Having a Retreat Helped Us Move Forward

— A day away from it all gave our staff a chance to generate ideas big and small

A photo of the Cornell Tech campus on Roosevelt Island, New York City.
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    Fred Pelzman is an associate professor of medicine at Weill Cornell, and has been a practicing internist for nearly 30 years. He is medical director of Weill Cornell Internal Medicine Associates.

This last week we got away from it all.

Over the past few months, we have been experiencing an overwhelming sense of inertia, apathy, burnout, and at times a little bit of anger. Everyone feels overwhelmed, put upon by forces often beyond our control. This seems to be happening locally, regionally, and nationally.

At our practice, it seems to manifest in people feeling frustrated, like things are just never going to get better, like forces are perpetually aligned against us. Reading on social media and in the mainstream press, we get a sense that this is happening almost everywhere.

We work at a large academic medical center, in a teaching practice that is sorely under-resourced and under-supported. Every time consultants come by to comprehensively review our practice, they tell us for the number of providers we have and the number of patients we care for, we need more support staff, more people answering the phone, more nurses, more medical technicians, and more people doing all the jobs that end up falling on the shoulders of providers, preventing them from truly practicing up to their licenses.

We are overwhelmed with portal messages and the hours we spend in the electronic medical record, struggling to do with limited resources all the things that our patients need. And yet, whenever we've come up with a project -- found something to address some problem that could be made better -- and we call for volunteers, everyone feels already pushed to their limits. Few seem to have the time needed to dedicate to a project to innovate and improve.

So a few months ago, after getting an enormous amount of unsettling feedback at our annual faculty reviews, we decided to plan an off-site retreat. It would be a day away from the practice, with just the faculty, the attendings, and the nurse practitioners, to give everyone a chance to talk things out, and to remind ourselves why we are doing this, what sparks joy for us, and where we see opportunities to bring about change -- from the very small things that would make an impactful difference to large global interventions that might make a huge difference for everybody.

We did a lot of planning, meeting weekly, coming up with what felt like a really great agenda. We blocked off everybody's schedules, sent out global portal messages to patients telling them that our practice would be closed for a professional development day, and even got buy-in from the administration that despite all the potential lost revenue from a full day of missed patient care sessions, we thought it would be worth it to everyone.

Once the day arrived, we all made our way to the retreat location, not far from our main practice site, in the middle of the East River on Roosevelt Island, at the very modern Cornell Tech campus in a beautiful education center reserved just for us. We spent the day being thoughtful about where we are, why we might feel disenfranchised and powerless, and how we might think about bringing solutions for building a better healthcare system for us, for our patients, and for our staff.

We brought in an outside expert in these issues, someone to help lead discussions and guide us, who asked us to highlight what was working and why we still loved coming to work each day, and then to think about the things we do not love, what to fix. Everybody put their nickel down to rank the problems, from the tiny to the massive, and then we broke up into workgroups to define those problems more clearly, and to start coming up with a couple of potential solutions.

Scattered in throughout the day were a couple of inspirational speeches from our leaders, as well as some team-building activities, including one led by an improvisational actor who, despite everybody's initial grumblings, really got everyone involved, on their feet, jumping around, and laughing hysterically.

The day ended with a promise to take everything back to the office, to think things through, and to generate a report about where we stood and what we could maybe put some effort into making better.

True, we're probably not going to get the hospital administration to hire 20 more people to answer our phones, or double our nursing staff, or hire physicians' assistants, or even give us all a semi-private dedicated assistant to manage our individual tasks. But there were enough seeds there, enough creative ideas, that I think we can move things forward. I think we can address some of the things that are nagging at us all, that are weighing us down, and that are preventing us from fully being there for our patients, for each other, and for our staff.

One big idea was a call for another larger retreat, bringing along everyone, including administrators, nurses, registrars, medical technicians, social workers, pharmacists, and maybe even some patients.

There were no magic answers, no silver bullets, and no global panacea. But perhaps with some small- and medium-size wins, along with increasing our voice at the table and demanding bigger changes, we can use this retreat to move everything forward.