Physician peer coaching reduces burnout, improves well-being
Physician coaching by professionally trained peers effectively decreased physician burnout and interpersonal disconnectedness, according to study results published in JAMA Network Open.
The approach also increased professional fulfillment and engagement, findings of a randomized clinical trial showed.
The study included 138 physicians in the Mass General Physicians Organization who volunteered to receive coaching.
Investigators randomly assigned 67 participants to six coaching sessions directed by a peer coach over 3 months. The other 71 participants received a delayed intervention, utilizing standard institutional resources for burnout and wellness for the first 3 months — to serve as a control — and subsequently receiving the coaching sessions.
Burnout based on the Stanford Professional Fulfillment Index served as the primary outcome. Secondary outcomes included professional fulfillment, effect of work on personal relationships, quality of life, work engagement and self-valuation.
The study showed a 30.1% reduction of mean score for interpersonal disengagement in the intervention group vs. a 4.1% increase in the control group (absolute difference, –0.94 points; 95% CI, 1.48 to 0.41). Mean scores for overall burnout declined by 21.6% in the intervention group but increased by 2.5% in the control group (absolute difference, 0.79 points; 95% CI, 1.27 to 0.32). Professional fulfillment increased by 10.7% in the intervention group but did not change in the control group (absolute difference, 0.59 points; 95% Ci 0.01-1.16). Work engagement increased by 6.3% in the intervention group and decreased by 2.2% in the control group (absolute difference, 0.33 points; 95% CI, 0.02-0.65)..
“Based on these findings, we were able to advocate for this program to be offered system-wide throughout the Mass General Brigham organization,” researcher Kerri Palamara McGrath, MD, associate professor of medicine at Harvard Medical School, told Healio. “We’ve also been able to work with a few other academic medical centers to help them follow the steps we’ve put into place.”
Healio spoke with Palamara McGrath and coauthor Stephanie Kiser, MD, MPH, attending physician in the division of palliative care and geriatric medicine and the clinical director for palliative care at Mass General Brigham, about the importance of identifying effective strategies to address burnout, the benefits of peer physician coaching and how this approach may serve as a model for other institutions.
Healio: Why are more evidence-based approaches needed to address physician burnout?
Palamara McGrath: Physician and health care worker burnout has increasingly gotten attention in both the lay and academic media. However, we don’t necessarily have the same guidance that we would for a medical problem in terms of protocols and outcomes of approaches that people have been researching for decades. There are some evidence-based approaches, but not necessarily agreement on the protocols and what to expect if you were to invest your time and resources in a program. There is a need for more information about the approaches and how they affect individuals and workplace culture. We also want to understand what needs an intervention might address within the spectrum of burnout, because there are many different drivers. Something that might help one organization in an evidence-based way might not meet the needs of another. We need a menu of options, services and interventions, and the evidence to describe what one might expect from those interventions.
Kiser: Physician burnout is not a new problem, but I think COVID-19 played a big part in amplifying the pressures in the system and what health care workers are going through. Those demands and the pressure that is driving them are only increasing over time.
Healio: How did you conduct this study?
Palamara McGrath: The process of bringing coaching to faculty at Mass General started before COVID-19 but the opportunities to recognize its value intensified during and in the aftermath of the pandemic.
Much of my research prior to this has been in trainee coaching, teaching faculty skills to help them become novice coaches and pair them up with a trainee. We have data to show that this reduces burnout and improves resilience and well-being.
As we were training faculty physicians to be coaches, we realized they had a tremendous need for coaching themselves. We needed people with deeper skills in coaching to provide that coaching for the faculty. We decided to take faculty who were excited about this and train them to become certified coaches. We sent them to an organization called Wellcoaches, an accrediting body for a coaching certification. The grand vision was that they would coach people one-on-one and also provide group coaching, retreats, listening sessions and leadership development. It wasn’t just, “I’m going to coach this physician and make them feel better.” These physicians would be part of a system, and we would infuse coaching into this culture. To understand the impact and the value of investment in this intervention, we needed to study it. We received an investment from the Mass General Physicians’ Organization to do this study.
We wanted everyone who wanted coaching to get it, but we also wanted to be able to compare people who got coaching with those who didn’t. We set up the study to be delayed coaching rather than randomly assigning participants to coaching vs. no coaching.
Healio: How did the intervention perform?
Kiser: The group that initially got coaching for 3 months had improvements in or reduction in burnout, as well as improvement in professional fulfillment and work engagement, compared with the group assigned the delayed intervention.
Healio: What are the potential implications of these findings?
Palamara McGrath: Our hope would be that any physician within the organization can receive coaching at any time that they feel is appropriate for their career trajectory and their personal development. We want them to see coaching as a resource that they can rely on when needed for hard times.
In our study, we did six sessions of coaching over 3 months. If you look at coaching literature, this is often the arc that you see. Maybe that is not enough. This might make them feel better, but what happens in the months or years after that? Maybe they need an opportunity to have “booster shots” of coaching along the way to evaluate how they are doing with their goals and their motivation for sustaining change. We’d like to see people be able to access coaching at any time that feels right and not be a time-limited resource. Importantly, our coaches were funded on a per-session basis. It wasn’t in their contract. In my perfect world, being able to offer coaching to anyone who felt it was necessary means we have coaches who are employed and part of our organization. That way, they can use their time as it seems appropriate. It might be one-on-one, or in groups or leaning in to help people with retreats or culture change in a practice or implementing a change policy within a practice.
Healio: Could other institutions adopt this approach?
Palamara McGrath: Yes. Since our study, we have worked with several other organizations to help them learn from what we did. There was a lot we had to figure out for the first time — whether this would work with electronic health records, with legal and mandatory reporting, how it works with liability insurance, how it would fit in the context of other offerings. We’ve worked out many of these kinks and can share what we’ve learned with other organizations. Some places want to hire us to do what we did at our institution for them. We’ll just insert our coaches into the organization.
Kiser: For this study, our goal was taking the first step in trying to explore whether this intervention would be helpful for people at our institution. This has had such an impact in so many ways. It’s changing our institutional culture. It’s providing an enduring resource of support that can be utilized in so many ways. There is going to be a lot more to come out of building this cohort of coaches that we are continuing to think about and study.
Healio: Is there anything else you’d like to mention?
Palamara McGrath: For those interested in coaching, there are many opportunities to become involved or become certified. A physician can do that independent of their organization. Many organizations around the country offer coaching for their employees. Anyone wondering about this might consider looking into the well-being offerings within their organization or their professional societies. Much of the work I do involves consulting with professional societies to help them offer this within their organizations.
Reference:
For more information:
Stephanie Kiser, MD, MPH, can be reached at sbkiser@mgh.harvard.edu.
Kerri Palamara McGrath, MD, can be reached at kpalamara@mgb.org.
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