Feeding the Soul via Creation of a Suborganization to Promote a Sense of Community

INTRODUCTION

Professional burnout has been characterized by Maslach and Jackson as a “syndrome of emotional exhaustion and cynicism” in which workers feel their emotional resources are too depleted to continue to give of themselves, develop cynical attitudes about others, and begin to negatively self-evaluate their own work, resulting in a diminished sense of accomplishment.¹ Burnout has both individual and organizational consequences. Among individuals, insomnia and physical exhaustion may lead one’s health status to decline. This can also lead to family and marital problems and increased substance use.² Burnout also adversely impacts organizations through deteriorating quality of work, increased absenteeism, low morale, and high employee turnover.¹ During validation of the Maslach Burnout Inventory among workers, Maslach and colleagues identified three key dimensions of burnout: emotional exhaustion, diminished sense of personal accomplishment, and depersonalization.^1,3

Burnout is a well-recognized factor contributing to attrition among faculty in health professions education.^4,5 Women, especially early in their careers, are more likely to experience burnout due to role conflicts between workplace and home.² In one survey of American Association of Colleges of Pharmacy (AACP) members, 95% of respondents reported working 40 or more hours per week while sleeping and exercising less than recommended amounts, all of which have been identified as risk factors for burnout.^6,7

A multimodal approach addressing the dimensions of the Maslach Burnout Inventory may be necessary to address burnout and attrition among female faculty. One of these methods may include improving a sense of professional accomplishment and fulfillment. Studies in physicians have found that improved professional fulfillment reduces burnout and improves organization performance.^8,9 One model that outlines approaches to improving professional fulfillment is the Stanford Model of Professional Fulfillment, which was developed to assess and improve wellness specifically among physicians.¹⁰ The framework organizes professional fulfillment into three domains, all equally important in the outcome of professional fulfillment (Table 1). Two of the domains, namely workplace efficiency and culture of well-being, are the primary responsibility of organizations. The third domain, personal resilience, is the primary responsibility of the individual.¹⁰

Although the Stanford Model charges organizations with improving the employee experience in these domains, there are limitations to relying solely on places of employment to support the organizational aspects of professional fulfillment. Workplaces may lack resources for providing comprehensive training to promote individual resiliency among faculty, thus limiting the pursuit of professional fulfillment. Additionally, while formal supervisor-supervisee and mentor-mentee relationships are vital for faculty success, these pairings are susceptible to an inherent power dynamic that may inhibit discussion of sensitive topics. The discomfort of sharing workplace frustrations and challenges may also prevent faculty from having important well-being and resiliency discussions among peers at the same institution. Further, a limited set of ideas or viewpoints may exist at a given institution, and an outside perspective may be valuable to help faculty navigate efficiency, wellness, or resilience concerns. Finally, some workplace cultures may not subscribe to public celebration of successes, but external recognition or support may be beneficial for faculty. The creation of suborganizations (Circles) addresses these limitations of organizations.¹¹

The purpose of this commentary is to describe how one Women Faculty Special Interest Group (SIG) Circle sought to enhance professional fulfillment and combat burnout through the framework of the Stanford Model for Professional Fulfillment. The Circle members worked within their suborganization to promote resilience and community, well-being, and efficiency with the overarching goal of increasing fulfillment and reducing burnout among its members.

In Spring 2019, the AACP Women Faculty SIG solicited interest from the membership in developing Circles, as described by the Lean In website (leanin.org).¹¹ Circles are described as “a safe space to share your struggles, give and get advice, and celebrate each other’s wins.”¹¹ The Circle framework was designed to leverage the Lean In approach to foster the personal and professional development of women in pharmacy academics. The Circles also provided a unique avenue for faculty to augment institutional experiences and opportunities related to each domain of the Stanford Model of Professional Fulfillment both at the individual and organizational level.

Our Circle began officially with a welcome email from the Women Faculty SIG leadership in February 2019. In our first meeting in March 2019, Circle members introduced themselves, their roles, and what they hoped to get out of Circle meetings. At that time, the seven members were strangers with no personal or professional knowledge of other members of the group prior to our first meeting. Additionally, our Circle included women from different geographies, institution types, years in academia, and leadership appointments within our respective institutions (Table 2). Our Circle members decided by consensus to meet for one hour approximately once every six weeks (eight to nine times annually). Although the original intent for the Circles was for a one-year duration, our members felt that the benefits of the Circle warranted extending scheduled community interactions, and we continue to meet regularly.

Our Circle meetings served a variety of functions aligning with each of three domains from the Stanford Model for Professional Fulfillment. We started out as an accountability and goal-setting group, which most closely aligns with the first Stanford Model domain: efficiency of practice. This domain refers to elements of the workplace that relate to effectiveness, positive interactions, and work-life balance. The first discussion item in our Circle meetings was always providing updates on the personal and professional goal(s) that we had previously shared.¹⁰ As our meetings were generally scheduled at six-week intervals, the meetings provided a deadline and an accountability mechanism for goals that otherwise kept moving lower in prioritization due to competing demands. Verbalizing the goals to the group and providing updates incentivized members to make progress toward goals between meetings and to report back and seek feedback on projects at each meeting. Examples of these goals included scholarship deadlines or having an important conversation with a coworker. Other Circle members shared experiences and wisdom related to streamlining work, enhancing teamwork, setting realistic schedules, and handling difficult conversations. Even when little movement had been made, Circle meetings kept the goals in the forefront, providing a mechanism for accountability and motivation. Members frequently reported that the Circle helped them gain traction when they were stuck with their goal through encouragement or idea sharing on how to overcome challenges and obstacles. The accountability aspect of our Circle interactions enhanced professional fulfillment through addressing efficiency of practice factors, such as teamwork models, and designing roles to practice at the top of our licenses.¹⁰ Specific examples for the efficiency of practice domain and other Stanford Model domains are detailed in Table 1.

As the fruits of the goal setting and accountability features of our Circle became apparent, the functions of the Circle began to evolve. Our Circle began using our time together to share individual struggles and brainstorm solutions, addressing the culture of wellness domain of the Stanford Model (Table 1).¹⁰ This domain refers to individual actions and attitudes that contribute to holistic well-being in the workplace.¹⁰ Although organizations are primarily responsible for maintaining a culture of wellness, our Circle functioned as a supplementary organization that promoted well-being. Members were accountable to each other for prioritizing wellness and personal goals in addition to professional endeavors. Members shared books, podcasts, or activities to help another member in her wellness journey. Members also recognized and celebrated each other’s successes, ensuring each member felt appreciated for not only their career accomplishments but also for their personal goals, such as completing an Ironman, learning a new skill, or seeking an additional professional degree.

Our Circle also addressed the personal resilience domain of the Stanford Model (Table 1).¹⁰ This domain refers to shared values and beliefs that prioritize not only personal and professional growth but also a sense of community and compassion for others. Personal resilience is primarily the responsibility of the individual, and our Circle provided a mechanism for individual-to-individual support. Circle members provided regular words of encouragement when individuals were facing difficult circumstances. On some occasions, regular Circle business was set aside to support a member suffering from a personal tragedy or difficult life transition. At times, one member would meet with another member outside of the regular meetings to provide encouragement, advice, or practical solutions for life challenges.