Physicians often know where the work can be better. They see the awkward handoffs, the confusing onboarding materials, the small workflow problems and the everyday friction points that may not show up clearly from a distance. But knowing what needs to change is not the same as having the time, structure and support to fix it.
That is the idea behind Colorado Permanente Medical Group’s Pebble Grant Program. The program gives physicians small amounts of compensated administrative time to work on short-term projects that aim to improve engagement and advance organizational strategy. It is not designed to replace clinical time. Rather, it gives physicians paid time above and beyond clinical work to solve problems that affect the day-to-day experience of practicing medicine.
“We had some capacity to fund administrative time for our physicians in short-term grants,” said Lise Barbour, MD, vice president of people and culture at Colorado Permanente Medical Group. “So, we created a program called the Pebble Grant Program.”
For Colorado Permanente Medical Group, the grants are one way to move physician well-being from broad commitment to practical action. They also reflect a larger lesson in well-being work: Organizations can listen to doctors, but they also need to create pathways for physicians to help lead change.
Colorado Permanente Medical Group is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Give physicians time
The Pebble Grant Program was opened to the entire medical group of 1,100 physicians and podiatric surgeons, inviting anyone to propose short-term projects that would improve engagement and further Colorado Permanente’s strategy. Each grant provides administrative time for project work.
That distinction matters, Dr. Barbour said, because the goal is not simply to add one more responsibility to already full schedules. Instead, the program recognizes that improvement work requires time. It also recognizes that physicians should be compensated for that time.
Additionally, the application was intentionally thorough. Applicants were asked to identify goals, lead and lag metrics, needed support, expected outcomes and how their project tied to strategy.
In one month, Colorado Permanente received 31 applications. Leaders selected 20 for the Pebble Grant Program.
“Many of the others were just out of scope for the project,” Dr. Barbour said. “But we did select 20, and so we’ll be learning over the next six months.”
The selected physicians are receiving project management support and analytic support to help move ideas from proposal to execution. The program sponsors have regular check-ins with the grant recipients to ensure they have the support they need to complete their project by the end of 2026.
Make ideas measurable
One reason the Pebble Grant Program stands out is that it does not frame physician ideas as informal suggestions. It asks physicians to define the problem, describe what success would look like and connect the project to broader goals.
That structure can help keep improvement work focused. It also gives leaders a clearer way to understand which projects may be ready to scale.
Colorado Permanente’s board and executive team have been enthusiastic about the program, Dr. Barbour said.
“They were blown away by the thoughtfulness and quality of the applications that we got,” she said.
That response matters because leadership support is a recurring theme in Colorado Permanente’s physician well-being work. The organization has spent years building a stronger infrastructure for well-being, including a wellness committee, annual measurement through the Mini Z survey and engagement action planning tied to leadership accountability at all levels of the organization.
This led to designation from the AMA Joy in Medicine® Health System Recognition Program, which recognizes organizations for documented work to support physician well-being and cut burnout. It includes six domains: assessment, commitment, efficiency of practice environment, teamwork, leadership and support.
The Pebble Grant program fits into that larger effort by giving physicians a concrete way to improve the systems they work in.
As the leader in physician well-being, the AMA provides organizational solutions that help physicians and health systems optimize practice efficiency, reduce burnout, and rediscover the Joy in Medicine.
Start with onboarding
One selected project came from a newer primary care physician who noticed a problem with onboarding materials. The physician had started building a SharePoint site for colleagues in her own clinic because the existing materials were not as user-friendly as they needed to be. But Colorado Permanente leaders saw that the issue was broader than one clinic.
“You’ve done such good work for your clinic,” Dr. Barbour recalled leaders commenting. “And the rest of primary care could really use this information as well.”
The physician received a grant of 60 hours over six months to expand the work. She will partner with IT and website designers to improve onboarding materials across primary care. This example showed leaders that even when an organization believes its materials are strong, frontline experience can reveal where they fall short.
“We thought our materials were pretty good, and they really weren’t as helpful to our new physicians as we thought,” Dr. Barbour said. “Now it’s going to be way better because we have frontline involvement, and she has a little time to do that.”
That is a core lesson of the program. Physicians do not just identify problems. With the right support, they can design better solutions.
Connect well-being to work
The Pebble Grant Program did not emerge only from the well-being strategy, Dr. Barbour said. But it is closely connected to engagement and well-being.
That connection is important. Physician well-being is often affected by the design of work itself—onboarding, EHR workflows, team communication, leadership support, administrative burden and other system-level factors.
By giving physicians time to improve those systems, Colorado Permanente is treating well-being as an operational issue, not just a personal one.
That approach aligns with broader physician well-being efforts across the organization. Colorado Permanente uses the Mini Z as part of its annual physician engagement survey and embeds well-being initiatives into engagement action planning. Leaders at every level have goals and metrics related to engagement.
Colorado Permanente has also strengthened collaboration between the well-being team and the Department of Medical Informatics. That partnership includes work on ambient listening technology and other tools that may improve physicians’ daily practice experience.
“We’ve realized we both have the same goal of improving the lives of our physicians,” said Heidi Clune, MD, wellness director at Colorado Permanente Medical Group.
Learn before scaling
The Pebble Grant Program is still in its early stages, but Colorado Permanente plans to study what happens over the first six months and learn from the projects before reopening applications.
Dr. Barbour said the board has already expressed interest in making the program annual. Another application window may open in February after the first-round closes and leaders review the findings.
That learning period will be important. Some projects may work well in one department but need adaptation before spreading more broadly. Others may reveal a systemwide need that leaders had not fully seen.
Already, the need for broader governance of the program has been identified. New applications in the future will be reviewed not just by quality, wellness and operational leaders, but also by IT and medical informatics who will bring additional insights into the feasibility of proposed projects and how they might be supported.
The structure of the program gives Colorado Permanente a way to test ideas, support physicians and decide what should come next. It also sends a message: physician input is not just welcomed. It is resourced.
What to do next
For health systems and medical groups interested in a similar approach, the first step is to identify a focused funding source for compensated project time. The next step is to build an application that asks physicians to define the problem, name the expected outcome and explain how the work connects to strategy.
Project management and analytics support can help keep the work practical. So can a clear review process that separates true improvement projects from routine IT fixes or requests that belong in another workflow.
The larger goal is simple: Give physicians time to improve the work they know best. For Colorado Permanente, that is where small grants can lead to meaningful change.
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