University of Utah Health Improving Wellness: 40 Champions, 20 Projects, 12 Months of Progress

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.
ProjectInsights
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.
Team met bi-weekly to define baseline and plan our
improvement.
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.
ProjectInsights
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.

DECREASING WORK OUTSIDE OF CLINIC
Improving 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.
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.
ProjectInsights
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 patient Prepares 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%
SameDayClosures
Family Medicine Pediatrics
13
8 7 8
17
19
12
27
17
19
4 3 4 3
6
11
0
10
20
30
Hours
Family Medicine Pediatrics

THE WELLNESS GAMES
CREATING 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?
• 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.
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.
ProjectInsights
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.
• 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)
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.
ProjectInsights
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
67
62
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
Well PIG
Use 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
• 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.
ProjectInsights
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.
Support for Catastrophic events
Protocol
Goal of the protocol: Is to offer support to our colleagues during difficult intraoperative or personal
events.
Further goal: to promote wellness by recognizing the emotional and physical toll that results as
we empathize and care for our patients during difficult circumstances
Further goal: to improve patient safety by ensuring that each patient has a provider that is not
emotionally or mentally compromised.
Definition of a catastrophic event: Intraoperative death, code, or unexpected or devastating course of
events intraoperatively, or personal family emergency.
Role of the coordinator: The coordinator may be made aware of a catastrophic event because the
anesthesia provider:
o Calls for help
o Requests a TEE
o A code is called
o Through colleague communications
1. The coordinator, when possible, will relieve the anesthesia provider for the rest of the day. This
includes the anesthesia attending, resident, and/or CRNA. If a replacement is not quickly, or
easily found, then the team can be moved to a different location, with the idea that a change in
setting, or change in type of case, or an assignment that reduces task load may be beneficial.
2. The coordinator will then alert the wellness team when possible.
Jen DeCou, Betty Boucher, or Clive Thirkhill
Debriefing
The anesthesia team will be offered a debriefing opportunity or peer-to peer counseling.
· Peer to peer counseling is optional to the anesthesia providers involved. The goal is to
be supportive to the emotional, mental, and physical toll that catastrophic events
involve. The counseling should not be thought of as punitive or information-gathering
regarding the event.
· Peer to peer training will be offered to colleagues that are interested in this role.
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.

What Do FM Residents Want For Burnout Prevention? Time.
DEPARTMENT OF FAMILY AND PREVENTIVE MEDICINE
Jordan Knox MD, Katherine Fortenberry PhD, Sonja Van Hala MD MPH FAAFP
Family Medicine Residency Program, Department of Family and Preventive Medicine, University of Utah
Introduction
• Burnout in medical trainees is high and impacted
by many factors; recent changes to ACGME
guidelines increase focus on resident wellness
• Challenging for programs to address these factors
with finite resources
• University of Utah Family Medicine Residency
Program has longitudinal wellness curriculum:
o protected support group
o established policies for physical/mental
health appointments
o structured wellness check-ins
o structured peer support
o structured faculty support
• Yet, our residents still report burnout/depression
symptoms at higher rates than we would like.
Results
• Time is of the essence – by priority and popularity
42% of votes favor time for personal and professional
needs
o Self-care: dental visits, exercise, adequate sleep
o Patient care: complete notes/charting, patient
panel outreach, read up on challenging cases
• Structured events
26% favored implementing activities for wellness
• Reducing redundancy and improving efficiency,
as well as “basic needs” (snacks, suggested
health care providers) were less heavily favored
by this voting.
Methods
• During one didactic session, we asked residents
the question, “What else could our residency
program do to support wellness?”
• Using nominal group technique, residents:
o Provided any/all answers, #nofilter
o Took turns providing suggestions until all
ideas exhausted
o Voted for top 8, weighted (8 = top priority,
1 = low priority)
• The authors independently coded these
suggestions into themes
Theme Sample Requests
Protect Time – allowing residents
more unscheduled or protected time
-Half day per week for administrative tasks
-Half to third day per month protected for self-care
appointments
-Build in registry work to schedules
Structured Events – promoting
wellness beyond basic needs
-Support Group for each class
-Required weekly group fitness
-Periodic debriefing for challenging rotations
Schedule Efficiency – Reducing
inefficiencies or needless burdens in
schedules
-Consolidate documentation
-Cluster work responsibilities to minimize impact on
weekends
-Rotate holiday coverage
Basics – Meeting residents’ basic
needs
- Provide snacks at clinics
-Provide residents with lists of medical/mental
health/dental providers
Protected Time
42%
Structured
Events
26%
Efficiency
24%
Basic Needs
8%
Discussion
• Our residents overwhelmingly prioritize time
o Personal / self-care
o Professional / patient-care
• Data from single residency, but likely translates across
residencies and settings.
• Difficult to implement other strategies (mindfulness,
healthy eating, medical appointments) without this.
o Baseline needs: adequate sleep, self-care
o Without this, capacity for self-care is severely
limited.
• Strained, moment-to-moment mentality impairs:
o introspection
o processing of emotions
o learning from challenging patient encounters
o possible leading factor in dissatisfaction
leading to burnout
• We have a system of training that normalizes over-
commitment. It is time to open a conversation about
redesigning medical training to reflect what we really
need as people – time for work, and time for life.
References
Accreditation Council for Graduate Medical
Education. ACGME Common Program Requirements
Section VI with Background and Intent. 2017. Accessed
4/17/17
Ripp, Jonathan A., et al. "Well-being in graduate
medical education: a call for action." Academic
Medicine 92.7 (2017): 914-917.
“What else could our residency program do to support wellness?”

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.
• 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).
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.
ProjectInsights
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.

Neurology Resident Wellness Program
Sarah Stone, MD; Jana Wold, MD; Amy Armstrong, BA; Rob Davies, PhD
Background
Physicians experience high rates of burnout
compared to non-physician workers in the US. Rates
are especially high in Neurology, Emergency
Medicine, Family Medicine, and Internal Medicine.
ACGME modified its basic program requirements to
include an emphasis on wellness. The Neurology
residency program addressed these new
requirements by establishing monthly wellness
rounds, increasing social interaction of residents
outside of work, and establishing a regular joint
resident-faculty social hour.
Objectives
• Provide resources
• Validate challenges
• Foster camaraderie
Initiatives
Monthly Wellness
Rounds
-Nutrition
-Exercise
-Difficult patients
-Spirituality
-Addiction
Resident Activities
-Escape Room
-Archery
-Jordanelle Reservoir
Resident/Faculty
Social Hour
-Brains and Brews
Discussion
Fig 1. Residents and faculty mingle at local bar and restaurant
Fig 2. Residents and their spouses finish the
Escape room
Fig 3. Residents learning archery
Fig 4. Residents enjoy some tacos after a day at
the VA hospital
Rates of burnout are high amongst
Neurologists with 60% of respondents
reporting at least one symptom of burnout
in a recent AAN survey. Autonomy,
meaningful work, and effective support staff
were associated with reduced burnout. In
January, 2017 77% of University of Utah
Neurology residents reported symptoms of
burnout. Counseling, team-based care
delivery, and recognition of individual
accomplishments are interventions effective
at preventing burnout.
Neurology residents at the University of
Utah have come together to increase
knowledge and access to resources,
encourage openness and teamwork, and
foster work-life balance to help maintain
well-being during training.
While trainee reported depression and
burnout did not improve over the course of
our first year of wellness initiatives, we hope
that continued attention to these issues and
adjustments of current programs will reduce
burnout in the longer term.
References
• Shanafelt TD, Boone S, Tan L, et al. Burnout and
satisfaction with work-life balance among US
physicians relative to the general US population.
Arch Intern Med 2012; 172(18):1377-1385.
• Busis NA, Shanafelt TD, Keran CM, et al. Burnout,
career satisfaction, and well-being among US
neurologists in 2016. Neurology
2017;89(15):1650-1651.
• Sigsbee B, Bernat JL. Physician burnout: a
neurologic crisis. Neurology 2014;83(24):2302-
2306.

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
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.
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.
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.
ProjectInsights
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
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.
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.
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.
ProjectInsights
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
3
0%
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)

Background
A 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 stress
3. 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).
Results
A 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
Hypothesis
Hypothesis 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 Evaluation
Participants 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.
• 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.
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.
ProjectInsights
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.
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.
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.
ProjectInsights
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%
Optimal
Good
Satisfactory
Marginal
Poor
45% report insufficient time for
documentation
39% 28% 28% 6%
Extrememly Valuable
Valuable
Neutral
Somewhat Valuable
Minimally 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.
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.
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.
ProjectInsights
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

CHALLENGES & STRATEGIES IN APPROACHING ONE
OF THE MOST UN-WELL SPECIALTIES NATIONALLY
University of Utah Health Department of Neurology
RESILIENCY CENTER | DEPARTMENT OF NEUROLOGY
PROJECT VISION
In a 2012 national survey of 7,288 physicians, Neurologists ranked 3rd for burnout. Neurology is the only medical specialty that has both one of the highest rates of burnout
and the lowest rates of satisfaction with work-life balance1. Recent published2 study of 1,671 neurologists found:
• 60% of neurologists reported at least one symptom of burnout; 53 percent had high emotional exhaustion, 41 percent felt high depersonalization and 21 percent had a
low personal accomplishment score.
• Neurologists work a median of 55 hours per week (compared to 50 hours for all U.S. physicians) and 56 percent of neurologists indicated that they had too little support
staff to assist them in their work. Furthermore, only 32% of neurologists indicated their work schedule leaves enough time for personal/family life compared to 41 percent
of all physicians, a rate lower than every other medical specialty.
We evaluated the 2016 wellness survey data provided by the Resiliency Center
and found:
• 78% of U of U Health neurology providers report working over 50 hours per week
• 38 % of respondents said their control over workload was marginal or poor.
• Needs assessment identified: Work flexibility, Nutrition education, mental health
resources, recognition/reward, and onsite child care
A major task will be to develop systems of clinical efficiency to reduce hours spent
on work that supports job satisfaction.
We developed a variety of program offerings aimed at different facets of
physician burnout, targeting all levels of the department, including:
• Clinic Flow/Efficiency Consultative Service: Tailored to individual with goal of
less after-hours work. Service includes an audit of Epic activity (time spent and
billing practice).
• Clinic Workspace Optimization: workstation availability, seating, patient rooms.
• Monthly Wellness Rounds: evening, after-hours, outside the university social
gathering.
Additional Improvements (In Development)
• Support of projects aligned with individual career and department goals.
• Faculty education in time management, emphasizing work-life balance.
• Child Care – for consideration institutionally (not through department)
RESULTS
• Few faculty have participated in clinic flow. Perception it may require sacrifice
in practice such as unrestricted face-to-face patient time, team rooms etc.
• Social activities greatly helped faculty maintain a sense of departmental
identity and “belonging”. Could not target all, i.e. family obligations.
• Departmental unification with renewed sense of senior faculty support for junior
faculty and cohesive departmental momentum.
PROGRESS TO DATE: Instituted a consultative service for chart efficiency and activities to
promote departmental cohesion.
ROADBLOCKS & BARRIERS: No Funding or support; participants must volunteer. Major
disruption in Health Science administration and threatened loss of our Chair.
VALUABLE LESSONS LEARNED: Wellness is a complex task affected by individual
personalities and goals, feelings of isolation, challenges involving clinical practice,
reimbursement, and impacts away from work. Promotion of Wellness is an iterative
process conducted over time.
ProjectInsights
GOALS
Improve neurology faculty overall burnout from 35% to 30% (U of U Health
2016 avg) through:
• Decreasing time spent on clinical tasks after hours.
• Offering opportunities to socialize outside of the university setting.
• Maintain department unity and maximize retention in the context of >6
months of institutional uncertainty (now resolving).
1
Stacey Clardy MD PhD; Susan Baggaley CRNP; Jana Wold MD;
Peter Hannon MD; John Greenlee MD
1. Shanafelt TD, Boone S, Tan L, et al . Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–1385.
2. Busis NA, Shanafelt TD, Keran CM, Burnout, career satisfaction, and well-being among US neurologists in 2016. Neurology. 2017 Feb 21;88(8):797-808.
Major Roadblock: For the majority of 2017 the Neurology Department was
in “crisis mode,” with threatened loss of our Chair. Many faculty found
discussion of wellness in the face of this obstacle to be disingenuous.

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.
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.
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.
ProjectInsights
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 CAMPUS
Bike 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).
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.
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.
ProjectInsights
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
Responses
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
eBike
Very 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

Wellness and Preventing Burnout
of Physician Assistant Faculty
University of Utah Health Division of Physician Assistant Studies
RESILIENCY CENTER | DIVISION OF PHYSICIAN ASSISTANT STUDIES
PROJECT VISION
Nationally, the PA faculty attrition rate is 9-10% annually and replacement of a lost APC faculty member costs the University of Utah system approximately $250,000. This
financial loss hardly covers the loss of historical and institutional knowledge, effect on students and effect on the greater community in the academic division when a
faculty member leaves. The most common reasons for PA faculty to leave their positions include role conflict and a perception in lack of the following: institutional support,
recognition by administration, support for scholarly work, fair promotion process, a sense of institutional community and support of the PA program by administration1.
Identifying and intervening on PA faculty burnout can have a positive impact on job satisfaction, wellness and retention of PA faculty.
We evaluated the October 2016 and 2017 wellness survey data provided by the Resiliency Center and found:
• 89% of Physician Assistant (PA) faculty report that overall they are satisfied with their job.
• While job satisfaction is high, 44% of PA faculty report signs of burnout (figure 1).
• 67% of PA faculty report working more than 50 hours per week (figure 2).
• Level of burnout is directly correlated with number of hours worked per week (Pearson correlation = .587)
Leadership is supportive and receptive to project
with plans to implement solutions based on the data
results.
Future Project Goals
Decrease rates of burnout through:
• Implement strategies to optimize work-life balance.
• Improve work efficiency to decrease overall
number of hours worked.
• Determine what contributes to high job satisfaction
and ensure that those factors remain a priority.
• Continue to survey faculty about ways in which to
improve wellness.
RESULTS
PROGRESS TO DATE: Results from 2016 system-wide survey were analyzed. A more
inclusive department survey was sent to faculty and staff that included open ended
solution-oriented questions. Results were shared with division leadership.
ROADBLOCKS & BARRIERS: Motivating leadership to develop actionable items, personal
time, and uncertainties on best approaches to improve have been challenging.
VALUABLE LESSONS LEARNED: Culture change and leadership engagement are critical to
success. Timely implementation of solutions is challenging.
ProjectInsights
GOALS
Define faculty and staff perceptions of wellness
Identify barriers to “living your definition of wellness”
Get Ideas from faculty and staff to improve wellness
• Ask faculty and staff what can be done to improve their idea of wellness;
concerns/suggestions in areas of administration, clinic, personnel,
scholarship, teaching wellness, & responsiveness to concerns.
1
Joanne Rolls, MPAS, PA-C; Amanda Moloney-Johns, MPAS, PA-C
1. Factors Predicting Physician Assistant Faculty Intent to Leave. Coniglio, David Martin ProQuest LLC, Ed.D. Dissertation, North Carolina State University. https://www.ncbi.nlm.nih.gov/pubmed/28207582.
2
1 2
3
Definitions of Wellness
• Work-life balance
• Positive environment
• Respect of time
Barriers to Wellness
• Workload
• Unclear assignments
• Time
3 Suggestions to Improve
• Wellness Activities
• Clear, consistent
leadership
We conducted an internal survey of faculty and staff (16) in May 2017 to better define wellness, barriers, and
potential solutions to improve wellness. Top themes include: communication, prioritization, time, organization.
33%
22%
33%
11%
I enjoy my work. I have
no symptoms of
burnout.
I am under stress and
don't always have as
much energy, but I
don't feel burnt out.
I am definitely burning
out and have one or
more symptoms of
burnout.
The symptoms of
burnout 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
SOM
PA
Figure 1
11%
22%
44%
11% 11%
< 20 20-29 30-39 40-49 50-59 60-69 70-80 >80
Time (hours) spent on work per week
SOM
PA
Figure 2

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.
The University of Utah Health Wellness Survey 2016 showed our department ranked
workload/work environment as a high source of dissatisfaction.
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.
ProjectInsights
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.
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.
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
ProjectInsights
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.
2
0%
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.
ProjectInsights
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
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 Disagree
5% 23%
14%
25%
25%
39%
50%
9%
11%
SOM All
Radiology
I feel a great deal of stress because of my job
Strongly Disagree
Disagree
Neutral
Agree
Strongly 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 & Chaotic
5%
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.
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.
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

• Improving individual wellness through:
• Traditional wellness activities
• Team function
• Clinic efficiency
• Responsibilities:
• Help department/division leadership identify quality metric for
wellness
• Lead their department/division through the process of choosing
a project(s) to support the metric with the assistance of the
Office of Wellness and Integrative Health
• Identify key stakeholders and outline the project. Determine
resources needed and cost
• Continual reassessment of the project using a Plan-Do-Study-Act
(PDSA) model
• Meet quarterly with Wellness Champions from other departments
to collaborate and learn best practices
• Poster presentation to share ideas at project completion
Wellness Champions
Wellness Champions
Addressing Faculty Burnout Through a Disseminated
Ground Up Approach
Amy Locke, MD; Robin Marcus, PT, PhD
RESILIENCY CENTER | Office of Wellness and Integrative Health
PROJECT VISION
2016-17 Wellness Champions Projects
Next Steps
PROGRESS TO DATE: Approximately 40 champions have initiated 20 projects that target
burnout and wellness using a wide range of strategies.
ROADBLOCKS & BARRIERS: Time and funds to implement projects were the biggest
barriers.
VALUABLE LESSONS LEARNED: Teams were more successful than individuals. Projects
specific to the needs of each group allowed a high degree of impact.
ProjectInsights
GOALS
Reduce faculty burnout and improve faculty retention
Support innovation at department level
1
2
1
2
Expand beyond SOM to University of Utah Health
Figure 1. Wellness Champions Program Process
The Wellness Champions project was the result of the SVP for Health Science’s request to address faculty
burnout in the School of Medicine and the Eccles Health Sciences Library. Burnout and related factors
were surveyed in Summer 2016 along with a needs assessment. Wellness Champions were nominated by
department leadership to address issues specific to their unit. Champions were supported through the
Office of Wellness and Integrative Health with mentorship and guidance.
University of Utah Health Resiliency Center
Unit Project
Anesthesia Peer support/crisis response
Bioinformatics Engagement in university wellness programs; behavior change videos
Community Physicians Group (SJ and GW) Clinical efficiency and office flow
Dermatology Team utilization
Eccles Health Sciences Library Team engagement through wellness game
Family Medicine Leadership feedback; clinical efficiency
Internal Medicine Faculty engagement; clinical efficiency
Neurobiology and Anatomy Grant writing support; exercise space
Neurology Clinical efficiency; social gatherings
Obstetrics and Gynecology Billing and coding evaluation to support clinical salary
Ophthalmology Wellness grand rounds; resiliency training sessions; newsletter
Orthopedics Clinic efficiency
Pathology Use of onsite wellness facilities at ARUP
Pediatrics Wellness release time; bike share
Physical Medicine and Rehabilitation Quarterly faculty sessions to improve team cohesion
Physician Assistants Division Leadership feedback survey to identify targets
Population Health Treadmill desks; meditation sessions; access to Red Butte Gardens
Psychiatry Focus on faculty retention and recruitment
Radiology Identification of targets
Surgery Clinical efficiency
Team based approach

University of Utah Health Improving Wellness: 40 Champions, 20 Projects, 12 Months of Progress

University of Utah Health Improving Wellness: 40 Champions, 20 Projects, 12 Months of Progress

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University of Utah Health Improving Wellness: 40 Champions, 20 Projects, 12 Months of Progress