Clinical Professor, Anesthesiology, Perioperative and Pain Medicine
Chief Medical Officer, University Healthcare Alliance (2014 - Present)
Associate Chief Medical Officer, Stanford Health Care (2011 - Present)
Co-Director, Clinical Effectiveness Leadership Program (CELT) (2014 - Present)
Senior Advisor, WellMD Center (2017 - Present)
Interim Director, WellMD Center (2015 - 2017)
Affiliate, Freeman Spogli Institute (2014 - Present)
Chief of Staff, Stanford Health Care (2008 - 2011)
Board Member, Stanford Health Care Board of Directors (2008 - 2011)
Medical Education:Univ Of Chicago - Registrar (1981) IL
Board Certification: Anesthesia, American Board of Anesthesiology (1988)
Residency:Stanford University School of Medicine (1986) CA
Board Certification: Internal Medicine, American Board of Internal Medicine (1984)
Residency:Stanford University School of Medicine (1984) CA
Internship:Stanford University School of Medicine (1982) CA
- Independent Studies (5)
Prior Year Courses
- Leading Value Improvement in Health Care Delivery
SOMGEN 275 (Aut)
- Leading Value Improvement in Health Care Delivery
Building a Program on Well-Being: Key Design Considerations to Meet the Unique Needs of Each Organization.
Academic medicine : journal of the Association of American Medical Colleges
The current health care practice environment has resulted in a crescendo of burnout among physicians, nurses, and advanced practice providers. Burnout among health care professionals is primarily caused by organizational factors rather than problems with personal resilience. Four major drivers motivate health care leaders to build well-being programs: the moral-ethical case (caring for their people), the business case (cost of turnover and lower quality), the tragic case (a physician suicide), and the regulatory case (accreditation requirements). Ultimately, health care provider burnout harms patients. The authors discuss the purpose; scope; structure and resources; metrics of success; and a framework for action for organizational well-being programs. The purpose such a program is to oversee organizational efforts to reduce the occupational risk for burnout, cultivate professional well-being among health care professionals and, in turn, optimize the function of health care systems. The program should measure, benchmark, and longitudinally assess these domains. The successful program will develop deep expertise regarding the drivers of professional fulfillment among health care professionals; an approach to evaluate system flaws and relevant dimensions of organizational culture; and knowledge and experience with specific tactics to foster improvement. Different professional disciplines have both shared challenges and unique needs. Effective programs acknowledge and address these differences rather than ignore them. Ultimately, a professional workforce with low burnout and high professional fulfillment is vital to providing the best care to patients. Vanguard institutions have embraced this understanding and are pursuing health care provider well-being as a core organizational strategy.
View details for DOI 10.1097/ACM.0000000000002415
View details for PubMedID 30134268
What Do We Mean by Physician Wellness? A Systematic Review of Its Definition and Measurement
2018; 42 (1): 94–108
Physician wellness (well-being) is recognized for its intrinsic importance and impact on patient care, but it is a construct that lacks conceptual clarity. The authors conducted a systematic review to characterize the conceptualization of physician wellness in the literature by synthesizing definitions and measures used to operationalize the construct.A total of 3057 references identified from PubMed, Web of Science, and a manual reference check were reviewed for studies that quantitatively assessed the "wellness" or "well-being" of physicians. Definitions of physician wellness were thematically synthesized. Measures of physician wellness were classified based on their dimensional, contextual, and valence attributes, and changes in the operationalization of physician wellness were assessed over time (1989-2015).Only 14% of included papers (11/78) explicitly defined physician wellness. At least one measure of mental, social, physical, and integrated well-being was present in 89, 50, 49, and 37% of papers, respectively. The number of papers operationalizing physician wellness using integrated, general-life well-being measures (e.g., meaning in life) increased [X 2 = 5.08, p = 0.02] over time. Changes in measurement across mental, physical, and social domains remained stable over time.Conceptualizations of physician wellness varied widely, with greatest emphasis on negative moods/emotions (e.g., burnout). Clarity and consensus regarding the conceptual definition of physician wellness is needed to advance the development of valid and reliable physician wellness measures, improve the consistency by which the construct is operationalized, and increase comparability of findings across studies. To guide future physician wellness assessments and interventions, the authors propose a holistic definition.
View details for DOI 10.1007/s40596-017-0781-6
View details for Web of Science ID 000424047400015
View details for PubMedID 28913621
A Brief Instrument to Assess Both Burnout and Professional Fulfillment in Physicians: Reliability and Validity, Including Correlation with Self-Reported Medical Errors, in a Sample of Resident and Practicing Physicians.
Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry
The objective of this study was to evaluate the performance of the Professional Fulfillment Index (PFI), a 16-item instrument to assess physicians' professional fulfillment and burnout, designed for sensitivity to change attributable to interventions or other factors affecting physician well-being.A sample of 250 physicians completed the PFI, a measure of self-reported medical errors, and previously validated measures including the Maslach Burnout Inventory (MBI), a one-item burnout measure, the World Health Organization's abbreviated quality of life assessment (WHOQOL-BREF), and PROMIS short-form depression, anxiety, and sleep-related impairment scales. Between 2 and 3 weeks later, 227 (91%) repeated the PFI and the sleep-related impairment scale.Principal components analysis justified PFI subscales for professional fulfillment, work exhaustion, and interpersonal disengagement. Test-retest reliability estimates were 0.82 for professional fulfillment (α = 0.91), 0.80 for work exhaustion (α = 0.86), 0.71 for interpersonal disengagement (α = 0.92), and 0.80 for overall burnout (α = 0.92). PFI burnout measures correlated highly (r ≥ 0.50) with their closest related MBI equivalents. Cohen's d effect size differences in self-reported medical errors for high versus low burnout classified using the PFI and the MBI were 0.55 and 0.44, respectively. PFI scales correlated in expected directions with sleep-related impairment, depression, anxiety, and WHOQOL-BREF scores. PFI scales demonstrated sufficient sensitivity to detect expected effects of a two-point (range 8-40) change in sleep-related impairment.PFI scales have good performance characteristics including sensitivity to change and offer a novel contribution by assessing professional fulfillment in addition to burnout.
View details for DOI 10.1007/s40596-017-0849-3
View details for PubMedID 29196982
Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness, and Personal Resilience
Think of physician well-being as a three-legged stool. Improvement efforts should focus on all three domains to achieve best results.NEJM Catalyst
- Novel Metrics for Improving Professional Fulfillment. Annals of internal medicine 2017; 167 (10): 740–41
- PREOPERATIVE EVALUATIONS WESTERN JOURNAL OF MEDICINE 1985; 142 (1): 102–3
- A PATIENT WITH POLYURIA AND HYPONATREMIA KIDNEY INTERNATIONAL 1983; 24 (2): 256-267
CENTRAL CHOLINERGIC EFFECTS OF TRICYCLIC ANTI-DEPRESSANTS IN MOUSE
ARCHIVES INTERNATIONALES DE PHARMACODYNAMIE ET DE THERAPIE
1982; 255 (1): 68–80
The apparent rate of acetylcholine (ACh) turnover and levels of ACh and choline (Ch) in whole mouse brain were examined 30 min following i.p. injection of 25 mg/kg of three tricyclic antidepressants (TAD's): amitriptyline, chlorimipramine, and imipramine. The effects of these agents on high affinity choline uptake (HACU), a rate-limiting, regulatory step in ACh synthesis, were also examined. All three TAD's inhibited ACh turnover (by 27-40%), increased Ch levels (by 33-37%), and inhibited HACU (IC50's from 1.7 - 6.8 X 10(-5) M). Two of the three drugs produced significant decreases in ACh levels. It is concluded that these agents possess anticholinergic activity which is independent of their previously demonstrated muscarinic receptor blocking capabilities. As substantial evidence has accumulated linking increased cholinergic function with depression, it is speculated that this additional anticholinergic activity may contribute to the clinical efficacy of the TAD's.
View details for Web of Science ID A1982NE53200007
View details for PubMedID 7073400
- Effects of tricyclic antidepressants on muscarinic cholinergic receptor binding in rat brain Life Sciences 1981; 29: 29