Dr. Andrea Austin, Emergency Medicine Residency Program Director at Ascension Sacred Heart Hospital: How to Create Changemakers in Healthcare

Van Ton-Quinlivan

Hello, I’m Van Ton-Quinlivan, CEO of Futuro Health welcoming you to WorkforceRx, an ongoing conversation with leaders and innovators offering insights into creating a future-ready workforce.

Today, I’m happy to welcome Dr. Andrea Austin, a physician, educator, and former Navy Lieutenant Commander who, through her blog, podcast, newsletter, coaching and teaching is pushing for progress in physician well-being and equity in medicine. Dr. Austin crystallized her perspective on these issues in her book, Revitalized: A Guidebook to Following Your Healing Heartline, which provides practical steps to overcoming burn out and creating a values aligned medical career. She’s also the host of the podcast Heartline: Changemaking in Healthcare, on which I was delighted to be a recent guest.

Dr. Austin is the inaugural Emergency Medicine Residency Program Director at Ascension Sacred Heart Hospital in Pensacola, Florida, and is chair of the American Association of Women Emergency Physicians.

Thanks very much for joining us today, Andrea.

Dr. Andrea Austin

Van, it’s great to be on the podcast. Thanks for having me.

Van

Absolutely. Well, let’s start with the research, writing and other work that you do on changemaking in healthcare. How do you define a healthcare changemaker and why do you think they are essential to the future of the healthcare workforce?

Dr. Austin

The term changemaker is one that I didn’t know until I started this work for my thesis in health professions education. A lot of us are familiar with the change literature and the term that’s usually used in the business world is change agent. But in my studies, I came across this term changemaker, which stems from the nonprofit world.

It’s defined as somebody that’s trying to make a change to improve something in society, and they use creative action and they have tenacity in what they do. And so when I reflected on what we need in healthcare, you know, I think we can all agree we’re trying to do something for the betterment of society. We’re trying to help our patients, ensure our colleagues have safe and fulfilling careers and we definitely need some creative people to help us do it and with tenacity because this work is hard.

So, for all those reasons, I think that this is really a critical moment. There’s so many problems and they’re so complicated. I think sometimes we keep focusing on the solutions, which is important, but I think we could get to the solutions faster if we supported more people to have the mindsets and skillsets to be the changemakers that the system needs.

Van

So, as medical professionals get trained, for example, doctors, I assume this is not a big part of the curriculum that they take.

Dr. Austin

You are correct. Physicians in training focus on the medicine. There’s a quote that the healthcare literature doubles every two to three months and so when you think about just the amount of science there is to learn, I think a lot of these other skills and how we create change, understandably, educators, deans say, what do want me to throw out? How are we supposed to add this to a very stacked curriculum?

Van

So then in your research interviews, what competencies and mindsets consistently distinguish those that are able to successfully do the changemaking versus those who may burn out, for example?

Dr. Austin

There’s quite a list and I’m sure we’ll have a link to the study in the show notes, but there’s a few items I really want to hone in on. Some of them you can already guess. One of them is insatiable learning. Yes, we should all keep learning. I feel like that one most people in healthcare already understand. But one of them that stood out was inspiration and sustainment and what that related to is the most successful changemakers understood their “why.” Why am I doing this work? Why do I keep showing up and having meetings and hard conversations?

Everyone in our study was able to articulate back to, well, when I was a patient, I didn’t always feel heard. Or I had family members that didn’t have the best healthcare outcomes because of issues and inequities around how black patients are treated in this country. And so these various themes came up and they were able to tie that to what they were doing today. So I think especially with how hard healthcare is, knowing your why is very important.

Van

Are there any qualities that you’re born with versus things that we can pick up over our career?

Dr. Austin

That’s a great question. When I look at the list right now, I honestly think some of the skills — for instance, like navigating complex emotional landscape — I think all of us have different set points for how we handle emotions and that’s variable based on our childhood and maybe how many adverse childhood events we’ve experienced.

Every skill that we discuss is something that you can definitely improve upon and learn. I think to me that’s really exciting and I’m sure we’ll get into it later that there’s things that organizations can do that would actually help their people to learn these skills faster. Because I think a lot of people learn these through what I like to call the school of hard knocks. You get knocked down quite a few times and you start to learn, all right, well, how am I showing up to work? What could I do to make sure that I’m as emotionally regulated as I can be?

Then I’d also highlight one of the skills is about communicating for influence, which we highlighted, listening for dissent and intentional messaging. You know, there’s so many things we can practice about being better listeners and learning to listen, even when people are upset, disagreeing, have a different viewpoint. And then how do we package communication to people? There’s so many emails. You know, I have so many people that tell me all the time, I’m overwhelmed by the emails in my organization.

So I think it takes a really skilled leader to recognize what are the different communication channels that are going to cut through the noise that I can both receive messages from my people and hear what the real perspectives are, and then I can also transmit to them what’s going well, or if we are hitting roadblocks, what they are and what we’re doing to remove them. So those are a few of the skills that came up.

Van

Let me zoom out for a moment. For those listeners who don’t come from healthcare, they may need a refresher on why there’s a whole topic of physician burnout and joy at work for physicians. Maybe you could just remind us what is happening in the macro landscape that is causing all of these burnout issues.

Dr. Austin

Gosh, do we have a whole hour just for that? I’ll try to hit the wave points. So honestly, there’s some room for optimism. We’ve seen burnout rates in the physician workforce improve some in the last couple of years. They hit their peak in the post-COVID era and now physician burnout is around 50%. But I would really caution listeners that you also need to look at the specialty specific numbers. So for the administrator thinking, “Great. Only 50%. We’re fine.” Well, for emergency medicine, my specialty, were as high as 63%. And then you see some of the surgical specialties are lower down into like the 30s. So there’s quite a bit of variability in the burnout numbers

But I think all of us would agree that even 50%…I’m not happy with that. If you told me that 50% of my direct reports were burned out, I would feel like I’ve got to make a change in my workplace.

Van

Absolutely, I thought you were gonna throw out numbers like maybe 10%, but 50% is quite a high number, especially given that we’re not gonna produce as many doctors —  especially primary care doctors — as we need as a nation.

So, all right, back to changemaking. What are your favorite examples of someone who has done change making effectively and it inspired big changes in healthcare?

Dr. Austin

There are so many really wonderful examples of physician changemakers out there. When I think about some of the people that were in the study, you’ve got people that created brand new career pathways, certificate programs, degree programs for healthcare professionals in their organizations.

You have people that opened up new service lines that recognize that their patients were suffering from mental health issues that were not going to be absorbed by the amount of psychological and psychiatry services and that primary care would have to expand into that realm.

There were people that recognized the extreme burnout, moral injury, frustration that happened during COVID and that they took ownership of their departments about really turning the ship around and owning the problems that were happening and making investments in their people to improve the fulfillment and dare I say joy.

I think joy is such a rare word that my physician colleagues use. Usually the words that we’re using are “survive” and “keep my head above water.” But I would love for us to get to a point where more of us are feeling that our workplaces can be joyful.

Van

What about the concept of resilience? Do the qualities or the competencies that you learn in being a changemaker make you a more resilient physician, for example?

Dr. Austin

Resilience is such a loaded word right now, so I want the listeners to keep listening. Don’t turn me off! For a lot of physicians, if they hear the word resilience, they instantly feel triggered because they feel like they’re incredibly resilient people and so their burnout, their frustration with the system is less a personal failing and more organizational. I’m of the opinion that two things can be true at the same time.

What I’ll say about the people in this study is they’re all incredibly resilient and some of the language that they would use is, “Well, when I hear no I think it’s just a starting place and I just know that whatever I’m working on is going to take much longer than I think it should and that I’ve got to have this like zoom out ability and know that I’m doing things for the right reason. I may have to change my approach, but eventually we’re going to get to a better place.”

So they were very, very resilient. But I think what was also interesting about this group of people, and what I didn’t know when I set out to do this research, is they also uniformly described the places where they were working as not perfect, but overall good organizations. What they said is, “I work at a big place. There’s a lot of bureaucracy. Change isn’t easy. But overall, I think our organization is doing things for the right reasons. Their hearts are the right place. We have a noble mission and I think most of my leaders in this organization are trying to help me.”

What I really took away from that is we have to make sure that if we want more changemakers, and we want health care to change, we also have to make sure the organizational conditions are there to allow people to take risks and do this important work.

Van

And so if an organization and its missions and values are aligned or purpose-driven, what would be some intentional strategies to cultivate changemakers and changemaking rather than leaving it up to chance?

Dr. Austin

I think the good news of this study is there’s actually a lot of things that organizations can do. There’s already some of the things I’m going to list, hopefully, where you can say, “Yes, my organization does that.” So when we look at insatiable learning, half of the people in our study, along with being physicians, had an advanced degree in another field. Some of them had a master’s in medical administration. Some were PhDs. I’m sure we had somebody with a master’s in public health. So they had these other areas of expertise.

I’m not going to say that everybody needs to go get another degree, especially among physicians that are in school so long. But it is important that you support their professional development. You know, in an era of cost cutting, the first thing to go in many organizations is their CME (Continuing Medical Education) dollars. They stop funding travel. They stop funding professional development opportunities or protecting the time to do that. And I would really encourage leaders — especially right now with how much change is happening due to AI and other technologies — your people need support to continue to learn and they honestly want to. Most people in healthcare love learning and so when you deprive them of that, that’s a risk for your organization.

The next one I want to spend a little bit of time on kind of hits multiple categories. I think making sure that you have a “just culture.” Culture influences all of this. None of this changemaking work can happen if you have a toxic culture, if you’re not supporting people. And so make sure that your work environment is one in which people can do the right thing, they can stand up, they can say what they think is necessary for safe patient care. We’re all dealing with cost constraints and other demands, but making sure that you have a psychologically safe workplace in which people can share their opinions and take risks is fundamental to this change making work.

Van

So, tell us about the work that you’re doing with organizations when you go upstream to fix some of these issues that you’re talking about.

Dr. Austin

Well, one thing that I do is I’m a certified coach and so I coach people mainly at the individual level right now, but I’d love to do more group-level coaching. Coaching is a really powerful vehicle for driving change in your organization and really the framework we used for this paper is everybody wants organizational big sweeping change. I want it too. But when you step back and say, well, how do we get there? How do we make a big sweeping change or all the changes we need right now? Well, honestly, it sounds trite, but it does start with the individual, and individual transformation influences teams, and teams drive organizational change.

So, for that burned out, frustrated healthcare professional listening – and if it’s not yourself, there’s somebody you work with that fits that description – offer coaching. And it’s even better if your organization has a funding mechanism or allows for internal coaching because that can really accelerate people’s ability to stay engaged in an organization knowing that our careers ebb and flow. You and I have talked about our careers….different parts of them and our journeys. People in healthcare are smart and hardworking and so I think it’s really important to try to find ways to keep them on the team.

You may hear from managers that coaching costs money…well, what’s the cost when you lose somebody and you have to recruit? So, an internal coaching program might really be a way that you can move the needle on not just retention, but fulfillment in your people.

Van

When I think about the doctor, they’re so analogous to the athlete, right? And every athlete has coaches that have worked with them either early career, mid-career, or later career. So I definitely see the value of coaching throughout one’s career.

So, of course, I have to ask you the AI question. I’m sure every healthcare organization is wrestling with how it will adopt AI and the governance structure they need. That’s another layer of technology that is going to be coming onto the healthcare system. I wonder if you have any observations or are hearing any tidbits about that?

Dr. Austin

Yes, I’m seeing different strategies out there. I would say the one to not do is the ostrich, and there’s definitely a lot of ostrich behaviors going on right now, both at the individual and the organizational level. I’ve heard some med schools saying, well, we’re just not going to allow our students to use AI. Well, that’s completely unrealistic and also creates problematic behavior, right? Because when we tell humans to not do something, our tendency is, well, let me see what that is now. I want to use it. And maybe I fall into using it in a way that’s not ethical.

One of the organizations I work with currently does not have an internal version of ChatGPT. Another one does. I was talking with the organization that doesn’t, this is something we really have to think about, right? Because if you have an internal version of ChatGPT that’s made for your company, that goes through your security practices and you allow your clinicians and other personnel to put protected health information into that, and they can put employee information into that, that’s much safer.

So my advice with AI is get ahead of it. As uncomfortable as it is, as much more work as it’s adding to our plates, I think it does offer some corners of optimism. For instance, the ambient dictation and decreasing administrative burdens for frontline people. But in the short term, it’s going to be more work for us and I think that’s what leaders struggle with is how do I add this to my already full plate? That’s especially true for the leaders for whom technology is not their strong suit and they feel uncomfortable even with some of the technology that’s existed pre-AI.

Van

What about value-based care? What’s your thought in terms of the changemaking related to value-based care and the rate of that change?

Dr. Austin

Well, when I listen to people talk about value-based care, there’s a group of us that are very excited about it, see the premise, and then there’s people that are very scared… you know, ‘don’t move my cheese.’ And so I think there’s a lot of opportunity with just increasing the mindsets and skillsets for navigating change and as we increase those skills, the transformation to value-based care, I think, would be more smooth because this is going to be one of the most radical revolutions we’ve seen in healthcare.

We think about the RVU system. This is really upending that very substantially. And so again, how do you navigate change like that? Well, you have a bunch of people that are skilled at change management and right now that’s not really happening in healthcare.

Van

As we all know, we have an aging nation, and so as you think about that and the care and caregivers that we’re going to need, what are your thoughts in terms of the changemaking that will need to occur there?

Dr. Austin

Woo, this is huge. I think what keeps me up at night is we are going to have such an increase in the volume and complexity of our patients, and when you’re dealing with that level of volume and complexity, you really need everyone to be off the bench. There’s a great analogy that Susan Fox shared with me — and I would highly encourage people to check out Susan Fox’s work. She has a great book called Rebel Healthcare and her premise is about getting patients more involved in their own care.

I think it’s an all hands on deck situation. We need to empower patients to be more aware of their health and how to navigate the system and the technology that could help them with their health and we need to empower our workforce and retain people.

The reason I’m a coach is every day I’m coaching physicians that are thinking about leaving medicine and it really worries me. You think about the number of years that people went to school, you know, the length of training for physicians is so long. So when we lose one of them, it’s a colossal loss to the system. So I really think we need this all hands on deck approach and to also think of more innovative strategies.

I’m actually working on a paper right now with Harry Severance, another brilliant mind in this area. We’re talking about how to help people that know they want to be a doctor. Like, I was that person. I knew I wanted to be a doctor in sixth grade. So if I knew that, could I have gone to college and medical school in six years instead of eight? And I’m not going to discount the value of my liberal arts education preceding medical school, but for somebody that wanted to be a doctor, could I have had courses in my liberal arts education that aligned better with medicine — going back to my paper on change making — that taught me more about communication?

Maybe I had a journalism or a PR course knowing that one of the biggest things that we’re struggling with in healthcare right now is disinformation, so we need healthcare professionals to be better communicators with the patients.And so that’s one example. To meet this huge demographic shift that we’re seeing, we may have to start coaching people to give up some sacred cows like medical school must be four years. Okay, why?

Van

Well, an accelerated pathway would make a lot of sense from a debt management perspective as well. We will see what the future holds as we deal with the crisis of a shortage in physicians. Perhaps there will be some of that creativity that you’re hoping to see.

Dr. Austin

Absolutely.

Van

So let’s go ahead and wrap up with the final question here which is, what makes you optimistic about the future of care, Andrea?

Dr. Austin

Honestly, I’m coming out of an interview season in which I had the honor of interviewing two hundred people that want to be emergency physicians. It’s the most interviews I’ve ever done. I’ll just tell you, interviewing the people going into emergency medicine was so uplifting for me and honestly was a reminder for me of what we all went into medicine for.

And also, really, it’s a challenge to me, a call to action that I need to continue — now that I’m getting to be a more senior leader in this specialty — I need to continue to do the work to create the conditions for these brilliant and altruistic and caring people to thrive. Because when you talk to these people and you think about the fact that there’s a 60% chance that they’re going to be burned out in five years, that they’re not going to be happy with their decision to be an emergency doctor… I mean that to me is like not defensible. That’s not good.

This podcast is about workforce development. The people in healthcare are amazing and we have to keep doing the work to make their professional journeys as joyful and fulfilling as they can be.

Van

Before we go, I wonder if I could ask you — because Futuro Health is in the space of the allied health careers within healthcare — what would be your recommendations to those who are thinking about creating pathways into allied health? What are your recommendations in terms of the future of care and which occupations are good bets?

Dr. Austin

My goodness. I mean, honestly, I think the demand for healthcare is so high, the best bets are what you love so I think it’s important to give people exposure to healthcare as a career pathway. I mean, I was starting to think about this when I was in sixth grade, so getting exposure to people in middle school and high school, I think is really important.

I came from a very small town in rural America, and reflecting back on that time, I chose to be a doctor because that’s what I knew was available. I knew there were police and teachers and farmers and people in healthcare. And I think healthcare is so big and there’s so many possibilities that we have to do a better job of exposing people to the limitless things that they can do.

Just as a quick example, I knew nothing about being a nuclear medicine technician and what a cool field that is. Or an MRI technician and quite frankly, they’re incredibly well compensated and they have the potential to have really great work-life harmony.

So I think creating more opportunities for people to know what’s out there in science and some of the other subjects that are relevant to healthcare… that if you’re doing well in those, you’re taking those courses, you’re not opting out too early, healthcare is going to be a door that you can go through.

Van

Wonderful advice. Thank you very much Andrea for being with us today.

Dr. Austin

Thanks, Van, it’s been a pleasure.

Van

Great to see you again. I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in the nation.