How Houston Methodist’s Joy in Medicine Initiative Is Redefining Physician Wellbeing

<p>There is no quick solutions I unless you really understand the problem and then you have to prioritize what you're going to do. There's endless things that we can invest in and do. But we really uh went about this very seriously. [Music] Hello everyone. This is Cole from the American Journal of Healthc Care Strategy joined by a really special guest today from one of my favorite institutions, Houston Methodist, Dr.</p> <p>Shawl, uh who's just an incredible physician leader with so many years of really interesting experience trying to push health care forwards. Dr. Shawl, please introduce yourself. Hello, my name is Schlomit Chal. I'm a clinician scientist. I am I've been in academic medicine my entire career. I'm a retina surgeon by training. Uh before I joined Houston Methodist, I was the chair of the department of opthalmology and and visual sciences at the University of Massachusetts.</p> <p>Then I became the president of the medical group at UMass Memorial Health. And in the past two years, I'm here at Houston Methodist as the chief physician executive and as the CEO of the Houston Methodist Physician Organization. It's so impressive to have you on, Dr. Shaw. You have kind of continued educationally to advance your career. You know, you have your MD, PhD in biochemistry.</p> <p>You also not too long ago got your mers in healthcare management from uh the Shan School of Public Health at Harvard. And so you've advanced your career in education. You've also continued to kind of level up in your impact as time goes on to where you are at Houston Methodist. I have to ask one of the first questions. What made you land at Houston Methodist? With all your accomplishments, you probably could have gone anywhere in the country. What brought you to Houston? Yes.</p> <p>So, I didn't know much about Houston Methodist. And you and I kind of discussed before the show that, you know, not everybody has been to Texas. And it is certainly if you're on the east coast or the west coast of the United States, yeah, the state of Texas is very far away from you. However, I really learned about the leadership of Dr.</p> <p>Mark Boom during the pandemic and you during the COVID pandemic, if you remember, Eastern Methodist was one of the leaders uh in healthc care during that very difficult time for healthcare and for our country. And so I became intrigued when I interviewed for my next opportunity. I already admired uh Dr. Boom for his leadersship style and for his courage.</p> <p>And as I went through the interview process here at Houston Methodist, I discovered that this is a wonderful organization, you know, one of the leading organization in terms of employee engagement. Uh people love to work here.</p> <p>uh we are really our our moto here is leading medicine as you can see behind me leading medicine and it is really we are really leading medicine in so many different fronts and so I'm just delighted to be part of this organization you said that I am uh you know have invested a lot in my education I still feel I'm learning here so much from so many leaders in this organizations not only uh Dr.</p> <p>boom, but his entire executive team really uh incredible people that I look up to and learn from every day. So, I'm delighted to to be part of this organization. And one of the reasons uh you know, as you said, most people haven't or a lot of people have not been to Texas or have not thought of it as this medical hub, but as I have, you know, I met Henry Burns who was one of the fellows there. I met Arian Dattle who's doing chief culture work now.</p> <p>I I've met a lot of other staff members along the way and even though I've never been to Houston, I can tell the excellence, the commitment. I've also read a lot of your data. I've read the, you know, the tax returns. I've read employee engagement reports and you all really are doing incredible things at Houston Methodist. The data reveals that.</p> <p>Um, one of the things though that I really wanted to talk about was this important initiative that you're all working on and this is that that joy in medicine initiative. And this is so important because as we're talking to our audience, we're hearing of course that physicians are burnt out. But even more concerning from the administration end is that administrators don't know how to help.</p> <p>They're kind of stuck spinning their wheels trying to assist their physicians, trying to reduce the burnout and they're becoming burnt out themselves, trying to help the physicians in fighting their burnout. And so when I heard that you were working on this incredible initiative that had been really successful, Joy Medicine, I really knew I wanted to talk to you about it. Can you share a little bit about what this initiative is and how it came about? Yes.</p> <p>So, first a little bit about us because you kind of touched uh about you know Houston and where we are. People are thinking you know Houston Methodist are you only in Houston and so I would like to give a little bit of perspective to people. You know what does it mean to be in Houston? And uh I have a little bit of a diagram here that I I love, but what it says, you're in Philadelphia, right? Yes.</p> <p>So you can put the entire city of Philadelphia next to Baltimore and Chicago and Detroit, one next to another like a puzzle, and that whole entire area would be smaller than the area of Houston. So Houston is a giant city. So if you think about it, it's actually bigger than many states. is almost at the size of the state of Massachusetts. We wanted to give that perspective to really say we are dealing with many people. We have about 33,000 employees at Houston Methodists right now.</p> <p>And we employ almost 2,000 providers, physicians, and a hospitals. There are also physicians who are not employed or provide pro providers that are not employed but work in our different hospitals almost nine hospitals. I think in like a week or two it's going to be nine nine hospitals throughout our our system in in Houston. So really when I joined uh I told you that I knew that this is a great organization and I was basing it uh on our press gaming data and I also have this in front of me.</p> <p>Our employee engagement scores here at Houston Methodist in 2023 when I joined the organization was 4.46 46 out of five which is just to translate it it's the 96 percentile ranked in the country. So in terms of employee engagement we are really doing something really well here at Houston Methodist and not only that if we compare it year out after year we keep improving our employee experience is going up.</p> <p>uh if we have to uh compare it to our physician experience, the physician experience uh in that year 2023 was 4.18 out of five which still is above average score. It's a good score. It's not a terrible score. Uh but it actually um aligns with the 66 uh percentile.</p> <p>So nowhere at the at the top percentile that we want to be andap yes there is a gap and we call it uh the physician employee uh gap why is there a gap if we are employing I'm talking about employed physician right now and employees who are not physicians so if we're employing everybody how come the experience for our physicians our healthcare providers is so different than our uh employees and you know I'm a physician scientist I'm always curious I don't come with an answer I always come with a question so the question was why and how can we discover the reasons for it and not only that what can we do about it so when I joined I didn't know a lot about uh wellness or professional fulfillment or anything and I had to really learn.</p> <p>So one thing that we did here at Houston method is we joined uh PEWAC which is an academic uh consortium for wellness for physicians. So physician wellness academic course consortium PEWAC it's le led by Stanford but there are many of uh very prominent health care systems all over the country that were already part of uh PWAT. We joined in 2023 and we learned about their framework for wellness. So they develop a framework that I think that makes a lot of sense and it has really three parts.</p> <p>One part of the framework was really the culture of wellness. culture of wellness wins. You know, does or your organization does your health care system really care about wellness and you know how is it u manifested in your everyday uh life in the way that the leaders talk in the way that the priorities are set. So this is one part of the three uh parts of the frame. The second part is really the efficiency of practice. How efficient is your everyday life?</p> <p>You come to clinic or you come to surgery, you need to take care of your patients. How easy or how difficult it is for you to do so. So this is the second part. And then the third part is really personal resilience. We heard a lot about personal resilience during the pandemic as well.</p> <p>We heard it you know from uh the uh our parallel industry which is the tech industry everything that you know Google and Amazon is doing for wellness for their own employees and how might you develop personal resilience in employees and specifically physicians. So we completely adopted that framework and we went on one something that we called our Jimmy tour. Jimmy. It's a Texan name. It's stands for the Joy in Medicine Initiative. Jimmy.</p> <p>And that tour we went and met our primary care physicians where they are. We had to start somewhere. So, we started in primary care. And you know that primary care physicians if you do you know wellness and professional fulfillment uh surveys you know that usually primary care physicians score at the bottom of the pack. So we wanted to start with them and see what what can we do what can we learn about their experience taking this frame way uh into our mindset and we asked three questions.</p> <p>We went to the physicians where they are. So, I told you how big and how large Houston is. So, sometimes it took us two hours to drive to where our physicians are and sometimes, you know, it took us less. But we really we when I say we, it's not only me. It's myself, but my entire executive team um and we have also a professional fulfillment and experience team. We went to meet the physicians where they are and we ask three questions. The first question is who are you?</p> <p>We introduced ourselves as the executive team in person and we introduced we asked them to introduce uh them themselves so we can know them on a personal basis. So this is the question first question who are you? The second question is what's good here at Houston Methodist? What do you like? Why do you work here? And the third question is what can we do better? What are the things we call them pebbles in your shoes?</p> <p>What are things that are causing you know points of friction that really kind of ruin your day and what can we do to make them better? So that was going on in the entire year 2023 and that's how you know in a in a very meticulous disciplined way we met all our physicians face to face primary care physician and then we we got the answers to all these three questions. How many physicians did you do you think if you had a ballpark or how many offices did you have to go to and and have to meet?</p> <p>So we have 250 primary care physicians and we met in person almost 200 of them. So you know in between you know maternity leaves and vacations uh we really met the most of them. And I would like to emphasize to your listeners because you just said, you know, administrators not do not know how to help. You do not know how to help if you don't hear what the problem is from the physicians. And in order to hear what the problem is, you know, it's not enough to fill surveys.</p> <p>Surveys were very good at surveys and surveys are important. I'm not saying they're not, but one very important act of respect is go to the physicians where they are. And we also toured clinics in in that area to see you know the actual physical environment that they are in and also get to know them a little bit on a personal level. They got to know me and they got to know uh our executive team and they got to ask us questions uh directly.</p> <p>So that's a very important act of respect that I would kind of give as a tip to your listeners. It's a it's a lot of effort. It's a lot of work. Um it's a lot of organization that has to be done but if you do that that's already you're ahead of the pack. Is there so you know when you're going to these offices and you're speaking with individuals I'm sure that you know some of them were probably very happy. I'm sure that some of them were probably not very happy with with different things.</p> <p>Is there any way that you prepared yourself and your team? I know that you know you're a physician with lots of leadership experience already. But is there anything that you did to prepare yourself? I know I'm early in my career and I feel like I'd be very nervous engaging in this kind of work, right? I'd be worried about some of the negative things that are going to be said or some of the tensions that might arise. Any tips uh for that? Yeah.</p> <p>So, I say, you know, first of all, it's not your age that makes you nervous. It makes you nervous because you are a human being and as human beings, we do not like bad news and we do not like criticism. And it really kind of hurt us that, you know, somebody's gonna say something bad. And you're not alone.</p> <p>I mean, our administrative team at the beginning when I kind of said to our chief operating officer, we're going to go and we're going to hear all these things and we're going to go to them and all of us are going to be there. You know, he was nervous as well. He, you know, oh, it's a we've never done that before. It's a little bit uncomfortable. But this was really an empowering experience for all of us and for our physicians. I went there as I go in every place. I am always a forever student.</p> <p>So I went there to really learn and as we structured the questions the first question was what's good here right the after who are you the first thing that they had to say is what's good. You didn't start from the bad. It was heartwarming and enormously rewarding to hear our own physicians, employed physicians, stand up and say, you know, I've worked all over the United States and this is the best system I've ever worked in. Many people said, and this is open questions, right?</p> <p>You don't give a multiplechoice answers. Many people said, I am so proud to be part of Houston Methodist System. I know we provide the highest quality of care to our patients and I am so proud to be part of a system that quality of care is our top priority. Many people said I am very happy to work here because I appreciate the relationship that I have with my team with my fellow physicians with my team members that are not not physicians.</p> <p>So as an executive sitting there and these are sometimes you know room with uh more than 100 people and sometimes there are intimate room with 20 people depending upon where we we went to you're sitting there it's it's a you know everybody that has a heart the heart a little bit expands and you know you already feel joy just by that.</p> <p>Now the second question was you know what doesn't you know what is what are the pebb pe pe pe pe pe pe pe pe pe pe pe pe pe pe pe pe pe pe pe pebbles in their shoes and people after you went through that you know kind of introduction and after you talked about everything that is good we also talked about you know what are the pebbles in the shoes and you know I have here the data there are three things that we heard in a 100% of the rooms that we went to and these three things are that it's very difficult for our primary care physicians to refer to social workers and social services.</p> <p>And we needed to hear that because we needed to build an infrastructure within the physician organization to make it better for our providers to refer to social services. So this is a you know it's a valid criticism.</p> <p>It causes you know uh loss of joy and it really you know people care physicians you don't go to become a physician especially a primary care physician if you don't care about your patients deeply if you're unable to help their social aspects of their lives you feel that you're not doing your job as you could be. So we did that. The second thing that we heard is that uh it's the most important thing for our providers, the most important thing is to start on time and end on time.</p> <p>And if you know people are late and the clinic starts late, if patients don't show up or if the clinic lingers you know way after it's supposed to end, this is really a big thief of joy. So we knew that this efficiency of practice should be a high priority uh for us.</p> <p>And then the other thing that we heard is um is the administrative burden that our physicians have and I'm not telling you something that you don't know as physicians as the uh profession of physician evolved over the years you know if we were here you and I speaking you know maybe 200 years ago first of all you would not speaking to me because there were no physicians women but let's say there were uh you know the area of medicine was very very narrow and people used to take their black bag and take care of anybody in their homes and you know the the availability and the knowledge was was kind of you know limited things that you you could do now the medical information is vast the uh accessibility to information Dr.</p> <p>Google right and other now there's chat GPT and others you can ask questions and you can also reach the doctors in so many ways now you can write a my chart meth message you can write an email you can call you can text there is a endless ways that our physicians can be approached by their uh patients and that creates a psychological burden on the physician because you can't be all the time on physicians I keep saying physicians are human beings and we also need a way to manage the load that is you know bestowed upon us.</p> <p>So how do we do that? So these are the things that we heard and we took it very seriously and we devised a strategy very meticulous strategy to to address all the things that we heard.</p> <p>How did you how long did that take after you so you went out and you you did this year tour and you got all this data uh and and of course now personally as well your whole staff is really invested because they've done it in person and they've really seen this but how how long does it take to devise that strategy afterwards right so one thing that you know I truly believe in as a scientist that there is no quick about this very seriously and the way that you said how much time first of all the tour itself took a couple of months.</p> <p>So two months before we completed and heard everybody we heard them in person. The second thing that we did, we used the press gaining crowdsourcing platform where people that were not in the sessions or even people that were in the sessions could give their ideas of what is the most pressing pressing issues that are they are facing and also in this platforms you can also vote these ideas up or down.</p> <p>So if I'm giving you a solution, let's say I say you know uh referral to social services is really the top priority and then you know another 180 physicians vote it and say this is a top priority. When I look at the data and say okay well this is important not only for one person it's important for many other people as well. So we did in person we did crowdsourcing and then we did two surveys. One is the PEWAC survey which we rebranded and named the Jimmy the join medicine initiative survey.</p> <p>It's a wellness and professional fulfillment survey that we uh distributed and we got the answers. And then we also did the class survey. The class survey is how uh how satisfied you are with the use of electronic healthcare records and the support that you're getting as a provider for that. So two surveys, one crowdsourcing, all this effort and then we took all the data and we sat the entire executive team in several meetings and we you know sorted it out according to the framework.</p> <p>What goes into the culture of wellness? What goes into the efficiency of practice? What goes into personal resilience? And then we prioritized and said okay these are the things but we really insisted on doing something a strategy for every every one of these three parts. So we have three strategies for the culture of wellness four strategies for efficiency of of practice and two strategies to enhance uh personal resilience.</p> <p>And then we we you know once very important thing you can learn you can devise a strategy but then if the people do not know what you're doing it's completely worthless.</p> <p>So we had our first Jimmy symposium, joy in medicine symposium in November at the end of the year when we you know finished devising the strategy and we revealed the strategy and there were uh more than half of these attendants of the symposium were providers both primary care and not non-primary care and they heard uh me reveal the strategies and what we're doing and how we did that and we also had a recorded session, a live session that was then recorded with all our primary care uh providers basically saying we heard you.</p> <p>You told us what's important for you and we devised the strategy and the priorities to address the things that are most important to you. So it it shows enormous respect to our physicians and providers which I strongly feel that without physicians without people who deliver the care you know what are we doing here? We are all you know all patients uh really seek to have uh capable providers and we need we as a health care system need to make sure that our providers are happy.</p> <p>So there's a respect to our providers, but there's also real action. This is not a nice, you know, feel nice or even though it feels really nice. I can tell you I really I it filled me with joy and my team with joy for sure, but it's more than that. It's actions that we are taking to make the lives of our physicians and our non-f physician providers better. And we're doing it very seriously.</p> <p>and restoring you know resources and many thoughts about this and in fact this has you know this has this tour has concluded in primary care but this year we're starting a same tour same kind of guidelines and principles in the specialty care group and because our specialty group is so much larger than our primary care group it's going to take us two years to complete and the issues that we're going to hear from our specialty physicians are going to be way different than our primary care physicians and our strategies to address their wellness and their professional fulfillment.</p> <p>Some of them are going to be the same and some of them are going to be very different. That is so incredible the work that and I love how you're separating it too by by the primary care by the specialty. I mean that's so important. Um one last question. Have you seen any early results to share? And if if so, when do you expect more a more full picture to develop? Yeah. So, I'm going to give you a one example that uh uh really makes me proud.</p> <p>We have something here at the Houston uh Methodist System that is called Pathway to Unparalleled. This is a annual uh kind of a event where all employees were mandated to attend and what it is is a few videos focused on one of our foundational principles.</p> <p>So it can be uh safety, quality, service, innovation or you know other things about our IARE values and histo year after year uh with very good feedback from our employees but our physicians were never asked to join and so before the Jimmy tour we had only 2% of our physicians join these sessions.</p> <p>When I came I said you know what our physicians are part of our employees they're employed physicians why are why are they missing out why are we not asking them to attend so we asked them to attend and remember the Jimmy tour was uh only in primary care physicians primary care we asked all physicians to attend right our total number you know last year it was 2% after we asked them to attend it was 70% but 100% of our primary care physicians, 100% attended.</p> <p>So that shows you that, you know, if you go as an administrator, as an as an executive leader, you go, you take the time, you um really give attention to physicians and give weight to what they have to say. then when you ask them to participate in something they respond and they're all in.</p> <p>So this is one example of the earlier uh results that we're seeing and then you know just by my own sense I have gotten to know so many wonderful people in our organization uh physicians and non-f physicians alike and I feel that something special is happening here in terms of what it means to be employed by the Houston Methodist physician organization. I can feel it. We're gonna measure it as well.</p> <p>But I can tell you, I can already feel the um the excitement, the pride, uh the sense of, you know, we can say what's bothering us and actually there going to be action to address that. I imagine a lot of other things are going to a lot of other initiatives that you maybe you're not even involved with are probably going to be going easier because that engagement, that involvement, that morale. I mean 100% attending, you know, an event like that.</p> <p>That that's unusual for even I'm assuming, you know, baseline employees a lot of organizations, right? It's hard to really get uh, you know, people involved even when things are mandatory. And so I think that's incredible as well if you hear about that. Um, I hope we can have you back on Dr. Shaw in in a year or two and discuss where things have gone. I mean, I'm interested in specialty care.</p> <p>you know, I was a medical assistant in neurology for a while and so I know that that brings very different challenges than primary care. Uh, and I'm wondering too in a couple years when you've gone through specialty and primary care, what synergies are going to develop in the organization. So, this has been a great conversation and I hope we can have you back on in the future. Thank you. Thank you. You're so kind and I really enjoyed sharing with you something about our organization.</p> <p>Thank you so much for this opportunity.</p>