WELLNESS CHAMPION - Faculty Wellness Poster Session

Wellness Champion Posters

Thursday, December 14th from 2:30 - 4:30 p.m.HSEB Alumni Hall

GOALS

Improve patient safety by relieving an anesthesiology who may be emotionally

or mentally compromised.

Improve job satisfaction and wellness by providing collegial support following a

catastrophic event.

Allow for debriefing or counseling for the provider involved in an adverse

event.

1

ANESTHESIA PROTOCOL FOR

INTRAOPERATIVE CATASTROPHIC EVENTS

Jennifer DeCou, MD; Phil Gnadinger, MD

RESILIENCY CENTER | DEPARTMENT OF ANESTHESIOLOGY

PROJECT VISION

Catastrophic events, such as an intraoperative death, code, or unexpected course of surgery can add significant stress to the job of an anesthesiologist. In the past, there

has been perceived production pressure to continue on to the next scheduled case without time off, or even time to debrief or process such an event. We believe that

adverse events in the operating room affect the wellness of the anesthesiologist, may immediately affect job performance and patient safety, and may ultimately

contribute to stress and burnout.

BASELINE ANALYSIS & INVESTIGATION

When we examined our baseline state we found:

• The pressure to continue one’s day was identified as a problem and a

contributor to burnout by colleagues and by administration within the

Anesthesiology department.

• Brainstorming sessions to define a catastrophic event. We found intraoperative

deaths rarely occur but unexpected adverse events, that affect the function of

the provider, may be equally stressful and appropriate to debrief.

• The anesthesiology coordinators, who are responsible for scheduling, were

consulted to provide their input on availability of anesthesia replacement staff.

When we examined the current literature we found:

• The rare incidence of catastrophic events was reviewed in the literature and

compared to incidents at our institution to analyze the feasibility of providing

appropriate relief to providers.

IMPROVEMENT DESIGN & IMPLEMENTATION

In order to address these issues, we have implemented a protocol to relieve an

anesthesiologist from duty following a case in which an adverse event occurred.

The protocol was distributed via email, discussed at faculty meeting, and

discussed with the anesthesia coordinators.

NEXT STEP - Counseling Training: Anesthesia providers will be trained in peer-to-

peer counseling and debriefing techniques to further support each other and

establish a healthy culture of camaraderie and emotional well-being.

PROGRESS TO DATE: Protocol established and introduced to team with three successful

usages to date. Next step is training for peer-to-peer counseling.

ROADBLOCKS & BARRIERS: Disagreements as to voluntary vs. mandatory protocol and what

constitutes “catastrophic event.” Piloting as voluntary as it is a significant change from

baseline. Other roadblock: how to alert an adverse event.

VALUABLE LESSONS LEARNED: Taking the time to pause and reflect on the emotional impact

has been invaluable to those who have experienced catastrophic events.

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2

3

Highlights of the new protocol:

• Defined Catastrophic Event: intraoperative

death, code, or unexpected or

devastating course of events

intraoperatively, or personal family

emergency.

• Time off: Protocol allows an anesthesia

provider to be relieved of duty for the day

following a case in which a catastrophic

event occurred.

• Support: The Wellness Champion should be

notified when a catastrophic event occurs

so that he/she may reach out to the

affected provider and provide support

and an opportunity to debrief.

University of Utah Health Department of Anesthesiology

DEVELOPING A VIDEO INTERVENTION THAT

TEACHES ACTION PLANNING

Bryan Gibson, PhD; Leah Yingling, BS; Marissa Tutt, BS; Jordan Harris, MBA; Jeff

Jackman, MEAE; Shelley Taylor, BA; Jorie Butler, PhD

RESILIENCY CENTER | DEPARTMENT OF BIOINFORMATICS

PROJECT VISION

Behavior change ( e.g., diet, physical activity, etc.) is central to an individual’s wellness. Although many people intend to change their behavior, these intentions are often

forgotten in the moment. Action plans (APs) are behavioral plans that take the form: "if situation X is encountered, then I will perform behavior Y." APs appear to work by

strengthening the mental link between the environmental cue and the target behavior; helping to make the behavior more automatic. A meta-analysis1 reported a strong

effect size on health-related behaviors. Most individuals are not familiar with APs or how to effectively make an action plan.

In response to the wellness programs goal of offering easily accessible assistance with behavior change, our multidisciplinary project team sought to develop two short

videos and a supporting worksheet to guide the viewer in this behavior change technique. The goal is for these materials to be usable by individuals alone or in

consultation with a health coach.

BASELINE ANALYSIS & INVESTIGATION

Team met bi-weekly to define baseline and plan our

improvement.

IMPROVEMENT DESIGN & IMPLEMENTATION

PROGRESS TO DATE: Two videos have been produced and evaluation began

in November 2017.

VALUABLE LESSONS LEARNED: As with all development projects, multiple

iterations and a willingness to integrate new feedback has been critical.

Recruiting a variety of experts in wellness, psychology, nutrition, physical

activity promotion, marketing, and graphic design and production, lead to

successful and smooth development of the videos.

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GOALS

Develop two short videos with supporting worksheet that impart the evidence based

principles2 of effective action planning.

Collect feedback on the content and presentation of the videos.

Assess perceived effectiveness of the interventions in helping individuals change their

health behaviors in the short term.

1

IMPLEMENTATION/ EVALUATION

PRODUCE VIDEOS & WORKSHEET

DESIGN & REFINEMENT

PLANNING

JUN JUL AUG SEP OCT NOV DEC

• Created shared purpose with team by defining:

o Action Plans (AP)

o Evidence based principles for APs

• Identified potential health behavior targets

• Rough draft scripts and graphics

• Focused on 2 AP storyboards

o What & Why APs

o Examples of APs in daily life

• Expert feedback on scripts

• Revise and repeat 2x

• Finalized script & artwork

• Finalized graphics for video

• Recorded voiceover with

professional actress

• Created AP worksheet

• Share videos with U of U Health

employees

• Have participants use AP

worksheet

• Gather feedback on content,

design, and effectiveness of tool

2

3

OUTCOMES

Two videos developed, entitled: “What are Action Plans and Why

are they Helpful,” and “Examples of action plan in daily life.”

Dissemination & evaluation of the videos started Nov. 16, 2017.

Assessment pending for 2018.

University of Utah Health Department of Bioinformatics

1

2

3

1. Gollwitzer P, Sheeran P. Implementation intentions and goal achievement: a Meta-analysis of effects and processes. Advances in Experimental Social Psychology. 2006;38:69-119.

2. 2. Gollwittzer P, Wieber F, Myers A, McCrea S. How to Maximize Implementation Intentions. In: Agnew C, Carlston D, Graziano W, Kelly J, editors. Then a miracle occurs: Focusing on behavior in social psychological theory and research New York: Oxford Press; 2010. p. 137-61.

BASELINE ANALYSIS & INVESTIGATION

DECREASING WORK OUTSIDE OF CLINICImproving Clinic Flow at South Jordan Health Center

Carolyn Sanchez, MD; Margaret Solomon, MD; Brian Ely, MD; Laura Johnson, MD;

Matthew Nimer, MD; David Owen, MD; Sarah Petersen, MD Alexis Somers, MD;

Catherine Shutler, PA; Jared Wrigley; Dane Falkner; Shane Gardner

RESILIENCY CENTER | COMMUNITY PHYSICIANS GROUP

PROJECT VISION

Community Physician Group providers experience burnout and decreased wellness as a result of work being done at home, after hours, and on weekends. With the help of

Value Engineering, our goal is to improve clinic workflow during office hours, making clinic more efficient, and freeing up provider time to complete charting during office

hours, thereby decreasing time spent working after hours.

IMPROVEMENT DESIGN & IMPLEMENTATION

RESULTS

PROGRESS TO DATE: Rollout mostly completed in our South Jordan Health

Center. Have begun rollout in several of our other clinics.

ROADBLOCKS & BARRIERS: Physician and staff interest in change has been

difficult, office layout has been more of a challenge in some clinics than

others, as well as staff changes.

VALUABLE LESSONS LEARNED: Big results can come from little changes. All

Providers experience an increase in teamwork and communication by

sitting together as a team.

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GOALS

Improve provider burnout and workplace wellness.

Increase % of charts closed same-day from participating

providers at SJHC clinics to 90% by12/31/2017.

• Family Medicine baseline average 65%

• Pediatrics baseline average 62%

Reduce average open chart duration from participating

providers at SJHC clinics to 1 hour by 12/31/2017.

• Family Medicine baseline average 46 hours

• Pediatrics baseline average 9 hours

1

Delivers direct patient care

Charts last visit

Completes 2-3 in basket items on

board

Rooms patientPrepares in

basket items

Places in basket items

on board

Performs procedures/ check outs

Updates facility

charge prn

Answers phone on 3rd

ring

Enters facility charge

Works MA Pool in basket

Manages nurse visits

Works MA pool in basket

Answers phone by 2nd ring

Flow MA

Provider

Runner MA

Pt. Away MA

• Analyzing our providers’ Epic

system activity data showed that

many complete work after hours.

• Seating arrangement (showed

work station setup was inefficient,

grouped by role rather than

team, without proximity to

assigned exam rooms. This led to

wasted time, excess travel, and

communication barriers.

• Staffing Analysis showed MA

availability was insufficient for

a 2:1 MA ratio when needed.

After hours work

2

3

PHYSICAL IMPROVEMENTS

• Flow stations: Figure 1. Reorganized by teams, assigned rooms.

• Proper staffing: Roster did not grow. Team schedules aligned.

TEAMWORK IMPROVEMENTS

• Roles and Choreography: Figure 2. Consolidate work, clear roles.

• Daily Huddle Sheet: Figure 3. Communication and planning.

• White Boards and Follow-up Sheets: Indirect communication.

• Standard Work: MA flow sheets/protocols for common in-basket

items, e.g.: prescriptions, letters, referrals, and FMLA.

ELECTRONIC MEDICAL RECORD (EMR) IMPROVEMENTS

• Template Optimization: Stay on time by managing patient variation and individual practice patterns.

• Charting Tips & Tricks: Epic trainers came for observations for more efficient charting techniques.

Figure 1: Multidisciplinary Flow Stations

Figure 2: Team Roles & Responsibilities

Figure 3: Daily Huddle Sheet – Family Medicine

86% reported positive

effects from flow in work

place wellness

1

6

0%

20%

40%

60%

80%

100%

2017

Negative No Change Positive

1 Increased same day chart closures

weighted average in Family Medicine

to 80%, Pediatrics to 87%

Reduced open chart duration

weighted average in Family

Medicine to 15 hrs, Pediatrics to 3 hrs

2 3

University of Utah Health Community Physicians Group

75%

87%86%

85%

82%

79%

83%

76%

79%

73%

80%

85%

93%

91%

86%

90%

70%

75%

80%

85%

90%

95%

Sa

me

Da

y C

losu

res

Family Medicine Pediatrics

13

8 7 8

1719

12

27

1719

4 3 4 36

11

0

10

20

30

Ho

urs

Family Medicine Pediatrics

THE WELLNESS GAMESCREATING AND IMPLEMENTING A WELLNESS GAME

V1. Tallie Casucci, MLIS; V2. Sarah Dickey; Jessi Van Der Volgen,

MLIS, AHIP; Peter Strohmeyer; Donna Baluchi

RESILIENCY CENTER | ECCLES HEALTH SCIENCES LIBRARY

PROJECT VISION

The mission of the Spencer S. Eccles Health Sciences Library (EHSL) is to advance and transform education, research, and health care through dynamic technologies,

evidence application, and collaborative partnerships. A burnout and satisfaction survey administered to EHSL faculty in fall 2016 found 42% of members experienced

burnout. The library contributes to the success of health professionals, students, researchers and the community - if we aren't well, how can we help our community?

BASELINE ANALYSIS & INVESTIGATION

When we examined our baseline state we found:

• Informal walking interviews were conducted to look

for burnout themes. We found many employees felt

a lack of appreciation and little sense of community.

When examining strategies for engagement we found:

• Serious games1,2 can be excellent tools for

engagement and learning. The Design Box3

methodology is a common tool used to design

games.

IMPROVEMENT DESIGN & IMPLEMENTATION

PROGRESS TO DATE: created a team-based game where employees collected points for wellness

related activities. V1 game participants celebrated with an awards lunch in June. V2 was

launched fall 2017 and is going better since there’s quicker turn-arounds for new games.

ROADBLOCKS & BARRIERS: No access to funds to support technology, awards, or food. Project

could not require ‘more work’ for participants.

VALUABLE LESSONS LEARNED: There are larger underlying wellness concerns for library personnel

that the game simply cannot address. Game has encouraged more socializing and comradery.

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GOALS & RESULTS

1

2

3

Encourage socializing

with colleagues:

84% say game encouraged

socializing with colleagues.

Recognize personal

wellness choice:

72% say they would

play game again.

Improve appreciation

and recognition:

69% say game encouraged

appreciation of colleagues.

Spencer S. Eccles Health Sciences Library

Figure 1. Break room game boards,

from Game 1 (version 1).

Figure 2. Digital game boards, from

Game 2 (version 2).

WELLNESS GAME - RULES & OBJECTIVES

• Participants are assigned to teams with colleagues who worked in different departments/physical spaces.

• Teams report individual activities related to appreciation, social, mental, and physical wellness for points.

• Each activity is worth 1 point, but social wellness activities get a bonus point.

• Team with the most points wins trophy and bragging rights!

To increase wellness and colleague interactions we designed:

• Wellness game: See rules and objectives below.

• Wellness award nominations: Anyone could nominate a colleague for an

award of their choosing; serious or funny.

• Celebrating Wellness: At the end of the game we celebrated with a potluck

lunch and awards ceremony.

o Large trophy was given to the team with the most points and is on display in

the break room.

o Certificate awards were given to all nominees and many post their

certificates in their workspaces.

To communicate with participants we used:

• Game boards: Posted in the break room to encourage collisions during Game

1 (Figure 1). Changes were made to Game 2 (Figure 2) based on participant

feedback; reporting and boards went digital with live dashboards.

• Regular reminders: emailed to employees and team captains encourage

them to send targeted messages to their members.

2. Stapleton, Andrew J. (2004). “Serious games: Serious opportunities.” Australian Game Developers Conference, Academic Summit, Melbourne.

1. Susi, T., Johannesson, M., & Backlund, P. (2007). “Serious games: An overview.”

3. Altizer, R. and Zagal, J. (2014). “Designing Inside the Box or Pitching Practices in Industry and Education.” Proceedings of DiGRA 2014. https://www.eng.utah.edu/~zagal/Papers/altizer_zagal_designboxDiGRA.pdf

‘GO TO GREEN’ CAMPAIGN

Erika Sullivan, MD; David Newton, MBA/MHA; Brenda Higgs;

Brady Kerr, RN; Rebecca Larsen, RN; Marci Thayne, R;

Bernadette Kiraly, MD; Susan Pohl, MD; Charles White, MD

RESILIENCY CENTER | DEPARTMENT OF FAMILY & PREVENTIVE MEDICINE

PROJECT VISION

Provider wellness is a complicated algorithm that is impacted by many things: environment, colleagues, work load, home life, nutrition and sleep. Identifying ways to

improve provider wellness can be tricky, as many techniques that might work (see fewer patients, work fewer hours) aren’t necessarily compatible with professional

success. One approach to improving provider wellness is to focus on getting “work done at work,” meaning, don’t take work home with you. For family physicians, this often

means closing clinic charts the same day they are opened, while you are still in clinic. Within our EHR (Epic) both providers and MA staff play a role in opening and closing

the clinic note each day. The dance between what the MA does (or needs to do) and what the provider does (and needs to do) in order to close a chart is complex.

BASELINE ANALYSIS & INVESTIGATION

When we examined our baseline state we found:

• Chart closure requires more than the provider finishing all of the clinical

documentation. In many instances the provider is unable to close a chart

because important documentation needs to be completed by the MA.

However, these steps often require that the provider signs an order first. This

cascade of "you do this, so that I can do this" can get backed up if there is not

an efficient way to communicate what needs to be done in real time.

When we analyzed the baseline state data we found:

• Providers who see the most patients (101 – 150+ charts per month) are the most

efficient at baseline at same-day chart closure with rates of 77% at Sugar House

and 84% at Madsen.

• Providers who closed fewer charts (0 - 50 or 51 - 100 per month) were less

efficient at same day chart closure (49% and 65% respectively at Sugar House

and 64% and 70% respectively at Madsen)

IMPROVEMENT DESIGN & IMPLEMENTATION

We created a communication channel whereby the MA and provider efficiently

and effectively communicate what needs to be done to facilitate chart closure:

To encourage participation in the improved process,

we created the ‘Go to Green’ campaign which rewarded the top MA’s at the

monthly Clinical Quality Meetings.

RESULTS

PROGRESS TO DATE: Implemented ‘Go to Green’ campaign with high adoption from

care team. Greatest impact in same-day chart closures seen in providers who had

0-50 or 51-100 charts per month.

ROADBLOCKS & BARRIERS: Finding a suitable way to recognize staff that complies with

University gift regulations without requiring additional attention to deliver rewards.

VALUABLE LESSONS LEARNED: Using existing technologies to enhance communication

can improve chart closure rates.

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GOALS

Increase same-day chart closure rates at Sugar House Clinic (SHC) to 80%

Increase same-day chart closure rates at Madsen Health Clinic (MHC) to 90%

• Providers with 0 – 50 chart per month from baseline 49% SHC, 64% MHC

• Providers with 51 – 100 charts per month baseline 65% SHC, 70% MHC

• Providers with 101 – 150+ chart per month from baseline 77% SHC, 85% MHC

1

2

49

6762

65

81

66

77 76 76

45%

60%

75%

90%

Baseline 17-Aug 17-Sep

1 Same Day Closures at SHC

Chart/mo : ▬ 0-50 ▬ 51-100 ▬ 101-150+

Same Day Closures at MHC

Chart/mo: ▬ 0-50 ▬ 51-100 ▬ 101-150+

2

-5% 0% 5% 10% 15% 20% 25%

MHC

SHC

SHC 0 - 50

SHC 51 - 100

SHC 101 - 150

MHC 0 - 50

MHC 51 - 100

MHC 101 - 150

64

75

80

70

56

67

85

77

83

45%

60%

75%

90%

Baseline 17-Aug 17-Sep

Total % Change

COLOR DOT LEGEND

No show

Provider needs MA

MA needs provider

MA has EVERYTHING done

Chart is closed

Resident needs Attending

• Utilized existing colored dots system in the schedule

tab of EHR (Figures 1 & 2)

• Pre-visit huddle: Provider-MA pair use a newly

designed clinic schedule that facilitates recognition

of important “to dos” for each patient: Medicare

status, MyChart status, depression screening, risk

score etc. (Figure 2)

Figure 2

University of Utah Health Department of Family & Preventive Medicine

Improving Chart Closure Rates at Two Family Medicine Clinics

Figure 1

• FM resident survey: improves communication, high satisfaction

• Survey categories: administrative, clinic, personnel, scholarship,

teaching, wellness, service, responsiveness to concerns

• Survey implemented Fall 2016

• Themes of frustration:

• Clinic hours of operation

• Work flexibility and consistency

• Sense of control

• Mission alignment

• Efficiency/clinic flow

• Recognizing and rewarding academic work

• Communication with leadership

• Facilitated faculty meeting discussions to review data and

discuss possible strategies

• Anonymous answers preferred by faculty

BASELINE ANALYSIS & INVESTIGATION

Well PIGUse of Wellness Practice Improvement Group (WellPIG) & Faculty

Feedback Survey to Improve Family Medicine Satisfaction & Burnout

Amy Locke, MD; Erika Sullivan, MD; Katie Fortenberry, PhD; Sonja Van Hala, MD, MPH

RESILIENCY CENTER | DEPARTMENT OF FAMILY & PREVENTIVE MEDICINE

PROJECT VISION

IMPROVEMENT DESIGN & IMPLEMENTATION

• Repeat survey quarterly

• Action plan process developed:

• Strategy to prioritize issues

• Focus on constructive input

• Regular feedback to group

• Clarification of roles

Progress to date:

• Clinic Items: changed clinic hours of operation, reduction in faculty clinic bumps and

increased work flexibility. Clinic flow and efficiency discussions are ongoing with steady

changes.

• Administrative & Teaching Items: Salary tied to teaching load to reward more active faculty.

An academic RVU strategy is under review to recognize academic work.

• Communication with Leadership: The flow of information and planning has been more clearly

defined and shared with the group.

• Burnout and sense of control markedly improved over baseline.

RESULTS

PROGRESS TO DATE: Developed & implemented quarterly faculty survey to facilitate an

ongoing improvement process for faculty wellness in the Division of Family Medicine.

ROADBLOCKS & BARRIERS: Creating an inclusive process that led to constructive

criticism evolved over time. Clearly stating the role of the wellness champion was

essential, as was having a clear process to discuss and make policy change.

VALUABLE LESSONS LEARNED: Faculty appreciate a way to share ideas around practice

improvement and policies that affect their wellness. The wellness champions role is

to advise not to implement policy.

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7%

38%45%

7% 3%

39%

17%

30%

13%

Poor Marginal Satisfactory Good Optimal

2016

2017

GOALS

Improve FM faculty burnout measured by single item emotional

exhaustion question from 48% to 30% (baseline for U.S.)

Improve FM faculty sense of control over workload as way to

improve faculty wellbeing

1

2

1 2Faculty Burnout (Emotional Exhaustion)

48%

26%

0%

15%

30%

45%

2016 2017

Ntl Avg

Faculty Perceived Workload Control

Figure 1. Single item question validated to the emotional

exhaustion portion of the Maslach Burnout Inventory:

• 48% University of Utah Family Medicine faculty

• 30% locally for School of Medicine faculty

• 29% nationally for all physician specialties

University of Utah Family Medicine (FM) faculty burnout was much higher than local or national levels in 2016

(Figure 1). Faculty turnover had been high and recruitment difficult. The Division Wellness Champions, as a part

of the Office of Wellness and Integrative Health Wellness Champion Program, were tasked with improving

faculty well-being and reducing burnout. An anonymous quarterly provider survey was instituted to assess

needs and foster two-way communication between faculty and leadership.

University of Utah Health Department of Family and Preventive Medicine

Wellness in Anesthesiology Dulce Boucher, MD

Introduction

There is very little emphasis on

physician wellness in residency,

but it is becoming increasingly

clear that physician health and

well-being are paramount for

effective medical practice.

Specifically in anesthesiology, a

study of residents demonstrated

that 22% of anesthesia residents

experience symptoms of

depression, the rate of suicidal

ideation was more than twice the

age adjusted rate observed in

other developed countries and

41% had high rates of burnout.

In order to improve wellness,

several initiatives have been

proposed and implemented in our

department.

Personal Days Policy

Residents may request personal

days off, no questions asked, up to

5 per year. This is to allow for more

flexibility in scheduling health care

appointments, for family needs or

just for self care.

In progress…

Resident Retreat

Initiatives

• Resident retreat

• Wellness orientation

• Personal days policy

• Peer to peer support

• Mindfulness moments

• Anesthesia simulation day

• Catastrophic event protocol

This took place Oct 7-8th as a two

day event with an overnight stay

at the Snowbird Resort. Residents

participated in workshops focused

on leadership, teamwork,

improved communication skills,

and well-being in an atmosphere

promoting interpersonal

connection and relationship

building.

SupportforCatastrophicevents

Protocol

Goaloftheprotocol:Istooffersupporttoourcolleaguesduringdifficultintraoperativeorpersonal

events.

Furthergoal:topromotewellnessbyrecognizingtheemotionalandphysicaltollthatresultsas

weempathizeandcareforourpatientsduringdifficultcircumstances

Furthergoal:toimprovepatientsafetybyensuringthateachpatienthasaproviderthatisnot

emotionallyormentallycompromised.

Definitionofacatastrophicevent:Intraoperativedeath,code,orunexpectedordevastatingcourseof

eventsintraoperatively,orpersonalfamilyemergency.

Roleofthecoordinator:Thecoordinatormaybemadeawareofacatastrophiceventbecausethe

anesthesiaprovider:

o Callsforhelp

o RequestsaTEE

o Acodeiscalled

o Throughcolleaguecommunications

1. Thecoordinator,whenpossible,willrelievetheanesthesiaproviderfortherestoftheday.This

includestheanesthesiaattending,resident,and/orCRNA.Ifareplacementisnotquickly,or

easilyfound,thentheteamcanbemovedtoadifferentlocation,withtheideathatachangein

setting,orchangeintypeofcase,oranassignmentthatreducestaskloadmaybebeneficial.

2. Thecoordinatorwillthenalertthewellnessteamwhenpossible.

JenDeCou,BettyBoucher,orCliveThirkhill

Debriefing

Theanesthesiateamwillbeofferedadebriefingopportunityorpeer-topeercounseling.

· Peertopeercounselingisoptionaltotheanesthesiaprovidersinvolved.Thegoalisto

besupportivetotheemotional,mental,andphysicaltollthatcatastrophicevents

involve.Thecounselingshouldnotbethoughtofaspunitiveorinformation-gathering

regardingtheevent.

· Peertopeertrainingwillbeofferedtocolleaguesthatareinterestedinthisrole.

Wellness Orientation

During orientation for incoming first

year anesthesia residents, a one

hour session was dedicated to

promoting wellness. This was

facilitated by the GME wellness

office.

Throughout orientation for

the 1st year residents, three

Sessions were dedicated to

“mindfulness moments” in which

residents were encouraged to

meditate using the meditation

app called Headspace.

Mindfulness Moments

Catastrophic Event Protocol

Facilitated resident check in:These would be group sessions in

which residents gather together

and discuss their experiences in

residency. This promotes self

disclosure, mutual sharing and

improves bonds between

residents. These would be

facilitated by the wellness office

and occur 2x per year.

Anesthesia Simulation Day:In order to improve understanding

and empathy between the

anesthesia residents and their

support network, family and friends

would be invited to participate in

an anesthesia simulation and learn

more about what anesthesiology is

all about.

RESIDENCY WELLNESS PROGRAM

Eric Moore, MBBS; Aaron Crosby, MD; Caroline Milne, MD;

Amy Cowan, MD; Jordan Hess, MD

RESILIENCY CENTER | GRADUATE MEDICAL EDUCATION

PROJECT VISION

Post-graduate medical training has high rates of burnout nationally. Surveying our residents in January 2017 with the Maslach Burnout Inventory (MBI) found 48% of residents

reported feeling burned out from their work, or that they had become more callous towards others, since starting their job at least once per week (Table 1). We aim to foster

a culture of wellness throughout our program and be able to intervene quickly when a resident is at risk of burnout.

BASELINE ANALYSIS & INVESTIGATION

When we examined our baseline state we found:

• Our internal medicine residents care for acutely unwell patients across three

busy hospitals.

• Data analysis from our semi-annual resident wellness and burnout MBI survey in

January 2017 showed that 48% reported feeling burned out from their work or

had become more callous towards people since starting residency (Table 1).

IMPROVEMENT DESIGN & IMPLEMENTATION

RESULTS

Follow up MBI survey will be completed one year from initiation, in January 2018.

• Implemented wellness seminars at orientation and ongoing lecture series

throughout the year.

• Organized a very well received indoor climbing activity for categorical internal

medicine interns; we hope expand to our preliminary year interns in 2018.

• Piloted healthy food at VA with an excellent response. Challenges include food

purchasing with University funds and distribution to multiple teams and clinics.

PROGRESS TO DATE: Developed a comprehensive wellness program delivered across

our three sites with the goal of reducing key markers of burnout to 30% by Jan 2018.

ROADBLOCKS & BARRIERS: Large program divided across three hospitals presents a

challenge trying to implement program-wide initiatives and schedule activities.

VALUABLE LESSONS LEARNED: Wellness initiatives and activities that work for some

residents may not work for others; we need to continue to offer a diverse and multi-

faceted wellness program to reach as many residents as possible.

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GOALS

Reduce number of residents reporting experiencing key markers of burnout, “I

feel burned out by my work” and “I feel I have become more callous towards

people since I took this job” from 48% to 30% by January 2018, through:

• Increase awareness of burnout and promote wellness with seminars and

lecture series.

• Increase cohesion and support through organized social/athletic activities.

• Improve access to healthy snack food across sites.

1

Table 1: Results of January 2017 Maslach Burnout Index Survey of University of Utah Internal Medicine

Residents. Percent of 96 total respondents reporting key indicators of burnout.1

Image 1. June 2017 Internal Medicine Residency Intern

Orientation Retreat to Zion National Park

• Our program includes regular monitoring of

resident wellness and burnout, wellness

seminars and lecture series, social and

athletics activities (see image 1) as well as

improved access to nutritious food for our

inpatient teams.

University of Utah Health Department of Internal Medicine

ONCE/WK FEW/WK DAILY TOTAL

“I feel burned out from my work.” 21.9% 18.8% 7.3% 48.0%

“I feel I’ve become more callous towards people

since I took this job.”13.5% 22.9% 11.5% 47.9%

• Through our resident wellness committee we have been able to gauge the

success of our program and seek out new ideas and initiatives to engage

more of our residents in our wellness program.

• Working with our chief residents and key faculty at each site, we have tried to

raise awareness of burnout and promote wellness. We recognize that not all

our activities will work for every resident and we have tried to offer a range of

different wellness activities and initiatives.

1. West, CP et al. Concurrent Validity of Single-Item Measures of Emotional Exhaustion and Depersonalization in Burnout Assessment. J Gen Intern Med. 2012: 27(11) 1445-1452.

AN INTERDEPARTMENTAL APPROACH TO WELLNESS

THROUGH COMMUNITY PHILANTHROPY

Aaron Crosby, MD; Eric Moore, MD; Sarah Stone, MD; Sean Slack, MD;

Megan Fix, MD; Jana Wold, MD; Caroline Milne, MD

RESILIENCY CENTER | GRADUATE MEDICAL EDUCATION

PROJECT VISION

Resident physicians are a group especially vulnerable to burnout. Depersonalization is one of the main domains of burnout1. We hypothesized that by fostering a sense of

community to address feelings of depersonalization we could decrease burnout. We aimed to achieve this by improving collegiality among residents by asking them to

work together toward a common goal, and by increasing resident engagement with their community by providing extramural philanthropic opportunities. The Neurology,

Emergency Medicine and Internal Medicine departments have collaborated to plan three interdepartmental philanthropic events over the course of the year. The first of

these was a dinner hosted by residents for families staying at the Ronald McDonald House. A clothing drive and trail clean-up are also planned.

BASELINE ANALYSIS & INVESTIGATION

To begin, we held a team brainstorming session to

identify an approach to improve community

engagement and burnout.

Literature review revealed the importance of a

sense of community in improving wellness, as well

as reducing the negative effects of

depersonalization. However, the literature revealed

little to no data examining the relationship

between philanthropic projects and resident

wellness: we believe this project has identified a

potentially novel avenue for wellness improvement.

IMPROVEMENT DESIGN & IMPLEMENTATION

The Neurology, Emergency Medicine and Internal Medicine departments have collaborated to plan three

interdepartmental philanthropic events over the course of the year:

1. Dinner hosted by residents for families staying at the Ronald McDonald House

2. Clothing drive – planned for 2018

3. Trail clean-up – planned for 2018

Communicating primarily via email, we have divided the task of organizing each interdepartmental event

among the three departments. The main barrier we have encountered is event scheduling, due to resident

clinical or other obligations. We have sought to minimize this issue by spreading the events throughout the year,

and varying the days and times the events are held.

PROGRESS TO DATE: Baseline assessment and one of three interventions

complete.

ROADBLOCKS & BARRIERS: Event scheduling difficulties due to the fact that

timing of clinical duties varies across departments.

VALUABLE LESSONS LEARNED: High engagement: Residents were very eager to

embrace the chance to engage in a wellness activity focused on providing

service to the community.

Pro

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GOALS

Improve resident community engagement by

increasing volunteerism from 58% to 70% by

06/30/18.

Improve resident burnout from 15% to 10% by

06/30/18

1

2

University of Utah Health Departments of Neurology, Emergency Medicine,

and Internal Medicine

1. Jodie Eckleberry-Hunt, Anne Van Dyke, David Lick, and Jennifer Tucciarone (2009) Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. Journal of Graduate Medical Education: December 2009, Vol. 1, No. 2, pp. 225-230.

Figure 1. Volunteers at Ronald McDonald House. Figure 2. Volunteers at Ronald McDonald House

preparing chicken and onions.

Figure 3. Volunteers at Ronald McDonald House

dicing chicken for the meal being prepared

NEXT STEPS: Conduct clothing drive and trail clean-up events and assess outcomes data in 2018.

2017 PATHOLOGY RESIDENCY PROGRAM WELLNESS

INITIATIVE – WORKSPACE IMPROVEMENTS

Jeffrey Mohlman, MD, MPH; David Hillyard, MD; Cheryl Palmer MD;

Robert Davies, PhD

RESILIENCY CENTER | GRADUATE MEDICAL EDUCATION

PROJECT VISION

The pathology residency program at University of Utah Health is a well-recognized training program with respected staff and great residents. But, as in all residency

programs, it has unique challenges that tax the wellness of our residents and we appreciated the opportunity to secure funding to invest in the wellness of our trainees.

For this project, we focused on three areas: 1) the sedentary nature of the work (e.g., long hours at the microscope, at the computer, etc.), 2) the uninviting atmosphere of

the pathology resident room for post-autopsy administrative work, and 3) the lack of nutritious food options during time-intensive rotations.

BASELINE ANALYSIS & INVESTIGATION

When we examined our baseline work state we found: • Pathologists often sit for long hours looking in the microscope and/or working

on the computer, which is very taxing for residents.

• Gemba (go and see): resident room was an uninviting space (below).

• Voice of the customer analysis: In consultation with other residents, our wellness

champion explored work place areas that could be improved: Sit/Stand desks,

photos of nature, plants, mugs and snacks were all identified as possible ways

to improve resident wellness.

IMPROVEMENT DESIGN & IMPLEMENTATION

Improved Pathology Resident workspace included:

• Sit/stand workstations: Residents now have the option to use

sit/stand desks and most (10/14=71%) indicated they will use.

• Room décor: Plants were placed in the workspace. Resident

photographs were displayed in the resident room

Resident/Fellow Photo Contest: Open to current and recent

residents to submit photos of Utah’s natural beauty; 7 residents

submitted photos. The photos were de-identified and voted on

using survey monkey. Top 4 were printed & on display in resident

room.

RESULTS FROM RESIDENT SURVEY

PROGRESS TO DATE: Two workstations have been outfitted with sit-stand desks;

pictures and plants are displayed, mugs are in process; Healthy snacks were

provided for 2-3 months.

ROADBLOCKS & BARRIERS: The time to implement everything was significant.

Not everyone was satisfied with everything. Awareness of the initiative could

be increased.

VALUABLE LESSONS LEARNED: The time investment is worth the improvements.

High-end materials and improvements should be used.

Pro

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GOALS

Improve pathology resident workstations by outfitting two workstations with sit-

stand desks and standing mats (completed August 2017), displaying plants

(completed August 2017) and inspirational/fun mugs (in process).

Improve resident workspace by holding a resident/fellow photo contest (July

2017) and displaying winning photographs in the University Hospital resident

room (November 2017).

Improve resident wellness by providing healthy snacks during challenging

rotations (August – November 2017).

1

2

30%

20%

40%

60%

80%

100%

Improved

Concentration

Improved Sense of

Wellbeing

Should spread

improvement to other

work areas

Improvements show

program cares

Completely True

Moderately True

Somewhat True

Not True

93% 79% 93%93%

University of Utah Health Department of Pathology

Future workspaces improvements could include higher quality standing desks,

larger plants, additional snacks and a resident room water cooler.

November 2017 Pathology Resident Wellness Survey (14/19=74% response rate)

BackgroundA large body of research suggests that medical professionals are at risk for increased physiological and psychological distress (Dyrbye et al, 2006; Tyssen et al, 2009). 1. First, dealing on a daily basis with the pain and suffering of others has a

negative impact on those serving in a helping role (Showalter, 2010).

2. Additionally, the grueling schedule, demanding environment, and lack of supportive peer culture may leave little time for physicians to manage care for themselves, leading to depression and decreased life satisfaction as compared to the general population (Goebert et al, 2009).

3. Furthermore, physicians and other healthcare professionals often lack the knowledge and resources to attend to their own self-care as these skills are only recently beginning to receive attention as part of the medical environment (Dyrbye, 2012).

While this suffering is concerning, risk of medical error and reduced quality of patient care are associated with burned-out and distressed physicians, making medical professional well-being a primary concern (Crane, 1998).

MBSR teaches a practice of relating to experiences as they unfold moment to moment with acceptance and compassion. This attention has been shown to be powerful in accessing our innate capacity for health and healing. Previous research suggest that MBSR and mindfulness practices may be effective for medical professionals in reducing stress, increasing compassion, and decreasing burnout (Shapiro, S.L., Astin, J. A., Bishop, S.R. & Cordova, M., 2005).

Methods & Participants

Crane, Mark. (1998). Why burned-out doctors get sued more often. Medical Economics,75(10), 210-218.

Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic Review of Depression, Anxiety, and Other Indicators of Psychological Distress Among U.S. and Canadian Medical Students. Academic Medicine, 81(4), 354-373.

Dyrbye, L. N., Harper, W. J., Moutier, C. V., Durning, S. S., Power, D. R., Massie, F. A., . . . Shanafelt, T. (2012). A Multi-institutional Study Exploring the Impact of Positive Mental Health on Medical Students’ Professionalism in an Era of High Burnout. Academic Medicine, 87(8), 1024-1031.

Fahrenkopf, A., Sectish, T., Barger, L., Sharek, P., Lewin, D., Chiang, V., . . . Landrigan, C. (2008). Rates of medication errors among depressed and burnt out residents: Prospective cohort study. BMJ, 336(7642), 488.

Goebert, D., Thompson, D., Takeshita, J., Beach, C., Bryson, P., Ephgrave, K., . . . Tate, J. (2009). Depressive Symptoms in Medical Students and Residents: A Multischool Study. Academic Medicine, 84(2), 236-241.

Tyssen, R., Hem, E., Gude, T., Grønvold, N., Ekeberg, T., & Vaglum, P (2009). Lower life satisfaction in physicians compared with a general population sample. Social Psychiatry and Psychiatric Epidemiology, 44(1), 47-54.

Showalter, S. (2010). Compassion fatigue: What is it? Why does it matter? Recognizing the symptoms, acknowledging the impact, developing the tools to prevent compassion fatigue, and strengthen the professional already suffering from the effects. The American Journal of Hospice & Palliative Care, 27(4), 239-42.

MBSR is an intensive 8-week training in mindfulness, meditation and movement. Groups meet weekly for 2.5 hours and for a 7 hour, day-long session between weeks six and seven. Guided instruction in various mindfulness practices is provided, including: sitting and walking meditation, body scan, gentle yoga, and other guided meditations.

This pilot study consisted of 19 participants: 10 staff, 8 residents, 1 attending.

Participants completed the following instruments:1. Orientation Questionnaire – Participants completed a series of questions

asking their reasons for participating in the course. 2. Professional Quality of Life Scale (ProQOL 5) – This scale assesses for

compassion satisfaction, burnout, and secondary traumatic stress3. Perceived Stress Scale (PSS-10) 4. Mindful Attention Awareness Scale – Items 1-16 were included in the pre and

post test analysis.

These measures were given at the orientation session before MBSR classes began and again at the last class (session 8).

ResultsA correlation analysis found the following:• High levels of mindfulness at the post test was positively and significantly related to high levels of

compassion satisfaction at the post test, r=.71, p<.05.• High levels of mindfulness were also related to low levels of burnout, r=.-67, p<.05.

Conclusions & Future Directions

HypothesisHypothesis 1: Participants will experience an increase in professional quality of life and mindfulness with a corresponding decrease in burnout.Hypothesis 2: Participants will experience a decrease in perceived stress and a corresponding increase in mindfulness and perceived stress.

Participants who reported higher levels of mindfulness at the end of the workshop also reported lower levels of stress. This result suggests that mindfulness may play an important role in keeping stress at bay for health professionals.

In addition, at the post-test, lower levels of burnout were related to higher levels of mindfulness. This indicates that mindfulness may aid in decreases in work burnout.

Participants reported less perceived stress at the conclusion of the workshop than at the start (r = -.76, p < .01).

Overall, the relationships among these variables are strong as demonstrated by consistently high correlations. Analysis of the trends in variables also points to important impacts of the MBSR course.

As the data set is small, conclusions must be drawn cautiously. Additional data collection during upcoming courses will add power to the analyses.

MBSR will be offered again January 24th through March 21st and is open to all UUHS & UUHC employees.

Participant Needs and EvaluationParticipants in the course identified key reasons for their participation in the Orientation

Questionnaire:“Lately I’ve been feeling overwhelmed since I just started my new job. I’m excited to be a

part of this course because I think it’ll be helpful for dealing with the stress I feel at work and at home. I’m nervous about the commitment, but I think it will be worth it.”

“In general my self worth is very connected to my job. This means I put 110% effort in to it. I get a lot of satisfaction from this but it also throws me out of balance when I let it take over my life. I have [children] and I don’t want to miss out on any of the important things that are happening with them. I have a lot of loss in my life as well and a lot of family obligations and family stress”

In final course evaluations, 100% of respondents reported that the course was very effective. Additionally, 100% of respondent's indicated that they agree or strongly agree with the statement that they have “felt a shift in [their] self awareness and [their] awareness of their surroundings since the beginning of the course”

We also completed paired-sample correlations, comparing pre-test and post-test mindfulness, stress, and professional quality of life:• Those reported higher levels of mindfulness at the conclusion of the workshop also reported

significantly less stress, r = -.68, p < .05.• At the post test, lower levels of burnout were related to higher levels of mindfulness, r = .67, p < .05• There were no statistically significant differences in pre- and post-test mindfulness. However, this may

be due in part to a small sample size (N = 10). Overall trends indicate increased mindfulness, decreased stress, and increased professional quality of life.

Correlations Among Variables at Course Completion

PSS PQL COMSAT BNOUT 2NDT MIND

PSS 1 -.45 -.56* .50 -.20 -.67**

PQL 1 .97** -.95** .94** .67**

COMSAT 1 -.86** .88** .71**

BNOUT 1 .83** .67**

2NDT 1 .52

MIND 1

Note. Total N = 11. * indicates significance at p < .1, ** indicates significance at p < .05.

PSS = Perceived Stress Scale, PQL = Professional Quality of Life Scale, COMSAT = Compassion Satisfaction,

BNOUT = Burnout, 2NDT = Secondary Trauma, MIND = Mindfulness,

Table 1

Correlations among Variables – Paired Samples

N Correlation Sig.

PSS 11 -.76 .006 **

PQL 10 -.36 .311

COMSAT 10 -.23 .518

BNOUT 11 .08 .825

2NDT 11 -.28 .411

MIND 10 -.26 .478

Note. Total N = 11. ** indicates significance at p < .05.

Table 2

Trends in Variables

N-Pre N-Post Mean-Pre Mean-Post Change

PSS 17 11 31.82 25.55 -.6.27

PQL 17 10 103.59 111.60 8.01

COMSAT 17 11 37.59 37.91 .32

BNOUT 17 11 31.65 36.0 4.35

2NDT 17 10 25.55 38.10 12.55

MIND 17 10 30.47 41.50 11.03

Note. Increases on PSS indicate higher levels of stress. Increases in PQL, COMSAT, BNOUT,

and 2NDT indicate higher quality of life, compassion satisfaction, less burnout and secondary

trauma. Increases on MIND indicate higher levels of mindfulness. Change scores are recorded as

post - pre.

References

IMPROVING JOY IN THE WORKPLACE

Caroline Milne, MD; Anna Beck, MD

RESILIENCY CENTER | DEPARTMENT OF INTERNAL MEDICINE

PROJECT VISION

Three areas of focus for faculty were chosen from the Faculty Wellness Survey (June 2016):

1. Building a sense of community for faculty where personal professional values are aligned with department leaders, through improved communication and

connectedness for feeling of belonging and mission alignment.

2. Focus on clinic efficiency by improving workflow in the ambulatory clinic.

3. GME focus on resilience building with mindfulness and stress management training, community building with social gatherings, and organized acts of philanthropy.

Benefits of improving in these areas would be 1) increased engagement, productivity, and retention, 2) less burnout over time with learned coping mechanisms.

BASELINE ANALYSIS & INVESTIGATION

• Extensive literature reviews were conducted for all projects.

• Faculty projects were determined by three initial meetings with invested faculty.

• An additional meeting with Drs. John Doane and MaryBeth Scholand for the

clinic efficiency project was held.

• Twice monthly meetings are underway for the graduate medical education

projects.

IMPROVEMENT DESIGN & IMPLEMENTATION

Different strategies were designed to combat the identified top 3 themes for

burnout:

1. Creating a sense of community for our faculty:

• Personal attention: Department Chair is conducting weekly small group

breakfast gatherings with goal to meet all faculty. Goal to meet faculty, get

to know them, listen to their needs, and communicate vision for the

department.

• Improving communication: Chair has hired communication director who

initiated weekly department emails sent out every Thursday.

• Faculty interest and development gatherings: To date two research

seminars and one “email efficiency” seminar held. Women’s gathering

planned for January 2018.

2. Improving workflow in the ambulatory clinic: [Project Gated] Design meeting

held with Drs. John Doane (experienced faculty) and MaryBeth Scholand

(chief value officer-Amb) in June 2017. The investment for this project is very

large and the department does not have the bandwidth to engage and

move forward.

3. GME resiliency and wellness initiative:

• Quarterly core lecture series devoted to mindfulness training

• Mandatory seminar (4 hours) for all interns on resiliency

• Partnership with Emergency Medicine and Neurology to organize

philanthropic activities. Initial event completed.

PROGRESS TO DATE: The Department of Medicine chose to focus on 1) community (professional

alignment with leaders), 2) clinic flow, 3) GME programs that include resident resilience building

with mindfulness and stress management, building a community, and philanthropic activities.

ROADBLOCKS & BARRIERS: Clinic flow has been stalled due to insufficient bandwidth. A significant

barrier has been the lack of a designated faculty champion.

VALUABLE LESSONS LEARNED: Without a faculty champion with protected time to support the

efforts, projects are stalled.

Pro

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GOALS

Provide structured activities to increase departmental faculty engagement

and satisfaction from measured sense of ‘team’ of 3.55 to 4.00 by July 2018.

Improve faculty satisfaction and clinic efficiency by working with value

engineers and Dr. John Doane to improve work flow in the clinic and improve

measured ‘sense of team efficiency’ from 3.61 to 3.8 by July 2018.

Improve resident physician wellness and decrease burnout by adding

structured training for mindfulness, stress management, activities to build

community, and provide organized acts of philanthropy as measured by

‘feelings of callousness once a week or more’ on the Maslach Burnout

Inventory from 48% to less than 30% by July 2018.

1

2

3

University of Utah Health Department of Internal Medicine

IMPROVING EFFICIENCY IN DOCUMENTATION

& CODING COMPLIANCE

Tiffany Weber, MD

RESILIENCY CENTER | DEPARTMENT OF OBSTETRICS & GYNECOLOGY

PROJECT VISION

The Department of Obstetrics and Gynecology at University of Utah Health is recognized internationally for excellence in clinical care, medical education, and research.

Our physicians and staff provide world-class expertise in the specialty and sub-specialties of obstetrics and gynecology. In recent years, there have been several budget

reductions in the department which have created a push for increased efficiency and productivity.

Our department strives for efficiency in clinic and patient encounters. The goal of the project is to improve our providers’ documentation and clinical billing knowledge.

This will ideally lead to improved efficiencies in documentation and increase our providers’ and department’s revenue and overall billing compliance without increasing

clinical work.

BASELINE ANALYSIS & INVESTIGATION

When we examined our baseline state for documentation and coding we found:

• Working with University Medical Billing (UMB) we identified several opportunities to improve our

templates to ensure we are documenting efficiently and at the highest level for billing

compliance.

• Knowledge deficits: We have identified a few critical areas that need provider development.

IMPROVEMENT DESIGN & IMPLEMENTATION

We aim to increase provider satisfaction by improving

documentation and coding workflows in clinic. We plan to start

presenting the information to faculty members and implementing

the improvements outlined below in early 2018.

To communicate our improved design we will use:

• Coding Workshop and Modules: Educate current and future

providers on best practices and identified knowledge deficits for

documenting and billing patient encounters.

To support the improved process we are designing the following

forcing functions into the workflow:

• Template Standardization: Current templates are being

evaluated with the UMB to incorporate documentation best

practices and improve compliance.

To track the progress and reflect on the effectiveness of the

improvement the team will:

• Audit: Following the education to determine the improvement in

documentation and coding compliance.

PROGRESS TO DATE: Improvements are in development. Currently working on

identifying critical areas of concern that will be presented as educational

opportunities to our faculty.

ROADBLOCKS & BARRIERS: The breadth of the project is much bigger than

expected and therefore the plan is more complex than anticipated.

VALUABLE LESSONS LEARNED: There are many resources at the University and

people who are willing to assist in quality improvement.

Pro

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GOALS

Improve provider wellness by increasing sufficient time for documentation by 20% from the

2017 weighted average of 2.61 (out of 5) to 3.13 by 1/1/2019.

Improve coding compliance in OBGYN providers from 70% to 95% by 1/1/2019.

1

2

22% 33% 28% 17%

OptimalGoodSatisfactoryMarginalPoor

45% report insufficient time for

documentation

39% 28% 28% 6%

Extrememly ValuableValuableNeutralSomewhat ValuableMinimally Valuable

67% perceive clinic flow/efficiency

projects as valuable.

University of Utah Health Department of Obstetrics & Gynecology

When we examined our baseline state data we found:

• UMB annual audit showed 30% of the OBGYN

department noncompliant in documentation and

coding.

• 45% of providers reported their time for documentation

was either marginal or poor (Figure 1).

• 67% of providers believe clinic flow and efficiency

projects would be valuable to improving provider

wellness (Figure 2).

Figure 1

Figure 2

AFFECTING THE CULTURE &

CONVERSATION AROUND WELLNESS

Griffin Jardine, MD; Christian Seiter;

Amy Henderson, LCSW; Lisa Ord, LCSW

RESILIENCY CENTER | MORAN EYE CENTER

PROJECT VISION

We at the Moran Eye Center have chosen to focus on interventions that decrease the bureaucratic sources of stress as well as improve individual resiliency and awareness

of wellness. Historically, there has been a great emphasis on creating a culture of wellness thanks to the leadership of our chair, Dr. Randall Olson. That said, physicians and

staff often neglect their individual personal well-being, so we have worked to improve upon that existing culture.

BASELINE ANALYSIS & INVESTIGATION

The University-wide burnout survey initially showed a high rate of

burnout at the Moran (50%), but the sample size was small and

felt inconsistent with the working environment we were seeing.

We sent an abbreviated version of the survey from our chair,

which had much greater participation and showed burnout

rates of less than 10%.

Given these two surveys, we decided to focus on increasing

awareness and provide strategies for coping with the highest

ranked causes of burnout: 1) Meaningful use requirements, 2)

Electronic Health Record, and 3) Lack of control of work/work

environment.

IMPROVEMENT DESIGN & IMPLEMENTATION

Our improvements can be divided into two targeted audiences:

RESULTS

PROGRESS TO DATE: Established an in-house physician coach, wellness grand rounds and resident lecture series,

Monthly R&R lunch meetings for faculty and staff, monthly newsletter, & resident administrative time.

ROADBLOCKS & BARRIERS: Subtle pushback on initiatives individuals felt were not going to be of benefit. What

became clear is that wellness looks different to each individual. Our reaction to this has been to come up with

multi-angled speakers & topics when addressing wellness.

VALUABLE LESSONS LEARNED (1) Wellness is a very charged, complex topic that means something different to

each individual, (2) Administrative & clinical staff are often suffering the most from the effects of burnout or

from the shockwaves of faculty burnout, and need to be included in the discussion and targeted initiatives.

Pro

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GOALS

Reduce University survey reported burnout at Moran from

50% to 25% by December 31, 2017 by:

• Increasing awareness and providing strategies through

targeted wellness grand rounds and lectures.

• Improving mindfulness by increasing attendance to R&R

lunch meetings of Moran faculty and staff from 0 to 25

by November 2017.

• Decreasing resident burnout by introducing resident

administrative time into schedule and wellness lectures.

1

1

Resident Wellness Activities

• Wellness Lecture Series: including off-

site meeting for breakfast, medical

improv teaching skills in empathy,

communication, and mindfulness.

• Administrative Half-Days: just initiated,

provide residents scheduled time off

to take care of personal health

matters, appointments, and

administrative tasks.

Faculty/Staff Wellness Activities

• Grand Rounds Lecture Series: topics have included

wellness, mindfulness, Epic optimization and

physician coaching.

• Moran Monthly Restore & Rejuvenate (R&R): 15-

minute open invitation group meeting for faculty

and staff led by LCSW Amy Henderson on

mindfulness, meditation, breathing techniques, etc.

• ‘Wellness For U’ Newsletter: Different wellness topics

discussed monthly. See example below.

• Positive reception & attendance of grand round targets on Epic

optimization, mindfulness and physician coaching.

• Attendance at R&R has steadily increased to 26 at the last group with

requests to increase to twice a month.

• Resident administrative time launched November 2017.

Images 1 & 2: Resident Wellness Activity; Image 3 (right): Wellness Newsletter

50%

18%

0%

10%

20%

30%

40%

50%

2016 2017

Goal

Moran Burnout

University of Utah Health Moran Eye Center

STREAMLINING CLINIC VISITS FOR PATIENTS

TRAVELING FROM AFAR

Angela Wang, MD; Ryan VanderWerff, MBA; Piper Ferrell, BSW;

Steven St. Thomas, ATC

RESILIENCY CENTER | DEPARTMENT OF ORTHOPAEDICS

PROJECT VISION

As tertiary care Orthopaedic providers for the Intermountain West region, we often see patients with complex problems traveling significant distances to our clinic. Having

all relevant information prior to the visit is crucial to creating an efficient and effective experience for both the patients and providers. Based on 2016 University of Utah

Health Wellness Survey data reflecting clinic efficiency as key area of need, we decided to scope our improvement to focus on improving clinic efficiency for patients

traveling from afar.

BASELINE ANALYSIS & INVESTIGATION

The 2016 University of Utah Health Wellness Survey identified two primary areas of

faculty dissatisfaction in our department:

1. Work Control & Environment

• 45% reported poor or marginal control in work/work environment

• 62.5% reported control in work/environment as top source of dissatisfaction

2. Electronic Health/Medical Record

• 50% reported high or excessive time spent in EHR/EMR at home

• 37.5% identified EMR/EHR as a top source of dissatisfaction

The results were discussed with the clinic manager and decided to focus efforts

on enhancing clinic efficiency to improve control in work/environment.

Faculty identified an opportunity to improve care coordination for patients with

complex problems traveling significant distances to the clinic. Obtaining previous

medical records and travel for additional appointments are particularly

challenging for this patient population.

IMPROVEMENT DESIGN & IMPLEMENTATION

To begin, we will target all patients coming from outside of Weber, Davis, Summit,

Wasatch, Salt lake, and Utah counties

In order to better serve these patients, minimize redundancy of imaging and labs,

and improve overall efficiency in clinic, we designed a pre-visit checklist for

patients traveling from afar to check for:

• Imaging: Xrays, MRI, CT Scan, EMG, Other.

• Medical records: Clinic visits, surgery records, physical therapy, other.

• Labs: Blood work, other.

• Record possession: Do we have the identified records?

Medical assistants will manage the checklist by reviewing the providers schedule

in advance and completing the check sheet for identified long distance patients.

After the first full quarter of implementation, data will be analyzed and faculty re-

polled biannual with an informal survey to assess the impact.

Results pending for 2018 rollout.

PROGRESS TO DATE: Pre-visit checklist for long-distance patients has been

designed and implemented into Epic. Go-live 2018.

VALUABLE LESSONS LEARNED: To be successful, the project team needed to

include a multidisciplinary team with representation from those involved in

managing these complex patients; faculty, clinic leaders, medical

assistants, and Epic managers were all involved in designing and

implementing the project.

Pro

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GOALS

Improve clinic and physician efficiency by decreasing self-reported time

compiling tests/results for long-distance patients during the visit by 30 minutes.

Will be assessed with biannual survey.

Improve overall patient experience in out of state patients from the 58.5%ile

(average FY17) to 65%ile by June 30, 2018.

1

2

Checking for availability/results of testing

that has already been done and identify

potential tests needed that could be

arranged at the same clinic visit should

minimize travel time for the patient and

diagnosis time for the physician.

University of Utah Health Department of Orthopaedics

CROSS CAMPUSBike Share Pilot to Reduce Cross Campus Driving

and Provide Fitness Opportunities

Joan Sheetz, MD; Ginger Cannon; Thomas Miller MD

RESILIENCY CENTER | DEPARTMENT OF PEDIATRICS

PROJECT VISION

Personal fitness is highly prized by many in the University of Utah Health community, yet finding the time and opportunity for fitness activities is often a barrier to personal

fitness. The U of U Health 2016 annual wellness survey demonstrated a burnout rate of 25% in the Department of Pediatrics. More specifically, when asked what issues are

essential to address for optimal wellness and life satisfaction, a summative score of 3.47/5 was reported for questions related to fitness (e.g., usefulness of on-site exercise

facilities and increased walkability/bike-ability of workplace).

BASELINE ANALYSIS & INVESTIGATION

When we looked at our baseline state we found:

• Voice of the Customer Analysis: a listening tour of 25 diverse Pediatric

faculty identified the most commonly cited stressor was lack of time &

access to fitness.

• Gemba (Go and See): Faculty and staff are housed at various locations

which they often must travel between. Travel between Williams Building

in Research Park and Primary Children's Eccles Outpatient Building –

about1.5 miles apart -- takes 7 minutes by car or 29 minutes walking.

Bicycling could provide an alternative to driving or walking: It encourages

exercise while keeping time cost to a minimum, improving employee

wellness, and reducing auto emissions.

• University of Utah Health does not have a commuter bike share option.

Maintaining personal bikes at work was perceived as a possible barrier

that could be overcome by a bike share program.

IMPROVEMENT DESIGN & IMPLEMENTATION

A bike share pilot was proposed by Pediatrics Wellness Champion in collaboration with

the University’s Active Transportation Manager, sponsored by the Department of

Pediatrics, Office of Wellness and Integrative Health and the Sustainability Office. The

new Active Transportation Manager was able to locate 10 available bikes to use for the

program.

• 25 participants were recruited from invitations sent to all faculty and staff of Pediatrics

housed at the 2 buildings. Agreements to participate were signed by 25 individuals.

• Suitable bike racks were located and locks purchased.

Pilot ran Aug 15 – Nov 15. Participants were surveyed and 82% (18) responded.

Reported barriers to use included:

RESULTS (n=18)

PROGRESS TO DATE: Cross Campus bike share pilot Aug 15 – Nov 15, 2017 with 19 participants and 10

bikes. Surveyed participants to investigate usage and interest in future bike share programs.

ROADBLOCKS & BARRIERS: Lack of program staff delayed start of program by placing a large burden

on 2 principle organizers; each spent about 50 hours uncompensated time to organize. Barriers to

use include lack of bike-specific pathways, insufficient bike parking and appropriate clothing.

VALUABLE LESSONS LEARNED: Interest in participation does not equal actual participation. We had 49

respond to the call for participants and invited the first 25 to participate. Of those, only 21 actually

completed necessary paperwork and picked up keys.

Pro

jec

t Insig

hts

GOALS

Improve individual wellness by encouraging cycling as a viable form of

transportation.

Decrease emissions by reducing number of trips by car1 CO2 Emissions

from a gallon of gasoline: 8,887 grams CO2/ gallon. The average

passenger vehicle emits about 411 grams of CO2 per mile.

Help to inform a bike share solution for the University.

1

1. Per FHWA 2017, 4.08 x 10-4 metric tons CO2E/mile for average US car - http://css.umich.edu/factsheets/carbon-footprint-factsheet

2

3

1

1

1

1

3

5

13

11

9

Campus Health

Emotional

Physical

None Somewhat A lot

93% reported personal or

campus health benefits

of Cross Campus bike.

1 2

88% would pay for bike sharing

3

0

5

10

15

20

0-2 2-6 ≥ 6

Re

spo

nse

s

One way trips per week

Car Bike

18 reported using a

bike 0-6 trips (one

way) per week.

67% said they are likely to utilize a

bike share program.

3

2

1 3

3

4

5

7

8

GreenBike

eBikeVery Unlikely

Unlikely

Maybe

Likely

Highly Likely

2 9 4 1 1

0% 20% 40% 60% 80% 100%

Amount/yr

0$1-20$20-50$50-75>$75

1. Bike Parking (8)

2. Clothing (7)

3. Time (5)

4. Weather (4)

5. Functionality/safety (1)

University of Utah Health Department of Pediatrics

ACCESS TO PHYSICAL AND MENTAL

WELLNESS PROGRAMS

Karina Pritchett

RESILIENCY CENTER | DEPARTMENT OF POPULATION HEALTH SCIENCES

PROJECT VISION

Population Health Sciences (PHS) is a relatively new department established in 2016, located in the lower level of the Williams Building. By improving access to physical and

mental wellness resources, we aim to decrease faculty and staff burnout.

PHS drives health care transformation and aims to be a hub for education, investigation, and expertise in health services, cost, quality, outcomes, and health delivery

systems research. The department provides methodological expertise and infrastructure that will advance capacity for population health scientists to pursue impact-driven

research and allow clinical professionals to provide better patient and population-oriented care in an increasingly complex health care delivery system.

BASELINE ANALYSIS & INVESTIGATION

The University of Utah Health Wellness Survey 2016 showed our department ranked

workload/work environment as a high source of dissatisfaction.

IMPROVEMENT DESIGN & IMPLEMENTATION

To improve access to physical and mental wellness resources the

department implemented:

• Treadmill Desks: available for use in Chair’s office, March 2017

• Red Butte Membership (shared): available for checkout, April 2017

• Guided Meditation Sessions: 15 minutes twice weekly, June 2017

PROGRESS TO DATE: Increased access to physical & mental wellness programs for PHS

department through: treadmill desks, Red Butte membership, meditation sessions.

ROADBLOCKS & BARRIERS: Limited space and funding for individual wellness

resources.

VALUABLE LESSONS LEARNED: Access to programs does not necessarily lead to

participation in programs.

Pro

jec

t Insig

hts

GOALS

Improve physical health by providing access to treadmill desks

Improve physical & mental health by providing access to Red Butte Gardens

Improve physical & mental health by providing short meditation sessions 2 x week

1

2

3

Improvements were communicated using:

• Campaign in Spring 2017 to introducing new

wellness resources

• Flyers (Figure 2)

• Weekly emails

• Reminders during weekly staff meeting

Discussions will be held at future faculty and staff

meetings for feedback on wellness programs.

RESULTS

Utilization of treadmill desks has been inconsistent

Red Butte Membership has been used 5 times since 5/5/17

Participation in meditation sessions varies and is often used by

other departments in the Williams building

1

2

3

• Voice of the Customer: Department chair met

with several faculty and heard recurring themes

of need for access to physical health resources.

Physically active group activities, 3.5

Physical Space (light/quiet), 3.5

Active Workstations, 3.75

Onsite Exercise Facilities, 3.75

Training on Mindfulness & Time Mgmt, 3.75

Grant/ Acadmic Writing Assistance, 3.875

Onsite Child Care, 4

Guided QI Project to Improve Efficiency, 4.25

0 1 2 3 4

Average rating out of 5

Ranked Most Valuable Improvements

Figure 1

• Survey identified high perceived value in

improvements to (1) work efficiency & (2) access

to physical & mental wellness programs (Fig. 1)

For the first year, we focused on increasing access

to physical & mental wellness programs.

To understand our baseline state we looked at:

• Physical Environment: Located in the basement/first floor of the Williams Building restricts

physical activity with minimal windows and natural lighting.

Figure 2

University of Utah Health Department of Population Health Sciences

OPTIMIZING COLLEGIALITY THROUGH SMALL GROUP

INTERVENTION TO ADDRESS PM&R BURNOUT

Rebecca Wilson Zingg, MD; Alan Davis, MD; Rob Davies, PhD; Amy Locke, MD;

Richard Kendall, DO

RESILIENCY CENTER | DIVISION OF PHYSICAL MEDICINE & REHABILITATION

PROJECT VISION

Based on 2016 burnout survey assessing University of Utah Health Physical Medicine and Rehabilitation, 44% of respondents in PM&R division (9 total respondents) reported

findings consistent with burnout in comparison to 30% of all School of Medicine respondents (608 respondents, 27 departments, 24 divisions). There was a high correlation

between stress due to work and burnout. Support and appreciation by peers and department chair, as well as atmosphere in primary work area, were lower than average

compared to all School of Medicine respondents.

BASELINE ANALYSIS & INVESTIGATION

Cultivating community at work has been shown to be a meaningful strategy to

reduce physician burnout1. When we examined our current state we found:

• The PM&R division includes individuals at locations across Salt Lake City and in a

variety of sub-specialties; these disparate sites and sub-specialties contribute to

limitations in cultivating PM&R community coherence.

• We administered a secondary survey to evaluate sources of stress/burnout

within the PM&R Division. The highest rated sources of burnout were: 1)

administrative duties, 2) academic responsibilities, 3) EPIC, 4) clinical duties, and

5) responsiveness to concerns.

• Interest in participation in small group intervention was assessed.

o Interest: Of the 13 respondents, 9 expressed interest in small group gatherings.

o Topics of highest interest: Work-life balance, job satisfaction and finding

meaning at work, and exercise/movements modalities.

o Location: There was greatest interest in off campus small group gatherings,

closely followed by outdoor gatherings.

IMPROVEMENT DESIGN & IMPLEMENTATION

With leadership support (PM&R Chief), quarterly, small group, after-work

gatherings were initiated starting in the Spring of 2017.

• Various locations were trialed based on preferences (Red Butte Gardens,

faculty home).

• A short mindfulness session was integrated at the start of all meetings including

education regarding the benefits of mindfulness.

• Some gatherings were structured with guided exercises to evaluate current

work-life balance and personal value assessment. Preference was expressed for

less structured, subsequent gatherings to focus on building collegiality.

• Attendance ranged from 3-6 individuals per gathering.

Additionally, EPIC help session was organized to provide individualized guidance

for providers with EPIC support.

RESULTS

PROGRESS TO DATE: We have completed two quarterly

small group interventions to build collegiality.

ROADBLOCKS & BARRIERS: Multiple provider sites (clinics/

hospitals) limits daytime gatherings; difficulty identifying

after work locations and engaging faculty to increase

interest in collegiality-building sessions

Pro

jec

t Insig

hts

GOALS

Improve PM&R faculty burnout at University of Utah Health from 44% to School

of Medicine average of 30% by 12/31/2017.

Optimize collegiality in the PM&R department through small group

intervention.

1

1. Shanafelt TD, Nosworthy JH. (2017). Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc, 92(1): 129-146.

20%

20%

40%

60%

80%

100%

Worth my time Improved

relationships

Increased

satisfaction

Like to

continue

Strongly Agree

Agree

Neutral

Disagree

2 Surveyed participants from small-group sessions1 PM&R Burnout

44%

33%

0%

10%

20%

30%

40%

2016 2017

School of Med Avg

University of Utah Health Division of Physical Medicine & Rehabilitation

IDENTIFICATION OF CONTRIBUTING FACTORS

TO RADIOLOGY FACULTY BURNOUT

Troy Hutchins, MD; Nicole Winkler, MD

RESILIENCY CENTER | DEPARTMENT OF RADIOLOGY

PROJECT VISION

Radiology has one of highest rates of burnout both here at University of Utah and across the United States. There are several reasons for this that have been published in the

literature1: increasing work load without increasing staffing or compensation, little control over case volume and complexity, little patient interaction, to name a few.

Though some of these factors are inherent to being a radiologist, some can be improved to maintain a healthy and happy work force. Our initial approach is to find out

how our group of radiologists are doing and what they think is important to maintain their personal wellness as it relates to work.

ANALYSIS RESULTS

A substantial proportion of respondents exhibit signs of burnout (53%) with 64%

reporting working > 60 hrs/week.

Majority (83%) engage in exercise-related activities outside of work.

Faculty suggest improvements in work hours, environment, & administrative support.

PROGRESS TO DATE: Compared internal survey to hospital-wide survey results to determine

level of burnout in our department and correlating factors.

ROADBLOCKS & BARRIERS: It is challenging to organize an approach for the complex

problem of burnout as designated wellness champions without formal training in wellness

or resiliency, and with limited time outside of clinical work and other duties.

VALUABLE LESSONS LEARNED: Seeing data about how our colleagues feel about their work

and what is important to them: in order to improve we have to know where to start.

Pro

jec

t Insig

hts

GOALS

Determine degree of faculty burnout and contributing factors.

Ask faculty what they do to maintain wellness in general.

Ask faculty what their section/department can do to improve faculty wellness.

1

2

3

BASELINE ANALYSIS & INVESTIGATION

Initial 2016 hospital-wide wellness survey had low response rate, so we

sent an internal survey which had higher response rate as did the

subsequent 2017 hospital-wide survey. Highlights from survey analysis:

• In many domains, radiology had higher scores of concern when

compared to SOM (see figures).

• 75% stated interest in discussions about wellness at faculty meetings

• > 60% reported working 60+ hours per week

• 75% reported a very busy, hectic and chaotic work environment

Faculty provided feedback about needs and ideas about how to

improve wellness, including:

• More clinical faculty: 41% responded fundamental issue is work hours.

• Better work environment: ergonomic desks at all sites, less

interruptions, less valium consents.

• More administrative support for clinical work, non-RVU and non-

research value added.

28%

11%

54%

50%

9%

11%

7%

21%

3%

7%

SOM All

Radiology

Overall, I am satisfied with my job

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree5% 23%

14%

25%

25%

39%

50%

9%

11%

SOM All

Radiology

I feel a great deal of stress because of my job

Strongly DisagreeDisagreeNeutralAgreeStrongly Agree

4%5%

4%

41%

21%

43%

57%

7%

18%

SOM All

Radiology

Which best describes your work atmosphere

Calm

Somewhat Calm

Reasonably Busy

Very Busy

Hectic & Chaotic5%

4%

31%

7%

33%

18%

24%

54%

8%

18%

SOM All

Radiology

My control over my workload is…

Optimal

Good

Satisfactory

Marginal

Poor

11%

36%29%

21%

4%

22%

48%

20%

8%1%

I enjoy my work. I have

no symptoms of

burnout.

I am under stress and

don't always have as

much energy as I did,

but I don't feel burnt

out

I am definitely burning

out and have one or

more symptoms of

burnout, e.g. emotional

exhaustion

The symptoms of

burnout that I'm

experiencing won't go

away. I think about

work frustrations a lot.

I feel completely

burned out. I am at the

point where I may

need to seek help.

Reported Burnout Radiology

4%7%

0%

7%

18%

32%

21%

11%

2% 3% 4%

18%

34%

25%

10%

4%

Less

than 20

20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 80 More

than 80

Time spent on work per week

Radiology SOM

University of Utah Health Department of Radiology

1. Burnout of Radiologists: Frequency, Risk Factors, and Remedies: A Report of the ACR Commission on Human Resources. Harolds JA, Parikh JR, Bluth EI, Dutton SC, Recht MP. J Am Coll Radiol. 2016 Apr;13(4):411-6. doi: 10.1016/j.jacr.2015.11.003.

IMPROVING FACULTY AMBULATORY PRACTICE EXPERIENCE

Robert E. Glasgow, MD; David Ray, MBA; In partnership with the Department of Surgery Value Council

RESILIENCY CENTER | DEPARTMENT OF SURGERY

PROJECT VISION

As of the 2016 Faculty Wellness Needs Assessment, 46% of Department of Surgery Faculty reported significant physician burnout. The factors identified to be most

responsible for surgery faculty burnout included insufficient staffing, the EHR/EMR (Epic), excessive workload, and a lack of control of work and work environment. These

issues were most pronounced in the ambulatory clinic. The goal of this project is to improve upon Department of Surgery faculty ambulatory practice experience by

optimizing clinic efficiency, work flow, minimize away work, and optimize staffing levels, training and utilization.

BASELINE ANALYSIS & INVESTIGATION

We discussed the issues identified in the survey in the Department of Surgery Value Council which consists of a

representative of each of the nine Divisions in the Department of Surgery:

• Clinic Needs/Prioritization: Each Division representative reported on their clinic operations including

identifying what works, what doesn’t, and what they feel would be necessary to make the clinic experience

better for their faculty.

• Performance Benchmarking: David Ray, Director of Clinical Operations, and Robert Glasgow, Vice Chairman

of Clinical Operations, did site visits with three high performing clinics outside of the Department

(Orthopedics, Dermatology, Ophthalmology) to learn from these clinics practices that may benefit our

provider experience.

The results from the discussions and site visits will be presented to the Surgery Value Council and Surgery

Executive Committee as a menu of options; each clinic will be empowered to implement the options that meet

their individual clinic needs.

IMPROVEMENT DESIGN & IMPLEMENTATION

Improvements will focus on two main areas:

• Clinic efficiency: by optimizing physician

templates, Epic optimization, and service

alignment by standardizing work flow across

clinics and sites.

• Care Team Support: clinic staffing levels (MAs,

scribes, RN, APC), training, and utilization to

support faculty clinic experience and efficiency.

Specific deliverables have thus far included:

• Scribes in Clinic (Shadowing/Pilots in coming

months)

• Template optimization (Improve flow for provider)

• MA/Provider Ratio (Increasing staffing to meet

provider needs)

• EMR Optimization

• Service Alignment (Home game wherever you

go)

GOALS

Improve clinic efficiency by optimizing work flow across all clinics and sites.

Improve faculty efficiency and experience in clinic by optimizing clinic staffing and staff utilization.

Improve patient access and faculty surgical volume yield (surgeries per new patient visits) by improving

clinic and provider efficiency while maintaining outstanding patient experience above the 70th percentile.

3

University of Utah Health Department of Surgery

2

1

QUESTIONS?

CONTACT: Amy Locke, MDCo-Director, Resiliency Centeramy.locke@hsc.utah.edu

Kim MahoneyProject Manager, Accelerate(801) 587-2157kim.mahoney@hsc.utah.edu

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