MSMS Michigan Medicine November December 2022


FEATURES & CONTENTS November / December 2022 12 Physician Burnout: How to Recognize It and Where to Turn for Help In this edition of Michigan Medicine®, for physicians in 2022, there is no escaping the subject of burnout. Volumes have been written on the topic in recent years, and for good reason: with each passing year, more and more physicians find themselves struggling to cope with it. (Story begins on page 12.)

ALSO INSIDE 27 NEW & REINSTATED MEMBERS 06 When Must a Data Breach be Reported? DANIEL J. SCHULTE, JD 19 The HPRP—Helping Michigan Health Professionals Overcome Substance Abuse and Mental Illness 21 MSMS Education: Live, Virtual, and On-DemandWebinars MICHIGAN STATE MEDICAL SOCIETY 08 DoWe Have“Quiet Quitters” in Our Practice? JODI SCHAFER, SPHR, SHRM-SCP 10 Now Is the Time to Get Caught up onVaccines SARAH DE RUITER, RN BSN MA MICHIGAN MEDICINE® VOL. 121 / NO. 6 Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN McFATRIDGE Publication Design HIAKATO DRACONAS Advertising GRANDT MANSFIELD Publication Office Michigan Medicine® PO BOX 950 East Lansing, MI 48826 517-337-1351 All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Kevin McFatridge. Postmaster: Address Changes Michigan Medicine® Kevin McFatridge PO BOX 950 East Lansing, MI 48826 Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine® reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine® are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine® (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2022 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. ©2022 Michigan State Medical Society 24 Reduce Clinician Burnout and ImproveWell-BeingWith People-First Leadership ROBERT D. MORTON, MAS, CPPS STAY INFORMED – STAY CONNECTED!

6 michigan MEDICINE® | Nov / Dec 2022 When Must a Data Breach be Reported? By Daniel J. Schulte, JD, MSMS Legal Counsel Q: My practice billing person recently missed some time due to an illness. She was a few weeks behind in processing claims. She took home a thumb drive loaded with patient records so that she could work on getting caught up over a weekend without having to come into the office. The thumb drive disappeared. She claims she last saw it in a pile of papers at home on her dining room table where she was working and fears she accidentally threw it in the trash with the pile of papers by accident. Is this a HIPAA data breach? Do I need to report this to someone? ASK OUR LAWYER The HIPAA Breach Notification Rule, 45 CFR §§ 164.400-414, requires HIPAA covered entities (i.e. your medical practice) and their business associates to provide notification following a breach of unsecured protected health information. I can only assume that the thumb drive your biller took home contained protected health information because this would certainly include the types of information necessary for her to make claims for payment. Notification of a breach is only required if the protected health information is unsecured. Were the files on the thumb drive encrypted or secured (i.e. some measure put in place to prevent an unauthorized person from accessing the information)? If the protected health information on the thumb drive was not secured, then the situation you describe is a data breach and reporting is required unless you can demonstrate that there is a low probability that the protected health information has been compromised based your assessment of the risk taking into account at least the following: (1) the nature and extent of the protected health information involved, including the types of identifiers and the likelihood of re-identification; (2) what you know about any unauthorized person known to have used the protected health information and/or those to whom disclosure was made; (3) whether the protected health

Nov / Dec 2022 | michigan MEDICINE® 7 Generally, all patients whose protected health information was on the thumb drive must receive written notice by first-class mail without unreasonable delay and in no case later than 60 days following the discovery of a breach including, to the extent possible, a brief description of the breach, a description of the types of information that were involved in the breach, the steps affected individuals should take to protect themselves from potential harm, a brief description of what the covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches. information was actually acquired or viewed by an unauthorized person; and (4) the extent to which the risk to the protected health information has been mitigated. In your case, a judgement call has to be made. There seems to be a low probability that the information has been compromised based on the fact that the thumb drive went straight to your biller’s home and appears to have been accidently thrown in the trash instead of being taken by an unauthorized person. You must document this risk assessment in writing. If you are not comfortable concluding that there is a low probability of compromise then you must determine which type of report(s) must be made. Individual notice is always required. Generally, all patients whose protected health information was on the thumb drive must receive written notice by first-class mail without unreasonable delay and in no case later than 60 days following the discovery of a breach including, to the extent possible, a brief description of the breach, a description of the types of information that were involved in the breach, the steps affected individuals should take covered entities must notify the Secretary without unreasonable delay and in no case later than 60 days following a breach. If, however, a breach affects fewer than 500 individuals, the covered entity may notify the Secretary of such breaches on an annual basis. Reports of breaches affecting fewer than 500 individuals are due to the Secretary no later than 60 days after the end of the calendar year in which the breaches are discovered. to protect themselves from potential harm, a brief description of what the covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches. If there are more than 500 affected, individuals must, in addition to individual notice, provide notice to prominent media outlets. Finally, in addition to notifying affected individuals and the media (if more than 500 affected individuals), the Secretary Health and Human Services must be notified. This can be done electronically by going to the HHS web site and filling out and electronically submitting a breach report form. If a breach affects 500 or more individuals, DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL.

8 michigan MEDICINE® | Nov / Dec 2022 DoWe Have “Quiet Quitters” in Our Practice? By Jodi Schafer, SPHR, SHRM-SCP | HRM Services | Q:It seems like now that we have passed the worst of COVID, our staff is burnt out and unmotivated. It is hard to get anyone to go above and beyond anymore, and it seems like somany want to do the least amount of work possible. For example, it is hard for me to find coverage for shifts when staff are taking vacation or are off sick, to find staff to step up and take on new tasks, or to find volunteers to help organize fun events for our team. I’ve heard this term called “quiet quitting”and it makes me wonder if that is our problem. What advice do you have? ASK HUMAN RESOURCES The phrase “quiet quitting” is relatively new and refers to employees who are still fulfilling their job duties, but not doing anything beyond the minimal expected for their position.

Nov / Dec 2022 | michigan MEDICINE® 9 These types of behaviors may include things like not volunteering to do anything extra, staying quiet during meetings instead of offering ideas, and coming into the office and leaving right at opening and closing times. If you are seeing these types of behaviors, then you may have a “quiet quitter” on your team. And you are not alone, some estimate that upwards of 50 percent of current employees are showing these tendencies. While this pattern of behavior may be alarming, you can’t apply a solution without more information. Check in with the employees you are concerned about one-on-one to see how they are doing. Let them know that you’ve noticed that they are quieter lately (or another passive behavior you have noticed) and ask if there is anything they need or if there is anything they want to talk about. Questions like this can open the door for deeper sharing and understanding. Are the signs of burn out and lack of motivation due to the job/work environment or are they due to a stressor in the employee’s personal life over which you have no control? If the concerns the employee shares are work-related, communication and connection are the path forward. For example, does the employee feel appreciated at work? Appreciation is different from recognition in that appreciation is about the individual person and not the results being achieved. Even when an employee makes a mistake, are they still appreciated as a part of the team? Leaders have a critical role in Many employees also don’t feel a strong connection to the bigger focus of the practice and the work. They may feel like a “cog in a machine” and have disengaged as a result. In this case, recommit to communicating your vision and values for the organization and the role that every team member plays in that. developing the trust and relationships needed to show genuine appreciation with individual employees and teams. Many employees also don’t feel a strong connection to the bigger focus of the practice and the work. They may feel like a “cog in a machine” and have disengaged as a result. In this case, recommit to communicating your vision and values for the organization and the role that every team member plays in that. Ask employees for their feedback on how things could be improved and encourage your managers/leads to do the same. Empower staff to handle duties that may be beyond their basic responsibilities and let them know that you believe they can make judgement calls that are in the best interest of the practice and the patients. Continue to have regular one-on-one meetings with your team. The most successful managers/supervisors check in at least 15–30 minutes a week. This ongoing connection promotes relationship building, provides time to see how things are going—at work and at home—and shows the employee that someone at your practice cares about their success. As humans, we are social animals, we look for connections to help us understand our place in the world and find fulfillment. This approach will help you create a positive company culture, reducing the amount of quiet quitting behaviors you are experiencing and improving employee morale and engagement along the way.

10 michigan MEDICINE® | Nov / Dec 2022 MDHHS UPDATE With the 2022–23 flu season ramping up and the inevitable prospect that the flu and COVID-19 viruses will circulate at the same time, now is the time to ensure that all children are caught up on their vaccines. In accordance with general best practices, routine administration of all age-appropriate doses of vaccines simultaneously is recommended for children, adolescents, and adults for whom no specific contraindications exist at the time of the healthcare visit. Getting patients up to date on vaccines now will prevent illnesses that lead to unnecessary medical visits, hospitalizations, and an additional strain on the healthcare system. Protecting communities from vaccine- preventable diseases is one of the most important things you can do to keep us all healthy and prevent outbreaks. A strong recommendation from a trusted healthcare provider is the best predictor of vaccination. It is now more important than ever to assess vaccination status of all of your patients, at every medical visit, whether the visit Now Is the Time to Get Caught up on Vaccines By Sarah de Ruiter, RN BSN MA, Immunization Nurse Educator, MDHHS Division of Immunization The COVID-19 pandemic severely disrupted life-saving vaccination at a global level, leaving millions at risk for infection with measles, meningitis, polio, and whooping cough. Now that schools have returned to in-person learning, children need to get caught up on routine vaccinations, so they are protected against serious diseases. Healthcare providers are uniquely positioned to identify families with children who are missing critical doses and contact them to schedule catch-up appointments. is in-person or remote (telephone, online, etc.). Healthcare providers have the knowledge, experience, and authority to make a strong case for vaccination, as well as the trust of their patients. When recommending vaccination, assume that most people will choose to vaccinate. This presumptive approach to recommending vaccination has been proven to be effective. Promptly schedule in-person appointments for catch-up vaccinations. Use

Nov / Dec 2022 | michigan MEDICINE® 11 References 1. Catch-up Immunization Schedule for Children and Adolescents Who Start Late or Who Are More than 1 Month Behind. schedules/hcp/imz/catchup.html 2. Childhood Vaccination Toolkit for Clinicians. https:// 3. Multiple Injections/Coadministration of Vaccines. administer-vaccines.html#multiple-injections 4. COVID-19 vaccine and coadministration with other vaccines. clinical-considerations/interim-considerations-us. html#timing-spacing-interchangeability 5. Timing and Spacing of Immunobiologics. https:// timing.html the influence you have with your patients to get them caught up on vaccines. You can implement the following tactics to encourage follow through on vaccination: • Extend your service hours (evenings and weekends) for vaccination services or to accommodate more appointments with vaccinations. • Use your patient reminder-recall system and notifications to reach patients and parents with children who have fallen behind on their vaccinations. • Provide referrals to another place where vaccines are available, such as pharmacies or local health department immunization clinics. • Partner with the health department or community groups to host a vaccination clinic or event. This strategy could be repeated for flu vaccines during flu season starting in October. CDC provides guidance on planning satellite vaccination clinics. It is crucial to communicate the importance of immunizations and ensure your patients are up to date on their vaccinations. You can champion vaccination in your practice by ensuring all staff are up to date on their vaccinations and that they are sharing frequent and consistent messages about the importance of immunizations.

12 michigan MEDICINE® | Nov / Dec 2022 How to Recognize It and Where to Turn for Help PHYSICIAN BURNOUT PHYSICIAN BURNOUT CIAN BURNO

Nov / Dec 2022 | michigan MEDICINE® 13 If you are a physician in 2022, there is no escaping the subject of burnout. Volumes have been written on the topic in recent years, and for good reason: with each passing year, more and more physicians find themselves struggling to cope with it. In fact, according to The Physicians Foundation’s 2021 Survey of America’s Physicians, 61 percent of physicians report often experiencing feelings of burnout—a significant increase since 2018 as tracked by The Physicians Foundation data. And yet, despite its growing prevalence—and in turn, the amount of attention it receives—only 14 percent of physicians sought out medical attention to address any of their various mental symptoms according to the same data. Why is t Why is that? Why (CONTINUED ON PAGE 14)

14 michigan MEDICINE® | Nov / Dec 2022 The answer is multi-pronged, and almost certainly beyond the scope of any one article. Undoubtedly, there is an institutional component to burnout. Physician satisfaction levels have been waning for years now—a trend that has moved in lockstep with increased bureaucratic and corporate burdens being placed on providers. Things like tending to cumbersome patient EMRs and working for organizations increasingly driven by volume and “quality” metrics continue to chip away at the amount of time physicians can spend listening to—and ultimately caring for—their patients, which is the exact kind of work they always intended to do and what likely drew them to medicine in the first place. That erosion of meaningful work has undoubtedly contributed to the rise of physician burnout, and the COVID-19 pandemic has only served to exacerbate those particular pressures. All that helps to explain the rise in burnout, but it does little to explain the enormous gulf between those needing help and those who actually seek it. That is because there is also a personal component to the development of burnout and the management of it, or rather, the lack thereof. In the world of medicine, burnout is easy to dismiss. Many physicians think it is just something that comes with the territory. The long hours, the rapid pace, the sheer intensity and consequence that come along with it—of course there is an inherent level of stress in all of that. But stress and burnout are not necessarily the same thing, and too often the last person most physicians think to treat and diagnose is themselves. And that failure to recognize and address a serious problem at its onset can come with serious consequences. In short, there is an awareness problem at play in all of this: a lack of awareness for how stress and burnout differ—what is healthy and normal and what is not. A lack of the necessary self-awareness to recognize and address mental and behavioral health concerns amongst providers—for all the tools and training physicians are given to treat others, they are ill- equipped to diagnose and care for themselves. And finally, a lack of awareness about the tools and resources available to help physicians cope should they be able to clear those first two hurdles. With any luck, this article will help to fill in those gaps. What Is Stress? What Is Burnout? What Is the Difference? Medicine is stressful. There is no escaping that fact. And, importantly, there is also nothing inherently wrong with it. In fact, properly managed, stress can promote growth, development, and resiliency, just as the stress of a deadline or a situation can help one to focus and perform. The easiest, and perhaps most relevant, analogy is one related to the human body. Every elite athlete trains their body to perform. That training is a form of stress, and growth and performance only come through strain. Properly implemented and managed, stressing one’s body in such a way can produce incredible results. However, there is an important and often overlooked component that goes along with effective training and that is the rest and recovery that must accompany it. Athletes who do not invest adequate time into that side of the equation eventually suffer. At some point, the body breaks down without the rest and recovery it needs—that is when injuries happen; that is when performance suffers. Managing the everyday stress that comes with being a physician is no different. “There’s a common misconception among providers that stress and burnout are one and the same, and that’s something we need to work to address,” says V. Simon Mittal, MD, MMM, Physician Consultant at VITAL WorkLife. “Because work-related stress can and does happen, and some degree of it is fine so long as physicians have

Nov / Dec 2022 | michigan MEDICINE® 15 10. the time and tools they need to effectively manage it. Burnout, on the other hand, is really more the cumulative manifestation of not being given the time, tools, or resources to manage that stress. When people lose their connection to the parts of their work that bring them happiness and feels purposeful, when they consistently lack that critical balance between their work lives and their professional lives and are left without adequate time to recharge—when these sorts of patterns develop, that’s when things go wrong, that’s when people and organizations suffer.” In short, burnout is the result of prolonged, chronic, unmanaged stress. And importantly, it is a state one does not reach overnight. But when does one cross over from being stressed to experiencing burnout? If the onset of burnout is subtle and progresses gradually, how do we recognize and address it before it escalates into something more serious and difficult to overcome? How to Identify Burnout in Yourself and Your Colleagues For a multitude of reasons, burnout can be tough for organizations, colleagues and even the person experiencing it to identify, especially at its onset. But from the perspective of the physician suffering, it must start with one simple question: are you willing to be truly honest with yourself? “Medical stoicism is one of the major roadblocks to physicians being able to notice early warning signs in their own feelings and actions,” says Doctor Mittal. “For a lot of us, if we aren’t struggling, we feel we aren’t working hard enough. We’re not good at looking at ourselves, and we rarely seek help. And if a physician isn’t willing to really be honest with themselves right up front about how they’re feeling, it’s really very easy for them to diminish all the symptoms they’re experiencing.” Thankfully, there are several physical, emotional, and behavioral signs and symptoms that burnout may developing, and self-identifying those telltale warning signs works much like any other effort to diagnose a problem—it starts with questions: 1. Am I having trouble sleeping? Has my appetite changed? 2. Am I more irritable at work? 3. Do I dread going to work? 4. Am I exhausted all the time? 5. Am I making more errors? 6. Am I no longer enjoying the things I used to enjoy outside of work? 7. Am I feeling increasingly cynical? 8. Do I feel detached from my work? From my family? 9. Am I losing my motivation? My ability to care? Am I having trouble in my rela- tionships at work, and especially at home? Taking a moment to ask and answer these sorts of questions is an excellent first step in trying to determine whether you may be suffering from burnout. And even if you do not think you have a problem, the exercise of taking stock of your feelings from time to time in this manner is a good practice from a wellness standpoint. “I think some of the earliest symptoms that people tend to miss are the fatigue and no longer enjoying the things outside of work that used to bring them satisfaction,” says Doctor Mittal. “So being mindful of how your feeling in these areas is critical to self-identifying burnout in its early stages.” Unfortunately, there are too many physicians that do not take the time for this sort of critical self-reflection. Part of that is undoubtedly explained by the time pressures that come with being a physician. Moments for uninterrupted self-reflection can feel like they are few and far between when one also must juggle the needs of their (CONTINUED ON PAGE 16)

16 michigan MEDICINE® | Nov / Dec 2022 patients, their practices, and their families. However, some of it is also institutionally driven—by and large, physicians are not provided with consistent and adequate guidance on how to look out for themselves. “Physicians are not trained to look at themselves and say, ‘I need help.’ That’s not where their training is,” says Doctor Mittal. “Their training is, ‘I’m here to help others.’ So, recognizing that the person that needs help is in the mirror is just a very difficult thing for most physicians to do.” For that reason, it is important that colleagues also be on the lookout for early warning signs that a coworker may be struggling. Subtle changes in a colleague’s demeanor, their remarks, or their ability to follow protocols and function well in a team could all be early warning signs that a coworker is struggling and in need of support. “As physicians, we tend to not only minimize our own problems but also the struggles of our colleagues,” says Doctor Mittal. “Too often in medicine when we observe another provider who is clearly struggling, we default to thinking, ‘Well, they’re struggling right now, but they’ll be fine,’ rather than saying, ‘Hey, it seems like you may be burned out. Let’s figure that out, and here’s the next step. Let’s give you a place to go that can actually help you deal with this so you can continue to be the successful and productive physician you want to be.’” SafeHaven™—Safe and Confidential Resources That Can Help Thankfully, that next step is clear for Michigan physicians. Officially launched in the spring of 2021, SafeHaven™ is a comprehensive and completely confidential physician health care provider well-being program, offering physicians, nurses, and health care providers access to a whole host of resources and support services that can help address career fatigue and behavioral health concerns. “Physician burnout has been a growing problem for years now and that’s only been exasperated by the COVID19 pandemic,” says Kevin McFatridge, chief operating officer of MSMS. “The fact is, we need to do a better job of caring for our physicians, nurses, physician assistants, and all health care providers so that they in turn can continue to provide excellent quality care for Michigan’s patients—that’s what SafeHaven™ is all about. Our hope is this resource will go a long way towards relieving our overly burdened provider community and ultimately help them rediscover the meaning, joy, and purpose in practicing medicine.”

Nov / Dec 2022 | michigan MEDICINE® 17 SafeHaven™, which is implemented in partnership with VITAL WorkLife, provides a host of discreet and confidential set of tools and resources health care providers can access to stay well, avoid burnout, and connect to their purpose without the fear of undue repercussions to their medical license. Originally launched in Virginia, the program has been a huge success with over 4,400 members and 48 percent utilizing the program—an extraordinary and unmatched usage rate for an employer-sponsored physician wellness program. Gertrude “Trudy” Shahady, MD, a family medicine doctor from Lynchburg, Virginia, is one of them. “Prior to programs like SafeHaven™, I think a lot of physicians were very hesitant to seek out any sort of help with addressing any signs or symptoms of burnout or other mental health concerns out of fear of consequences from their employer or licensing board,” says Doctor Shahady. “That’s what makes SafeHaven™ so great—the confidentiality piece of it is absolutely critical.” Doctor Shahady’s decision to pursue help was prompted by the COVID-19 pandemic and the various pressures it presented. Overburdened by staffing shortages, the surge of sick patients, and, finally, those refusing to help themselves by getting vaccinated, Doctor Shahady finally hit her limit. “At one point, I lost three patients in one week to COVID-19—three patients whom I essentially pleaded with to no avail to get vaccinated in the weeks and months prior,” says Doctor Shahady. “By that time, I had already lost a number of patients and had seen a lot more really suffer with COVID-19, and that just felt like a breaking point for me. I could tell I was losing my motivation to keep plugging away on coming to work and pushing my patients to get vaccinated, and I was also having trouble sleeping. It was then that I decided to call SafeHaven™.” Just the initial phone call brought Doctor Shahady a sense of relief. “When you call, you are immediately helped by a master’s level person who is trained to assess and triage you, and as I was talking to this person on the phone, she basically told me, ‘I’m hearing this a lot, you’re not alone,’” (CONTINUED ON PAGE 18)

18 michigan MEDICINE® | Nov / Dec 2022 says Doctor Shahady. “Just hearing that made me feel a lot better.” SafeHaven™ offers much more than that though. In addition to in-the- moment, 24-hour telephonic support, SafeHaven™ also offers provides clinicians and their families access to the WorkLife Concierge—an all-purpose virtual assistant that can manage every day tasks—legal and financial consultation services and resources, the VITAL WorkLife App, and peer coaching—something Doctor Mittal has been doing for a number of years now as a certified coach. “I think the power and real value of the peer coaching lies in the fact that you’re providing clinicians with access to someone who really understands what you’re going through and what you’re experiencing,” says Doctor Mittal. “We’ve been there. We’ve seen it. We’ve experienced it. So, we’re in a position to say, ‘It’s normal, it’s okay, there’s a way forward, and here it is.’” Through SafeHaven™, physicians are eligible to participate in up to six sessions of confidential peer coaching with one of VITAL WorkLife’s certified coaches. Working together, clinicians and coaches talk through the problems at hand, work to identify values and set goals, and then identify the strategies and action steps necessary to achieve those goals. And while it may not sound like much, the numbers indicate just the opposite. According to recent research from the Mayo Clinic, physicians receiving peer coaching sessions experienced a 17 percent decrease in burnout compared to a 5 percent increase in burnout for physicians who went without coaching. Vital WorkLife’s own qualitative and quantitative data similarly bears out an impressive positive impact, with pre- and post-coaching surveys indicating that 92 percent of participants reported an improvement in overall well-being with an average improvement of 58 percent across specialties. After her initial phone call, Doctor Shahady decided to utilize the services of one of VITAL WorkLife’s peer coaches, in this case a psychiatrist from Atlanta. In just one session, Doctor Shahady was provided with a new set of resources and ideas to help her deal with the stresses that came with being a provider during the peak of the pandemic as well as an effective new way to talk with her patients about vaccines that provided exactly what she needed to keep practicing and move forward. “It was such a helpful and freeing experience for me,” says Doctor Shahady. “In just one session, it reset me enough to say to myself, ‘Alright, here’s what I can do as a provider and here’s what I can’t do, and I have to be okay with that.’” In addition to the confidentiality component, the in-the-moment availability of SafeHaven™ services and resources make it a particularly attractive tool for busy health care providers. “Most of us just aren’t going to take a half day off to go and talk with a counselor about an issue we’re having,” says Doctor Shahady. “We’re not going cancel half a day of patients for our own needs—we just don’t work that way, so having in-the-moment access to things like the concierge, the VITAL WorkLife app and the 24-hour phone support—the ease and accessibility of all these tools make SafeHaven™ a really easy thing for physicians to utilize.” All SafeHaven resources are provided in support of one aim—helping suffering physicians to reset and refocus, to find balance and reconnect to the joy they once found in medicine. “I think we’ll soon see more and more providers utilizing SafeHaven™ services and say to themselves, ‘Oh my gosh, I needed this. And I really need to tell my colleagues about this because it’s been so helpful to me,’” said Doctor Mittal. “That’s the kind of culture of care that providers and organizations alike need to be building and championing. I’m optimistic that we’ll one day get there, and I think SafeHaven™ will play a big part in that.” Learn More To learn more about the SafeHaven™ program and what it can offer you and your organization, please visit: Gertrude “Trudy” Shahady, MD V. Simon Mittal, MD, MMM Kevin McFatridge, MSMS COO

Nov / Dec 2022 | michigan MEDICINE® 19 The HPRP—Helping Michigan Health Professionals Overcome Substance Abuse and Mental Illness Burnout is in no way the only threat to physician wellness. Just like people from all other walks of life, there are health care providers that fall victim to substance abuse, addiction, and other mental health disorders. Thankfully, the state of Michigan’s Health Professional Recovery Program (HPRP) is there to help. Established in 1994 by the state legislature and administered through the Michigan Department of Licensing and Regulatory Affairs, HPRP provides health care providers with the treatment and support they need to overcome addiction, mental illness, and substance use disorders. Help through the HPRP is voluntary and confidential, providing health care professional with the treatment and support they need to recover and safely return to practicing medicine and providing quality care. “The goal of the HPRP is simply to encourage suffering health care providers to seek out treatment for their substance use and mental health disorders before those impairments result in irrevocable harm to their careers, or even worse, the patients they serve,” Thomas Veverka, MD, FACS, MSMS President. “One of the keys is getting physicians and other providers to recognize that just because they’re in the field of health care doesn’t mean they’re immune to mental health disorders and substance abuse. These issues affect all sectors of society.” And the numbers would agree. According to figures provided by the HPRP, over 20 percent of adults suffer from a diagnosable mental disorder in any given year, and 10 percent of full-time employees in the U.S. workforce who are 18 and older are struggling with a substance use disorder. Thankfully, these impairments are often a treatable problem. For Michigan health care providers, the first step is picking up the phone and scheduling an intake appointment with the HPRP. Following a telephonic intake appointment, eligible participants who have SIDEBAR been deemed to be suffering from an impairment brought on by substance abuse, chemical dependency, or mental illness are provided with a plan of action and a monitoring agreement that can get them on to the road to recovery. Plans and monitoring agreements vary but typically require regular drug screening, counseling, and group meetings. And all participants are provided with a case manager who can clarify, support, and encourage participants to follow through and ultimately achieve recovery. “The HPRP is a wonderful program that offers suffering physicians the help and support they need in a manner that’s safe and confidential. Through HPRP, participants are afforded the ability to retain their jobs, avoid disciplinary action from their licensing boards, and most importantly, get on the road to long-term, sustainable recovery,” says Doctor Veverka. “The most crucial piece is just having the courage to admit you need help.” For additional information, visit www. or call 800-454-3784.

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Nov / Dec 2022 | michigan MEDICINE® 21 The MSMS Foundation has a library of over 30 on-demand webinars available, many of which are free, making it easy for physicians to participate at their convenience to meet their educational needs. MSMS EDUCATION: LIVE, VIRTUAL, ON-DEMAND WEBINARS

22 michigan MEDICINE® | Nov / Dec 2022 Once registered, you will receive an email within 15 minutes with links to watch the on-demand webinar and to complete the survey evaluation. Contact: Beth Elliott at 517/336-5789 or Practice Management Series Ask the Experts – Legal Panel Embezzlement: How to Protect Your Practice Helping Patients Navigate Insurance Navigating the State and Federal Surprise Billing Legislation: 2022 Update Office Billing Policies and Procedures for No Surprises Resources to Navigate Surprise Billing Requirements A Team Based Approach Training Modules Module 1: How to Develop a Pharmacist-Physician Collaboration Module 2: Medication Therapy Management Reimbursement and ROI Module 3: Best Practices for AddressingWorkflow, Resources, and Challenges Module 4: Patient Case Scenarios Other Webinars: Connecting Treatment Courts and Health Care Professionals CPT/ICD-10 Updates for 2022 Health Care Providers’ Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities Improving Health Outcomes for Healthy Michigan Plan Patients: Using the Health Risk Assessment to Help Address Social Determinants of Health Integrating Pharmacists into Practice: The Missing Link for Comprehensive Medication Therapy Management Long COVID and Post-Viral Syndromes Update on Chronic Fatigue Syndrome, Part 1: Clinical Diagnostic Criteria for Chronic Fatigue Syndrome/CFS now called Myalgic Encephalomyelitis or ME/CFS Update on Chronic Fatigue Syndrome, Part 2: Uniting Compassion, Attention, and Innovation to treat ME/CFS Webinars that Meet Board of Medicine Requirements: A Day of Board of Medicine Renewal Requirements Human Trafficking Medical Ethics – Confidentiality: An Ethical Review Medical Ethics – Conscientious Objection Among Physicians Medical Ethics – Decision Making Capacity Medical Ethics – Just Caring: Physicians and Non-Adherent Patients Medical Ethics – Reclaiming the Borders of Medicine: Futility, Non-Beneficial Treatment, and Physician Autonomy Medical Ethics – Research Ethics Pain and Symptom Management – Naloxone Prescribing Pain and Symptom Management – Balancing Pain Treatment and Legal Responsibilities Grand Rounds Series A Review of COVID-19 Variants Changes to Michigan’s Auto No-Fault Act for Physicians LGBTQ Health in MI: An Overview of Efforts to Improve Care & Reduce Health Disparities Navigating the No Surprises Act Post-Exertional Malaise Update on the Omicron Variant Vaccine Recommendations for Patients Who Are Immunocompromised Part 1 Vaccine Recommendations for Patients Who Are Immunocompromised Part 2 To register or to view full course details, please visit:

Nov / Dec 2022 | michigan MEDICINE® 23 Annual Scientific Meeting Date: November 17, 2022 Time: 3:00 – 6:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Brenda Marenich at 517/336-7580 or A Day of Board of Medicine Renewal Requirements Date: November 4, 2022 Time: 8:30 am – 4:15 pm Location: In-Person, Sheraton Ann Arbor Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or 26th Annual Conference on Bioethics — Contemporary Challenges in Clinical Bioethics Date: November 5, 2022 Time: 8:45 am – 4:00 pm Location: In-Person, Sheraton Ann Arbor Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or Grand Rounds Date(s): November 9, and December 14, 2022 Time: 12:00 – 12:45 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or Practice Management Date(s): December 14, 2022 Time: 1:00 – 2:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or Monday Night Medicine — Implicit Bias Date(s): November 7, 2022 Time: 6:30 – 8:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or Wednesday Night Medicine — Implicit Bias Date(s): November 30, 2022 Time: 6:00 – 8:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Beth Elliott at 517/336-5789 or Implicit Bias Two-Part Series — Reducing Unconscious Bias — an Imperative (RUBI) Part 1: Recorded Webinar Part 2: Virtual Date(s) - November 16, and November 30, 2022 Time: 12:00 – 1:00 pm Location: Virtual Conference Intended for: Physicians and all other health care professionals Contact: Brenda Marenich at 517/336-7580 or 2022 LIVE VIRTUAL CONFERENCES For more information or to register, please visit: Questions? Contact Beth Elliott: email or call 517/336-5789

24 michigan MEDICINE® | Nov / Dec 2022 Reduce Clinician Burnout and Improve Well-Being With People-First Leadership Robert D. Morton, MAS, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company

Nov / Dec 2022 | michigan MEDICINE® 25 Contributed by The Doctors Company (CONTINUED ON PAGE 26) Leaders in healthcare recognize that clinician burnout is not a new problem—and that it grew in severity during the crucible of the COVID-19 pandemic. But burnout in healthcare is too complex for a single leader or resource to solve. Driving burnout are work overload, loss of control, insufficient reward, erosion of community, absence of fairness, and misalignment of values.1 Addressing these drivers in highly complex sociotechnical systems requires comprehensive organizational commitment, multiple strategies and tools, and support for high-functioning teams. Solving these issues also requires respectful, humble leaders who have the tenacity to change systems and can deliver the solutions that healthcare workers need to thrive. These types of people-first leaders (some use the term “servant leaders”) put the needs of others first by sharing knowledge and power and by helping individuals perform to their highest capacity. People-first leaders whose actions have a positive impact on clinician burnout and well-being share common traits. Leaders recognize burnout as a problem unique to the workplace(s) in their charge that profoundly affects the multidimensional well-being of the people they lead and the patients they serve. They understand a hard truth about burnout, as described by experts Christina Maslach and Michael Leiter: “Burnout is shown to be a sign of a major dysfunction within an organization, and [it] says more about the workplace than it does about the employees.”2 With this realization, people-first leaders react by saying, “This is unsustainable. We have to do something!” Commit People-first leaders elevate their organizational commitment by making workforce well-being a measurable strategic imperative—prominently displayed on the organization’s performance dashboard—with dedicated resources, the same as other major strategic organizational priorities. Depending on the size of the organization, actions may include creating a chief wellness officer or champion position that has authority and resources. Measure Impact People-first leaders assess their workplace with validated instruments that measure burnout, well-being, and the organizational costs of burnout in physicians, nurses, and other clinicians. Evidence-based tools support accountability and help establish a baseline for tracking and reporting measurements over time as commitments are put into action. Build Leadership Skills Leaders committed to healthcare worker well-being are needed at all levels. People-first leaders acknowledge this and take steps to strengthen and develop their own and others’ leadership skills and behaviors and invest in building high-functioning teams—expert teams instead of teams of experts. One of these behaviors is to shadow clinicians at work, using “humble inquiry” to ask frontline staff questions to which the leader does not already know the answer.3 Questions that will reveal opportunities to support include: “How has the pandemic affected your life? What do value and appreciation look and feel like at work? What gets in the way of doing a job you would feel proud of? What can be done to move forward and help you do a job you are proud of?”4 Answers to these questions from frontline staff point to the solutions that leaders with operational authority can deliver or enable staff to design and implement. People-first leaders de- emphasize “doing more with less” in favor of change that is done with, not to, people. Teamwork and inclusion are critical. Involving frontline workers in the improvement process empowers them to do the work well. A positive rounding frame used by people-first leaders in “Positive Leadership WalkRounds” is “associated with better healthcare worker well- being and safety culture.”5 Instead of asking, “What isn’t working?,” leaders ask, “What are three things that are going well and one thing that could

26 michigan MEDICINE® | Nov / Dec 2022 REFERENCES 1. Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999;21(4):472-89. 2. Maslach C, Leiter MP. The truth about burnout: how organizations cause personal stress and what to do about it. Jossey-Bass;1997. record/1997-36453-000 3. Schein EH. Humble Inquiry: The Gentle Art of Asking Instead of Telling. Berrett-Koehler; 2013. 4. Palamara K, Sinsky C. Four key questions leaders can ask to support clinicians during the COVID-19 pandemic recovery phase. Mayo Clinic Proceedings. January 1, 2022. 5. Sexton JB, Adair KC, Profit J, et al. Safety culture and workforce well-being associations with Positive LeadershipWalkRounds. Jt Comm J Qual Patient Saf. July 2021. showPdf?pii=S1553-7250%2821%2900094-5 6. Shanafelt TD, Makowski MS, Wang H, et al. Association of burnout, professional fulfillment, and self-care practices of physician leaders with their independently rated leadership effectiveness. JAMA Netw Open. 2020;3(6):e207961. jamanetworkopen/fullarticle/2767214 7. Gamble M. Hospitals’ ivory tower problem. Becker’s Hosp Rev. February 2, 2022. https://www. 8. National Academy of Medicine. Resource compendium for healthcare worker well-being. https:// 9. ALL IN: WellBeing First for Healthcare. 2022 healthcare workforce rescue package. https://www. For further assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each health care provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered. Reprinted with permission. ©2020 The Doctors Company ( be better?”5 They openly acknowledge the individuals and teams doing the good work and take respectful, supportive action to effect change. Effective people-first leaders also model pro-wellness behaviors for selfcare6 and cultivate these actions for their teams. Take a Hard Look Next, people-first leaders examine their policies and practices with an eye toward eliminating the drivers of burnout that come from lead- ership mandates. These include non- evidence-based policies, metrics over mission, dysfunctional EHR systems, unaddressed patient safety concerns, trivial administrative tasks, regulatory myths, staffing shortages, and lack of childcare or mental health support. Leaders gain knowledge by rounding during busy late shifts and observing firsthand the change opportunities that stare them in the face.7 Fix Inefficiencies While shadowing, rounding, and (most importantly) listening deeply, people-first leaders scan for opportunities to enhance workplace efficiency and facilitate improvements for streamlining functions. Implementing time-saving team-based documentation and care, Lean methods, EHR optimization, and staff training eliminates waste in workflows and allows clinicians to spend more time with patients. Cultivate a Culture of Well-Being Finally, people-first leaders work to cultivate and sustain a culture of respect, community, connection, and support. This starts with creating conditions that allow healthcare workers to feel safe and joyful at work and return home with enough time and energy reserve to enjoy their personal lives. It continues by building support and time for a culture that includes at-work buddy systems, meal sharing, and peer-to-peer and mental health programs. People-first leaders destigmatize and normalize asking for help. The evidence-based actions discussed here have been field tested by healthcare leaders in the real world, organized into a framework of six essential elements based on expert guidance, and assembled into a compendium of resources for healthcare worker well-being by the National Academy of Medicine.8 With the promulgation of these resources and others—like the 2022 Healthcare Workforce Rescue Package from ALL IN: WellBeing First for Healthcare—a movement is underway.9 While leaders may not be able to fix every problem, people-first leaders achieve quick wins on easier challenges and take collaborative action to build the capacity to address the bigger challenges. Taking people-first action is imperative. The well-being of our nation’s healthcare depends on it.