In this episode, Dr. Steve Hippler, Retired Chief Clinical Officer at OSF HealthCare, and Dr. Larry Weinzimmer, the Caterpillar Inc. Endowed Professor of Management at Bradley University, discuss fortitude, new insights you can use to decrease burnout.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- What led them to study burnout
- Fortitude, why it’s important.
- What individuals can do to improve their fortitude and therefore decrease the risk of burnout
- What will they be looking at next?
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome Dr. Steve Hippler and Dr. Larry Weinzimmer. Dr. Hippler recently retired from his role as Chief Clinical Officer at OSF HealthCare. In this role, he was the accountable executive overseeing the employed physician and provider enterprise and ambulatory care practices. In addition to his many leadership roles, he has delivered many CME presentations, keynote addresses, and been the principal investigator for over 50 clinical trials. He has also co-authored eight peer-reviewed articles and a book chapter on comparative effectiveness research to promote adherence to clinical practice guidelines. In retirement, he remains an active researcher on the topic of physician burnout, engagement, and retention. Dr. Hippler earned his medical degree from the University of Illinois College of Medicine at Peoria and completed his residency in internal medicine at the Mayo Clinic. He is board-certified in internal medicine, is an ICF-certified leadership coach, and currently serves as a clinical associate professor of internal medicine at the University of Illinois College of Medicine at Peoria.
Dr. Weinzimmer is the Caterpillar Inc. Endowed Professor of Management at Bradley University. He is a sought-after business advisor to numerous Fortune 100 companies and author of four books, including two bestsellers. His most recent book was ranked #1 on the Barnes & Noble bestsellers list, #3 on the Wall Street Journal bestsellers list, and was rated the top leadership book in North America. Forbes released its 15 best leadership books you must read, and Dr. Weinzimmer’s book was ranked #8. Dr. Weinzimmer has frequently been featured in leading business outlets, including Fortune and The New York Times, and has appeared on leading national news networks. His research appears in over 15 languages, and he has been widely honored for his research accomplishments in leadership, healthcare, and strategy. He’s a frequent keynote speaker at various healthcare venues and has designed and delivered numerous executive programs to healthcare leaders. In this episode, we’re discussing fortitude, new insights that you can use to decrease burnout.
Welcome, and thank you for joining us, Drs. Hippler and Weinzimmer.
Dr. Steve Hippler: Thank you, Kelly. We’re very excited to be here and share some of our findings in our research to your listeners and give them strategies that they could use to really work on improving their own well-being. We started down this path, Larry and I, probably seven or eight years ago, as we looked out there and found that the prevailing notion of what caused burnout in physicians just didn’t seem to ring true to our experience. Right now, the prevailing notion is that it’s the EMR, long work hours, call burden. But yet, in our experience, we found many people who were working hard, had a lot of call burden, maybe in less supportive environments who didn’t get burned out, and others who were in supportive work environments who did. So, we started on this path and this journey to uncover why certain people don’t burn out in spite of the situation they find themselves in. And one thing we want to tell your listeners upfront is that we did our research in physicians, but everything we found is applicable to every one of your listeners. It’s our perspective that burnout is a human phenomenon, that people burnout, not doctors, not nurses, but people do. And this is relevant to finance people, nurses, doctors, lawyers, parents, everyone out there.
Kelly: Completely agree with that. Well, let’s go ahead and jump in here. So, what led you to study burnout?
Dr. Larry Weinzimmer: We first took a look at the literature, and we found that a recent meta-analysis of burnout studying different interventions hasn’t been working. And so, a lot of effort has been made in trying to reduce burnout in hospitals with physicians. And rather than getting better, the problem seems to be getting worse. And so, we took a different view than the research that’s been out there. And rather than taking a look at reasons or factors why a physician would burn out, we took a look at a perspective where if roughly 50% of physicians burn out, why don’t the other 50% of physicians burn out when working in the exact same environment? And so, we really studied those that didn’t burn out to try to find reasons, factors, antecedents why some physicians wouldn’t burn out in the same work environment as those that did.
Kelly: That makes a lot of sense. Let’s talk about your paper. So, it’s about fortitude. Please tell us about it and why it’s important.
Dr Hippler: Well, we looked at the literature and healthcare. And in healthcare, there’s a lot of discussion about resilience as a way to battle and to prevent burnout. But when you think about it, Kelly, resilience is really the ability to bounce back after getting knocked down. So, the question Larry and I addressed is, what helps people from not getting knocked down in the first place? Why is it that 50% of doctors and many other workers in other industries can persevere and withstand an environment and not get burned out? So, we started by looking at the literature outside of healthcare and came upon things like grit, which is very well studied in academics, right? It’s been shown that students with grit, medical students, nursing students, have a much greater chance of completing their course of study than those with lower grit. We looked at things like self-efficacy, which has been studied a lot in teachers, that those teachers with a higher degree of self-efficacy or skills, especially the ability to control their classroom and the ability now to do remote learning, have a much higher chance of not getting burned out and not leaving the profession. We also looked at athletics. It was right around the time of the Olympics, and we looked at mental toughness and hardiness. And it’s been shown that athletes who have a greater degree of mental toughness and hardiness and can really peak at the right time and put forth their all and excel in spite of the stress did much better than those that didn’t. We also looked at resilience, and we also looked at things like hope and optimism. And we looked at all these attributes that had not been widely studied in healthcare and looked to combine them into a concept that we titled fortitude or the ability to withstand pressure and stress with grace and courage.
Dr. Weinzimmer: And the interesting thing with that, Steve, as you were mentioning that, when we were doing the research, and Steve mentioned seven different subdimensions, all of these literatures argue why their measure is different than all of the others. And again, we took an opposite approach or an opposite view here, and instead of arguing that they’re all different, we argued that they’re all the same. And we took similar items, sometimes identical items, from these seven different scales and came up with an original list of, I believe, 96 items. And then we went through 13 focus groups of physicians. We narrowed it down to about 30 items. And then we did three different empirical studies to try to narrow that down to a statistically reliable and valid instrument. And we really wanted to make sure, Kelly, that our measure of fortitude was reliable and valid. Oftentimes, we find in industry that there are personality scales being used that aren’t statistically valid, aren’t statistically reliable, so we wanted to ensure that through the research. And we recently published a paper, which we can talk about at the end of the podcast if listeners want to take a look at it. But we recently published a paper on our scale development showing that our measure is statistically reliable and it is statistically valid.
Dr. Hippler: So, our hypothesis was that it was the combination of all these attributes together that helped an individual person withstand the stress of the environment and prevent burnout. So those are the studies Larry mentioned, that we looked at this measure, 12 items, across over 800 physicians and advanced practice providers and leaders to look at how people with high fortitude did differently than those that didn’t.
Dr. Weinzimmer: Yeah.
Kelly: Wow, that sounds amazing. I’m excited to read that paper. That sounds really fascinating. So, while you were doing all of this, is there anything that you learned that surprised you?
Dr. Weinzimmer: Yeah, and so we’ve done a follow-up study, actually, and we found that fortitude is really important in impacting the relationship between organizational interventions and burnout. Stated differently, an organization makes an effort to try to improve culture for its physicians. And as we mentioned before, a recent meta-analysis said that these interventions aren’t working. If we use fortitude as a factor that moderates that relationship between an intervention and burnout, it’s statistically significant. And what that means is if somebody has high fortitude and an organization uses an intervention, let’s say, improves culture, that physician’s burnout will decrease, and so the intervention will actually work. However, if a physician doesn’t have high fortitude, that same intervention will not have any statistical impact or any influence on burnout. And so really, it’s the interaction between the individual and the intervention or interaction between the individual and the organization that impacts burnout. It’s not the individual. It’s not the organization. It’s the interaction between the two.
Dr. Hippler: And from that, the one thing that surprised me, was a big aha moment for me, was dealing with physicians for many, many years, I think the prevailing perspective on burnout is it’s the environment puts individuals almost in a passive state of waiting for someone else to fix the situation and environment for them. I think the research on fortitude and the findings Larry mentioned about the interaction really, in my mind, underscored, really, the important message that people can really do something to improve their own well-being and to prevent burnout. It’s not a phenomenon that they have to sit back and passively hope for the environment to improve. They can do a lot about it. And that was a big eye-opener for me.
Dr. Weinzimmer: And also the ability to take ownership. And so again, passively waiting versus taking ownership and understanding that each physician has to play a role or a part in improving their level of burnout, their level of engagement, and their potential intent to leave.
Kelly: Right, those are great insights there. So, what can individuals do to improve their fortitude and therefore decrease the risk of burnout?
Dr. Weinzimmer:And it’s interesting, Kelly, when we first started making these presentations, we just talked about the research, and the question came up, so what? These are interesting findings, fortitude. And by the way, fortitude as a scale predicts burnout better than any of the other seven dimensions Steve talked about earlier. And it was so– and I think, again, talking about surprises we found, fortitude can predict over 40% of variance in burnout. The next best measure, resilience, can predict about 10%. So, our measure of fortitude predicts minimally four times more variance in burnout than any existing measure out there. And so, again, interesting findings, so what? We actually have completed several programs now where we do fortitude training. And so, can you train somebody in fortitude? Absolutely. Fortitude is a perspective. It’s an attitude. It’s not a fixed personality trait. And so, we’ve actually put physicians and APPs through a training program, and we found some pretty exciting results.
Dr. Hippler: Yeah. So, it starts with opening people’s eyes to the fact that they have to be active participants in their own well-being to prevent burnout and intent to leave. Then we run through, really, the science behind not just resilience, but grit, hardiness, mental toughness, the importance of skills, and really focus on teaching people this comprehensive list of attributes that they need to develop to improve. That’s followed by a facilitated group coaching session where people spend some time coming up with their own individual action plan, followed by socialization of this to the group and the cohort, and then time to try. We believe deliberate practice is really important. So, to leave our training session, go out, deliberately practice with or without an accountability partner, and then come back at a later time and talk about what’s been done, what they’ve learned, and share with the entire group. Because we think people can learn from each other as well.
Dr. Weinzimmer: And probably the most exciting finding we have with all of the research we’ve been doing, Kelly, is we did a baseline measure of participants’ level of fortitude and a baseline measure of their burnout. At the same time, we also measured baseline for the people that they work with, their direct reports, their peers, people in the same work environment that they were in. And then we gave them the training. We followed up about four months later, and what we found was there was a statistically significant increase in fortitude for all of the participants that went through our program, and there was no significant change in those that didn’t. More interesting than that was we saw a statistically significant decrease in burnout for our participants, and we saw no change in burnout for their peers and their direct reports that were in the same work environment. And so statistically, we were able to conclude that the training actually increased fortitude and, more importantly, decreased burnout.
Dr. Hippler: So, I think where we are now, Kelly, in this body of literature, is we’re at a crossroads in a way. We know the work environment is really, really important. And through our studies and in our conversations, we’ve talked to a lot of healthcare leaders who themselves are frustrated because they try to fix their work environment, but they’re struggling to do so. Because quite honestly, a lot of it is fixed by regulatory payment policy, the economics of healthcare today. So, they’re trying to fix the work environment, but we’re not making a lot of progress, as important as it is. Individuals in the work environment are waiting for things to be fixed and looking at their leaders to fix it for them. I think we’re at a crossroads now because our data shows that it’s not either/or. It’s not the individual or the work environment; it’s both. And we believe that it’s critically important now to move forward, focusing not just on fixing the hassles in the work environment, but really helping people build their fortitude to address this critical issue, really from both perspectives: from the individual as well as the work environment perspective. And again, I know we talk about health physicians and doctors in healthcare, but this concept really should hold true truly for every person in every work environment and every profession.
Dr. Weinzimmer: Yeah. And as you mentioned before, Steve, it’s a human phenomenon, right?
Dr. Hippler: Correct.
Kelly: Right, yeah. No, that makes a lot of sense to me. It’s really fascinating to me, really. That’s why I reached out to you guys to begin with. I was just so fascinated by this topic. So, what will you guys be looking at next?
Dr. Weinzimmer: And so, we just completed the study Steve just alluded to; it’s not the individual or the work environment; it’s the individual and the work environment. That paper is under review. We hope to get that published very soon. We’ll also be launching a fortitude study of nurses probably later this week, to be honest. And so, we have it, it’s been approved through IRB, and it’s ready to launch, we’re ready to go. And then we’re also initiating a study taking a look at AI technology and improving EMR processes for physicians to see if fortitude moderates the relationship between improvements in EMR management and physician burnout.
Dr. Hippler: And then we’re going to continue to work on our fortitude training seminars and continue to focus on improving that and gathering data in healthcare and outside of healthcare to show that training people on improving their individual fortitude will improve their well-being and decreased burnout in spite of whatever stresses they may have in the current work environment.
Dr. Weinzimmer: Yeah. And actually, later this week, we’re going to be revisiting with the group that went through fortitude training. And it’s now been about a year, and we’re going to go back and see if their levels of fortitude have maintained to be high, or to maintain high levels of fortitude if they’re going to need consistent coaching. So, we’ll actually be following up with that original cohort later this week to see where they are in terms of their fortitude, where they are in terms of their burnout.
Kelly: Wow, we’re looking forward to seeing what you all put together next and looking at the results of this work that you’re doing now. We really appreciate you both joining us today, Dr. Steve Hippler and Dr. Larry Weinzimmer, and for sharing these great insights on fortitude, new insights that you can use to decrease burnout. So, thank you both very much.
Dr. Hippler: Oh, you’re very welcome. Thank you for the invitation to speak to your audience.
Dr. Weinzimmer: Yeah, and Kelly, we are just so excited about this research and the ability to change the conversation. And so, again, the inroads we’re making right now, we believe it’s only the beginning, and then we’re going to keep doing the research and keep sharing our findings.
Kelly: Wow, yeah, that’s great. So, if a listener wants to learn more or contact you to discuss this topic further, how best can they do that?
Dr. Weinzimmer:Yeah, so a few different ways they can get a hold of us. First of all, they could visit our website. It’s nexusinsights.com, N-E-X-U-S insights, one word, dot com. And there’s some background on our fortitude research. There’s links to our papers that we referred to earlier in the podcast today. And they’ll also be able to get ahold of us on that website. Additionally, they can get ahold of us on our LinkedIn pages: Larry Weinzimmer and Steve Hippler.
Kelly: Great. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
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