#ACGME2026 Session Summary: Developing a Sustainable Approach to Well-Being – Lessons from an Award-Winning Program

At the 2026 ACGME Annual Educational Conference, leaders from HCA Healthcare shared a data-driven, systems-focused approach to physician and resident/fellow well-being, one that moves beyond individual resilience to fundamentally improving the work and learning environment. Drawing on nearly a decade of experience, this Featured Plenary outlined how organizational design, leadership behavior, and psychological theory can be translated into measurable improvements in engagement, retention, and well-being.

ACGME Vice President, Well-Being Stuart Slavin, MD, MEd introduced panelists Gregory Guldner, MD, MS and Jason An, MD, who shared wisdom, insights, and lessons learned from their experience building HCA Healthcare’s graduate medical education (GME) program with the goal of creating an environment where high-quality care and physicians can thrive. Dr. Guldner is the Chief Wellness and Retention Officer at HCA Healthcare, and Dr. An serves as the designated institutional official at HCA Healthcare Riverside. They discussed how they built a GME enterprise from the ground up, and how, by prioritizing well-being from the beginning, they grew it from one emergency medicine residency to a multi-hospital, multi-program, multi-state system where residents reflect on their learning environment with comments like, “I would choose this residency over and over and over again if given the chance.”

Dr. Guldner shared that seeing colleagues a few years out of residency that wanted to leave medicine struck a profound chord within him, and that he knew he wanted to change that.

Dr. An framed their intention to create something different by referencing his undergraduate alma mater, Indiana University, whose football team recently won the national championship after being one of the losing-est teams in college football history. In 2023, Coach Curt Cignetti was hired, and in 2025 they won it all.

“I tell you that to make one point,” said Dr. An. “It really only takes one great leader to create a culture of change, and it can take just one great leader to create a culture of well-being.”

From “Wellness” to Workplace Well-Being
The presenters then explained how they built what they built, beginning by reframing how well-being is defined. Traditional “wellness” initiatives focus on individual behaviors – sleep, exercise, mindfulness, stress management – placing responsibility primarily on the individual. In contrast, workplace well-being is a systems- and environment-level construct, rooted in organizational psychology and shaped by leadership, policies, and culture.

This distinction matters because evidence consistently shows that job demands, not personal deficits, are the strongest drivers of clinician burnout. Clinicians report that improving staffing, workflows, and work environments has a greater impact on mental health than adding wellness or resilience programs alone.

Evidence-Based Foundations
The presenters’ program is grounded in two complementary, well-established frameworks:

• Job Demands-Resources (JD‑R) Theory, which explains burnout and engagement as the balance between workplace demands (e.g., workload, administrative burden, cognitive load) and available resources (e.g., support, autonomy, meaning); and,
• Self Determination Theory (SDT), which identifies three universal psychological needs essential for flourishing at work: Autonomy; Belonging; and Competence. Dr. Guldner suggested there is a fourth universal need, adding a D to the ABCs of SDT: Deep meaning. When these needs are supported, motivation and engagement increase; when they are thwarted, well-being suffers.

Together, these frameworks provide both a diagnostic lens and a roadmap for intervention.

Designing Optimal Work and Learning Environments
In an optimal work and learning environment, as the presenters defined it, job demands are balanced by job resources and the system actively supports autonomy, belonging, competence, and meaning. The presentation highlighted three interrelated domains shaping daily experience:

• Built environment (space, temperature, food access, sleep rooms, equipment, noise, parking)
• Interpersonal environment (leadership behaviors, civility, inclusion, freedom from mistreatment or harassment)
• Policies, procedures, and operations (workload design, complexity, clarity of purpose, conflicting demands, the hidden curriculum)

When small, practical changes across these domains are consistently addressed, they can have an outsized impact on how clinicians experience their work.

Turning Theory into Action
Rather than relying on one-time interventions, the program emphasizes continuous, structured listening and response. One key strategy was the systematic identification and tracking of “hindrance job demands,” or work elements that unnecessarily drain energy or impede performance. These demands are logged, prioritized using impact-feasibility frameworks, and addressed with visible feedback loops so learners and staff members can see that concerns lead to action.

Engagement rounds, wellness committees, and transparent “you said/we did” reporting were highlighted as mechanisms that reinforce trust and signal institutional commitment to improvement. Importantly, the presenters cautioned against failing to follow through or dismissing concerns as trivial, both of which undermine credibility and belonging.

Supporting the ABCDs
The presenters offered concrete examples of how leaders can support each core psychological need:

• Autonomy: using perspective taking, offering choices when possible, providing rationale for decisions, and minimizing controlling language in policies and communication
• Belonging: fostering inclusive team structures, addressing mistreatment, examining who may feel excluded by rotations or social activities, and ensuring psychological safety
• Competence: designing work so mastery is the dominant experience, providing meaningful feedback, and creating clear paths for growth rather than repeated experiences of failure
• Deep meaning: carving out time to assess impact in meaningful interactions – holding “meaning interventions” to provide space for faculty members and learners to digest a difficult or otherwise important experience, such as the death of a patient

Across each psychological need, leadership behavior (how people are spoken to, listened to, and supported) was emphasized as a critical determinant of culture.

A Sustainable Model for Well-Being
Importantly, Drs. Guldner and An stressed that it’s possible to provide high support and high standards simultaneously.

“You create this environment and everyone does better; patients do better, too.”

The central message was clear: well‑being is created or undermined by systems. Sustainable improvement requires shifting attention from fixing individuals to designing environments where people can thrive. By aligning evidence, measurement, and daily operational practices, organizations can create work and learning environments that support flourishing, improve retention, and ultimately enhance patient care.