Fayola Edwards-Ojeba, MD (Host): Welcome to the Healthcare Executive Podcast from American College of Healthcare Executives, providing you with insightful commentary and developments in the world of healthcare leadership. To learn more, visit ache.org. Welcome to today's episode where we tackle the pressing question, how can healthcare leaders prioritize clinician well-being in today's challenging financial climate?

I'm Dr. Fayola Edwards-Ojeba, a physician and founder and CEO of RechargedMD, an online platform dedicated to helping healthcare leaders build sustainable clinician wellness programs. Today, I am honored to be joined by Dr. Bernadette Melnyk, former Chief Wellness Officer at Ohio State University, and a recognized leader in evidence-based wellness initiatives.

We'll be talking about how organizations can invest in the well-being of their teams, even in the face of budget constraints and why it's so important. So, let's go ahead and get started. And I wanted to start by saying warm welcome and thank you so much, Dr. Melnyk, for being here today.

Bernadette Melnyk, PhD: I'm so excited to have this conversation today.

Host: All right. So before we delve into questions, I just wanted to hear a little bit more from you about your career journey and what led you toward healthcare as a profession.

Bernadette Melnyk, PhD: This is such a great story. My background is of a PhD nurse researcher and nurse practitioner. I actually was getting recruited by the Ohio State University for their nursing deanship. And when I got cold contacted by the chair of the search committee, she said, "Bern, we've seen how you've exploded the college at Arizona State, and we want you to come to Buckeye Nation and do the same thing. But I was studying Corporate Wellness for about three years. I was flummoxed at the fact CEOs of large corporations got why employee well-being was so key. They were hiring chief wellness officers, chief health officers to improve their population health. I wanted to be a chief wellness officer.

But when I went to look at universities, academic medical centers who had a CWO, none could be found. I said, "I'm not interested in moving from sunny Arizona to cloudy Columbus. But if there were an opportunity to combine the deanship with the first CWO position at a university in the country, I might talk with you." And Fayola, I just have to add this, the next day, our former president, E. Gordon Gee called me and here's exactly what he said: "Bern Melnyk, this is E. Gordon Gee, the president of the Ohio State University. What in the Sam Hill is a chief wellness officer? And what would you do for Ohio State if I appointed you in this pioneering position?" That's how I became the first CWO at an academic institution.

Host: Thank you for sharing that. That's why we're really excited to be able to talk to you today because you really pioneered the role, and I know it's gaining more popularity and we need to see kind of more chief wellness officers and more of a focus. But I know you really set the way and paved a lot of the work that's been done in that area. And so, really excited that we're able to learn from your experience and your expertise, and I know you've been in this role since 2011. And I just wanted to hear from you, what were some early wins that helped you to establish its credibility?

Bernadette Melnyk, PhD: Well, because it was an unknown entity, I think people were really skittish. Territorialism is very common when you enter a pioneering role. But one of the earliest wins I had was we needed to establish a strategic plan for well-being. We had to catch an exciting, aligned vision. Ohio State was doing a lot of good things. We had our own health plan. We had an online wellness portal for faculty, staff, clinicians. Student life was doing really good work. But there was no alignment, no strategic plan for well-being. And that is essential that that be established early on because silos are alive and well throughout this country, and you cannot build a culture of well-being in silos. So, that I think was so key early on to the success of our program.

Host: Hundred percent. And I think that echoes from, you know, what I hear in a lot of conversations with leaders as well, or those who are trying to establish this work in their organization that there are actually things that are going on already that maybe they don't know about or they're not thinking about it in terms of wellness.

And so, it can be overwhelming to think that you need to build this big plan, but sometimes it's just aligning on the things that you're already doing and making sure to communicate that. So, I think it's so important to your point to have these conversations and make sure that you are aligned on the vision. And this really dovetails really well into the next question that I wanted to ask you.

So, wellness programs, they're sometimes viewed as a nice-to-have rather than essential. But how have you made the financial case for wellness as a strategic priority over the years? And again, that importance of buy-in from senior leadership, and how do you make it part of the fabric of what you do as an organization?

Bernadette Melnyk, PhD: Yeah, I think it's important for people to hear. I lived through five presidents in my almost 14 years at Ohio State. So, every time a new leader came in, I was knocking at their door to show them the return on investment and value of the investment that we were getting from our initiative at Ohio State. When you show your leaders the return and value of investment, they start to change their perspective on wellness as a nicety to wellness as a necessity. It is so key.

Finance showing numbers absolutely helps. In fact, when I show them our ROI that it not only covered our wellness initiative, but benefited the university more with increased dollars. My resources continued to be increased. So, that's really key.

Host: I wanted to delve into that a little bit deeper because sometimes I hear from people in doing wellness work or chief wellness officer, it's hard to know what to actually measure or what speaks to leadership. And sometimes wellness can seem a little bit nebulous or the value you see of it maybe years later, right? It's not something that you can necessarily measure in months. And so, I was just curious, what were you measuring at your organization? What really stood out to you?

Bernadette Melnyk, PhD: I think you bring up a super important point. You got to establish your key metrics, your outcomes. Because if you measure things but then you don't share the outcomes and use the outcomes to target improvement, you're not going to move the needle that much.

I want to share with people, you'll get the biggest, quickest bang for your buck by focusing on improving your people with chronic disease. But that said, at the same time, you've got to focus on well-being and prevention. At Ohio State, we always looked at healthcare claims, what we were spending money on. But we also measured 10 key outcome indicators that are responsible for 25% of the healthcare costs for employees. Those 10 indicators that have been published by Ron Goetzel are really key in terms of improving and prevention. Those are things like obesity, blood pressure, cholesterol, poor nutrition, physical inactivity, tobacco, alcohol use, depression, and high stress. So, that is what we would factor in to calculate our return on investment. Typically, range for every dollar we invested in well-being of our people, we got a $2 to $3.65 return. And that's pretty impressive. Because again, it covered our initiative.

Host: It looks like he really had a broad holistic approach because sometimes we talk about wellness, we think that it is only meaning-- obviously, burnout is a huge issue and it needs to be addressed-- but it looks like he really even just took us steps further back, and looked at kind of the whole individual and their needs and how they can cater to their health as well.

And I just wanted to highlight, I know there is a great case study written about all of the work that you've done, and that outlines really what those metrics are and goes into the numbers a little in more detail. So, I'm encouraging you all to check that out. So, we wanted to focus as well kind of about what's going on currently. And I know a lot of hospitals are facing a lot of financial troubles and hardship, and we expect that to grow. So, how do you balance short-term budget pressures with the long-term benefits of investing in clinician well-being, taking into account everything that leaders are currently facing?

Bernadette Melnyk, PhD: When we look at burnout currently in clinicians and also staff, it ranges between 40% and 60% in most national studies. We know burnout is highly correlated with depression, with anxiety, with stress. And in my latest work, we're even seeing a correlation with suicidal ideation.

But the other thing we know is that burnout, when clinicians are burnt out, they make more preventable medical errors. Patient outcomes are worsened. There's more turnover. There's more presenteeism, people are showing up for work, but they're not really mentally there. So when you take into consideration the adverse effects of burnout, not only on our wonderful clinicians, but on hospital outcomes, patient outcomes, turnover, people have got to start looking at this as an investment, not as an expense.

Host: A hundred percent. And I just wanted to go into that a little bit more deeper, because I know sometimes there's this misperception that you have to spend millions and millions of dollars on a new tech solution to be able to and be involved in wellness. But there are actually a lot of really good low-cost strategies and interventions that hospitals can start employing now.

So, what have been some of the most cost-effective interventions you've seen and implemented? As we said, those high impact, low cost strategies that healthcare organizations can learn from.

Bernadette Melnyk, PhD: Before I talk about a couple of examples, I want to emphasize if you really want to turn the needle on this at your healthcare institution, you've got to focus on three important things. But first, you got to fix system issues that we know cause burnout. We know what those are, things like short staffing, too many bureaucratic tasks. We got to get rid of stupid stuff so that our clinicians can focus on what they love and that is caring for their patients.

Two, you've got to scale evidence-based interventions that we now work into our settings. It still takes, on average, 15 years to translate evidence-based interventions into our real life clinical settings. We know what works. We've done systematic reviews, but there's such a delay in getting them translated into our settings. I've always had a philosophy in God we trust, but everybody else better bring data to the table. And then, we got to de-implement what's not evidence-based. We still have this philosophy, and this is the way we do it here. Even if there is good evidence behind it, we've got to really cut that.

And the third thing is culture, culture, culture, culture. We've got to break down mental health stigma. We got to make it easy and fun to engage in healthy behaviors. So, two or three high impact, low cost evidence-based interventions create a widespread wellness ambassador program at your facility. We have over 700 Buckeye wellness innovators at Ohio State. These are clinicians, faculty, and staff who volunteer three to four hours a month to work with me and my wellness team to create cultures of well-being in the grassroots. They really are force in the grassroots. A lot of organizations have those people, but they don't have a structured program for them. You've got to have a structured program if you're going to start one of these initiatives, but they are so low cost, such high impact.

The other two programs, clinicians don't want to hear any more. We got to be more resilient. We need our system issues fixed. However, we do have to build their resiliency. We know it's a protective factor. So, we actually use throughout the organization a wonderful evidence-based mindfulness program and an evidence-based cognitive behavior skills building program for our clinicians. We've published on those outcomes. They're terrific.

Host: Great. And there are so many key things that you said that I think will be really helpful for our audience members who are listening, particularly around like just reviewing policy issues. A lot of times, it can be overinterpretation of what's needed to be done to be within code or it's just the way things have always been done and gets continued. And so, those are things that you can review today and really make an impact in terms of removing barriers to provide care and just make it easier to be able to do the day-to-day work. So, I definitely wanted to highlight that.

And I think another thing that you mentioned too is that sometimes we get these pilots and they're great, but then they don't go anywhere and they don't scale. And so, that really dovetails into the next question that I have perfectly. And so, what advice would you give to healthcare leaders trying to launch or scale a wellness program, especially in smaller or resource-limited settings?

Bernadette Melnyk, PhD: Yeah, you have to have a leader, whether you call him a chief wellness officer, a director of wellness, whatever, you've got to have a strong person that sits at the executive team arena to focus and lead this effort.

Now, I'll tell you, Fayola, I get a lot of calls from people who have been recently appointed as the CWO, because we've gone from me in 2011 to about a hundred of us now throughout the United States. However, the problem is people are being appointed as a CWO, so people are checking that off. "Check. We have one." And then, they're not giving them resources, proper placement at the C-suite table or a team. You're not going to get a lot done if you hire a CWO and give them 30-50% time sincerely. This takes an investment that will reap so many benefits for your organizations. But you need a leader, and that leader has got to form an aligned team, a vision for this, a mission, and a strategic plan with an evidence-based quality improvement strategy is key.

Host: I completely agree. It starts with senior leadership. And without that buy-in, it's really hard to make progress. But once you have that, there's so much that you can do. And there's so much impact that you can have. And we have the information out there about what are the strategies that work? It's just needing that initial buy-in and that commitment. So, final question that we have before we wrap things up. What's one things healthcare leaders need to do or can do to start building that culture of well-being that we know is so important?

Bernadette Melnyk, PhD: Fayola, I also want to emphasize before I wind up with my final though it's important to measurets, wellness culture because in all of my research I have shown people's perception of their wellness culture, if they believe their organization supports their well-being, they have so much better physical and mental health outcomes along with increased engagement, productivity, less turnover.

The other key factor that's not talked about much that I've shown again in my work is this concept of mattering. People who believe they matter to their healthcare organization have much less burnout, stress, and depression and higher functioning. So, leaders must buy in, invest in this. They must walk the talk themselves. Do you know a decrease in meetings by 40% increases productivity by 70%? Getting back to we got to get rid of the stupid stuff and meetings that people sit in constantly throughout their day. Got to get rid of them. Shorten them again. So, it takes and investment. It takes a strong leader in a CWO position with an aligned team. It takes a multi-component approach from top leaders, middle managers who are so key. We would target middle managers because they so deeply affect the grassroots of the organization, but not doing wellness for your people is a business risk. Again, we got to shift this paradigm and we got to do it now, not 15 years from now.

Host: Well, thank you so much for being here today. Thank you for sharing all of your insights and all your experience. It's been a wonderful conversation. And I want to direct everyone to the ACHE website. There are more resources there. We have upcoming webinars about this topic, delving into it in a little bit more detail.

And just to conclude, this has been the Healthcare Executive Podcast from ACHE. For more information, please visit the healthcareexecutive.org website. Let's connect on LinkedIn. We'd love to hear your thoughts about today's episode, and what your experience has been like. And thank you again to everyone for listening.