At the Wingspread Summit in November, I met many colleagues engaged in addressing physician burnout. From Corey Martin, MD, I learned about a really innovative program in Minneapolis—although initially I struggled to see the connection between the initiative and physician wellbeing.
The Bounce Back project builds on the evidence that happiness improves health outcomes and on the idea that specific practices (“tools”) can build resilience to stress—enabling people to “bounce back when life doesn’t go as planned.”
On the phone recently, I asked Martin why he became involved in Bounce Back. He explained that three painful events led him to help found the Bounce Back project.
In 2014 a young, well-loved physician at Martin’s hospital died in a vehicular crash, leaving a spouse and four children. As the hospital staff struggled to recover from his death, a respected pediatrician took his own life in the hospital chapel. His death profoundly shook the hospital staff and the local community.
The morning after his death, a unit clerk confided to Martin that when she heard the news, she thought it was Martin who had died by suicide. He told me, “If other people could see the burnout in me and I could see it in my colleagues, I knew we had a serious problem.”
Soon thereafter, a 15-member group consisting of medical staff and senior administrators of the hospital attended a conference on resiliency convened by the Minnesota Hospital Association. Bryan Sexton, PhD, director of the Duke Patient Safety Center at Duke University Health System, presented several tools that have been shown in research studies to increase resiliency. According to Martin, these evidence-based tools form the basis of the Bounce Back project.
The resiliency tools include Random Acts of Kindness, Three Good Things, Gratitude Letters, Social Connections, and Resilience Travel. (For detailed descriptions of the tools see www.bouncebackproject.org/inspiration.) To share the tools with the larger community—with the ultimate goal of improving health—the group gave almost 90 presentations in the first 6 weeks—to high schools, police departments, large employers (literally a talk in the aisles of a big box store), and civic groups. Participants were given the option to join an online research study to track the effect of the tools, and about 2800 people enrolled.
According the Martin, the study showed a prevalence of burnout than was higher than expected and higher than other previously studied communities. However, after just two weeks of using the Three Good Things tool, the prevalence of burnout dropped and resilience, happiness, and engagement scores increased.
I asked Martin how the Bounce Back project related to addressing physician burnout. It seemed like a great community-based health-promoting initiative, but I failed to see how it could help physicians working in chaotic clinical environments. Given my strong belief that individual-based strategies alone are insufficient to fix the underlying systems issues that drive burnout among physicians, I was keen to hear what he had to say about whether the Bounce Back tools would address the system fixes needed to halt the burnout epidemic.
Martin said, “As physicians, we have a desire to do things that matter. Sometimes the onslaught of clerical tasks and EHR documentation get in the way of feeling like you’re involved in changing the world.” His explanation echoes what I’ve heard from faculty of the Healer’s Art course: that teaching and meaningful connection help physicians rediscover joy, meaning, and purpose in their clinical work.
This makes sense to me. And perhaps, like Appreciative Inquiry, building resilience through meaningful work is a prerequisite for building the capacity and will to address the systems problems that stifle optimal clinical care.
In the meantime, I’ve committed to writing a monthly gratitude letter. According to Sexton, the positive effects of a letter that expresses authentic gratitude toward the receiver last for four to six months—a pretty long half-life!
I wrote the first letter to my 15-year-old son, who developed a nasty gastrointestinal illness on the night before my flight to the Wingspread Summit. At 4 a.m., two hours before I was to leave for the airport, and in between bouts of vomiting, he looked at me and asked, “Mom, will you be able to sleep on the plane?” Seeing his capacity for compassion more than compensated for the lost night of sleep. Writing the letter helped me to remember and delight again in the gift of that moment.
Due to a glitch in the postal delivery service, the letter just now arrived, more than a month after I mailed it, and he has not yet read it. In a way it doesn’t matter. It’s already done its job.
Questions to consider: