Assessment of a Recognition Program in an Academic Family Medicine Department

Increased recognition and feeling valued are associated with engagement, job satisfaction, and reduced turnover among clinicians and faculty (ie, advanced practice providers [APPs] who are faculty, APPs who are clinicians, faculty who are clinicians, and faculty who are not clinicians) in medicine. ^1-5 Insufficient recognition increases risk of burnout and is associated with faculty leaving academic medicine. ^{6, 7}

In seeking to address local levels of burnout that are consistent with national averages, ⁸ and based on internal data suggesting a need for fairness in a recognition system, ⁹ we created a recognition program with particular care regarding fairness and inclusion to build group cohesion and a sense of shared values. ³ We implemented the program on the two campuses of our large academic family medicine (FM) department.

We explored clinician, faculty, and staff experiences of the program.

Starting in October 2019, from a department of 145 clinicians and faculty, three individuals were selected monthly to be recognized using a random number generator in Excel and were then removed from future eligibility (Table 1). Awardees were selected randomly to mitigate concerns regarding favoritism and fairness ¹⁰ and to promote the concept that all are doing valuable work and are worthy of recognition. Clinicians and faculty were asked to name someone who had helped them with their accomplishments, who would be recognized with them as their hidden hero (HH). All clinicians and faculty were expected to be present at department meetings, where each awardee received a $100 Amazon gift card and was recognized by having positive comments from peers read aloud. The awardees then shared why they selected their HHs. In April 2020, department meetings and awardee recognition changed to a virtual format due to COVID-19. The program is still ongoing.

This study was approved by the institution’s IRB (STUDY#11378).

Clinicians and faculty receiving recognition were labeled as awardees (n=20), individuals who were selected by awardees as HHs (n=36), and clinicians and faculty who were not awardees or HHs as bystanders (n=89). Awardees were able to opt out of receiving recognition. All awardees, HHs, and bystanders were eligible to be interviewed.

All individuals who were recognized, their selected HH, and randomly selected bystanders were invited via email 1-2 weeks following recognition to participate in an interview (Figure 1) during which they were asked about the program. Interviews took an estimated 10 minutes and were analyzed on a rolling basis, facilitating continuous program adjustments in response to feedback. Adaptations are footnoted in Table 1. Interviews were conducted from November 2019 through April 2020.

We used deductive content analysis for the program evaluation. Authors J.P. and J.A.R. developed a categorization matrix to identify main, generic, and sub categories based on a previous study ⁹ and interview questions. ¹⁰ We reviewed the interviews for content and then grouped the coded content based on the conceptual categories. Using a consensus approach, we reached 100% agreement for each category.

Twelve awardees, 12 bystanders, and 12 HHs were interviewed to ensure saturation of qualitative data (Table 2). ¹¹ Interviews lasted 8.09 minutes on average. Table 3 contains the main, generic, and sub categories along with representative quotes.

Questions and subsequent interviewee responses related to the processes and evaluation of the “We Are” Recognition Program were the focus of our categorization matrix. We reviewed the data for content and coded for correspondence with the categories impact and HHs. The content of each of these categories is described through subcategories as follows.

Three subcategories were identified related to impact of the program on the department: process positives, process negatives, and fairness of program.

Process Positives. Participants found the program to be positive, as it led to wider awareness of the work of clinicians and faculty. Many expressed appreciation of the program initiative to promote well-being.

Process Negatives. Awardees appreciated being recognized but felt that the random selection process diminished the overall impact of the recognition. Some expressed a lack of enthusiasm for public recognition and having to speak at the faculty meeting.

Fairness of Program. Many interviewees found the program and selection process to be fair and considerate of all clinicians and faculty.

Two subcategories related to selecting an HH were identified: teamwork and awareness of the program.

Teamwork. Awardees appreciated the opportunity to recognize HHs and expressed gratitude for their recognition.

Awareness of Program. Participants reported being aware of the program if they attended department meetings. Those who did not attend department meetings (often HHs) were not aware unless someone told them about it. Bystanders agreed with the need for better recognition for HHs.

The majority of interviewees perceived the program as fair and as effective in facilitating comradery and positive messaging regarding intradepartmental work. Clinicians and faculty derived positive meaning from feeling empowered to recognize their coworkers. All groups noted appreciation for the accolades, highlighting the benefits of the manner in which the award was delivered. Most participants did not identify the gift card as essential. The results reinforce the role of acknowledgment (eg, positive comments from colleagues) in feeling valued. ⁷ Other health systems could implement a similar program that does not use financial rewards.

Our single department and small, relatively homogeneous study population limits generalizability and our ability to identify themes related to differences in recognition preferences based on diversity factors. Since a majority of awardees and bystanders were faculty and a majority of HHs were clinicians, we were not able to draw inferences regarding group differences.

This recognition program, developed through an iterative process, represents a model that could be easily replicated, requires no special training or significant financial investment, and can be implemented virtually. Deeper exploration of the elements of the program that contribute to clinicians and faculty feeling valued by the organization may help optimize effectiveness. Its impact can be further assessed through broader implementation and study.

This research was supported by the Penn State College of Medicine Office of Faculty and Professional Development Wellness Mini-Grant Program and the Thomas L. and Jean L. Leaman Research Endowment, Department of Family & Community Medicine.

This research was presented as a poster presentation for the 2019 NAPCRG Annual Meeting and the 2019 FMEC Annual Meeting.