For Dr. Jennifer Hartwell, it’s personal.
In June, Hartwell was named the associate dean for wellness at Indiana University School of Medicine and chief wellness officer for IU Health Physicians. In a time when nearly 45 percent of physicians have reported experiencing at least one symptom of burnout, for Hartwell the memories of her own struggles with exhaustion and disillusionment as a health care professional remain crisp in her mind.
For the surgeon, drawing on those “low points” in her career will be an important tool as she tackles this inaugural role. Striving to help fix a system she deems broken on the national level, Hartwell said she’s focused on those big-picture goals—though her No. 1 priority will always be the individual.
What are some examples of the system drivers that are leading to physician burnout?
System drivers of burnout include inefficiencies in our practice, documentation requirements resulting in a disproportionate time spent in the Electronic Medical Record (EMR) instead of with the patient, complex insurance paperwork, and the burden of non-clinical work we are required to complete.
Health care in the U.S. has shifted dramatically over the past few decades, pushing chronic but complex patients toward the out-patient setting and only the sickest of the sick who remain in the in-patient setting. This leaves both in-patient and out-patient based physicians with a large burden of increasingly complex patients to care for in the same number of hours in a day for minimal increase in compensation.<
Too many physicians describe feeling a loss of autonomy, feeling overworked, undervalued and isolated in their profession. Similarly, physicians describe how hard it is to balance work, home, family, and personal care. We are exhausted!
Additionally, research shows us that leadership matters. Effective leaders with clear vision and values lead teams of physicians who are healthier, happier and more productive. In large, complex health systems, such as IU Health, it’s easy to feel lost or like I am just one more cog in the wheel. As more and more health systems in our nation grow to be giant multidisciplinary organizations, physicians describe the loss of a sense of agency. Executive and physician leaders need a unique set of skills and experience to navigate the health care system with their team with clarity and respect. How those leaders engage physicians in helping with solutions really matters.
When you hear the term “wellness,” what does that mean to you?
For a lot of people, when they hear the word “wellness,” in a professional setting I think the tendency can sometimes be for them to roll their eyes. We think of it as yoga and mindfulness, and the other popular examples of wellness that we’ve been exposed to in the past. We also might think of physical wellness—things like healthy eating and exercise.
To me it means all of that, but I think it also means a sort of comprehensive wellness—physical, emotional, spiritual, psychological, financial and relationships. It’s a whole-person wellbeing. And for me, part of that wellness of course is having a workplace where I feel like I’m thriving—where my work is meaningful to me and I’m making a difference.
Wellness isn’t something we achieve, but is something we’re constantly working on. It’s something that is always going to be a part of what we strive for. I don’t think there is a destination in wellness, where you wake up one day and say, ‘And I am well.’ It’s a constant effort, as I think it should be. At work wellness means we have the vitality to come to work, do meaningful care, and at the end of the day, feel we have made a difference.
When did you start thinking about wellness in a professional setting?
After I’d been in my first job for about three years or so, I went through something I didn’t know how to describe at the time, but now I realize is what we traditionally call burnout. I was exhausted, not finding meaning in my work, my relationships were strained, I wasn’t physically very healthy—I was just kind of in a bad place. At that time, I don’t think I could really articulate what I was experiencing, and during that process of trying to just muddle through a couple of my colleagues were really integral in offering me support.
I don’t think I ever heard the word “wellness” throughout medical school, and I certainly didn’t hear it during residency. Even in my early career, I don’t think it was something I was aware of or focused on. Looking back on it, what I see is that my journey to where I am now required a heck of a lot of work and effort, and the support from people around me—my family and my close friends. What I went through defined my career, and has led me to believe that it is really important to support my colleagues. It helped me to understand what it took for me to get through that tough time and to start to focus on my own wellbeing, and shifted my focus toward helping further that effort in a broader way.
What made you want to tackle the inaugural position of associate dean for wellness and chief wellness officer?
I read a study that said there are hundreds and hundreds of papers that have been written on wellness, and only about 15 percent of those papers actually define what wellness is. I think largely right now, wellness is this nebulous concept that people don’t really understand.
I personally believe that our paradigm for understanding wellness is a little bit upside down. We put too much emphasis on the physician, or the student, or the advanced practice provider, to take command of their own wellness, but force them to do it in a broken system. I think we need to fix the system drivers that are challenging our wellness first.
All of this really came to light for me as I look back on the struggles that I had. When I tried to get access to a counselor, I found that the resources were not nearly as reachable as I thought they were. I also found that when I was having my toughest days, I didn’t even have the wherewithal to know that I needed to reach out for help. And so I think that my impetus in wanting to take this to the next level and take this job is to help realign our focus.<
The things that we have done here at IU are fantastic, and we need to keep building on them. I think we can shift the way we think about wellness a little bit, and really reach out to capture the clinicians who are struggling so much that they are just burned out and depersonalized. They don’t even know how to reach out for help, and that is the audience I really have a heart for.
On the national level too, I think we really need to change the way we focus on wellness and make it less about personal resolve and resilience. When you think about it, we’re pretty resilient people already, aren’t we? We’re professionals who made it through medical school. I think we need to have a national conversation about how right now in this country the administration of health care is sabotaging the people who are actually providing that care. We need to go all the way up to congress and say ‘We have got to change the way we’re doing this, because it’s not healthy for our patients or our caregivers.’ And I think IU can be a true leader in this effort.
What do you think it says about IU School of Medicine and IU Health Physicians that they have created this new role?
I think it sends a tremendous message to the community as a whole. It’s a significant personnel and financial investment to have a wellness officer, and IU School of Medicine and IU Health are pouring tremendous resources into this effort. They’ve recognized that it’s a great need, and as the largest medical school in the country, along with one of the largest health systems, we have the opportunity to be leaders in this arena.
In this new role, how are you planning to address those system drivers that lead to burnout?
First and foremost, IU Health and IU School of Medicine must be recognized for the thoughtful design of the role of Associate Dean and Chief Wellness Officer (CWO). I will maintain 50 percent of my time continuing to practice trauma and emergency surgery and critical care, my passions and the very things I spent over a decade training to do. The other 50 percent of my time will be spent working hard for the same colleagues I work with every day in the hospitals and clinics, the residents and students I mentor, the Advanced Practice Providers who elevate our clinical care, and all of the faculty I work with both on hospital and School of Medicine committees and throughout campuses around the state. The CWO is strategically placed on the front lines of health care with those whom they serve every day.
In my role, I will be working with other executive leaders to identify real, concrete and fixable issues with our current systems and processes in our hospitals and clinics, in our school and in our graduate training programs. My job is to look for common themes and get creative in how to address identify a strategy that will address the root issues, not simply stamp out every small problem in every corner of our system. I will be working with the Executive Team of IUHP and IUSM, because they have asked me to be the lens for well-being in our organization. I’ll be the one at the table saying, “Is this decision, this plan, this project good for our APPs, faculty and learners in its design and implementation? Is there a way we can do this better and maintain respect and autonomy?”
In the first few weeks in my role, I have responded to every email or call or request to meet with a “yes.” Everyone has a voice. My role is to listen, to gather information, to get ideas from all of the talented people who work in every area of IUHP. So I am listening, and one of the first things I have noticed, in all of the conversations I have had recently, is that not one person has asked for more programs to attend or modules to complete. While all of that is wonderful, and there are some awesome resources around here, there is a hunger for something more. My role is to inspire and equip local level leaders to empower the members of our community and support them even better. To build relationships and nurture a healthy culture. To recognize that while we each own some personal responsibility for our own wellness, there is more. We must work together to create a healthier system in which to practice, teach, and conduct research.
My personal core values are connectivity and authenticity. I couldn’t think of a better way to describe this role of CWO: to more directly connect our front line people to the executive team, in a real, honest, respectful way, to collaborate on solutions to our everyday concerns. I won’t fix all of the health care problems in the U.S., but I will leverage my position with one foot at the bedside and one in the board room here in Indiana to make our days run a little easier and bring a renewed sense of hope and joy across our three core missions of research, teaching and service.
Associate Dean and Chief Wellness Officer Jennifer Hartwell, MD, FACS, CNSC, joined the IU School of Medicine faculty in 2016 as a trauma, acute care and surgical care surgeon. She lives in the Indianapolis suburbs with her husband of 21 years, Scott Hartwell, and their four children—Jack, Allie, Ben and Sam.