This year’s Intersociety Conference, hosted by the American College of Radiology, talked about Fostering Wellness & Professional Fulfillment Through the Development of Highly Functioning Teams.
Since the President-Elect of the Society of Interventional Radiology (SIR) couldn’t make it, I attended in his place. It was an honor, and a once in a lifetime chance! The Intersociety Conference is an exclusive gathering of leaders from many radiologic, rad onc, and radiation physics societies.
The venue for the conference, Skamania Lodge in Stevenson, WA, is situated on the Columbia River Gorge, one of my bucket list destinations. Hiking around the grounds of Skamania, I felt like I was in a rainforest. Petite ivy leaves cover swaths of ground everywhere, under the shade of mammoth trees. Ivy creeps up the sides of the trees, concealing bugs and woodland fairies, I imagine.
Later, I enjoyed a soak in the grotto-like hot tub. Plump raindrops plopped on my face and shoulders, as I chatted with a traveler nearby. I decided this was the perfect venue to learn about and discuss solutions to the stressors affecting our daily practices.
During the conference, Tait Shanafelt, MD, Chief Wellness Officer at Stanford, discussed real-life examples of what it means to be a part of a culture of wellness. He’s been studying physician burnout for 20 years, long before it was a hot topic.
Through his lectures, I learned about the Stanford WellMD model, which is comprised of three parts: a culture of wellness, efficiency of practice, and personal resilience. It’s not just about recommending physicians meditate or do yoga; it’s about recognizing the parts of the system that are burning people out. One lecture focused on the difference between what our culture claims is important (physician wellness), versus what the culture actually produces (excess physician clerical work). This causes a moral dissonance, while revealing a culture’s true priorities.
Doctors want to be great at what they do, but that doesn’t depend on their knowledge and skill alone. They need an environment that supports and encourages excellence: hence, the concept of highly functioning teams. To be a great interventional radiologist (IR), for example, you can’t do it alone. IRs rely heavily on support staff, like techs and nurses, just as the body relies on blood circulating through our vessels. Without support, our brains and hands wouldn’t work so well.
What Dr. Shanafelt discussed about practice efficiency really hit home. For about a year, my department suffered from crippling nursing turnover. Some nurses used IR as a stepping stone, with their eyes trained on nurse practitioner school. Others realized they preferred working with infants and new parents. Some were attracted to IR as a way to maximize overtime pay, but became disillusioned when they realized how taxing a call weekend could be.
For those that remained, there was a culture of learned helplessness. Management burdened the staff with excessive handoffs, fragmenting the RN-patient relationship. When this happened, the nurses didn’t know their patients well. It was frustrating, and decreased work satisfaction for all of us.
IR nursing is a specific skillset. Arriving from the ER or ICU, nurses need about a year of training to become really good IR nurses. Because of staff turnover, I was always training new nurses. Since people kept leaving once they were trained, my extra efforts weren’t going to improve the quality of our practice long term. It was not just inefficient, it was disheartening.
At the Intersociety Conference, I learned how much stress is incurred when a team loses just one member. This made me feel compassion for myself that year, when we saw nurses come and go, one after another.
At the time, I struggled. If I could just be perfect all the time, we’d get through the week. If I could know every detail about every patient on the board, I wouldn’t need to rely on anyone else. It was exhausting.
When support is lacking, it overburdens the physician. Burnout creeps in. Mistakes become more likely.
With improved staff retention, there is a boost in departmental morale. Since members of a highly functioning team are empowered to work at the top of their license, nurses and techs attend to some of the issues that would otherwise be handled by a trainee at an academic center. I depend on staff to communicate with departments throughout the hospital. They prepare patients, and shepherd them through procedures. Proactive staff members can often answer their own questions and accomplish much of their work without physician input, through applying their experience. This frees up physician bandwidth needed to address the next clinical conundrum.
Being a leader is hard because you’re expected to produce results, despite factors outside your control. For example, even as Chief of IR, I have no real control over hospital staff; they are employees of the institution. Even hospital-employed leaders don’t have total control. They can try to build a strong team, but have competing pressures, including budgets and regulation.
For now, our management seems to be the ticket to maintaining a highly functioning team. They have set expectations, and allow members to practice with as much autonomy as their scope allows.
As a result, my quality of life has soared, and I enjoy work more. When I enjoy the work, the patient experience improves. When we work as a cohesive team, the resistance is relieved, and I feel we can handle anything that comes our way.
Dr. Shanafelt recommended the book Tribal Leadership, by Dave Logan et al, which describes research on great leaders. Its essence is about how exceptional leaders leverage naturally occurring groups of people to produce loyalty, productivity, and innovation. It’s a great listen so far.
Dr. Shanafelt is my new hero. It was a privilege to hear him speak a couple weeks ago. Check out his outstanding work.
Let me know what you’ve done at your place to help retain staff and keep morale high. What gives your department its team spirit?
The path can be riddled with failures, even if you're doing it right. In this recording, I share some of my gaffes with you.