Resource Library

[This is an excerpt.] Prior authorization (PA) is a cost-control process that requires health care professionals to obtain advance approval from health plans before a prescription medication or medical service qualifies for payment and can be delivered to the patient. While health plans and benefit managers contend PA programs are necessary to control costs, physicians and other providers find these programs to be time-consuming barriers to the delivery of necessary treatment. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Other Private Organizations: Private Payers

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BACKGROUND AND OBJECTIVES: Medical students face difficult transitions throughout their training that increase their risk of burnout. Resiliency training may prepare students to better face the demands of their medical careers. This project is an initial investigation into medical students' long-term utilization of learned resiliency skills. METHODS: Medical students completed a survey 1-18 months following Active Resilience Training (ART). The computerized survey assessed the program's success in meeting its stated objectives and how often students used the skills they had learned during the training. RESULTS: ART is highly effective in increasing awareness of the benefits of resiliency training. The majority of participants would recommend the course to their peers. Students continued to utilize the skills learned for more than 18 months after completing the training. These skills include planned breaks, prioritizing sleep, building support systems, and mindfulness techniques. CONCLUSIONS: This work adds to the existing literature regarding participants' valuation of novel resilience curricula. Students utilized the skills learned in ART as long as 18 months after completing the program. More study evaluating the specific effects of ART on traditional measures of resilience such as the Brief Resilience Scale (BRS) is needed.

INTRODUCTION: Orthopaedic surgeons face decreased reimbursement, lower income, and increased rates of burnout. As subspecializing through fellowship training in orthopaedics becomes more and more prevalent, the value of membership to a general orthopaedic society (American Academy of Orthopaedic Surgeons [AAOS]) warrants investigation. METHODS: One hundred thirty orthopaedic surgeons were surveyed by e-mail through a 14-item anonymous survey administered through SurveyMonkey. The survey inquired about surgeon experience, practice type, fellowship training, and details regarding AAOS and subspecialty society membership. RESULTS: The response rate was 67%, with 94% of respondents indicating that they were members of AAOS and a subspecialty society. The most common reasons for AAOS membership were tradition (65, 74.7%), continuing medical education (46, 52.9%), maintenance of board certification (44, 50.6%), and political advocacy (40, 46.0%). The most common reasons for subspecialty society membership were continuing medical education (73, 83.9%), tradition (49, 59.8%), and political advocacy (33, 40.2%). DISCUSSION: Most surgeons in our study cohort were members of both AAOS and a subspecialty society, but the reasons for membership in each differed. Almost 80% of respondents think their subspecialty society provides all their professional needs. The orthopaedic societies need to continue to evolve to provide value to their members to succeed in the future.

[This is an excerpt.] UK dentists experience high levels of stress, anxiety and burnout. Poor mental health can lead practitioners to exit the profession, contributing to workforce and service loss. Therefore, there is a need to focus on interventions to protect the mental health and wellbeing of dental teams. Three levels of intervention can be deployed in the workplace to support mental health and wellbeing: primary prevention, secondary prevention, and tertiary prevention. [To read more, click View Resource.]

[This is an excerpt.] As a follow-up to the American Nurses Foundation's first two Mental Health and Wellness surveys completed in summer 2020 and December 2020, and the COVID-19 Impact Assessment Survey - The First Year, completed in January-February 2021, the Foundation conducted this survey to determine the changes and further impact of the pandemic on the mental health and wellness of nurses, with additional enquiries concerning emotional health, post-traumatic stress, resiliency, and stigma around seeking professional mental health support. Between August 20 - September 2, 2021, there were 9,572 nurses who completed the survey. When using this data in media, communications or presentations please reference as follows: American Nurses Foundation, Pulse on the Nation's Nurses COVID-19 Survey Series: Mental Health and Wellness Survey 3, September 2021. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Measuring Well-Being & Accountability).

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Working in correctional facilities is inherently stressful, and correctional workers have a high rate of anxiety, depression, PTSD, and professional burnout. Correctional workers faced an unprecedented set of challenges during the COVID-19 pandemic, exacerbating an already dire situation. There has been a relative shortage of studies evaluating effective interventions for the psychological consequences of working in correctional facilities. Well-being and mental health Interventions for correctional workers should be embedded in a general framework of support, reducing occupational risk factors, improving mental well-being by developing a positive work environment, improving mental health literacy, and identifying and treating mental health issues. The backbone of the correctional system is its workforce and the mental health and well-being of correctional workers are of paramount importance in an effective correctional system.

Mental distress is a widespread phenomenon that has existed across human lifespans. Most people experience stress or have experienced it throughout the history of humankind. Given the lack of studies identifying the stressors for law enforcement officers, their mental health considerations have so far been left unaddressed. For officers to remain true to their purpose of serving and protecting, it is important to holistically consider the adverse impact of their mental distress. This study examined the incidence of psychological distress among law enforcement officers and the organizational and operational factors contributing to mental distress. A quantitative probabilistic sampling strategy was used in the study. The Police Stressors Questionnaire (PS), a 40-item testing instrument adopted to evaluate various law enforcement stress elements, was used to evaluate 66 sworn law enforcement officers' stress as it gave the chance to evaluate the life of law enforcement officers and what makes them susceptible to mental distress. The research determined the direct impacts of organizational and operational stress factors on law enforcement officers. There were no significant relationship between mental distress and organizational and operational stress. Although, some factors reflected a correlation to cause mental distress. However, the participating law enforcement agency implemented several programs to intervene when an officer is experiencing distress. A positive, strong, and significant relationship exists between organizational and operational stress (R = 0.624, P<0.01).

Medical trainees and physicians experience high rates of depression, anxiety, suicidal ideation, and burnout. The stigma surrounding mental health may deter help-seeking behaviors and increase informal treatment to maintain anonymity. Invasive health history questions on state medical licensure applications regarding mental health diagnoses and treatment likely increase stigma, reduce help-seeking, and consequently may motivate some applicants to report an inaccurate history to the state medical board. Research on physician mental health, suicide rates, and lack of help-seeking have led to recommendations for changes to licensure questions. In this article, the authors review the language of health history questions, disclosure requirements for applicants, and the potential consequences of disclosing mental health or substance abuse history on state medical licensure applications. They review recent changes to some states’ health history questions, using the changes to Florida’s licensure application in 2021 as an example, and explore the implications of these changes for reducing stigma and encouraging help-seeking. The authors recommend that state medical boards review and refine licensure applications’ health history questions regarding mental health disclosure in ways that strategically address concerns related to stigma, bias, and unwarranted scrutiny. They call for research to examine the impact of such question changes on applicant response accuracy, help-seeking behaviors, and mental health outcomes and stigma. They also recommend that medical schools offer and promote access to mental health services, encourage faculty to normalize help-seeking behaviors, and provide students with information about state licensure processes. Reducing stigma, normalizing trainee and physician experiences, and promoting help-seeking are preliminary steps to promote a culture in academic medicine that prioritizes mental health. In turn, this will encourage trainees and physicians to care for themselves and cultivate physicians who are better equipped to heal and support their patients.

[This is an excerpt.] The Department of Labor’s Employee Benefits Security Administration is dedicated to ensuring all Americans have access to mental health and substance use disorder benefits, but this past year we’ve been particularly busy. In fact, we’ve undertaken more mental health parity investigations than we have in previous fiscal years on the parity requirements. This increase is no accident: We’re purposefully ramping up our efforts to ensure everyone gets the mental health and substance use disorder care they are entitled to under the law. As a federal agency tasked with enforcing the mental health parity law, we’re uniquely positioned to help millions of Americans who depend on their health plans for access to these benefits—and we take the responsibility seriously. In short, this means more proactive enforcement than what plans and issuers may have become accustomed to. The recently passed Consolidated Appropriations Act provided a new, important enforcement tool and additional resources which helps EBSA in our mission to facilitate greater parity in mental health and substance use disorder benefits. All of these efforts are highlighted in a new report to Congress released today. The report summarizes the actions we’ve taken to implement and enforce these new mental health parity requirements and sets the stage for what’s to come in our enforcement program. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Ensuring Workers' Physical and Mental Health (Support Workers' and Learners' Mental Health & Well-Being).

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BACKGROUND: Adverse Childhood Experiences (ACEs) increase risk for negative mental health outcomes in adulthood; however, the mechanisms through which ACEs exert their influence on adult mental health are poorly understood. This is particularly true for Public Safety Personnel (PSP; e.g., police, firefighters, paramedics, etc.), a group with unique vulnerability to negative psychiatric sequalae given their chronic exposure to potentially traumatic, work-related events. OBJECTIVES: To examine the role of moral injury (MI) and emotion regulation in the relation between ACEs and adult mental health symptoms in adulthood. Participants and setting Participants (N = 294) included a community sample of Canadian and American PSP members aged 22 to 65. METHODS: The current study uses cross-sectional data collection via retrospective self-report questionnaires administered between November, 2018 and November, 2019 to assess level of ACEs (ACE-Q), emotion regulation difficulties (DERS) and symptoms of post-traumatic stress (PCL-5), dissociation (MDI), depression, stress, and anxiety (DASS-21). Additionally, participants completed the Moral Injury Assessment for Public Safety Personnel, the first measure of MI developed specifically for PSP. RESULTS: Path analysis revealed that ACEs significantly predicted adverse mental health symptoms in adulthood; this effect was mediated by symptoms of MI and moderated by difficulties with emotion regulation. CONCLUSIONS: This study is the first to identify MI as a mechanism involved in the relation between ACEs and adult psychopathology and highlights the protective role of emotion regulation skills. These findings can inform the development of future research and clinical interventions in PSP populations.

BACKGROUND: While understaffing and work-related stress are not unusual within first responder professions, the past few years have added additional strain. COVID-19, political and civil unrest, and economic downturn have stretched the first responder workforce thinner than ever, contributing to a reduction in the workforce through death, early retirement, attrition, or decreased vocational effectiveness. Unfortunately, public stereotypes coupled with the tenets of first responder culture have done little to support those who serve. Public perception often involves polarized stereotypes about first responders (e.g., good guys or bad guys, heroes or villains), and first responder culture encourages a machine-like demeanor. The imagery of heroes, villains, and machines is indicative of dehumanization, or denial of some aspect(s) of humanity. The purpose of this study was to examine how first responders’ perceptions of dehumanization (meta-dehumanization) relate to workforce threats including suicidality, burnout, and decreased self-efficacy. METHODOLOGY: A total of 211 first responders from the US and Canada participated in this study by completing two measures of meta-dehumanization, the Suicide Behaviors Questionnaire- Revised, the Burnout subscale of the Professional Quality of Life Scale, and the General Self- Efficacy Scale. Analyses included Pearson product-moment correlation, ANOVAs, and hierarchical regression analyses. RESULTS: Statistically significant relationships were found between meta-dehumanization for each of the three workforce threats when controlling for time in the profession. Results from ancillary analyses indicate that these relationships continued to be statistically significant even after controlling for country of residence (US or Canada).

OBJECTIVE: Stress and burnout are serious problems that impair the well-being and academic performance of medical students. Published systematic reviews and meta-analyses on interventions to reduce the stress experienced by medical students did not conclude which interventions are the most effective due to the heterogeneity of the studies. To enhance the hierarchy of evidence, our study selected only randomized controlled studies. The aims were to obtain more reliable outcomes and to precisely summarize the specific interventions which effectively reduce the stress levels and burnout of medical students. METHODS: We performed a systematic review and meta-analysis according to PRISMA guidelines. Medical databases (Embase, Ovid, and CINAHL) were searched for relevant randomized controlled studies published up to December 2019. Two treatment timepoints (postintervention, and the 6-month follow-up) were chosen. Stress measure outcomes were the main outcomes. A random effects model was used. An intention-to-treat analysis was conducted. RESULTS: Six high-quality studies were found. They compared the efficacies of mindfulness-based interventions and clerkship as usual (N = 689). The stress measurement scores of each mindfulness-based intervention at postintervention were significantly better than those of the control groups, with medium effect size and low heterogeneity (95% CI 0.07–0.51; p = 0.01; I-squared index = 45%). At the 6-month follow-up, the mindfulness groups had significantly better results than the control groups, with medium effect size and negligible heterogeneity (95% CI 0.06–0.55; p = 0.02; I-squared index = 0%). DISCUSSION: The results indicate that mindfulness-based interventions are effective in reducing subjective stress in medical students at both the short- and long-term intervention timepoints.

Caring for people with chronic kidney disease, let alone during a pandemic, can place nurses at risk for burnout. This study explored the effects of the Mindful Self- Compassion (MSC) 8-week training on nephrology nurses' levels of self-compassion, burnout, and resilience. Twelve nurses participated. Surveys were completed before, immediately after, and three months after training. A focus group was also conducted. Results demonstrated in - creased levels of self-compassion, mindfulness, and resilience while levels of burnout decreased. The central qualitative theme was enhanced resilience. Subthemes were creating a community of support, awareness and discovery, and the mastery of the techniques. The MSC training was an effective intervention to build essential skills for maintaining a healthy workforce. Implementation of such training programs within the health care environment are highly encouraged.

INTRODUCTION: There is a lack of curricula addressing the alarming rates of resident physician mistreatment. As the ACGME works to address diversity, equity, and inclusion in GME, there has been increasing attention paid to the issue of mistreatment. Previous studies have noted a high prevalence of mistreatment within GME. Despite this, there are few published interventions to address the mistreatment of residents. We developed a workshop for residents to provide an overview of mistreatment in residency and teach them REWIND (relax, express, why, inquire, negotiate, determine), a communication tool to address mistreatment directly. METHODS: We designed a 60-minute workshop for residents with didactics on mistreatment in GME, followed by three case discussions. Four case scenarios were developed to represent different types of mistreatment and situations. We implemented the workshop twice and asked participants to self-rate proficiency around the workshop objectives with pre- and postsurveys. RESULTS: A total of 11 GME learners completed both the pre- and postsurveys between the two workshop implementations. GME learners who responded demonstrated significantly higher self-rated proficiency on each objective postworkshop compared to preworkshop (p < .05). Free responses on the survey demonstrated that participants particularly enjoyed the case discussions and wanted more practice with REWIND. DISCUSSION: Our workshop improved participant self-rated proficiency around the mistreatment of resident physicians. The workshop can be used in the future as part of a multifaceted institutional response to mistreatment.

This quality improvement project used data from individual conversations and group development theory to implement a team-building intervention to mitigate burnout and improve team climate in a group of advanced practice providers. Two validated questionnaires were used to measure the impact of a teambuilding workshop and the drafting of a team agreement. Results demonstrated signi?cant improvement in team burnout scores immediately post-intervention; however, improvement was not sustained. Anecdotally, the team agreement has successfully improved con?ict resolution among group members.

[This is an excerpt.] Acknowledge that “Burnout is not a ME problem, but a WE problem.”Identify aspects of workplace culture at your organization that impact the well-being of staff (both positive and negative). Look for ways to implement aspects of integration that will benefit staff at your organization such as increasing collaborative opportunities. Take steps to prevent isolation by celebrating the value you bring to your colleagues and taking the time to acknowledge the realities of your work with fellow team members. You are not alone! [To read more, click View Resource.]

RATIONALES AND OBJECTIVES: The purpose is to describe a hybrid teleradiology solution utilized in an academic medical center and its outcomes on radiology report turnaround time (RTAT) and physician wellness. MATERIALS AND METHODS: During coronavirus disease 2019, we utilized an alternating teleradiology solution with procedural and education attendings working in the hospital and other faculty remote to keep the worklist clean. RTAT data was collected for remote vs. in house emergency department (ED) and inpatient cases over a 6-month period. Pre and post implementation burnout surveys were administered. RESULTS: RTAT significantly improved for ED and inpatient MR and CT, and inpatient US and radiographs when interpreted remotely compared to in-hospital. Physician wellness scores improved and open-ended comments reflected positive feedback about the hybrid work solution. 74% enjoyed the autonomy and flexibility, and 51% said the solution positively influences my desire to remain in my current institution and improves their clinical and/or academic productivity. CONCLUSION: Hybrid work from home solutions allow faculty autonomy and flexibility with work-life balance, improving wellness. It is important to alternate the at-home faculty to maintain interdepartmental relations, particularly for junior faculty, and prevent isolation. The hybrid solution also demonstrated improved patient care metrics, possibly due to decreased distractions at home compared to the reading room.

OBJECTIVE: There is currently little consensus as to how burnout is best defined and measured, and whether the syndrome should be afforded clinical status. The latter issue would be advanced by determining whether burnout is a singular dimensional construct varying only by severity (and with some level of severity perhaps indicating clinical status), or whether a categorical model is superior, presumably reflecting differing ‘sub-clinical’ versus ‘clinical’ or ‘burning out’ vs ‘burnt out’ sub-groups. This study sought to determine whether self-diagnosed burnout was best modelled dimensionally or categorically. METHODS: We recently developed a new measure of burnout which includes symptoms of exhaustion, cognitive impairment, social withdrawal, insularity, and other psychological symptoms. Mixture modelling was utilised to determine if scores from 622 participants on the measure were best modelled dimensionally or categorically. RESULTS: A categorical model was supported, with the suggestion of a sub-syndromal class and, after excluding such putative members of that class, two other classes. Analyses indicated that the latter bimodal pattern was not likely related to current working status or differences in depression symptomatology between participants, but reflected subsets of participants with and without a previous diagnosis of a mental health condition. CONCLUSION: Findings indicated that sub-categories of self-identified burnout experienced by the lay population may exist. A previous diagnosis of a mental illness from a mental health professional, and therefore potentially a psychological vulnerability factor, was the most likely determinant of the bimodal data, a finding which has theoretical implications relating to how best to model burnout.

OBJECTIVE: To explore the causes and levels of moral distress experienced by clinicians caring for the low-i­ncome patients of safety net practices in the USA during the COVID-1­ 9 pandemic. DESIGN: Cross-­sectional survey in late 2020, employing quantitative and qualitative analyses. SETTING: Safety net practices in 20 US states. Participants: 2073 survey respondents (45.8% response rate) in primary care, dental and behavioural health disciplines working in safety net practices and participating in state and national education loan repayment programmes. MEASURES: Ordinally scaled degree of moral distress experienced during the pandemic, and open-e­ nded response descriptions of issues that caused most moral distress. RESULTS: Weighted to reflect all surveyed clinicians, 28.4% reported no moral distress related to work during the pandemic, 44.8% reported ‘mild’ or ‘uncomfortable’ levels and 26.8% characterised their moral distress as ‘distressing’, ‘intense’ or ‘worst possible’. The most frequently described types of morally distressing issues encountered were patients not being able to receive the best or needed care, and patients and staff risking infection in the office. Abuse of clinic staff, suffering of patients, suffering of staff and inequities for patients were also morally distressing, as were politics, inequities and injustices within the community. Clinicians who reported instances of inequities for patients and communities and the abuse of staff were more likely to report higher levels of moral distress. CONCLUSIONS: During the pandemic’s first 9 months, moral distress was common among these clinicians working in US safety net practices. But for only one-­quarter was this significantly distressing. As reported for hospital-­based clinicians during the pandemic, this study’s clinicians in safety net practices were often morally distressed by being unable to provide optimal care to patients. New to the literature is clinicians’ moral distress from witnessing inequities and other injustices for their patients and communities.

Moral challenges have clear impacts on physician well-being. The concept of moral injury emerged from work with combat veterans. Existing diagnostic categories did not adequately capture the psychological challenges and distress seen in soldiers returning from war. The concept of moral injury was later applied to augment the understanding of physician distress, with the aim of considering varying etiologies of the symptoms of distress seen in healthcare workers. Healthcare worker moral injury occurs when physicians are repeatedly asked to participate in or witness acts which are not in accordance with their personal moral compass. System changes which acknowledge these distinct drivers of physician distress will be needed to improve physician well-being and enhance individual self-resilience.