Alleviating provider burnout and promoting a culture of wellness are two huge areas of focus for any successful health care organization. But with the rapid-fire pace of health care, what strategies and solutions can be implemented? In this conversation, Kristin Jacob, M.D., medical director of the Office of Physician and APP Fulfillment at Corewell Health West, discusses the organization’s foundation for well-being strategies, the successes they’ve had in reducing burnout, and the vital importance of "change agents" to propel the work forward.

Tom Haederle

Welcome to Advancing Health. Coming up in today's episode, a conversation with Corewell Health about alleviating burnout and promoting a culture of wellness. What individual physicians can do, what hospitals and health systems can do, and how, in the end, healthier providers lead to healthier patients and communities.

Chris DeRienzo, M.D.

Hi, I'm Dr. Chris DeRienzo, the chief physician executive of the American Hospital Association. As part of my job at the AHA I spend a lot of time on the road. And being on the road that much I get to be in a lot of hospitals with a lot of really interesting people. I am ridiculously excited to get to spend some time with Dr. Kristin Jacob.

Chris DeRienzo, M.D.

She is the medical director of the Office of Physician and APP Fulfillment at Corewell Health West. Kristin, we actually got to meet a few months ago. In our first go-around to trying to launch this podcast, you were spectacular and my recording was a total disaster. And so we get to now do this remotely together. Thank you so much for being with us.

Kristin Jacob, M.D.

Absolutely. Thanks for having me.

Chris DeRienzo, M.D.

As we get started, the first thing I always like to ask is to tell the audience and me a little bit about you and the role that you get to serve at Corewell Health.

Kristin Jacob, M.D.

By trade, I practice outpatient internal medicine and pediatrics. I practice primary care, and that's incredibly foundational and important to me. I also am a mother and of three kids that are school age. So I would say that at my core, I identify most deeply with that. But I have also had the opportunity to be a leader within the system.

Kristin Jacob, M.D.

Kristin Jacob, M.D.

And so really proud of the work that we've been able to establish and the strategy for so much more work to be done in the future.

Chris DeRienzo, M.D.

We were having a little conversation about this before we started the recording, but the title, Physician and APP Fulfillment is an interesting one. Tell us a little more about that. Like, what does that actually encompass?

Kristin Jacob, M.D.

Yes. So it was a few components were really important to that name. So when we build our strategy, it stems from the Stanford Professional Fulfillment Model. And so that encompasses three key domains promoting a culture of wellness, promoting efficiency of practice and personal resiliency. And whenever we speak to this model, we're really careful to point out that two of those three domains really lie within the hands of the system, that there's system responsibility.

Kristin Jacob, M.D.

We know that 80% of the drivers of burnout occur at the system level. That us as clinicians, as physicians and APPs do not have a resiliency deficit. So that word fulfillment has been something that had really resonated with our populations. We will often use it somewhat synonymously with well-being. But I think that when we get to the core of our why and our call to action for the system, is to support our physicians and APPs so that they can take the best care of their patients.

Kristin Jacob, M.D.

And that really gets to the core of how all of us altruistically showed up to this profession. And getting back to the core of that.

Chris DeRienzo, M.D.

I love that because you're right. Well-being isn't just sort of a single leg of a stool. It has to be multi-part. And I love that you've gotten to craft a role at Corewell, that recognizes that from the outset and acknowledges that, in order to improve our fulfillment, you know, it's not just a focus on me. That's an important thing.

Chris DeRienzo, M.D.

And I think as physicians, we've historically done a really poor job at recognizing that. But it's a both end. There has to be a ton of system work. But before we dive into that more, tell us about those communities, because one of the things that we've heard from folks in roles similar to the one that you serve for Corewell Health West is we're exposed to a lot in the practice of medicine, and much of what we're exposed to has to do with the communities who we get to serve.

Chris DeRienzo, M.D.

So who are the people they get to work with in this part of Michigan?

Kristin Jacob, M.D.

Yeah, absolutely. So we are based in Grand Rapids. So and the surrounding areas is a population of about a million people. So our two largest hospitals are based there. And then we have additional 13 regional hospitals that make up that extended area. And so certainly a large amount of rural population that we are serving, as well as our local Grand Rapids-based, certainly a diversity across social determinants of health.

Kristin Jacob, M.D.

From an ethnicity standpoint. And we have gone through the process of really working as an integrated health care system for quite a few years now. And so I am grateful that we have been able to preserve, with still work to do, but preserve the local communities of our regional hospitals. That's been incredibly important to respect the communities, to respect those populations, while at the same time leveraging the efficiencies, and additional resources from being part of a large health care system.

Chris DeRienzo, M.D.

Incredibly well said. You know, I've seen that when I was in western North Carolina, every community has its local flavor. And it's an incredible challenge to try to balance the value of systemness and ensuring that if I walk into a hospital in Traverse City or in Grand Rapids, that some of the experiences, the core clinical pathways are as easy to execute on as they are anywhere else, but recognizing that each of those communities grew up in a different way and they have a different local population, their physician population has a different history behind it.

Chris DeRienzo, M.D.

And so in order to do the job that you do, having that recognition is super important. You have a lot to be proud of. And since we have relatively limited time on a podcast, we get to talk about it. What is one thing that you are incredibly proud of in the work that you get to do?

Kristin Jacob, M.D.

I am incredibly proud of the way that over the last five years since we started this, we have been able to shift culture within that organization. And I define that, you know, in its simplest terms of I walk into a meeting and I am not the only one who is talking about well- being. I am not the one inserting myself, the language, the vernacular that the understanding is coming from our operations leaders, from our finance leaders.

Kristin Jacob, M.D.

And so it really proves the case that this is starting to evolve into

a notion where well-being is everybody's responsibility, and there's a deeper understanding of the value of taking care of people as our greatest resource within health care. And I think that that's been achieved in a number of different ways. We started this work quite organically with a small team, some of the most foundational things we've done have been, using an assessment tool.

Kristin Jacob, M.D.

So we use the Well-Being Index yearly as our validated assessment tool. And it is a helpful self-assessment tool. It’s a helpful tool as a resource, but incredibly important to promote the platform and be able to speak to, we measure what matters at our organization. And so elevating that to bring visibility and accountability throughout the organization has been incredibly impactful.

Kristin Jacob, M.D.

And then also having a robust followup plan. So what we have done is make sure that we get detailed data back to every clinical service line, large independent group. We're encouraging them to put action plans together that align with their already established or enhance the operational goals that they are already focusing on. And then early on in this work, we had used that platform to also then look out into our community for change agents ¬— who's passionate about this work?

Kristin Jacob, M.D.

A lot of spaces had a lot of organic well-being work going on. How can we bring those physicians and APPs that are passionate about doing, propelling this work forward in their space to become liaisons of our office? And so we have over 60 colleagues that are part of our Well-being Champion Network, who are existing knowing our resources and our programs.

Kristin Jacob, M.D.

While that can be available to support their colleagues, that can share the resources, that have funding opportunities to propel work forward in their space, and we know that so much of burnout is local. What the primary care office needs in one region is very different than the cardiothoracic service line in another hospital. And so getting change agents at the local level has been incredibly important for spreading the word and also changing that culture and starting to change that culture.

Chris DeRienzo, M.D.

That is so true and spectacular on literally all fronts. And I also recognize that this is a journey. So I'm sure there are still some things that you find frustrating. What is one of the things that you think is most frustrating to your teams right now who are trying to continue propelling this flywheel now that you've got going across a huge swath of Michigan?

Kristin Jacob, M.D.

Yeah. So I think that, you know, we have had, you know, five years now to build foundational programs. So we needed to especially walking through a pandemic, recovering from a pandemic. We needed to have strong mental health support, which we have both through our EAP and our internal mental health providers. We have invested in coaching because we know that's an effective way to mitigate burnout, peer support group sessions, and so now feel fairly confident that we have a profile of signature programs that can meet people where they are foundationally. Where we really have been trying to get is getting upstream of those drivers, looking at using data, using the literature, using the

Kristin Jacob, M.D.

feedback from our own teams about what are those drivers of burnout, and they tend to be consistent. We hear administrative burden as essentially number one. We hear flexibility. And that's an extraordinarily broad term that can be everything from your call schedule, to your day to day, to how the FTE is designated to workload. And so those are certainly two areas that that we have been digging into.

Kristin Jacob, M.D.

And I think this is all on the backdrop of we are chronically understaffed in terms of both our support staff and just the shortage of physicians. And workloads and acuity going up. And so I think that when we think about that, we've certainly taken some impressive strides in each of these areas.

Chris DeRienzo, M.D.

Yeah, you hit on something that's challenging in lots of ways. One, clearly, we can't possibly recruit our way out of the workforce crisis that health care faces. We know that even if every school of clinician threw its doors wide open, we would still, according to entities like the Bureau of Labor Statistics, be tens if not hundreds of thousands of FTE

Chris DeRienzo, M.D.

Short of what demand is going to be. So that means we have to innovate and we have to transform. And doing that is hard, going through, you know, that that kind of change in models of care means that what I'm doing today is something different than what I learned to do, perhaps in medical school 15 or 20 years ago.

Chris DeRienzo, M.D.

And having a leader like you able to walk with folks through that change and to connect them to, here is the why behind these decisions that are being made, is so, so important. You are such a strong leader on the fulfillment front. If you were sitting with policymakers either, up in in Michigan or in Washington D.C., and they asked you, what's one thing we could do to help make the work that you do easier?

Chris DeRienzo, M.D.

What would you tell them?

Kristin Jacob, M.D.

Two things come to mind. I think that looking again, going back to that foundational basic, that we as clinicians are higher risk for suicide, for mental health disorders. We are a high- risk population and thus we need legislation to protect us. And so, I want to point out that supporting the work of the Lorna Breen Heroes Foundation in making legislative change at the state licensure level, as well as encouraging and empowering hospitals to change their credentialing language, is incredibly important, and I'm proud that at Corewell Health, we were just awarded the Heroes Foundation recognition that we have changed all of our credentialing at our hospital, to align with best practice.

Kristin Jacob, M.D.

The other component is I touched on administrative burden, and there's so many ways that legislators could impact them. This everything from addressing the burden of prior authorization and other things from that vein, all the way to looking at and helping guide and support using artificial intelligence for supporting the work of the clinician. That's been a niche that I've been incredibly interested in.

Kristin Jacob, M.D.

We've been running some really interesting pilots here at Corewell Health and seeing astounding outcomes. And I think that, having some guidance, support. This is to your point. Working smarter, not harder is going to be the way of the future. And so whatever we can do to smooth that runway so that all health care organizations can have access to those resources would be very exciting for the future.

Chris DeRienzo, M.D.

That is an uplifting note to end on. Kristin, it has been a true privilege getting to spend some time with you today. And thanks to all of the listeners in the audience. We look forward to catching up again soon. Take care.

Tom Haederle

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