First bite of dinner at a magnificent restaurant — Ping! “Could you send the pharmacy a refill for my prescription ASAP?”

As the opening credits roll for a long-awaited movie with family — Ping! “What should I do about the swelling?”

While enjoying a picturesque mountainscape — Ping! “Urgent!!! Can you cover for Marcie on the twenty-second?”

It is a strain healthcare providers know all too well — the round-the-clock ping of requests from Epic In Basket —  the communication hub where healthcare providers send and receive messages and tasks, including communications from patients; staff messages; and refill requests.

“I was in Europe,” said Jenny Soep, MD, pediatric rheumatologist and medical director at Children’s Hospital Colorado. “I still remember being in England and getting messages from one of my patients and feeling like, ‘Oh my God, they're flaring and I need to do something about it!’”

Working on vacation is exactly the kind of work-life imbalance which can contribute to faculty burnout, according to Lotte Dyrbye, MD, MHPE, a global thought leader in physician burnout and engagement, and Senior Associate Dean for Faculty and Chief Well-being Officer at University of Colorado School of Medicine (CU SOM).

Dyrbye leads Offices for the Faculty Experience, the goal of which is to promote work-unit and school-level efforts to improve faculty well-being.

A well-being innovator, Dyrbye has conducted numerous national and multi-institutional studies and randomized clinical trials of possible solutions; and co-authored the National Academies of Sciences, Engineering, and Medicine consensus study report, Taking Action Against Burnout: A Systems Approach to Professional Well-Being.

According to Dyrbye’s findings, burnout is a crisis affecting healthcare providers, and requires healthcare organizations to prioritize major improvements in clinical work environments to prevent and mitigate clinician burnout and foster professional well-being.

“Physician burnout leads to adverse outcomes across the board,” Dyrbye said. “When physicians experience burnout, they leave their jobs, leave medicine, and cut back on the time they take care of patients. Compounding this is the adverse impact of burnout on quality and safety of care, and on the patient experience. It is of great benefit to all for healthcare organizations to prioritize solutions.”

As part of the Offices for the Faculty Experience initiatives to address faculty burnout, Dyrbye has deployed Well-being Leaders to identify and address work-unit specific needs and priorities related to professional well-being and fulfillment of faculty. The Well-being Leaders also serve as communication liaisons between the departments and CU SOM, then share their learnings broadly.

Well-being Leader Jessica Bloom, MD, MSCS, a pediatric rheumatologist and colleague of Soep, elaborated on the stress caused by the work-life imbalance of working while away from work.

“It just added more guilt associated with vacation,” Bloom said. “Either I had to ask someone else to take on my work, or continue to respond to tasks while on vacation. It was blurring a lot of lines.”

Soep acknowledged the value of In Basket as a communication tool for patients and healthcare providers, but added, “Many of us have a hard time turning off In Basket when we are doing other things, and so it does creep into our away or vacation time. And so obviously that had a negative impact on our ability to unplug.”

With their department risking work-life imbalance and burnout, Bloom approached a solution through utilizing strategies she learned as a Well-being Leader about project management and data gathering.

“In preparation for an upcoming section-wide retreat, I created a survey that was open-ended,” Bloom said. “It was basically, ‘What fills your cup and what drains your cup?’”

From Bloom’s survey emerged a theme of stress around In Basket, for which Soep proposed a remedy, a system of In Basket coverage Soep had been ideating over the previous six months.

“We were willing to try,” Soep said. “We were not too averse to change. And we also, I think, trust each other enough to know that if it's not working, we'll adjust.”

Soep proposed an equitable, thoughtful In Basket coverage model that recognizes the workload of each team member and the diversity of the team, rather than a one-size-fits-all approach, with an if-then guide of contingencies for how to delegate In Basket coverage in various circumstances.

For instance, the coverage model adjusted expectations for a provider with more overnight call hours, versus one with fewer; and for when there are three or more providers out at a time; and for the number of days providers will be out.

In drafting the model, Soep and Bloom sought feedback from the team, a critical point of success, they said.

“We allowed for discussion and gave [everyone] an opportunity to be involved,” Bloom said. “There would have been more contention if [Soep] just went with her own thoughts.”

Through a process of incorporating feedback from the team, Soep continued refining the proposal.

“That's why it took so long,” Bloom said. “[Soep] was working on it, but she'd bring the idea to a faculty meeting. And then we'd all give input and she's like, ‘OK, I'll go fix that part.’ And then she'd bring it back and we'd give input. That could have gone on forever.”

Recognizing that endless delays could adversely impact workplace well-being, Bloom and Soep continued forward, while also embracing the iterative nature of the process.

“We were casual in that we are just going to try this,” Bloom said. "This might not be the final version. If it’s not, we will readdress.”

Soep and Bloom proceeded decisively, implementing the In Basket coverage plan in their department, with the understanding that the iteration may be imperfect, but they would remain flexible and adapt to feedback.

“We launched an imperfect version rather than stagnated to find perfection,” Soep said. “Not stagnating in perfection made all the difference.”

Most importantly, according to Bloom, having empathetic, receptive, and trustworthy leadership has fostered workplace well-being, and contributed to the success of their In Basket coverage model.

“This initiative coming from leadership shows that they want people to detach when out,” Bloom said. “This definitely came from listening to what everyone’s pain points were. We're supportive of each other. We have fun. That's not to say we're not stressed, overwhelmed, annoyed, frustrated, all of the things. [But] we see each other as more of a family who helps each other.”

For teams with high stress or burnout who don’t know what the central problems are, or how to address, Bloom advised “having a forum to identify the problem and a way to do it anonymously, or in a way that not the loudest person in the room is the one speaking.”

“The lesson that keeps coming up is sometimes you just have to do something,” Bloom said. “We spend a lot of time preparing things and being meticulous. And that's important, but there's a balance. I don't have to make something perfect before it begins.”

Now successfully launched and in practice, Bloom and Soep’s In Basket coverage model has fostered for their team the ability to log off from work while away or on vacation, with the added benefit of improving the patient experience by minimizing or eliminating lapses in provider responses.

“We see this as an initiative to help overall well-being,” Bloom said. “We want you to enjoy your time off.”

The team response has been positive.

In an anonymous survey of providers, 100% of respondents said they view the changes positively or very positively.

“I really love it,” one survey respondent said. “It has tremendously reduced the stress associated with figuring out who to ask, and the guilt associated with asking.”

Now, Bloom said, vacations are blissful.

“I went away this summer and really didn’t have to worry,” Soep added. “I knew that people were covering [my In Basket]. It really did allow me to enjoy my week away and not have to stress about what's happening. I trust that they can handle everything, and my patients will be in excellent hands. It allowed me to enjoy [my vacation] without [work] hanging over me.”