There is power in transparency: UNC Health leader on preventing physician exits

Physician shortages and burnout are topics that many health leaders have become all too familiar with, especially in the last few years following the COVID-19 pandemic. 

Becker's recently connected with Nadia Charguia, MD, associate professor and executive medical director of the integrated well-being program for Chapel Hill, N.C.-based UNC Health, to discuss the continued struggles that many physicians are facing, and how UNC Health is dedicated to tackling this problem head on.

Editor's note: Responses were lightly edited for length and clarity.

Question: How can we reduce these levels of intention to leave? 

Dr. Nadia Charguia: The time is critical and the problem is complex. Advocacy and policy change is needed broadly, and while advocating for that, we can also have an impact locally. It is imperative that healthcare organizations work to directly engage their physicians, having them help in both understanding needs but also to design solutions that will have a meaningful impact for the better.  Additionally, there is a growing and persistent disillusionment that has occurred in a majority of healthcare systems between their leaders and front-line workers with a perception that leaders do not understand the experience, stress or circumstance that is carried on the shoulders of our physicians. Facilitating a means of connection between a system's executive leaders and physicians is also necessary to stem this growing trend.  

Q: How does UNC Health work to ensure a strong sense of physician well-being? 

NC: There is recognition of our own vulnerability — we do not have all the answers and it is important for us to recognize and communicate that. We remain flexible and inventive in our approach. That mindset drives this work, as we are continually striving to learn from our physicians themselves what helps them connect to a sense of meaning, purpose and fulfillment in their work as well as define what are the barriers of our system that stand in the way.  Although personal wellness and well-being is important and having resources to provide individual support is a foundational aspect and constitutes a part of our practice, the core of this work revolves around shifting our well-being culture and working in partnerships across our healthcare system so we can move forward in a meaningful system change, at all levels within our system. 

Q: What types of programs and strategies is UNC Health implementing to reduce physician departure? 

NC: We have a number of initiatives in motion, and we are in the process of standing others up.  The physician experience — not just patient experience — has to be a driver to what we are doing and how we are doing it. To help engage and empower our physicians, a number of efforts have been launched to promote more intentional communication between leaders, staff, doctors, nurses and everyone across our system to inform meaningful change. 

In order to understand the voice and perspective more broadly, a series of listen and learning sessions took place across our healthcare system, where our leaders stated their commitment to meaningful change. These sessions helped kick off a number of projects, and we are ensuring ways to make sure these conversations result in continued dialogue, sharing steps that have been taken in response to needs and suggestions provided. Similarly, this past fall, our What to Fix Campaign launched with a focus on our faculty in the School of Medicine, and we are exploring similar efforts for our expansive healthcare system. Through this effort, we want to maintain the ability to have regular and meaningful conversations in person and continue to engage and empower our physicians.   

Additionally, our Well-Being Program has expanded upon efforts led by our human factors engineering team to apply new knowledge from staff inquiries and embedded observations we learn through immersion within various departments, units and other clinical settings across our system. The goal of this work is to elevate the voices and experiences of our clinicians to identify change efforts that will have the greatest chance for a positive effect on their day-to-day professional livelihood.

To address workload and burden, we are addressing a number of factors, including embarking on reform of the electronic health record, embracing new technologies such as AI, and routinely updating policies, procedures and practices where redundancies have accrued. 

Leadership development and engagement is another domain that impacts the workplace experience, burnout and retention. UNC Health has leveraged technology and expanded our Leadership Development Institute, coaching for leaders and physicians as well as other resources to promote positive connections and shared professional development between our leaders and front-line clinicians.  

Q: Do you have any advice for healthcare leaders who might be dealing with high physician departure? 

NC: Start from a place of honesty and vulnerability. There is power in the transparency this provides. So many of my physician colleagues, be they within UNC Health or across our nation, express a similar sentiment. We understand there may not be ready answers or quick solutions to these very complex circumstances, but to be heard, validated and valued by our system leaders provides hope. Starting from a place of listening, validating and taking a swing at solutions is where we all must find ourselves. Engage your physicians in these conversations, listen to the solutions they have considered.  As one of my colleagues reminded me the other day, "We are here because we still have hope." We must hold that hope and build trust.  

There is a widespread perceived divide of connection or trust between our front-line clinicians and their system leaders. A leader communicating their own vulnerability helps provide a reminder that they too are working on the same side of humanity. Such honesty does not shake confidence that has already been shaken, but rather it serves as a bridge to build trust and mend the divide. 

Our physicians and teammates must be our priority, because we know and trust that patient care is theirs.

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