures and look at the feedback and in terms of the times that I spend with house officers in particular and fellows and hearing about their experiences of the stresses of training and just try to be flexible and meet those needs going forward.

Dr. Elizabeth Harry:

That's great. Hearing a lot of qualitative feedback, definitely keeping track on what are the themes that are coming up. Greta, you also mentioned that KLAS survey as a more quantitative measure in addition to the quantitative analysis of the ambient AI. Could you share a little bit more about the KLAS survey? What can we expect coming forward or moving forward with the KLAS survey and how does it help us keep our finger on the pulse of how people are doing, how our care teams are doing in relationship to our EHR?

Greta Branford:

Yeah. Yeah. Data is key obviously. And our KLAS Arch collaborative survey is... KLAS is a group of people who help to rate EHR and vendor in terms of how well they work in an instance, are they designed and do they work well for the provider that's using them? And they have this Arch collaborative where we join and with other member institutions, we develop best practices. We hear about other people's sharing of ideas, but in addition to that, one of the things they offer is benchmarking across the nation to see where you stand with your EHR instance and how people feel about it. Do they feel that it helps them take care of patients? Do they feel it's like bottom of the barrel? Do they feel that it's broken more than it works? Do they think that it really is useful in their day-to-day work? And then it puts you on a scale of where you fall compared to all the other organizations that do this survey.

And so we've done this survey twice before in 2021 and '23, and then we're getting ready to do it again in 2025 this fall, along with our sister organizations at UMHS West and UMHS Sparrow. And then we are going to be joining and using our Epic instances and merging them into one Epic over the coming years. And so as we do that, we're going to be needing that information from all three organizations to keep our finger on the pulse of how that's going. And so it includes things like the NASA task load index, it includes things like cognitive burden as measured by that, burnout scales, in basket, workload measurements, likelihood to turn over and leave the organization is included on there. As well as getting at the nitty-gritty of the EHR too in terms of how much you feel that you have an ability to change some of the build. Are you able to customize it? Do you feel you have support, downtime, training? All of that sort of stuff is covered in the KLAS Arch collaborative survey. So we're very fortunate to be able to do that.

Dr. Elizabeth Harry:

That's great. And so I just want to really highlight, we talked about how COMPASS is available to everyone at Michigan Medicine and how there's qualitative data, really trying to understand what themes are coming forward from the peer supporters. We're obviously getting a lot of data from our clinical teams from the Arch collaborative data as well as our own internal studies on how the ambient AI is driving things. We also partnered with Stanford's PWAC collaborative recently to study our research faculty to better understand how their well-being is and what are the key stressors for them. And we're now meeting with each chair to go through their data and to really help implement an action plan. There's also data being collected at the medical school level trying to understand what the drivers for burnout are there. And so I just want to highlight that this is a very nuanced thing where there's a lot of data being collected at different levels, trying to understand how each population is doing and what interventions will work well for that population.

We're just covering some of the studies that are being done in this podcast, but there's a lot of evaluation being done across all of our populations to really understand the drivers of burnout, including our right of Voices survey that asks questions around us too to our entire staff. So I just want to put a plug out there for everyone who's listening. If someone is asking, what's contributing to your workplace satisfaction and trying to understand the drivers, and if you're curious about who that person is, please reach out and we'll get you more information. So I'm curious, Whitney and Jodie, what's next? What's on the horizon for OCWR? What can we expect to see in terms of the future of supporting emotional health and resilience?

Jodie Eckleberry-Hunt:

Well, I will mention COMPASS, again, that's what I'm cheering on today it seems. We are on the verge of doing some really additionally cool things, I guess, in looking at episodes of workplace violence and how those are increasing and maybe even reporting of things that maybe weren't reported in the past and looking how COMPASS can support people who are on the receiving end of incivility or even workplace violence. I would also say that Denise and I are looking at how to provide additional support specifically for leaders. Leadership can be a very, very lonely position. And so how can we tailor interventions for that as well as, I think I'm hearing more imposter syndrome. So if you think about people who are developmentally new to their profession and being able to pair them with somebody who understands the fears associated with that. As well as, as I mentioned earlier, we are really going to have an eye for gathering some data, some harder data than we've gathered before. So those are some of the newer efforts with regard to COMPASS.

Whitney Begeman:

And I'll jump in to share that I'm very excited about the unique area of focus for OCWR on the next generation of physicians. Thanks to our wonderful partnership with the medical school, OCWR is home to the psychological care services arm of the expanded medical student mental health program. And each academic year, our team of therapists provides care to approximately 40% of the medical student community. And that tells us that many students are seeking help sooner or even establishing therapy as a basic self-care practice. We are learning from them about their needs and concerns and collaborating with the medical school to evolve our services and continue to integrate our support into the medical education experience. So this is no doubt going to have a ripple effect as these aspiring physicians move through their training and into their career.

Jodie Eckleberry-Hunt:

I just want to add, if I can, also, I really feel like maybe it deserves a specific call out for how important it is that we really intentionally develop our sense of community. I think that a lot of people feel lonely and isolated and maybe feel misunderstood. And there are a lot of things going on in the world that we might not feel like we can control, but we can control the energy we bring in supporting each other. I feel like that's understated. So just to put a fine point on it.

Dr. Elizabeth Harry:

I love that shout out, Jodie, and that ties really well actually to our belonging work in the BASE priority, which our office is partnering with Health Advancement to help sponsor and really trying to help think about how we create that sense of community for every single person at Michigan Medicine. And we got some great data to guide those efforts as well. So I really appreciate that shout out and that belonging effort plugs right into that. So that's wonderful. Greta, can you round us out? What are you excited about in terms of AI or other technology based or EHR based interventions that we can be looking forward to?

Greta Branford:

Yeah, that's a really exciting area right now. It can be a little bit scary because we don't exactly know how well it works and if it introduces any other errors or any issues. So we're being very cautious about it in our approach. But we do have several other AI tools that we're excited to evaluate. One tool can help respond to a patient's portal messages. So when the patient sends in a question, it can give a first draft of what a typical response might be. Again, to give us a little bit of a head start. I've been using this for a bit. It's not great just yet. We're working on improving it and improving the prompt. And so hopefully, that will be helpful more in the future. And then the bigger thing I'm very excited about is the summarization of large amounts of information.

That's something that AI does very well, and it's something that is desperately needed because whenever anybody comes into the hospital or they come in for a visit or they come in for a new patient visit, especially there is a mountain of health information that needs to come with them and needs to be digested in order to take care of that person well. The problem is that we typically have three to five minutes maybe or something to look back through the previous notes and gather information on the patient. And that clearly isn't enough. We have some people spending up to 40 minutes per patient the night before the visit looking through and digesting information to be able to understand what that patient needs.

And so if we have these summarization tools, which we're going to be implementing in the next month for a pilot inpatient and outpatient that looks at the past 30 notes and tries to develop a summary of what that patient has been through and the testing that they've had and the values and hits the high points, and then we can actually put in and redirect that summarization and say, "Please focus on their heart failure and look at visits from cardiology and discharge and rehab." And so we can fine tune it a little bit to look even more closely where we want it to to give us a head start. And then from those summarizations, it actually gives us reference points where we can jump and look at that information to get a deeper dive. It gives us, again, a head start, which is so helpful and will dramatically decrease that cognitive load.

Dr. Elizabeth Harry:

Well, I just want to first thank each of you because the work that you're doing is incredibly geared towards helping restore and promote joy and professional fulfillment and professional satisfaction for everyone at Michigan Medicine in the way that they engage in their work or learning day. And so to that end, to close, I'd like to ask each of you, what gives each of you hope or joy in this work and what is sort of one message you'd share with our listeners about the future of well-being in medicine? And Jodie, maybe we'll start with you.

Jodie Eckleberry-Hunt:

Oh, boy. I think that probably what gives me joy and hope the most is talking to younger learners and hearing how they're not afraid to talk about the things that are troubling them. And I think that in a positive way and supporting each other, and so the energy that they bring, the willingness they are to be human, I just think that that's fabulous.

Dr. Elizabeth Harry:

I agree. I love that it's, as you said earlier, a part of their sort of self-care practice. I know it's a part of mine. I think we all have to have our physical self-care practice, our emotional self-care practice, our sort of mental and cognitive self-care practices. And so I just love hearing that. Whitney, how about you?

Whitney Begeman:

I really love leader consultations. They're such a bright spot because it allows me to, I think, harness one of my superpowers as a clinical psychologist in that I can hold multiple truths and invite multiple perspectives and oftentimes find myself also speaking the language I do in my world is new language for physicians and other leaders. And I often receive feedback that the way I have framed something or the words that I use are so helpful toward inviting self-reflection or creating a pathway for engaging with their teams differently. So I find those very gratifying for myself personally. And the feedback I get says that leader consultations are truly helpful. And so to know that the work that OCWR is doing is effective is such a bright spot.

Dr. Elizabeth Harry:

I love that, Whitney, and I love that you're sharing too about the importance of leader well-being. And we know that when we talk about well-being-centered leadership, one of the core tenets is that we manage our own well-being and that we're able to model and have a lot of awareness of where we are going into a conversation because that can deeply impact our ability to lead in the way that we affect those around us. And I know our office has partnered with you and several others on leading through uncertain times and some frameworks for our leaders right now. And I know that the institution is deeply committed to making sure that each of our leaders have the skills and resources that they need to be able to not only care for themselves, but then show up as their best selves to support others. And it is a tough job. So I love that you're doing that work. And Greta, what brings you hope or joy in the work that you're doing?

Greta Branford:

Well, I always have liked helping other providers learn how to deal with the EHR in a way that doesn't make them crazy. None of us went to medical school to type on a computer and be tied to a desk or to learn how to bill a visit, but a lot of my interactions with providers is teaching them the shortcuts. I run home for dinner program where we learn efficiencies and we delve into every wrench and we make sure that they don't feel scared by the EHR and that they know how to use it wisely. But I think what gives me the most hope is actually all of the new AI things that we're getting to roll out, they're truly transformational and offer so much hope for people.

It's actually been really fun. I get to be like the DAX fairy or something. So it's super exciting to be able to have a tool that can make such a difference so that they can go back to focusing on what they did go to medical school. And that's actually to help people and to be able to listen to the person in the visit and offer empathy and not be worried about which buttons to click. And so it's a really super exciting time to be involved in this work.

Dr. Elizabeth Harry:

What I love about this is even though these may seem like really disparate areas, everybody is doing the same thing, which is helping those who help other people and helping them be able to do that well. And you guys are a handful of many incredible leaders we have across our organization that are working really hard to try to bring joy and professional fulfillment to every day for our teams. And we're just so honored for the recognition from the AMA, thank you to all of you for your contributions to that work and to everyone else on your teams and elsewhere who's participating in that work. And thank you so much for coming on and sharing some of the work that you're doing so people know how did we get this recognition and where are we going? And I guess just to close on my end, I would say that there's so many amazing things happening.

You guys have shared a lot of them, and there's a lot yet to come, and there's a lot that people are working on and we haven't hit, it's not like we checked off the box and we're done and we're not going to focus on this anymore. There's so much still to be done. There's so much momentum and so much enthusiasm from all of you and so many others doing this work. So I just want people listening to know that this is a point in time to sort of recognize where we are, but we're going to continue to build and continue to push the envelope to make sure that we create spaces for everyone who works, learns or investigates at Michigan Medicine to be able to experience joy and professional fulfillment when they come to work. So thank you all so much for joining me today.

Greta Branford:

Yeah, and thank you, Liz, for your leadership and for all of our leaders and being able to make all of this possible so that we can improve life for all of our providers and all of our staff and patient.

Jodie Eckleberry-Hunt:

Agree.

Whitney Begeman:

Thank you, Liz.

Dr. Elizabeth Harry:

Welcome to the Office of Well-Being Podcast. I'm joined today by Dr. George Mashour, Senior Associate Dean for Faculty and Faculty Development at the University of Michigan Medical School. Dr. Mashour is a nationally recognized leader in anesthesiology, neuroscience and faculty development. Today, we'll explore how leadership behaviors, strategic planning, and community building efforts can support faculty well-being and retention. So can I call you George?

Dr. George Mashour:

Yes, of course.

Dr. Elizabeth Harry:

Okay. So George, you've led departments, you've founded centers, you oversee faculty development across Michigan Medicine. Can you share what drew you to this role in faculty development and how you see leadership development as a lever to enhance well-being?

Dr. George Mashour:

Yeah. First of all, thank you very much for inviting me to the podcast. I really have always been interested in faculty development and actually at a relatively early stage of my career was appointed as the associate chair for faculty affairs in our department. And we have incredible team members. I do believe that the faculty are really key in actualizing our tripartite mission. They are the individuals leading the clinical care teams. They're educating, they're mentoring in the clinical realms, in the laboratory and in the research domain. And they are also creating new knowledge through research. So they are really the medium through which we achieve excellence and positive impact as an institution. So from my perspective, really the health of the institution depends on the vitality of our faculty and their ability to actualize their own career aspirations. So this is what drew me to faculty affairs in early stage. I really enjoyed that aspect during my time as a chair and now I have the great privilege of being able to serve all of our faculty across the 29 clinical and basic science departments.

Dr. Elizabeth Harry:

That's amazing. And I love thinking about the faculty development as a real lever to be able to give people the opportunity to thrive, to be able to be creatively productive in ways that serve our communities, which is a big reason that people come into healthcare. And I believe that our organization is very committed to really helping our faculty thrive, and part of that is this faculty development and making sure people have the skills that they need. And part of that is skills to the end of promoting well-being in the workplace. And so I'm curious, just from your vantage point across the organization, what signals have you seen, what executive level commitments, whether it's in people or budget or governance, have you seen that credibly signals to our faculty that their development and their well-being is strategic, it's not discretionary?

Dr. George Mashour:

Sure. Well, first of all, we have really robust offerings in faculty development and we are endeavoring to really stay in touch with the faculty to make sure that we're seeing their needs. We have thousands of participants each year across all 29 clinical and basic science departments, and we're really proud of the dimensionality and diversity of those offerings. And we also partner with departments and institutes, centers when they have faculty development or leadership development program. So I think that is reflective of a major commitment to have robust, diverse, frequent, and sometimes tailored offerings for faculty members. And, of course, the office that you lead, which is, I think, really remarkable and robust is another commitment, evidence of a commitment to faculty well-being.

Dr. Elizabeth Harry:

And when you think about this, how should we as an organization balance celebration of all this progress? We do have a lot of investment. We do have my office, your office, a lot of institutional programming, trying to go on, doing a lot of work, trying to reduce administrative burden, advance things through AI, et cetera. So we're making a lot of progress and then we want to celebrate that. And at the same time, how do we balance that with the knowledge that there's more to do and that we still really want to achieve an even better future state for our faculty?

Dr. George Mashour:

Yeah, great question. I think we have to celebrate moments. It's the same thing in an academic career. You celebrate those wins, you get the paper accepted, you get a grant accepted, but you recognize there is more work to be done. So we want to be celebratory, but we also don't want to be self-congratulatory and feel like mission accomplished. It most certainly isn't. I think the other thing that's really important, and I've felt this as a leader, as a chair and in the senior associate dean role in the past five years or so, it's a dynamic landscape. I mean, things are changing rapidly and I think that's another reason why we can't just view this as a static accomplishment. It's a dynamic. It's going to require ongoing energy both to address the unmet needs that currently exist with our faculty and other team members. I'm focusing on faculty because of my role, but also the new needs and new challenges that can develop and that have developed, the pandemic certainly is a great example of that.

So this needs to be ongoing work. There needs to be the continuous investment of energy and resources and attention. And the other thing that's important, and I try to live this and maybe could be doing a better job, is to make sure we're hearing directly from our team members. Because it is definitely easy when you're serving in a dean role or a chair role or some administrative position to think that you're doing the right thing, but to not really be connecting with the needs. One way I try to do that in making myself accessible to questions and concerns is to have virtual office hours where faculty can just spend time with me and they pop in and out. And I've met a lot of wonderful people that I wouldn't have otherwise met, but I also have a much better sense of where needs are just not being met. So definitely want to celebrate the moment, but recognize there's more work to be done now. And as healthcare changes, as higher education changes, as research changes, new needs are going to arise.

Dr. Elizabeth Harry:

There's so much richness in what you just said both between this idea that as the landscape continues to evolve, we need to make sure that we're continuing to equip leaders to be able to lead in these dynamic times and with changing landscapes and maybe the skills that worked to be a great leader five years ago or 10 years ago are not exactly the same skills that we need today. And so your office runs a lot of leadership development programs. How are you using those programs to help our leaders sort of stay current in the skills they need to navigate our current landscape?

Dr. George Mashour:

Yes. So I think the content needs to be updated. I think a lot of the core leadership principles probably haven't evolved that much. I think where we need to really stay ahead is in the modality through which we deliver this content. The traditional, let's show up in one room and spend the day together, it's just not working out in the same way that it used to. And I've seen a change post pandemic, and I think you brought a lot of great perspectives of how do we package this content so it can be received and consumed, if you will, by faculty members or other team members in a way that is convenient for them, it's meaningful for them, they can process it because I think we're in a different world in a lot of respects. And so for me, that I think is really important.

The other thing that comes up is how do we scale the leadership development opportunities, and again, I credit you with bringing some new opportunities to our office because the faculty's growing. We have more people who are interested, we have more leadership roles. And so I think that is an ongoing opportunity and challenge to think about how do we package this? How do we frame this? How do we stay current? And also, how do we scale this across a growing number of leaders? And in many respects, all faculty play some sort of leadership role. I work in an operating room as an anesthesiologist. There are leadership skills that are required for all of us in the OR, in a clinical setting, in a research lab, in a class. So I think we can all benefit from continued leadership development.

Dr. Elizabeth Harry:

Well, I love so much about that, especially the idea of kind of modernizing maybe how we deliver some of this so that we have scalability, recognizing that we have more leaders than maybe we even think. And the other piece that I love about that is that it gets rid of a little bit of the othering or the us, them, this sort of leader versus the frontline recognizing that we're all leaders in a way and we all follow in a way. And that's part of being a team and a culture that works together. And you mentioned earlier the office hours, which I think are an incredible way to create psychological safety for sort of safe feedback loops for people to share what's going on if they can't maybe directly navigate through their leader. Could you share a little bit more about options that you see that are available for people if they feel like maybe they are getting stuck trying to talk about something and they would like to escalate it maybe farther than where they're able to get through their direct leader?

Dr. George Mashour:

Sure. So I'll point out one resource and that is the Ombuds program for those who are grappling with a conflict. And that might be just one part of what you're referring to, but I think this does happen where people are in a challenging situation, they're in a conflict. Sometimes that conflict could actually be with their division chief or their chair and they don't know where to go. We have four ombuds at the medical school who connect more broadly with the Ombuds program at the university. And I really think they're an excellent resource because they're a neutral third party. They really understand the medical school policies, and importantly, the conversations are confidential.

They are not mandated to report events, they're not mandated to share information with me, and in fact, they don't. They come to me for more general advice. So I think I'm pointing out one resource and that primarily relates to conflict. Another thing that comes up though is just the complexity of our organization in terms of trying to figure out who to turn to when you have a certain issue. And I think that's something that we really need to work to improve in terms of... And this work is ongoing. How do we streamline administrative structures and how do we make it easier for people to get the information they need, get the decisions they need in a timely manner?

Dr. Elizabeth Harry:

So your office is part of many offices that are part of the assessment, trying to understand how our faculty are doing. And we do this in many ways, but one of the ways that we do this is sort of our engagement survey and we ask questions about how they're doing in many ways, including their well-being, but also their perception of their leaders. And I'm curious, as you think about assessment and as you think about understanding current state, what cadence of these sort of assessments it seems to be most meaningful without causing survey fatigue, and what would ideal state around assessment look like from your perspective?

Dr. George Mashour:

So the question of survey cadence is an important one. I think it's also important for leaders and offices to recognize that the survey that they're sending out is likely not the only survey our faculty or team members are receiving. And so I think if we're trying to establish a cadence that allows us to get our finger on the pulse of well-being without creating further fatigue or irritation, we really need to coordinate better. And we really need to think about the kinds of instruments that are going to be manageable for somebody taking the survey, but also rich enough in information to guide our actions. I think the other important thing, and I just want to call out that I don't think we've done a great job of this and I think we can do a better job, is how we close the loop and how we not only evaluate and make decisions, but communicate that back. And I think people do take seriously the data that are coming in and they focus on improvements. Sometimes we don't communicate that back to our team members to really establish that cycle of conversation.

Dr. Elizabeth Harry:

Yeah, it's a real challenge, I think. And having been part of that planning too, trying to figure out how to get the information to everyone in an digestible way is very challenging, and I agree with you, I think there's a real risk there if people feel like they aren't hearing back, then they don't want to fill out the survey the next time because they don't feel like they're hearing anything. And so part of the purpose of the surveys is really to understand how people are doing, how are they feeling from a well-being standpoint? How engaged are they? How do they feel like their leaders are interacting with them?

What kind of psychological safety do they have? And a great mechanism to also have a finger on the pulse of how people are doing is just community and interactions with people. And you talked about having these office hours where people can kind of pop in. I know your office does a lot around sort of community building structures. What are your thoughts around what kinds of groups or pulling together of people works well and has an impact in belonging and retention? And/or to your point, are we just past that? Post-COVID, is that not something that we can really do anymore?

Dr. George Mashour:

Yes. I think about this a lot in terms of culture. And I thought about it as a department chair and I think part of the challenge, a big part of the challenge is the size of our medical school, of our health system and a growing size. I mean, when I started as a faculty in 2007 in the department of anesthesiology, the department was largely housed in the office suites of the university hospital. We had MOT, but it was right across the courtyard. We had ICUs in the building, pain. It's very, very different now. First of all, we have more faculty. The teams are larger, we have more patients, there's more complexity, there's more geographical isolation. The cardiovascular center, East Ann Arbor, Brighton, the new children and women's hospital, and now the pavilion all create these sub communities and subcultures.

And I don't have a trivial answer because I think this is something that many of us struggle with. How do we continue to have a sense of shared purpose, a common culture, a common goal, a sense of community, a sense of belonging to the medical school or Michigan Medicine writ large as opposed to more local communities? So I think whatever the answer is, it's got to be multidimensional. I don't think that there's going to be one single approach that brings it together. I think communication structures are really important. I think accessibility of leaders is critically important. I think being able to clearly articulate and to repeatedly articulate our shared goals, our tripartite mission, the value that we place on that are all important. But it is an ongoing challenge.

Dr. Elizabeth Harry:

It is a challenge. And having just joined two years ago, it takes time to get your sense of the landscape and all of the interwoven pieces. And that leads me to think about things that your office has really done to help people when they land here and to help them really get their bearings in this very complex environment. And you have a lot of offerings in terms of launch committees and things like R01 boot camp and these sorts of things. And I'm curious if you could just share a little bit about that programming, what the intention is and how you see it serving not only leadership development but really well-being and a sense of belonging and inclusion in our broader community.

Dr. George Mashour:

Yes, thank you. There are a number of early opportunities for intervention. I mean, the new faculty orientation is great, and I've gotten to speak to that crowd the last two times, crowds of 50 to 60 new faculty members. And that's really I think a special event for me to be able to see many who have come up through this system, but also important, people coming from new institutions or new to us. So that's a wonderful opportunity. As you mentioned, we have at Michigan Medicine Launch Committees, we have a kickstart program that engages our clinical faculty. And importantly, we are starting to flesh this out, if you will, across the academic lifespan. Because another issue that comes up in faculty development traditionally is that there is naturally lots of attention on the new faculty, the junior faculty, those who are in that promotional stage from assistant to associate professor or whatever the equivalent is on the track.

And then traditionally there's been a cliff and support. You're technically senior faculty and there are not as many development offerings. So we have tried to address this through mid-career programming. We have now recently launched something for senior faculty and those who are considering retiring and our emeritus and emerita faculty to keep them as part of the community and to keep them engaged. So I think it's really important at the beginning, and there are a number of mechanisms, but it's also important to keep people engaged, to recognize that there are different challenges and different phases and different demands in different phases, both professionally and personally. So that's been a focus for us over the past few years.

Dr. Elizabeth Harry:

I love that idea of sort of support across the career lifespan and what are the different stressors that people might need support for. And so we've talked a lot about how we're trying to offer support directly to frontline faculty, how we're trying to offer leadership development to the leaders that they interact with and the positive impact that both of those things can have on professional fulfillment or well-being. And I'm just curious your thoughts on how we will know if we've been successful. How will we know if these types of investments directly in our faculty or in the folks that are leading our faculty are successful in creating this environment of professional fulfillment or reducing burnout or intent to leave? What are your thoughts?

Dr. George Mashour:

Yes, I don't have a trivial answer and you might be able to answer the question better than I can. I think the engagement survey data are important to track. I'll tell you as a chair in the past, I was really looking at who's coming, who's leaving, who's staying. And for me, in that composite calculus of well-being, being able to hold onto great people was the index for me that okay, it might be challenging in many respects, but we must be doing something right if we are bucking the national trend in my field, for example, of having a shortage of anesthesiology faculty and we're growing our faculty and we're robustly staffed.

So I do think that that very basic index is important. And you can see what happens in different units when conditions start to change, people start to leave. And again, pursuant to our earlier conversation, this really is a dynamic. It's not you don't achieve something and then you're done. It's not set it and forget it. It is constantly reevaluating what's going on, not just within Michigan Medicine, but outside of it, what's happening in neighboring health systems, what's happening in other academic systems, peer institutions. And it just really needs to be a continuous process.

Dr. Elizabeth Harry:

Yeah. I love that idea of continually attending to it in that it's never a destination. It's the way that we do things. It's a journey. And to that point, my final question for you would be what advice would you give to an emerging leader who really wants to center well-being centered leadership or some people call it a human centered leadership as part of their leadership style during their journey?

Dr. George Mashour:

Yes. For me, and this is just one person's opinion, I think it's important to have a framework for well-being or job satisfaction. I had a very simple three-dimensional framework, and that was, it's about time, it's about money, and it's about the qualitative experience. And a lot goes into that third category, a sense of purpose, a sense of community, a sense of meaning, joy and work, et cetera. And it's pretty simple, and it's probably not comprehensive, but I think it captures a lot, and it did for me. And when I made decisions, I thought about those dimensions and I thought about how is this going to impact someone's time? How is it going to impact their compensation? How is it going to impact their experience of being a team member here or their autonomy or their sense of feeling valued? And I certainly didn't get it all right.

But I think having a straightforward framework, whatever it is for you as an emerging leader or senior leader, but then leveraging that framework and the process of decisions so that when you have resultant structures, you've got that factor built in because it's got to be intrinsic to the system. It's not something that can come in from outside. Like many things like quality clinical care, it's not an add-on. It's got to be intrinsic to the system. And so I think finding ways to make dimensions of well-being or job satisfaction intrinsic to your decisions, and therefore the resultant structures of your departments or units is important.

Dr. Elizabeth Harry:

But as we think about having well-being not just be a value, but really part of our strategy, how do you think about the impact of having faculty that are well, not only the impact it has on them, but the scalable ripple effect that it has on the institution as a whole?

Dr. George Mashour:

So one dimension of this, and I'm sure there are many dimensions that go beyond the individual who's experiencing the wellness, is that I would suspect that many of the conditions for a sense of well-being are also the same conditions for creativity. And ultimately, what we want to do at the University of Michigan is to make a unique and major and significant impact on our communities and our patients, our learners, fields of scholarship, the state, the nation, the world. And we do that by developing great ideas and unique ideas and actualizing and operationalizing them. I think faculty members and other team members who are in a positive state and relationship to their work and to their teams are likely going to be able to be more creative in more unique ways than if they are stressed or burned out. So I think to me, that is one connection between that subjective experience of well-being and the institutional impact that we can have.

Dr. Elizabeth Harry:

I love that. And it's a beautiful picture to paint, too. You can just picture this space where people are really getting to tap into creativity and envisioning being part of creating the future that's possible. And I think that's a really exciting note to land on. So thank you so much. And your leadership is helping shape a culture where well-being isn't just a value, but it's part of our strategy. And so I'm really excited to see how all these efforts that we've talked about are going to evolve and continue to impact our faculty. So thank you so much.

Dr. George Mashour:

Thank you, Liz.