How to Move Clinician Well-Being Beyond the Buzzword

Welcome to the AMA Steps Forward Podcast. Here we explore physician-developed solutions to help care teams and their organizations thrive. Empowering physicians, transforming practices, this is AMA Steps Forward. Hello and welcome to this episode in the AMA Steps Forward Podcast series. I'm your host, Dr. Kevin Hopkins, a family medicine physician at Cleveland Clinic, and physician director of health system engagement here at the AMA. As physicians, our typical learned adaptive behavior is just to keep our heads down and our noses to the proverbial grindstone. We push through long hours, heavy workload, consequential decisions, taking care of everyone else first. But what happens when leaders start to center on wellness and well-being, not just as a buzzword, but as a real priority for themselves and their teams. Perhaps you've heard the phrase "a rising tide lifts all boats"? I've seen that when physician leaders create time and space for relationship-centered care, caring for yourself and caring for others, it doesn't just help one person. It changes the culture by shifting priorities, norms, and expectations, and before long that rising tide really does start to give everyone a lift. Here to share her story of developing a comprehensive multifaceted system-wide clinician well-being program dedicated to raising everyone up is our guest, Dr. Heather Spies. Dr. Spies is an OB/GYN physician and physician director of clinician experience and well-being at Sanford Health. Heather, thank you so much for joining us on the podcast. Hi, Kevin. Thanks so much for having me on today. It is a pleasure and an honor. Before we get started, would you mind telling our listeners just a little bit more about yourself and background, please? Absolutely. As you said, I'm an OB/GYN by training, still practicing, and in my 20th year practice this year, actually. I've had the privilege of peering for patients and families during some of life's most important moments. Women's health just has such a variety of things that's been such a joy. I also serve as our clinician well-being officer at Sanford Health, the largest rural health system in the country, so we have a lot of unique needs and challenges. We have over 2,400 physicians and over 2,000 APPs at this point. And really over the past six years in that role, I have worked along with my team to really help build a coordinated system-wide approach to clinician well-being, really including the full life cycle from when we onboard clinicians all the way through their late career, hopefully. So, yeah, what really began as a set of initiatives has really evolved into a core workforce strategy for us. And we try to really ground it in relationships, listening, leadership investment and meaningful improvements so we can see how we can really help clinicians find joy and have a good experience in their daily work. So ultimately, I get to work alongside clinicians to help find ways to do that and really to hopefully sustain meaningful careers, keep the joy in their days and continue to deliver high-quality care to our patients. So, looking forward to talking about these things today with you. All right. Well, so am I. I've been looking forward to this for a while now and can't wait to get into it. And congratulations on that milestone in practice. I was 20 years and practice a few years ago. And in some ways, you know, it's like any other anniversary. It feels like it was just yesterday, but it also feels like a lifetime. So, I agree. So, Sandford Health, I want to talk about your health system a little bit. Your health system earned gold level recognition from the AMA's Joy and Medicine program in 2025. And this marks the third time that Sandford has been recognized by the program and the second time at the gold level. So, congratulations on that. And I want to ask with that type of longevity around the Joy and Medicine program, it really, to me, speaks to the prioritization of clinician well-being. Has supporting clinician well-being always been as much of a priority at Sandford as it is today? Yeah. Thank you for that. We're really proud of this because it does reflect years of intentional work and sustained commitment. I think over time, you know, it has been a foundational component. But with time, clinician well-being has become more of a standard core strategy and a priority at Sandford. And so, it's been a joy for me to be a part of this for the past six years to really see it evolve from really strong local efforts into a more coordinated system-wide approach. We've grown so much as a system across the Midwest and across a really large footprint. And so, to be able to create a clinician experience office so that we can expand the locally really well-known things to our entire footprint and enterprise has been really great. And I think that's contributed a lot to our success as to have a whole team working together to support clinicians. The AMA Joy and Medicine roadmap has also really helped us along this journey because it has that structure. It has some, you know, objective things we can do, look at and keep track of to ensure that we're really focusing on the system-driven, measurable improvements that we have been working on. So, yeah, so today we see political being as foundational to really sustaining our workforce. And we have to have it to have strong teams and high quality care. Yeah, that's terrific. And you know, we like to say that while burnout can manifest in individuals, it begins in systems. And so, consequently, systems solutions to help improve physician and clinician well-being and decrease the rates of burnout are certainly going to be the most effective. So, what does it mean to you to take a relationship-centered approach to physician well-being? So, for us, every relationship-centered approach really means how do we recognize that the everyday experience of a clinician is shaped by the quality of the relationships around them. So, especially their direct leaders, the people they're working with, their colleagues, their teams, because we are clinicians, but we're humans first, right? And without those relationships, we're not going to find joy in our day to day. We're not going to do the best job we can in our work with patients. And so, we have really found the more clinicians feel heard and supported the more connected they feel to others. The more that creates the foundation for being engaged and trusting each other and feeling fulfilled professionally. So, we've tried to embrace this philosophy more and more as we've grown our clinician experience team, because culture is really built through relationships. We like to call our clinician experience liaisons and our team members connectors, because often we say, "If you don't know who to go to with something, you know, reach out to your market liaison and they will connect you to the right people that might know the answer." So, I think that's why our models really intentionally grounded in communication, collaboration, and investment in leadership. So, we can really create those relationships and support those relationships. And we've seen the fruit from that. Right, so much of what's important around what helps physicians to feel fulfilled and professionally satisfied is those connections, those relationships, certainly with colleagues, co-workers, our patients, you know, and even outside of that group of people. So, I think that makes a lot of sense. Did it occur to you to have any other philosophy or approach when it came to a well-being program or was it simply obvious that a sort of relationship-centered approach makes sense? You know what, that's an awesome question, because I think it was an evolution. As I look back over six years, you know, just experiencing this and working on these things, it wasn't that that was necessarily what we wrote down, you know, as a strategy. But what we found is that all the things we were working on improving, all the things that we wanted to see to build the culture of, you know, decreasing stigma, the culture of finding a trusted colleague to talk with, the culture of, it's not "we versus them" with administrators and clinicians, like all of those things, ultimately, when you start to think about it and break it down, it's all foundationally built on relationships. And so, I think it just was an evolution, you know, it wasn't that. But the more and more I share with others about the way we do work clinician experience team, it's become just such a obvious thing. And then, as you can tell, I feel really passionate about relationships and people and how we work together as teams. And so, I think that's shifted as a personal focus of mine. If we just really talk about relationships, that's at the heart of so much of it. Yeah, that's so interesting to me that it wasn't intentional off the bat. But now, looking back, you can see that everything you did along the way was really rooted in that. So, what were some of the intentional strategies that you, your team at Sanford Health really implemented to foster a wellness-centered culture? Yeah, so if you back up and look at where we found the relationships being a part of it, are intentional? strategies. Really were anchored in three areas. Listening to our clinicians, right? Like, because people want to be heard and know that we're trying our best to find solutions to things that are getting in their way. And then we really invested a lot in leadership development and then reducing friction in their daily work. And so, yeah, when you look at those intentional strategies, we need those relationships to be strong to make all of those work. So we really worked to create a strong culture of listening through surveys, town halls and forums, focus groups, we have some small focus groups that kind of branches out of our clinician well being counsel. And then direct conversations, we really made it a requirement for clinicians to meet at least annually, if not more, with their direct leader, which just wasn't always happening, right? You said a goal of that happening, but sometimes without it being really required, it wasn't happening. And so once people got to know each other more, it was evident that we were starting to see some improvement in those areas. And then we also incorporated something called the Sanford Leader Model over the last couple of years. And that was really intentional too, so that we could all start to learn to speak the same language. So the leader model really has leading self first, then learning to lead others, and then leading our mission at Sanford Health. And so it just, it aligns with kind of our expectations of our clinicians, our leaders, and really serves as a guide to inspire confident, effective and values driven leadership across our organization. Because, you know, to have a strong culture, you have to have similar values. And that's where we're finding it's just, it kind of is a way to have a model to bring this together for us. Especially in our rural systems, I think sometimes teams are smaller, they're more interconnected. We saw that investing in some of these things, they already have the Relationship Foundation, but then we, that's where they needed the help and the support. So that's where I was really helpful. I love to share one example if I may about our coaching program. We have a coaching program called the Professional Practice Support Program. And I love when you just see the light bulb go off in someone's fate on someone's face when they are kind of getting this individual coaching as a leader. They learn something about themself. And this light bulb goes off and they say, oh, I think this might be helpful in leading my team. Now that I'm aware that this might be a plate, like my, this might be my, you know, thing I need to watch for or be cautious of that might derail me or might, you know, sidetrack me a little bit as a leader. So that's just been something really fulfilling where when we intentionally invested in a lot of those things, we would start to see it evolve. Yeah, how cool to have sort of a move on of realization like that and really follows along with what she described as the Sanford leading model, like the lead yourself, lead others, and then lead the mission of the organization, you know, it's sort of a natural progression as people do develop as a leader. So I heard those three things you said sort of listening through surveys and town halls, leadership development, and then reducing friction from their work that those were really the intentional strategies that you prioritize. I want to ask you some more questions related to listening specifically. What role and how valuable did you find that period of listening and how valuable has that been an ongoing framework, as far as getting physician feedback and how has that shaped well-being work at Sanford? Yeah, I think that's also been a learning curve for us, right? Because you everybody wants to listen, everybody wants to get feedback, but sometimes I think it's a challenge on how to do it well, how frequently enough to do it, all of those aspects of it. And so we wanted to find ways for clinicians to have maybe several different avenues in which to engage and give their feedback. So we've kind of built a communication framework over the past few years where we have both an annual and then a six-month pulse survey so that we, you know, can trend data and see what what themes are out there that we need to address, but also that we give it, you know, a pulse of, are we in the right direction and guess, keep going forward or more pivot a little bit? And then we've incorporated our AMA organizational biopsy every other year to really dive into the well-being burnout and be able to trend that because we felt like, you know, so much was happening in 2020, in 2022 and people were getting survey fatigued. And we also want to try to tie in our employee engagement with our clinician engagement. And so when we're doing the surveys, this is just kind of what's made sense to us. So I think every organization has to figure out what that looks like. But then also for listening, we've built in, like I mentioned, those annual meetings that are one and one's or sometimes one on two with their diet department here and director. We also have listening sessions that we've implemented in departments, right? So I know the AMA has that framework for listening sessions and then those forums. I think really the biggest thing we've learned along the way too is to communicate that you're listening and to communicate what you have done in response to it, right? Because people stop giving feedback if they don't think anything's happening because of it. And so in our newsletter or in our weekly clinician experience email, we say you spoke, you know, we listened and then we maybe just give three bullets of like what has happened lately as a result of them giving their feedback. So they can connect the dots. Because I think sometimes we get the question of like, well, what exactly falls into the wellbeing category, the experience category. And so that just helps them tie those, tie those through lines together. And then I feel like it's helped us to continue to get feedback, right? Because then people feel like, oh, this might make a difference. And if also closing the loop, if it's a no or not yet or whatever that is, maybe giving some type of, you know, high level reason why I think has gone really that we have found it to be really helpful. So, so yeah, I think just, you know, like opening to the stuff, we rise together, right? So, I mean, just being honest with people and say, hey, we want to hear from you, but let's talk about how we build trust and how we find solutions together has been kind of a key to it. Yeah, those those are great points, particularly about the, you know, the follow-up because everybody wants to take a victory lap when something goes well and we're able to solve something or fix it and really promote it. But even when maybe we're not, you know, to circle back and to explain why something was unable to be changed, not that you forgot about it or you blew it off or, you know, people feel like if they never hear hear anything about their suggestion again that they were dismissed, they weren't listened to, even if that's not the case. And so being able to provide that follow-up and closing that loop certainly seems like an important thing. Are you able to share any specific examples of maybe some operational changes that that helped to reduce administrative task burden or, you know, time spent doing work outside of normal work hours? How do those changes improve what the clinician experience is like? Yeah, absolutely. So, this has been an important area focus for us because we're all hearing a lot about the options out there, AI and the things. And we've all heard for many, many years about the burden that is kind of been shifted to clinicians, for documentation, et cetera. So, a couple of things that we had big wins in. One was getting rid of some of the computer-based training modules. I mean, we just found that once we started diving in and looking, a lot of them were labeled as required, but when we actually dug in, it's like, okay, show me the policy that actually shows that this is a must for our physicians. And what we found is some of them were old, worked, required any longer, whatever. So, we were able to get rid of hours of that. It took a lot of work, my partner, Austin Campbell, put in hours and hours and hours to really vet those out. But then what we found is that investment in time to do that. Now, our team is kind of the gate keeper going forward. So, before anyone can add a module for computer-based training for a clinician, she is one of the people at the table at the meeting to say, show me the policy or show me what's required or what is the benefit of all physicians needing to do this one and things like that. So, it's good. We gained and got rid of a lot of hours and going forward. We feel like we have a sense of control over it. So, I think that has been a huge win. And then, of course, the AI ambient listening for progress notes, that's also been a huge win for us. So, we have that, we've had it for a little while now, and the clinicians that have been utilizing it have just been reporting that it's been life-changing for them. 90% of them reported that they just felt better about their job and, you know, their work-life balance. We kind of did a survey before and after to kind of gauge how it was working. So, 95% reported reduced cognitive burden, just being able to use that tool. And 80% said it increased their likelihood of continuing to practice. We have one particular physician and family medicine who was starting to tell everyone that he was going to retire. And he now said, because of this tool, he talked with his wife and he's just not ready to do it yet. And he feels like he can go home at 5.30 every night with his charge done and still continue to practice. So, those are the ones we're looking for, right? Those. stories, you know, I've shared the other one before with my neighbor who, you know, stopped me in the street when I was walking my dogs to tell me that him and his daughter were going to look for a car, you know, for a 16-year-old daughter because they had his church done. So just these are real things that people are experiencing that are different because of that. So we've expanded that, like, once we start sharing those stories a year or two ago, we got great buy-in from our executive leadership and now we're expanding to hundreds more of our clinicians to use the tool with the eventual over the next year or so of anyone that wants to use a tool, have access to it. So that's a huge win. Yeah, thanks for sharing those those examples. I mean, talk about bringing the joy back to the practice of medicine. I mean, literally that happened for that person. So great examples and yeah, I've heard similar responses to these types of tools and we use one here in our health system and I'll say my charts are done sooner than they were before. I've never really done the the the legwork to figure out does it save me time? If so, how much? But I completely agree with the cognitive burden. When I when I open up a note that is incomplete and at least there's a draft there and I don't have to try to remember what I did, oh gosh, it just takes such a weight off. Yes, yes, you know, we're talking about relationships. So think about when your cognitive burden is less, you can actually have a more meaningful relationship with your nurse at the end of that afternoon as you close up and go home. You have a better relationship with your family or friends when you, you know, go to do whatever you're doing in your evening. And so I agree, I think it's been uh, children is going to continue to evolve and I hope it's important to send even more ways. Yes, for sure not perfect, but it is going to continue to get better and relationship wise, I'm even thinking about the patients. I find that I'm more attentive to my patients in the exam room rather than trying to, you know, capture everything in the EHR in real time or scribble my notes or something like that. Years ago, I had a team-based care model where I had two medical assistants that did a lot of the documentation for me sitting at the computer and had a very similar experience at that point. And then I've not been practicing in that model for the last several years. And so to have something that took on at least a portion of the documentation burden for me from a technology partner team member or electronic standpoint, I found to be very valuable. And the patient senses that in a million ways, right? They sense your presence, they sense that you are in that human relationship with them and not just a transaction with the computer. So I agree. Sure. Yeah, one of the things years ago that encouraged me to try, I got to figure something else out with this documentation was a patient set on a patient experience survey regarding a visit with me. The doctor spent more time examining the computer than examining me. Yes, it is. It's humbling. As a primary care physician, especially, I'm just sort of like that was like a shot to the gut, you know. Yes, yeah, we're not intending to do that, but sometimes we're just trying to survive and keep up, right? So absolutely. Better tools to hold this. Absolutely. So related to those specific operational challenges or any others or even just the well-being work as a whole, were there any also challenges or resistance that you and your team encountered when rolling out some of these, maybe changes, programs related to clinician well-being. And if so, how did you overcome? Of course, right? I mean, anytime you're you're building something, especially any large-scale change, it just takes a lot of consistency, you know, trusting the people that you've built teams with and then follow through. I think one of the things I mentioned earlier is, you know, we're a pretty large rural health system with a big footprint. And so what we found sometimes is we would think something that we were going to try to implement or improve on just sounded like a no brainer. And then as we went to implement it, we maybe have, you know, three out of the four main markets would be all in and one would just be extremely resistant to it. And we always want to navigate and respect some of the market differences, right? I mean, there's different cultures, especially if you're looking at people in Bemidji, Minnesota versus, you know, Sioux Falls, South Dakota. I know people that aren't from the Midwest might think they're close together, but they're not. And they have very different cultures, different populations, different sizes, all the things. And so different resources for their medical care. So what we found is that sometimes we had to just say, okay, where's it working or where where is the buy-in? Let's try it here first. And then show maybe the market that didn't think it would fit for them, how it worked, you know, somewhere else. And then say, do you think it would work now that you've kind of seen this example? And then maybe we tweak it with whatever might need to be tweaked for your region. So that's been really helpful and successful, I think. And then again, like we've just found ways to really build relationships. As a clinician experience team, we will go do rounds and just make sure to be physically present in each of those markets occasionally so that we can get to know the people in person so that when we do come to them with an idea, they know where we're coming from, right? They've learned to get to know us and hopefully trust us and know that we're bringing it because we've seen it be helpful in other areas. One one story I love to share is that we had someone that I would say was pretty resistant to a lot of this in one of our areas and they actually joined our RISE's leadership program. And so we have a leadership program that we, you know, have clinicians in to your program. And you could just tell the first couple months of meeting that he was a little resistant. He would say things sometimes like administration versus me, you know, that kind of language that we talk about. And he, after one particular session, again, light bulb moment, I think, for him. And that's what he said. So he sent a message just saying that that session just expanded his understanding of leadership by really showing transparency, kind of helping him to understand the complexity of operational decision making and the reality, the realities that leaders navigate daily. So I think hearing candid discussion from real human beings sitting in front of them, not just administrators, you know, helped him to see real world examples. And he said it challenged his own assumptions and prompted him to really reflect over the next couple of weeks how his personal tendencies influence how he interprets decisions and communicates within his team and his system. And so he reported to us that as a result, he felt greater perspective curiosity and empathy is a leader and really strengthened his self-awareness and his effectiveness in, you know, being a department chair. So again, if we invest in our leaders and we just kind of take one person at a time, one market at a time and keep trotting forward, we start to see those aha moments and those transitions all the way. Yeah, wow, it's cool. So it sounds like that person specifically got so much of the leadership development as it means this sort of just going through this process and exposure. And that's a really cool example. I did want to ask you to like about the Sanford Rises program. So Dr. Spies is also co-creator, co-director of the Sanford Rises program. She mentioned this is a clinician leadership program. So how did that clinician leadership development program contribute to the building of stronger teams and relationships within your organization? I mean, you just shared one example. Any others you're able to tell us about? Yeah, I love talking about this program because again, it's about relationships and, you know, I get, I just feel so honored to be a part of it and get to honestly learn alongside these clinician leaders, right? So we're there leading the program, but we're learning from them every day. So it's really, I think, been one of our most meaningful investments. You know, we talked about, you know, leading self-first and leading others and then kind of leading mission. And it's been a way as an organization that we can say, okay, we're going to invest in this time together to teach our leaders about Sanford, about our values. And about what our goals are, ask them for their feedback when we're facing challenges, kind of in real time. So it's just been such a fun way to not only invest in leaders, but also have them be our go-to sometimes when we're trying to brainstorm solutions for certain challenges. So I think that's helped it be successful because we've learned that that's a good way to look at it as well. And then a through line has also been wellness center leadership, right? So we start every meeting together with an hour or more of a check-in, a wellness check-in, what's gone well since we last met. What have your challenges been and how can we support each other? And so that has rapidly accelerated how quickly this group gets to know each other, there's 30 of them. And we quickly see within two or three months that they are each others go to the built-in network of support. And so, you know, we're in our third cohort now. So we're now to, you know, over 80 clinicians who are rises alumni or participants and we're starting an alumni group so we can support each other. So it's just it feeds on itself and grows and I think the investment itself is as shown to be extremely worth it. Fantastic. So obviously, Sanford Health and you and your team under your leadership has done just a lot of work and invested a lot in clinician well-being. Is it making a difference? Are your clinicians any better off today than they were before? You know, I hope so. You know, like I said, I-- just the individual stories to me are so fulfilling. But then we also obviously want to be tracking to be sure that we're following data and making sure that it's making a difference. And so we have seen evidence based on our surveys that we have made big improvements forward. And I think every time we look at the surveys, we are diving into the comments. We're diving into the themes. You know, what are we doing? Well, how can we keep making sure to do that well and not drop that ball? Because just because we are doing well at it now, let's make sure we keep on that. And then also how do we keep people engaged, right? So yeah, since 2022 to the end of 2025, our data shows that we've really increased our job satisfaction, decreased job stress, our intent to stay has increased by 12% and our burnout improved from 50% down to 36%. So I think those are huge strides. So yeah, I always have to remind myself because it's never enough, right? I want to reach every single clinician. I want every single person to feel that joy. And you know, life is hard. And this is a hard career to be in. And so we know that we're going to have our ups and downs. But I think as long as we're focusing on those system-wide things that we can make sure we're keeping eye on and improving and investing in. And then also investing in relationships so that we know we're trying to build a culture of support so that every individual position also feels like they have a person to go to or feel supported by where they work. I really do think that it makes a difference when you're focusing on those things. Sure, it does. Is there any other advice that you would give Heather to say another health care leader who's hoping to improve physician well-being in their own organization that we haven't already talked about and anything else that you would tell them? Yeah, I would say start by listening, right? Start by listening to individuals, to groups, wherever you can find ways to do that. And then don't just listen, but then find what's actionable from that and try to loop back, close the loop and give the reasons why things are moving forward or why they're not. And then alongside listening comes the relationship building, right? So I think it's just a slow and steady, strategic, intentional movement forward. I think all of us are go getters by nature, being in health care. And so I always have to remind myself just to not be frustrated when things take a little while to keep moving forward. So it's better to kind of have that slow study pace. And then just start by one little thing at a time, right? Looking for practical ways to make clinical work easier, more efficient, more meaningful. Even those small improvements like we talked about earlier can sometimes make a huge impact on the people that they affect. So I think just, yeah, staying intentional, thinking about the relationships of those around you and being involved and being ready and willing to step forward and suggest ways that we can improve or the key. - Yeah, it's easy to get frustrated when we're not where we want to be yet, but it's important to remember that we should value progress over perfection and that well-being is not to be too cliche, but well-being is a journey, not necessarily a destination. - Yeah. - Anything I haven't asked you about that you want to make sure we include? - I think the one thing I would just touch on is just because we are a rural health system, I think everything we've talked about today is even resonates even more for anyone who might be out there in more of a rural setting. So many of the places we serve, a single clinician can represent access to care for like an entire community, right? So supporting clinicians isn't just about their personal well-being, it's about preserving care for our patients, families, and the communities who rely on them. And so really over time, I think at Stanford, we've committed to supporting our workforce and just building that foundation, so we can deliver that high quality care. And that's why this work matters so much, right? So if we ever get frustrated along the way, we just have to keep moving forward. That's why it has to be set up and sustain. And when you really invest in listening, relationships, like you said, they're beginning all both rise together. So that's what our goal is. Fantastic. Our guest has been Dr. Heather Spies, physician director of clinician experience and well-being at Sanford Health. Heather, thank you so much for your willingness to share your experience and expertise. And for our listeners, please check out the episode description to explore the resources associated with this episode. And until next time, stay well. Thanks for listening to the AMA Steps Forward podcast. For more episodes, resources, and CME opportunities, visit stepsforward.org.