Northwestern retools the ‘coal mine’ to reduce clinician burnout

Gaurava Agarwal, MD, grew up with coal mine references through his father, and those metaphors have informed Northwestern Medicine’s approach to clinician wellness and burnout prevention.

Dr. Agarwal, who serves as Chicago-based Northwestern Medicine’s chief wellness executive, told Becker’s that growing up with coal mining in his family background — and later treating impaired physicians as a psychiatrist — he recalled one physician telling him that, rather than focusing on making physicians more resilient to their work environment, wellness should focus on “fixing the coal mine” and addressing the root causes of burnout within the system.

“That really resonated with me with my childhood experiences,” he said. “And so while I was trying to do a lot of rehabilitation work with doctors that become ill, I said, ‘I think there’s a role for prevention.’ And that preventative approach is one Northwestern has tried to do, where we have embedded this work into our organizational strategy, which is simply to provide a superior work environment that promotes well-being.”

This philosophy and various initiatives have led to the health system earning consecutive American Medical Association Joy in Medicine Gold awards. The program recognizes systems for their commitment to  supporting physician well-being by reducing “system-level drivers of work-related burnout.”

To turn philosophy into practice, Northwestern has focused on technology and teamwork. One initiative Dr. Agarwal pointed to is the rollout of ambient AI to attending physicians and advanced practice providers who use the EHR for patient notes.

“The ambient AI listens to the visits and documents the notes in the format that is typical for each individual specialty — truly a game changer for many of our physicians,” he said. “For the first time they’re not doing work at 9 p.m. at home, when they should be hanging out with the kids. [It’s the] first time they haven’t done work on the weekends. They’re able to see more patients, which obviously makes them feel like they’re providing help to the access-to-care problem that we’re also noticing out there.”

On the teamwork front, he pointed to the system’s after-hours nurse triage initiative. 

“In primary care, they looked at these docs that are on call. Somebody’s on call every night and on weekends,” Dr. Agarwal said. “Historically, they get a lot of calls. Because if you call the call center, where somebody who is not clinically trained picks up the phone and the patient says, hey, I need to talk to the doctor, what are they going to say? They’ve got to call the doc. And the docs would get tons of calls because they’re not covering just their patients — they’re covering a group of doctors’ patients. So you get tons of interruptions at night, tons of interruptions during the weekend.

“And so they created an after-hours nurse triage. So now the nurses get that call, and the nurses can handle almost 80%-90% of [calls] coming in — it doesn’t need anyone paged or called or interrupted at night.”

The after-hours nurse triage line has resulted in positive outcomes. Call volume dropped from about 150 to just 15 — a 94% reduction in urgent calls requiring a physician. 

While there are various metrics to monitor, Northwestern communicates the impact of its well-being office around four pillars: well-being metrics (tracking burnout, PTO and other indicators), accreditation and recognition (such as the AMA awards), advancing the science (through research, publications and national presentations) and reach (expanding programs such as peer support to reach 22,000 employees across the system). 

For Dr. Agarwal, the real difference-maker has been Northwestern’s Scholars of Wellness program, which he created to train clinicians to serve as well-being leaders in their departments.

“That psychiatrist shouldn’t be telling a surgeon how they should do their work. I don’t have any credibility,” he said. “But another surgeon is trained in well-being, and they can go to me and say, ‘These are the pain points our surgeons are feeling. This is the approach that we take to improve that, based on well-being science.’ Well, now you’ve got people that are really close to the work, that have the buy-in, the credibility amongst their peers, to be able to make those changes.”

The program has expanded from attending physicians to advanced practice providers and, most recently, to pharmacists. Overall, roughly 160 people are trained across the system. 

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