Innovation
Reflective Practice with Pediatricians
Pierce County
Description
This innovation integrates reflective practice into pediatric primary care through the evidence-based Promoting First Relationships (PFR) curriculum.
Pediatrics Northwest trains all clinical staff, including pediatricians, Advanced Registered Nurse Practitioners, nurses, integrated therapists, psychiatric providers, and Community Health Workers in reflective, relationship-based approaches. Reflective practice cultivates curiosity, self-awareness, and thoughtful engagement with families, strengthening clinician empathy and connection. By leading with curiosity and pre-admiration rather than judgment, the practice supports clinician fulfillment while improving families’ experience of care.
Need / Problem Statement
Pediatric clinicians face intense pressure from productivity demands, documentation burdens, and expanding patient panels, which contribute to moral injury and burnout.
Historically, there was little protected space for clinicians to process the emotional and relational complexity of their work. Signs of increased clinician dysregulation and elevated Mayo Wellness Index scores indicated the need for a new approach. This innovation addressed the gap by creating a shared understanding of reflective practice and embedding it as a core element of both practice wellness and family engagement.
Process
The approach began with curiosity and the recognition that family partnership and reflective practice are deeply intertwined.
Pediatrics Northwest engaged consultants, held practice-wide town halls, and hosted clinician retreats focused on well-being and equity. All clinical staff enrolled in the University of Washington’s Promoting First Relationships coursework through the Barnard Center (School of Nursing), supported by an experienced pediatrician who helped design the curriculum and now facilitates reflective practice groups. Reflection was introduced gradually, respecting differing readiness levels and normalizing resistance as self-protection rather than disengagement.
Partnership
Families influenced this work directly through their advocacy for clinician well-being.
Family leader Shayla Collins reinforced the shared goal that everyone wants what is best for children, and that rested, supported clinicians are essential to that goal. Parents participate in lunch-and-learn sessions, governance, and care-transformation spaces, where reflective practices and mindfulness are modeled. Family input helps frame reflection not as a luxury, but as foundational to respectful, effective care.
Implementation
Reflective practice was implemented within six months and embedded across the organization.
Participation was voluntary and invitational, fostering psychological safety and co-ownership rather than compliance. Key stages included:
- Practice-wide town halls and clinician retreats, to address practice wellness
- Enrollment of all clinical staff in PFR training
- Monthly reflective practice cohorts for pediatricians, ongoing for more than two years
- Routine lunch-and-learns across all clinic sites
- Integration of mindfulness, narrative medicine, and reflective pauses into committee meetings, parallel process modeled ongoing
Changes & Outcomes
Clinicians report feeling more supported, regulated, and present with families.
Reflective practice has changed how clinicians enter exam rooms, shifting toward observation, affirmation of strengths, and co-constructing care with families. Families experience more positive feedback and feel seen for their strengths. Workforce stability has improved, with zero turnover among integrated therapists and psychiatric providers over six years, and anticipated improvements in pediatric clinician wellness metrics. Team-based care and family partnership are now viewed as normal and necessary.
“It has changed my way of being. Slowing down has shifted families’ experience. There is joy and discovery of strengths.” – Pediatrician
Measurement for Success
- Mayo Wellness Index for pediatric clinicians
- Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSS MPI) or the ‘Mini Z Burnout Survey’
- Participation in reflective practice groups
- Increased clinician engagement in committees co-created with family leaders
- Practice-level focus on comfort at pediatric visits and caregiver mental health screening
- Qualitative feedback from clinicians and families
Payment & Funding
Funding type: Philanthropic Support
Anticipated gains: Improvements in clinician retention, workforce stability, patient access, and trust, as well as support for sustainable team-based care through buffering burnout and strengthening relational health across families and providers
Resources
To learn more about this innovation please email Rachel Lettieri, Director of Care Transformation at Pediatrics Northwest: [email protected].
