In Conversation with Bethan Richards, Australia’s first CMWO

In Conversation offers a glimpse into the life of an ‘outlier’ – an exceptional person who goes above and beyond to innovate in their field and improve patient outcomes. This edition’s guest is Bethan Richards — Australia’s first Chief Medical Wellbeing Officer (CMWO), Head of the Department of Rheumatology at the Royal Prince Alfred (RPA) Hospital in Sydney and Deputy Director of the Institute of Musculoskeletal Health.

How did the CMWO role come about?

Before becoming the Department Head of Rheumatology at RPA, I was the network director of physician education. The work involved looking after the training and well-being of 60 basic physician trainees (BPTs).

Having been in the role for five years I have noticed a significant increase in distress which seems to occur in pupils every year. This meant that I spent more and more time advising them and that I referred greater numbers of pupils for formal external assistance. This, despite the fact that we ran a training program that was probably the best in the country, with every trainee receiving formal mentoring.

In 2017, in a four-month period, four GPs (out of 400) in NSW took their own lives. It was shocking and heartbreaking – it led to a lot of sadness, anger and reflection. Locally, this has strengthened the conversation about pupil well-being and efforts to better understand the factors that influence it.

At my health district we had an initiative called ‘The Pitch’ where anyone could pitch an idea to the Chief Executive for $50,000. The trainees and my training team came together and designed a pilot program for wellness called BPTOK. In 2017, we successfully introduced the program to the Sydney Local Health District (SLHD) and ran the pilot over the next two years.

In 2018, NSW Health launched the JMO BeWell program to fund initiatives that addressed the wellbeing of junior doctors. We applied for funding to deliver BPTOK to all junior doctors in a three-year phased approach across the Sydney LHD (RPAH and Balmain Hospitals in 2018/19, Concord in 2019/2020, Canterbury in 2020/21) as MDOK to roll out, and was successful in our grant for $210,000. We also realized the importance of addressing senior doctor’s well-being, which is why we opened MDOK to all doctors working in the district.

In 2018 I went to Stanford University to learn what had been achieved in the US (there were no similar programs in Australia) and did the Chief Wellness Officer course. After my return, my Chief Executive Officer created the first Chief Medical Welfare Officer in the country. The role involved establishing the SLHD MDOK Wellness Center and creating a project team, establishing routine wellness measurement of medical officers at SLHD, and developing, piloting, evaluating and promoting medical officer wellness initiatives in the SLHD.

Bethan Richards. Image: Provided.

Tell us about the early days in the role.

The early days were difficult. Emotions were high and well-being was not a topic that was openly discussed in the medical world for fear of being seen as ‘weak’ or ‘not coping’.

Convincing people to spend precious time on wellness skills and knowledge training was challenging, and there was a lack of understanding about what physician burnout was, why it mattered, and what meaningful changes could be made.

At that time, there was no management structure around wellness within the organization. There was limited evidence to guide us and while many anecdotes and opinions were offered, there was no data to back them up. There was also pressure to help everyone at once. It also became apparent early on that what one doctor emphasized did not necessarily influence another, and conversely, if a wellness strategy helped one doctor, it did not mean it would help others.

Much of the early days were spent gathering data and educating managers, junior and senior medical staff and their colleagues about what the problem was, why it happened, why they should care about it and what it was suggested we should do about it. do.

What does the program involve?

MDOK is Sydney Local Health District’s multifaceted and evidence-based wellness program that drives organizational, cultural and systemic change. The model developed and piloted in the RPA BPT cohort of 60 physicians has been successfully implemented at various facilities in the SLHD for approximately 3000 physicians. Components of MDOK have also been adopted by various specialty societies and other craft groups. Please refer to Image 1 for our phased approach to the program:

Image 1. Source: Bethan Richards

Over the past four years, we have managed the delicate balance between running a resourced, sustainable and tailored program with the pressure to address the wellbeing of greater numbers of doctors at all levels of their careers, as well as the need to help address staff well-being.

Over time, we have built MDOK around five key pillars of well-being (physical; psychological; social connection; leadership and performance; and culture and safety), as well as ensuring cultural and system-level interventions and the use of a data-driven approach.

Image 2. Source: Bethan Richards.

Each pillar has a range of tactics to address wellbeing, and to date over 200 initiatives have been launched. In 2020/21 we had 56,302 measurable interactions with the MDOK programme. This included 18,969 interactions with MDOK’s physical wellness initiatives, 27,633 interactions with psychological wellness initiatives, 3,915 interactions with social wellness initiatives, 1,159 interactions with leadership and performance initiatives and 4,626 interactions with culture and system change initiatives.

COVID-19 has created many challenges for the program. There have been shifts in work roles, constant uncertainty and staff shortages, and the strict rules on isolation have interfered with our ability to deliver many face-to-face wellness activities. We turned to the virtual world, which had some advantages – there was greater engagement and flexibility in reaching people, but at the expense of real human connection.

We had 3588 Zoom session attendances at the MDOK COVID-19 Education Series and 2010 hits for the MDOK initiatives presented on our private YouTube site. With various initiatives targeting all staff and difficult to measure individual interaction with (e.g. sparkling/still water fountains, #TheatreToastie, sheltered lunch, RESET, call room upgrade), it is likely that the true engagement of SLHD staff in MDOK initiatives are much higher than that.

Do staff do things differently because of MDOK?

Our data shows:

The number of doctors who have a family doctor increased from 55% to 75%. Rates of doctors reaching out for help to EAP or MDOK increased by 150%. Sick leave rates among junior doctors have increased (meaning they are not coming to work sick as was the historical culture). COVID really helped that. The number of doctors who eat lunch has increased. The number of doctors who drink water during the day has increased significantly. Lower rates of distress and burnout and higher rates of self-compassion and resilience in physicians who engage in MDOK activities. Medical staff more often share difficult experiences publicly, have check-ins and huddles built into workday practices. All orientation processes now include MDOK sessions, all junior doctors have specific MDOK sessions built into their training programs, MDOK is an agenda item on quality and safety committees, departmental committees, medical boards. Well-being measures are now a routine part of practice and are measured annually (ethics-approved database created). How critical is leadership to bring about change and improve well-being?

Absolutely critical. We have a pillar dedicated to this and the buy-in of executive and senior clinicians is a must. Yet, ironically, doctors receive no leadership training, and those in leadership positions have limited support. Our leaders are the guardians of the culture; to change the culture, we need to have leaders involved and role modeling the behavior we aspire to. In healthcare, work is done in teams and leaders therefore have a large sphere of influence on the well-being of medical and non-medical colleagues around them.

Wellness champions are a critical part of achieving a shift in culture around the issue of wellness in large organizations and can happen at any level. Must have dedicated leadership resources to address wellness and a governance structure that empowers these leaders to effect change. There is good evidence for the positive effect of coaching in doctors leading to a reduction in burnout and improvement in well-being levels.

Can you summarize key insights from the program journey?

Some of the key points included: staff wellbeing requires a data-driven approach; burnout is a quality and safety issue; there is no one solution to wellness/burnout, so we need a menu of options; each department or hospital has different problems, so we cannot use a ‘mixed approach’; staff wellbeing should be a number one priority with dedicated resources allocated to it; we cannot address ‘all staff wellbeing’ without understanding the issues affecting different groups; instead of focusing on the individual, we need to address the system and cultural issues; senior management involvement is critical to achieving meaningful and sustainable change; solutions come from the front line; social connections improve well-being.

After reviewing our model, the Australian Medical Association recommended the appointment of a Chief Wellbeing Officer in hospitals as part of its Position Statement on the Health and Wellbeing of Doctors and Medical Students 2020. In 2021, NSW Health recommended the appointment of a Chief Wellbeing Officer . officer in his Staff Wellbeing Strategic plan.

Top image credit: iStockphoto.com/PeopleImages