Above all else, we are committed to the care and improvement of human life. This promise extends beyond our patients and includes all of our teammates - resident physicians, faculty physicians, medical students, administration, and the myriad of other team members who make GME possible at HCA Healthcare. Our goal is to apply evidence-based and expert-informed approaches to improving the lives of our healthcare team.

Improving and flourishing through well-grounded theories

While many, if not most, programs across the country have focused on event planning and skills courses on resilience building as their foundation for well-being we have gone farther. We believe initiatives to improve well-being and encourage flourishing must spring from well-grounded theories rather than a collection of individual ad hoc approaches. Furthermore, we embrace the research suggesting that well-being initiatives that change the work and learning environment provide more robust impact than those designed to change the provider.

Accordingly, we have embraced several underlying theories that guide our approach to provider flourishing focusing heavily, but not exclusively, on improving the work and learning environment. First, we recognize that flourishing requires both the reduction of negative states, such as workplace burnout and depression, but also the promotion of positive drivers of well-being such as meaning, joy, connection, purpose, challenge, and growth. We have thus adopted strategies from both the clinical psychology and psychiatry realm along with those from the newer field of Positive Psychology.

Next, we utilize Self-Determination Theory (SDT) as our overall theory as to what specific work and learning environment conditions create flourishing. SDT suggests that all of us have three primary psychological needs and the degree to which our environment supports, or thwarts, these needs determines our ability to flourish. We all strive for autonomy, competence, and relatedness - the three primary psychological needs. Work and learning environments must develop and support each of these needs to allow our team members to grow and thrive.

Autonomy

Belonging

Competence

We turn next to the robust work done by the National Academy of Medicine to help define a model that organizations can use to focus efforts to develop environments most supportive of the SDT needs. This model focuses on 6 strategies that organizations can use to support healthcare workers.

Resources for health care worker well-being: 6 essential elements

Cultivate a culture connection and support

Advance organizational commitment

Strengthen leadership behavior

Ehance workplace efficieny

Examine polices and practice

Conduct workplace assessment

Enhancing workplace efficiency and strengthening leadership behaviors

While all of these elements are necessary we have focused on enhancing workplace efficiency and strengthening leadership behaviors as early important interventions for well-being. Despite a multitude of research focused on building resiliency in providers as a means of addressing workplace burnout, what has become clear is that resiliency is only a small portion of the solution. The organizational psychologists have studied workplace burnout using a model called the Jobs Demands Resources (JDR) model. This model suggests that burnout results when job demands chronically exceed job resources. While personal resilience is indeed a job resource it is generally more effective to reduce job demands or provide other resources than to focus only on building resilience.

Influential leaders

Finally, most environments that support well-being do so through the efforts of influential leaders. Most of us have an intuitive understanding that some leaders, teachers, or supervisors push us to flourish with their leadership approach. What is less clear intuitively is the specific elements these leaders bring to the interaction that have such impact. Following from the SDT literature comes the study of Autonomy Supportive Leadership (ASL). This type of leadership, which can be learned and developed, encourages autonomy, a sense of growth and competence, and a sense of belonging and relatedness. Together these characteristics enhance and support a strong sense of meaning that provides a foundational anchor for well-being.

In summary, at HCA Healthcare we recognize the role of wellness events, such as ice cream socials, as a means to develop belonging within the SDT framework. We see skills based modules such as mindfulness training as contributing to the resource side of the job demands resources model. We focus on workplace efficiency as a means of dropping job demands and on leadership development to create the overall work and learning environment that best supports flourishing physicians and team members.

The HCA Healthcare flourishing project is designed to ensure we follow the newest literature, determine the best approaches, and eliminate barriers to their implementation. Learn more about HCA Healthcare Flourishing Project