Health System Leaders Research Articles

Improving Vaccine Equity: How Community Engagement and Informatics Facilitate Health System Outreach to Underrepresented Groups.

Given the inequities in access to health care resources like COVID-19 vaccination, health systems should carefully consider how to reach underrepresented groups. Reflecting on vaccine rollout efforts holds insight on the role of community engagement and informatics support in promoting health equity. This study aimed to assess the effectiveness of four outreach strategies deployed by University of Washington (UW) Medicine in improving vaccine equity over traditional vaccine scheduling online or by phone, we report on appointment scheduling and completion of appointments (i.e., vaccine administration) through (1) automated outreach to individuals from underrepresented groups, (2) temporary "pop-up" clinics in neighborhoods highly impacted by COVID-19, (3) vulnerable population clinics, and (4) mobile vaccine vans. We conducted a 6-month retrospective analysis of electronic health records (EHR) to describe the sociodemographic characteristics of individuals who scheduled appointments using the outreach strategies and characteristics associated with a greater likelihood of vaccine administration based on appointment completion. To help explain trends in the EHR data, we engaged 10 health system leaders and staff who spearheaded the outreach strategies in follow-up conversations to identify qualitative insights into what worked and why. Compared with traditional scheduling, all outreach strategies except vulnerable population clinics had higher vaccine appointment completion rates, including automated outreach (N = 3,734 [94.7%], p < 0.001), pop-up clinics (N = 4,391 [96.0%], p < 0.001), and mobile vans (N = 4,198 [99.1%], p < 0.001); and lower cancellation rates, including automated outreach (N = 166 [1.1%], p < 0.001), pop-up clinics (N = 155 [0.6%], p < 0.001), and mobile vans (N = 0 [0%], p < 0.001). Qualitative insights emphasized ongoing community partnerships and information resources in successful outreach. Vaccine equity outreach strategies improved the proportion of patients who scheduled and completed vaccination appointments among populations disproportionately impacted by COVID-19. Engaging community partners and equity-focused informatics tools can facilitate outreach. Lessons from these outreach strategies carry practical implications for health systems to amplify their health equity efforts.

How Do Professional Associations Influence Health System Transformation? Lessons from Ontario, Canada

Introduction: Internationally, there are increasing collaborative efforts to transform health care systems in ways that align with the principles of integrated care. Within the Canadian context, the current province-wide reorganization of health care into Ontario Health Teams (OHTs) is an example of a large-scale system transformation, requiring collaboration between system stakeholders at macro-, meso- and micro-levels. Literature on the topic inter-organizational collaboration does not fulsomely consider the role of local professional associations in health system transformations. There is value in examining the role of professional associations in influencing health system transformations, as they have significant expertise and influence, particularly in the domain of health policy. &#x0D; Methods: We used a qualitative descriptive approach to explore the research question: what strategies have local professional associations used to influence the development of Ontario Health Teams? We collected data from eight, 60-minute interviews with senior level leaders from eight professional associations. Interviews were transcribed and data were analyzed using content analysis to construct four descriptive themes. &#x0D; Results: During times of health system transformation, professional associations balance the functions of: (1) supporting members, (2) negotiating with government, (3) collaborating with stakeholders, and (4) reflecting on their role. In this presentation, we focus primarily on themes #2 and #3, given the specific relevance of governance, leadership, and collaboration. In both themes, participants emphasized the importance of findings areas of alignment with the government and other stakeholders; and using shared aims as way to amplify their influence. Characteristics of a “good” collaborator included consistent demonstration of mutual respect, clear communication, and interest in building trusting relationships. Participants also described barriers to collaboration, such as power imbalances and lack of role clarity. These challenges were heightened within the context of the “low rules” OHT rollout, in which OHTs had a high degree of control in adapting their team structures to ideally meet the needs of their local care partners and patient population(s),&#x0D; Conclusion and Implications: Professional associations are highly connected groups, deeply engaged with their members (often frontline clinicians) and regularly engaged with other key stakeholders and decision-makers (e.g., government). PAs play a critical role in influencing health system transformations, by bringing forward practical solutions to government that reflect the needs of their members, often frontline clinicians. Sharing insights from this work with an international audience could support global dialogues with health system leaders, policymakers, and researchers about leveraging the strengths of professional associations to enhance large-scale health system transformations via strategic collaboration.&#x0D; Next Steps: This research was conducted to fulfill the requirements of the Health System Impact Fellowship (doctoral level, funded by the Canadian Institutes of Health Research). We have continued to engage selected professional associations in building a collaborative framework, grounded in their experiences of participating the development of Ontario Health Teams.

Accelerating Health System Change and Transformation with the Health System Transformation Playbook: A Work Shop for Practitioners

Introduction: Health systems are complex adaptive systems (CAS) operating within larger socioeconomic contexts. Health system transformation (HST) is a complex endeavour that often results in unintended consequences. Existing methods to drive health system transformation is slow, have intrinsic limitations, and may impede successful implementation in local contexts.&#x0D; Yishun Health is a small regional population health system of 320,000 people. In our HST experience, services redesign and transformation projects were initiated continuously through time with transformation actions interacting across all health system sub-systems e.g. governance, manpower, financing, informatics systems, etc. Ensuring synergistic and coherent transformation into a more people-centred, integrated and value-driven health system at scale was extremely challenging.&#x0D; We designed a Health System Transformation Playbook (HSTP) as a design-, systems-, and complexity-thinking enabled methodology to systematically design, prioritize and test health system and services transformation actions, anchored on a three-step (1) iterative story-telling, (2) model building and (3) pathfinding process that tackles the scale of socially and technologically complex adaptive systems through time.&#x0D; It is hypothesized that the use of HSTP enables stewards of health systems to gain a more systematic and coherent understanding of health systems services planning and organization development, so as to accelerate transformation towards people-centred, integrated and value-driven health systems.&#x0D; Workshop: Our experience suggested that any HST method with the hope of accelerating whole system change must address the need to train and gather numerous stakeholders as co-designers, it must enable a continual series of innovations that remain synergistic despite their introduction at different time points and into different sub-systems of a CAS, and it must guard against incremental-only innovations, premature convergence and lock-in into HST paths that are less transformative or with potential negative effects.&#x0D; We hope to engage with health system leaders, designers, organization development and change management practitioners across the world through a facilitated workshop that encourages participant sharing and group discussion on how we lead and accelerate HST in our own organizational and cultural contexts. The session aims to co-create new knowledge on HST methodologies that can accelerate whole health systems change and transformation.&#x0D; &#x0D; Outline of Workshop (90 minutes) &#x0D; &#x0D; Introduction to Health System Transformation (5min)&#x0D; Presentation on Health System Transformation Playbook (15min)&#x0D; Table Discussions (25min):&#x0D; &#x0D; - Group Story Telling: Each participant to share own experiences in leading and facilitating large scale or whole health systems change and transformation. Highlight valuable lessons, especially what didn’t work, counter-intuitive results and reasons.&#x0D; - Pathfinding: Generate questions or recommendations for accelerating HST. &#x0D; &#x0D; Table Read Back &amp; Facilitated Q&amp;A (25min)&#x0D; Invitation to Share Personal Takeaways (15min)&#x0D; Closing (5min)&#x0D; &#x0D; Facilitators: A/Prof Ng Yeuk Fan &amp; Dr Teo Ken Wah

Creating a system wide third sector - health system partnership

Introduction: The volunteer (third) sector provides double the care in the community than does the healthcare system. However, within the geographic jurisdictions that a health system operates, there may be thousands of third sector organizations. In order to best meet individual and population medical and social needs, care provided by the third sector needs to be integrated with health system care. This can be challenging given the complexity of a health care system and the number of third sector organizations. The process by which the province of Alberta, Canada approached this integration challenge is described below.&#x0D; Target audience: This topic is pertinent to those working at a systems level in healthcare, government and the third sector.&#x0D; Who was engaged: In developing this approach government, health system planners, and a variety of third sector representatives, typically “umbrella” organizations representing a number of individual groups, were involved.&#x0D; What was done: With a single healthcare system divided into five administrative zones, we used the approach of doing centrally, zonally and locally that which made sense to do at those levels. Third sector actors functioning at those levels were engaged with their health system counterparts. Joint committees, accountable only to the members, were typically established to set a common vision and to coordinate activities in support of that joint vision. Wherever possible, an asset-based community development approach was used to identify what services existed at the various levels, service deficits, the wants and needs of individuals and communities, and the way in which the community could be supported to address those needs and wishes. From an infrastructure perspective, the health system, government and third sector leadership established mechanisms to facilitate cooperation.&#x0D; Results: Creating formal linkages between the health system and third sector, at all levels, was extremely helpful for the healthcare system to understand community needs and factors impacting health. The third sector found the relationship helpful to focus their efforts on programs or interventions which most effectively impacted health and wellness. Individuals and communities benefitted from an integrated approach to health and wellness.&#x0D; Learnings: Giving up control, on the part of the health system, was initially uncomfortable. However, the effectiveness of joint committees accountable to the members, rather than to a hierarchy, was found to be an extremely effective way of working together. At a more local level, allowing communities to determine priorities and approaches similarly resulted in much more effective and productive relationships in meeting the needs of the community, the healthcare system and its providers. Components of the quadruple/quintuple aim were much more effectively addressed than by using a medical model of community engagement.&#x0D; Next steps: From a health system perspective, we plan to use this approach at a community level. However, we find that our workforce will need to be adapted to include those who have skills in developing and maintaining relationships, are comfortable working in complex systems and with uncertainty, and an ability to adapt in keeping with a learning health system. &#x0D;

HEALTH SYSTEM LEADERSHIP PERSPECTIVES AND PRIORITIES ON CARE FOR OLDER ADULTS

Abstract Innovative care models for older adults such as non-institutional and home-based care have the potential to improve quality and efficiency of healthcare, but adoption of these models requires resources from health systems. Health systems leaders can influence the relative priority of geriatric care and associated resource allocation. This influence is especially important for areas with limited resources such as in rural areas. We interviewed recently retired health system leaders about their experience and how priorities in health systems can be aligned to improve the quality and reach of geriatric care. We conducted qualitative interviews with 10 participants (40% female) using a snowball sampling strategy of geographically diverse, retired hospital, regional, and national leaders in the Veteran Healthcare system, the largest single-payer system in the US. Participants described how they managed myriad competing health system priorities by weighing and devoting attention and time to tackle the crises of the day, the numerous national mandates and directives, and the goals for the local hospital or system, as seen from their own perspectives. Alignment with performance metrics provides strong impetus for some health system leaders to determine their priorities. Incentives to encourage health systems leaders to prioritize and allocate resources aimed at long-term improvements in care could be important. Additionally, building relationships and maintaining trust amongst partners across facilities and offices is critical to initiating and growing geriatrics programs. This work highlights that influence must work on multiple levels to effect change in prioritization of care for older adults.

EFFECTS OF IMPLEMENTING AGETECH TO SUPPORT DEMENTIA CARE IN A RURAL AND NORTHERN SETTING

Abstract Older adults wishing to age in northern and rural communities deserve equitable access to technologies that support optimal health, well-being, and quality of life. A new dementia care home opened in a rural and northern community in 2022 with consciously embedded multiple AgeTech solutions to enhance residents quality of life and care. The AgeTech solutions including hydroponic gardening, circadian lighting, and virtual exercise programming, were implementated into the 10-bed facility through a partnership between the Center for Technology Adoption for Aging in the North (CTAAN), health systems leaders, and community partners. The purposeful implementation of AgeTech within the facility through this partnership aimed to enhance the life-skills and living model of care to maximize independence, function, and resident well-being. We conducted a process evaluation assessing data from interviews with facility staff, health systems leaders, and secondary analysis of existing documentation to objectively measure the implementation process and inform a framework for ongoing assessment of AgeTech. Results highlight areas for ongoing technology innovation and inform policy decisions for future initiatives. Informants described the benefits in use of non-invasive circadian lighting technology to support resident well-being by enhancing sleep, rest/activity, reducing behaviours associated with dementia. Technology enhanced environmental well-being and expanded opportunities for residents to engage in meaningful activities. Participants also described the physical and social benefits for residents using individual and social multiplayer modes of exercise technologies. Providing equitable access to services across dispersed and sparse populations is challenging, yet with implementation of AgeTech quality of care can be enhanced.

ASHP and ASHP Foundation Pharmacy Forecast 2024: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems.

The 2024 ASHP Pharmacy Forecast identifies and contextualizes emerging issues and trends that will influence healthcare, health systems, and the pharmacy profession and provides recommendations to inform long-term strategic planning that should prompt action by pharmacists and health-system leaders. Drawing on the “wisdom of crowds” concept, a survey was constructed with 6 general themes, each with 6 to 9 focused statements and a seventh theme on preparedness (58 survey items in total). The size of and representation within the survey panel were intended to capture opinions from a wide range of pharmacy leaders. The survey instructed panelists to consider the likelihood of the events/scenarios described in the statements occurring in the next 5 years as being likely, somewhat likely, somewhat unlikely, or very unlikely. Then, survey panelists assessed the preparedness (from very unprepared to very prepared) for 12 of the statements. The 6 survey themes identified were Urgent Public Health Priorities, Responding to the Mental Health Crisis, Achieving Care Equity, New Disease Paradigms and Treatment Innovations, Workforce: Focus on Culture for the Future, and Artificial Intelligence: Can Ethics and Regulators Catch Up? The survey was completed by 250 respondents, yielding an 88% response rate. Analysis of survey results was provided by chapter authors along with strategic recommendations to guide actions for each theme. The focus of the Pharmacy Forecast is on large-scale, long-term trends that will influence healthcare and the pharmacy profession over months and years and not on day-to-day situational dynamics. The report provides insight to stimulate thinking and discussion and provides a starting point to proactively position leaders, their teams, and departments for potential future events and trends.

Crossing the Decarbonization Chasm: A Call to Action for Hospital and Health System Leaders to Reduce Their Greenhouse Gas Emissions.

Crossing the Decarbonization Chasm: A Call to Action for Hospital and Health System Leaders to Reduce Their Greenhouse Gas Emissions.

Personalized medicine in a community health system: the NorthShore experience.

Genomic and personalized medicine implementation efforts have largely centered on specialty care in tertiary health systems. There are few examples of fully integrated care systems that span the healthcare continuum. In 2014, NorthShore University HealthSystem launched the Center for Personalized Medicine to catalyze the delivery of personalized medicine. Successful implementation required the development of a scalable family history collection tool, the Genetic and Wellness Assessment (GWA) and Breast Health Assessment (BHA) tools; integrated pharmacogenomics programming; educational programming; electronic medical record integration; and robust clinical decision support tools. To date, more than 225,000 patients have been screened for increased hereditary conditions, such as cancer risk, through these tools in primary care. More than 35,000 patients completed clinical genetic testing following GWA or BHA completion. An innovative program trained more than 100 primary care providers in genomic medicine, activated with clinical decision support and access to patient genetic counseling services and digital healthcare tools. The development of a novel bioinformatics platform (FLYPE) enabled the incorporation of genomics data into electronic medical records. To date, over 4,000 patients have been identified to have a pathogenic or likely pathogenic variant in a gene with medical management implications. Over 33,000 patients have clinical pharmacogenomics data incorporated into the electronic health record supported by clinical decision support tools. This manuscript describes the evolution, strategy, and successful multispecialty partnerships aligned with health system leadership that enabled the implementation of a comprehensive personalized medicine program with measurable patient outcomes through a genomics-enabled learning health system model that utilizes implementation science frameworks.

The impact of cognitive biases, mental models, and mindsets on leadership and change in the health system.

Understanding how cognitive biases, mental models, and mindsets impact leadership in health systems is essential. This article supports the notion of cognitive biases as flawed thinking or cognitive traps which negatively influence leadership. Mental models that do not fit with current evidence limit our ability to comprehend and respond to system issues. Resulting mindsets affect cognition, behaviour, and decision-making. Metacognition is critical. The wicked problems in today's complex health system require leaders and everyone involved to elevate their personal, organizational, and disciplinary perspectives to a systems level. Three examples of mental models/mindsets are reviewed. They do not change simply because we wish or will them to. The first step is being aware of what they are and how they impact our thinking and decision-making. Some tips for managing these traps are offered as examples of how to challenge our leadership approach in the health system.

Strengthening health system leadership in practice.

The field of health leadership is shifting rapidly, and there is an opportunity to learn with health leaders about what is needed to support health leadership education, research, and practice. In 2022, to augment student feedback and faculty praxis, Royal Roads University conducted 12 virtual interviews with senior health system leaders across various settings to learn how health leaders can better respond to emerging and future leadership needs and priorities facing health systems. Findings from this study informed the development of a health-specific elective for the Master of Arts in Leadership, Health Specialization program entitled Considerations for Health Systems Renewal. This elective explores the following topics that emerged from this research study: (1) an orientation to possibility; (2) emerging strategic human resource concerns; (3) healthcare innovation; (4) relational and social systems leadership; (5) polarity thinking; (6) trauma-informed leadership; and (7) Canadian healthcare networks. In this article, we share our research process and findings to arrive at these recommendations.

Defining the Learning Health Care System: An International Health System Leadership Perspective.

Over the past 2 decades, many academic health centers (AHCs) have implemented learning health systems (LHSs). However, the LHS has been defined with limited input from AHC leaders. This has implications because these individuals play a critical role in LHS implementation and sustainability. This study aims to demonstrate how an international group of AHC leaders defines the LHS, and to identify key considerations they would pose to their leadership teams to implement and sustain the LHS. A semistructured survey was developed and administered in 2022 to members of the Association of Academic Health Centers President's Council on the Learning Health System to explore how AHC leaders define the LHS in relation to their leadership roles. The authors then conducted a focus group, informed by the survey, with these leaders. The focus group was structured using the nominal group technique to facilitate consensus on an LHS definition and key considerations. The authors mapped the findings to an existing LHS framework, which includes 7 components: organizational, performance, ethics and security, scientific, information technology, data, and patient outcomes. Thirteen AHC leaders (100%) completed the survey and 10 participated in the focus group. The AHC leaders developed the following LHS definition: "A learning health system is a health care system in which clinical and care-related data are systematically integrated to catalyze discovery and implementation of new knowledge that benefits patients, the community, and the organization through improved outcomes." The key considerations mapped to all LHS framework components, but participants also described as important the ability to communicate the LHS concept and be able to rapidly adjust to unforeseen circumstances. The LHS definition and considerations developed in this study provide a shared foundation and road map for future discussions among leaders of AHCs interested in implementing and sustaining an LHS.

Effects of COVID-19 pandemic on provision and use of maternal health services in Allada, southern Benin: a local health system perspective.

To assess the effects of the COVID-19 pandemic on the provision and use of maternal health services in southern Benin from a local health system perspective. We conducted a qualitative study from April to December 2021 in a health district in southern Benin. We interviewed health workers involved in antenatal, delivery, postnatal and family planning care provision, alternative and spiritual care providers, administrative staff of the district hospital, community health workers, adolescents and women who had given birth in the past six weeks in public health centers were interviewed. The World Health Organization health systems building blocks framework was used to guide the thematic analysis from a local health system perspective. The COVID-19 pandemic changed the lines of command and the institutional arrangements in the local health systems leadership; it put the interpersonal relationships in the health care provision team under stress and reduced the overall revenues of the district hospital. The motivation of allopathic health workers was undermined. Communities underutilized maternal health services in the COVID-19 period. Plausible causes included negative patient perceptions of COVID-19 measures taken at the public health facility level as well as well as fear of being forcibly vaccinated against COVID-19 in the health facilities. In times of health crises, appropriate local health system governance that integrates providers' concerns into effective guidelines is critical to reach and maintain a sufficient level of work motivation to ensure quality maternal health services.

Targeting systems not individuals: Institutional and structural drivers of absenteeism among primary healthcare workers in Nigeria.

Universal Health Coverage (UHC) can only be achieved if people receive good quality care from health workers, yet in Nigeria, as in many other low- and middle-income countries (LMICs), many health workers are absent from work. Absenteeism is a well-known phenomenon but is often considered as the self-serving behaviour of individuals, independent from the characteristics of health systems structures and processes and the broader contexts that enable it. We undertook a qualitative inquiry among 40 key informants, comprising health facility heads and workers, community leaders and state-level health policymakers in Nigeria. We employed a phenomenology approach to examine their lived experiences and grouped findings into thematic clusters. Absenteeism by health workers was found to be a response to structural problems at two levels -midstream (facility-level) and upstream (government level) - rather than being a result of moral failure of individuals. The problems at midstream level pointed to an inconsistent and unfair application of rules and regulations in facilities and ineffective management, while the upstream drivers relate mainly to political interference and suboptimal health system leadership. Reducing absenteeism requires two-pronged interventions that tackle defects in the upstream and midstream rather than just focusing on sanctioning deviant staff (downstream).

Launch of new resources from Frontline Connect announced

The American Psychiatric Association Foundation (APAF) last week announced the launch of new resources from Frontline Connect, an initiative designed to increase access to mental health services and supports for leaders of hospitals and health systems. According to APAF, 60% of health care workers said the COVID‐19 pandemic negatively impacted their mental health. In 2021, one in three health care workers either received mental health services or thought services were needed but did not seek out care. Frontline Connect is a resource from APAF's Center for Workplace Mental Health that provides hospital and health system leadership with high‐impact tools for overcoming barriers to mental health care. Each of the innovations and interventions highlighted in the new toolkit is operating at various pilot institutions, and many require little to no additional financial resources, the APAF news release stated. Made possible by the Brave of Heart Fund, Frontline Connect includes resources on peer support, employee assistance programs, reforming licensure and credentialing questions, manager training, and more. The new video toolkit includes conversations with several leaders in the field of health care workers' mental well‐being. For more information, visit https://frontlineconnect.org.

Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study

ObjectiveTo characterize racial differences in receipt of low value care (services that provide little to no benefit yet have potential for harm) among older Medicare beneficiaries overall and within health...

The value of BAME health professional networks in tackling vaccine hesitancy

Abstract This presentation discusses the findings from a Black, Asian and ethnic minority (BAME) Health Professional Leadership Engagement Session hosted by England's CMO between national health and care system leaders and the leadership of BAME health and care professional networks in England. The aim was to use an asset based approach, engage with the health professional networks both as citizens and as trusted sources of their communities, to acknowledge their contributions, to actively listen to concerns and issues, and develop sustainable solutions to address Covid vaccine hesitancy and improve uptake in the BAME communities in England. Three questions were posed to selected professional representatives of BAME networks: 1. What are the underlying factors/ key concerns responsible for reduced uptake of the COVID-19 vaccine within your communities? 2. What examples of good practice regarding increasing uptake of COVID-19 vaccine would you like to highlight? 3. What can we, as leaders, collectively do to help address underlying factors/ key concerns? Key insights included: a need to understand how the disproportionate impact of Covid on BAME communities is underpinned by different levels of acculturation and a variety of experiences; how conspiracy theories such as vaccine causing infertility can target important cultural expectations such as child bearing; the collective impact of years of historical injustices and health inequalities compounding what we see manifested as COVID-19 vaccine hesitancy.Some examples of good practice cited were around collective leadership, focusing on the younger BAME generations, role of social media, the role of the BAME health professional networks, leveraging the power of existing relationships and through representation in decision making and engagement. A set of recommendations were shared with health system leaders.

Implementation of US Post-Acute Care Payment Reform and COVID-19 Policies: Examining Experiences of Health System Leaders, Staff, Patients, and Family Caregivers-A Protocol.

In fiscal year 2020, new national Medicare payment models were implemented in the two most common post-acute care settings (i.e., skilled nursing facilities (SNFs) and home health agencies (HHAs)), which were followed by the emergence of COVID-19. Given concerns about the unintended consequence of these events, this study protocol will examine how organizations responded to these policies and whether there were changes in SNF and HHA access, care delivery, and outcomes from the perspectives of leadership, staff, patients, and families. We will conduct a two-phase multiple case study guided by the Institute of Medicine's Model of Healthcare Systems. Phase I will include three cases for each setting and a maximum of fifty administrators per case. Phase II will include a subset of Phase I organizations, which are grouped into three setting-specific cases. Each Phase II case will include a maximum of four organizations. Semi-structured interviews will explore the perspectives of frontline staff, patients, and family caregivers (Phase II). Thematic analysis will be used to examine the impact of payment policy and COVID-19 on organizational operations, care delivery, and patient outcomes. The results of this study intend to develop evidence addressing concerns about the unintended consequences of the PAC payment policy during the COVID-19 pandemic.

Coaching as a Tool to Create Transformational Health System Leaders.

Coaching as a Tool to Create Transformational Health System Leaders.

The Chief Wellness Officer: A long overdue catalyst for systemic change in Emergency Medicine.

The American healthcare system is amid a burnout epidemic, worsened by COVID, that must be addressed expeditiously and with high priority. The burden Emergency Physicians encountered before and during the pandemic is well known, with countless healthcare workers exiting the work force. A Chief Wellness Officer (CWO) is a senior leader who works primarily to cultivate organisational wellness and to foster and promote a culture of well-being throughout an institution. Specifically, the CWO assists the health system leadership promote clinician engagement and address clinician burnout. This paper explores the status of existing CWOs, and cites the benefits, impacts, and barriers to implementation of a CWO, with focus on the field of Emergency Medicine (EM). A steering committee of wellness experts was formed from a national EM organisation. A purposive search and literature review using search terms relating to CWOs was completed. Publications were examined for relevance and recency. The committee created an online questionnaire surveying current US CWOs, conducted personal interviews, and met through regular focused meetings. A framework delineating the role of a CWO as an organisation evolves from instituting novice wellness interventions to expert organisational innovations was created. Despite their title, CWOs are not regularly included in c-suite decisions. Barriers to instituting a CWO include perceived financial cost, the medical system itself, and physician resistance. Defining and measuring objective return on investment may be a solution to overcoming barriers. CWOs who create comprehensive institutional wellness innovations bring organisations to the highest proficient and expert levels of wellness practices, positively affecting physician engagement and deflecting burnout. CWOs instituting novice and beginner levels of wellness interventions, especially in EM, only modestly impact individual wellness practices. A CWO and team with an organisational voice and a C-suite stakeholder's seat are essential to centralising and leading effective wellness efforts and innovations in EM and other specialities. This team will improve the work environment and culture and begin to fix our broken healthcare system and providers.