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Recent major health shocks, such as the 2014–16 Ebola, the Zika outbreak, and, last but not least, the COVID-19 pandemic, have strongly contributed to drawing attention to the issue of resilience in the healthcare domain. Nevertheless, the scientific literature appears fragmented, creating difficulties in developing incremental research in this relevant managerial field.

It is well-established that different leadership styles are associated with followers' mental health. However, little is known about the relative strength of the relationship of different leadership styles with followers' mental health. So far, there is no meta-analysis comparing the incremental contribution of different leadership styles to mental health and studying potentially problematic construct proliferation. We included studies that compared at least two leadership styles in view of their relationships with followers' mental health and directly estimated the relative contribution of seven leadership styles (i.e., transformational, transactional, laissez-faire, task-oriented, relationship-oriented, and destructive leadership, as well as leader-member exchange) to followers' mental health. Using meta-analytical regression models, we compared the strength of the relationships between these leadership styles and followers' overall mental health as well as positive (well-being and psychological functioning) and negative aspects of their mental health (affective symptoms, stress, and health complaints). Fifty-three studies with 217 effect sizes comprising 93,470 participants met the inclusion criteria. Transformational and destructive leadership were the strongest predictors of overall and negative aspects of mental health among followers. In contrast, the strongest predictors of positive mental health outcomes among followers were relations-oriented and task-oriented leadership, followed by transformational leadership. In sum, our results suggest that various leadership styles make unique contributions to explaining followers' mental health and thus construct proliferation mostly does not pose a major problem when predicting relevant outcomes in this domain of leadership research. Our results are relevant for leadership development programs and for future organizational leadership models.

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

This mixed-methods pilot study explored the psychological and emotional experiences of chaplains and the feasibility, acceptability, and impact of workshops designed to support chaplain well-being. After the workshops, scores on a measure of self-compassion increased, while secondary traumatic stress and burnout scores decreased. Qualitative data reflected the range of experiences of chaplaincy as well as the benefits of the workshops. This pilot study supports further exploration of organizational interventions to promote chaplain well-being.

Few career paths are as mentally, physically, and emotionally exhausting as a career in healthcare. Due to the nature of the job responsibilities, healthcare professionals often sacrifice their own wellbeing for the sake of their patients. The COVID-19 pandemic has asked an even greater sacrifice from healthcare professionals and continues today with little end in sight. The majority of healthcare workers report that stress has a negative impact on their work, which can ultimately manifest in poor patient outcomes and decreased work satisfaction. As stewards of wellbeing, it is imperative that healthcare professionals prioritize self-care and find their own individualized way(s) to manage stress. Building resilience, which is the ability to adapt to traumatic or adverse events in a positive manner, can help decrease anxiety, depression, and burnout. Resilience also helps healthcare professionals re-establish meaning in both their professional and personal lives, and has been proven to improve patient safety and job satisfaction. Complementary and integrative modalities treat the whole person by focusing on the physical, emotional, social, economic, and spiritual needs of the individual. Techniques such as meditation, progressive muscle relaxation, 4-7-8 breathwork, acupressure, aromatherapy, and Jin Shin Jyutsu have been used with great success in the workplace setting to help build resilience. Such techniques offer options for stress reduction and can decrease feelings of work-related burnout. These techniques can be used in real time at the moment of a stressful event. They may also help reduce stress when used prior to, or at the end of a workday. Consistent practice can reduce the feelings of stress that contribute to compassion fatigue and burnout. These integrative health modalities do not require any additional tools or extensive training. They are easy to learn and perform, and can be easily incorporated into a daily practice to encourage stress reduction and promote wellbeing.

At a time when the older adult population is increasing exponentially and health care agencies are fraught with crisis-level short-handedness and burnout, addressing the Quadruple Aim of enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers is more crucial than ever. A multi-step education model was designed to advance competencies in geriatrics and Interprofessional Collaborative Practice (IPCP) for health profession students focused on each element of the Quadruple Aim. The goals of this education were to equip students with knowledge and experience to provide team-based care for older adults and achieve satisfaction with the education program. The education steps consisted of online didactics, team icebreaker, skills practice, professional huddles, and interprofessional simulation with debriefing. Over 2,300 students and 87 facilitators from 16 professions completed the training over three years. A positive statistically significant increase was found between pre- and post-measures of IPCP competency, knowledge, and attitudes. Additionally, high satisfaction with the education was reported by students and facilitators. By providing positive geriatric education and experiences for health students to work in interprofessional teams, it can translate into future improvements in older adult population health, health care provider job satisfaction, and reduced health care costs.

OBJECTIVE: The objective of this study was to characterize work engagement and burnout as well as potential demographic factors associated with each student and faculty member at 2 pharmacy programs in the US. METHODS: A survey including the Utrecht Work Engagement Scale-9 (UWES-9) and a single-item burnout measure was conducted from April to May 2020. Demographic data including age range, gender, and other characteristics were also collected. Mean UWES-9 scores, scoring category results, and the proportion of the cohorts reporting symptoms of burnout were reported. Point biserial correlation was used to compare the relationship between UWES-9 mean scores and burnout rates. Regression analyses were also performed to assess variables predictive of work engagement and burnout. RESULTS: Students (N = 174) reported a mean UWES-9 score of 3.0 (SD = 1.1), while faculty members (N = 35) reported a mean of 4.5 (SD = 0.7). Over half (58.6%) of the students and 40% of faculty members reported symptoms of burnout. Faculty members demonstrated a strong significant negative correlation between work engagement and burnout (r = −0.35), while students did not (r = 0.04). Regression analyses found no significant demographic factors predictive of UWES-9 scores in students or faculty, while first year students were less likely to report burnout symptoms, and no significant factors for burnout were found in faculty. CONCLUSION: Our study found that work engagement scores and burnout symptoms were inversely correlated in pharmacy faculty members surveyed but lacked correlation in students. Larger, more robust studies should be conducted to further elucidate the relationship between work engagement and burnout.

BACKGROUND: Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. MATERIALS AND METHODS: We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children’s Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. RESULTS: Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. CONCLUSION: Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions.

OBJECTIVE: To summarize articles reporting on burnout and well-being among attending and resident radiation oncologists in the United States in a narrative review. METHODS: PubMed was searched for peer-reviewed articles from 2010 through 2023 reporting on burnout and well-being among radiation oncologists in the United States. Each study was critically reviewed and included if it reported primary data utilizing a validated tool to measure burnout among radiation oncologists. A subset of high-quality studies was included. RESULTS: There are limited studies regarding burnout among radiation oncologists in the United States, especially when compared with data from other countries. Despite these limitations, there is a prevalence of burnout among radiation oncologists of all career stages, with rates of burnout ranging from 30% to 63%. A few smaller studies have explored interventions to decrease burnout and enhance professional fulfillment among radiation oncologists. Best practices to enhance professional fulfillment for radiation oncologists include optimizing support structures to alleviate physicians of administrative duties; including physicians in departmental decisions that affect their work; providing dedicated time for research; promoting work-life balance and job satisfaction; providing support for trainees, including psychological tool-focused approaches and humanities exercises; and encouraging mindfulness. CONCLUSIONS: A large cross-sectional study is warranted to further explore modern burnout rates and causes among radiation oncologists in the United States. This may inform areas of advocacy to improve professional fulfillment among radiation oncologists.

PROBLEM DEFINITION: Moral distress (MoD) is a vital clinical indicator linked to clinician burnout and provider concerns about declining patient care quality. Yet it is not routinely assessed. Earlier, real-time recognition may better target interventions aimed at alleviating MoD and thereby increase provider well-being and improve patient care quality. INITIAL APPROACH AND TESTING: Combining two validated MoD instruments (the Moral Distress Thermometer [MDT] and the Measure of Moral Distress for Healthcare Professionals [MMD-HP]), the authors developed a novel mobile and Web-based application environment to measure and report levels MoD and their associated causes. This app was tested for basic feasibility and acceptability in two groups: graduate nursing students and practicing critical care nurses. RESULTS: The MDT app appears feasible and acceptable for future use. All participants (n = 34) indicated the MDT app was satisfying to use, and 91.2% (n = 31) indicated the app was "very appropriate" for measuring MoD. In addition, 84.2% (n =16) of practicing nurses indicated the app fit either "somewhat well" (47.4%, n = 9) or "very well" (36.8%, n = 7) into their typical workday, and 68.4% (n = 13) said they were either "extremely likely" or "somewhat likely" to use the app daily in clinical practice. KEY INSIGHTS AND NEXT STEPS: Education about moral distress and its associated causes proved important to the MDT app's success. It is ready for future validity and reliability testing, as well as examining usability beyond nursing, longitudinal data monitoring, and possible leveraging to pre- and postintervention evaluation studies.

[This is an excerpt.] We were pleased to read the article by Davis et al examining the association between burnout and professional milestone attainment for family medicine resident physicians.1 We were very surprised by the finding that, in their study of over 2500 family medicine residents, Black, Latinx, and Asian family medicine residents experience burnout at lower rates than their White peers. It defies logic that residents who identify as Black, Indigenous, or a Person of Color (BIPOC) experience lower levels of burnout when they are differentially and systematically burdened by experiences of discrimination, microaggressions, and inequitable access to mentorship and structured opportunity and lack of belonging compared to their non-BIPOC colleagues.2- 4 In the discussion, the authors did not have room to explore why burnout trends show the opposite of what we would expect to see. We offer the following insights as to why these findings might be valid, and we would welcome discussion from the authors on this finding. [To read more, click View Resource.]

BACKGROUND: Vaccination is an important component of the public health response to the pandemic, and a large health care system such as UCLA Health must optimize mechanisms to address questions from patients to expedite vaccine acceptance and administration. Local Problem In 2020-2021, COVID-19 vaccines were developed, studied, and approved at unusual speed, leading to both vaccine hesitancy and requests for urgent availability. This required up-to-date responses from physicians to questions through the online patient portal in the UCLA health care system. There was the additional risk of physician burnout due to the large number of questions. INTERVENTION: We developed a physician strike team that enabled accurate and timely dissemination of vaccine information in response to patient queries. The strike team served a dual purpose of answering patient questions quickly with accurate information, and reducing the workload for other physicians. Using a strike team of 10 early career physicians responding to a collection of patient messages, this large community-based health system was able to provide timely, high-quality responses to COVID-19 vaccine-related questions. RESULTS: After the introduction of the physician strike team program in late January 2021 through April 2021, there was a significant reduction in the average number of messages and calls received by covered providers per month compared to the adjusted number of messages and calls they would have received had the pool not existed. The strike team provided a service with high satisfaction scores from both the participating strike team members and the physicians being covered by the strike team. CONCLUSIONS: The success of this small physician strike team to impact inbasket patient messages and calls in our institution suggests that a similar mechanism can be developed to centralize the replies to certain messages, which may reduce the workload and burnout of physicians.

PURPOSE: Rates of burnout are high during medical training including psychiatric residency. This study examined the impact of improvisational theater training on psychiatry residents’ experiences of burnout and on several outcomes associated with improv training: tolerance of uncertainty, playfulness, and self-compassion. METHODS: Fourteen psychiatry residents with minimal background in improvisational theater participated either in an improv (N = 9) or comparison group (N = 5). The improv group met weekly in 2020 for four weeks in person and two additional weeks online. Surveys were administered before the program, after the first four weeks, and following the complete program. RESULTS: Nine residents participated in the improv program. Eight completed all follow up surveys (100%) as did all five non-participants (100%). Initial results indicated that improv contributed to residents’ self experienced well-being, either through reduced burnout or tolerance of uncertainty, increased playfulness, self-compassion, or some combination thereof. Residents reported that improv affected their work and life in general and that it differed substantially from other types of coursework in their psychiatric curriculum. CONCLUSIONS: This study, utilizing a relatively low-cost six-week program, suggests that improv can help psychiatry residents overcome burnout, increase tolerance of uncertainty, and enhance their playfulness, self- compassion, sense of joy, and connection to others.

RATIONALE AND OBJECTIVES: Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction. MATERIALS AND METHODS: This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center. In pre- (2017) and post-intervention (2019) periods, we administered the previously-validated Stanford Physician Wellness Survey to faculty in our 11-division radiology department. Faculty rated their burnout level across 8 domains (professional fulfillment, emotional exhaustion, interpersonal disengagement, sleep difficulties, self-compassion, negative work impact on personal relations, organizational/personal values alignment, perceived quality of supervisory leadership). Between the two surveys, departmental initiatives focusing on culture, team building, work-life balance, and personal well-being were implemented (e.g., electronic medical record training, shorter work hours). Pre- and post-survey results were compared, using Whitney-Mann U test to calculate Z scores. RESULTS: Faculty members rated lower professional fulfillment (Z-3.04, p=0.002), higher emotional exhaustion (Z=2.52, p=0.012), increased sleep-related impairment (Z=2.38, p=0.012), and reduced organizational/personal values alignment (Z=-4.10, p<0.0001) between the two surveys. No significant differences were identified associated with interpersonal disengagement (Z=1.82, p=0.069), self-compassion (Z=1.39, p=0.164), negative impact of work on personal relationship (Z=0.89, p=0.372) and perceived supervisory leadership quality (Z=0.07, p=0.942). CONCLUSION: Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, self-reported burnout was unchanged or worsened over time.Physician and employee wellness embedded into institutional culture maybe more effective than departmental improvement initiatives.

BACKGROUND: The purpose of this work was to describe the experiences of EMS personnel in responding to drug overdose-related calls and the impact the pandemic has had to help better inform current response and treatment efforts. METHODS: Semi-structured interviews were conducted with 99 EMS personnel across 18 areas throughout the United States that were designated as Early Warning Network sentinel sites by the National Institute on Drug Abuse-funded National Drug Early Warning System. Participants were asked about topics including the potential burdens from the pandemic and the opioid crisis. We coded the interview responses and identifed themes through qualitative analysis. Multiple cycles of descriptive coding, recoding, subcoding, pattern-coding, and thematic coding of responses were conducted. RESULTS: Responses were categorized into the following themes: 1) being over-worked from increased call volume; 2) increased risk for personal harm when responding to patients; 3) compassion fatigue due to long hours and repeat calls for the same people; 4) conflicting perceptions of the utility of naloxone; 5) the need for better treatment options to respond to opioid crisis on top of COVID-19. CONCLUSIONS: The burden of the substance use disorder (SUD) crisis on EMS personnel has been compounded by the COVID-19 pandemic. These reports from EMS personnel throughout the US can help inform policy and procedures to better protect the mental health of EMS personnel and to ensure better care for patients with SUD. These experiences and recommendations may be of use for other countries as substance use and COVID-19 are global health issues.

OBJECTIVE: The primary objective of this qualitative study was to describe key themes discussed by student pharmacists and preceptors related to recognizing burnout and maintaining wellbeing during an experiential assignment. METHODS: This qualitative study used directed content analysis to examine themes that emerged from discussions between student pharmacists and preceptors as part of a required lifelong learning interview during Introductory Pharmacy Practice Experiences that took place between August 2019 and May 2020. Iterative axial coding was used to develop and redefine codes systematically until consensus was reached and a final codebook was established. All responses were coded using the consensus categories. RESULTS: From the 228 interviews analyzed, 3 overarching themes emerged: causes of burnout, manifestations or symptoms of burnout, and strategies to manage stress and burnout. Preceptors identified the mechanics of the job and feeling extreme pressure or worry as 2 major causes of burnout, which manifest as physical exhaustion, mental exhaustion, and poor work performance. To manage stress, preceptors reported using personal and work-positive coping strategies. CONCLUSION: The major themes derived from the analysis—causes of burnout, manifestations of burnout, and strategies to manage stress—align with what is already known about health care provider wellbeing. Although it remains unknown if this type of wellness intervention is effective at changing student stress management habits, results indicate that the intervention sparked conversations that could assist students in establishing a baseline of knowledge on the topic and supply students with a toolkit of resiliency strategies.

During recent years, police have suffered from job dissatisfaction, exhaustion, stress, and burnout; this issue has led to shortages of sworn police across the country. A high percentage of police officers leave the job in the first 5 years of service. A goal of this study was to discover how police investigators build resiliency to those challenging factors so that the individual can remain resilient despite exposure to adverse incidents and conditions that lead to severe stress and burnout. A generic qualitative method was used so that police investigators could share their lived experiences during their interviews and describe their beliefs, reflections, and opinions about their exposure to adversities on the job, and how they built resilience to those experiences. The target population for this study was police investigators who had more years of experience on the job than the less experienced sworn police members who were reportedly quitting the job from job-related dissatisfaction and burnout. The sample consisted of seven sworn police investigators from a small urban police department in the northeast region of the United States. I conducted semi-structured interviews of the seven participants, recorded the interviews using a Sony digital voice recorder, and used Descript transcription software to transcribe the audio recorded interviews to text. A thematic analysis approach was taken to find repeating patterns to identify five common themes from the collected data. These emerging themes were: (a) alcohol consumption used as a temporary coping strategy; (b) setting emotions aside; (c) family and nonlaw enforcement friends were perceived as not understanding: (d) exercise used as self-care method of effective coping; and (e) talking and venting to fellow law enforcement members as an effective coping method. During the interviews, the participants discussed several critical adverse incidents and conditions that caused stress and hardship for them. Through those shared experiences, I learned from the participants how they coped with those adversities and what helped them build resiliency.

Pharmacy residents are especially vulnerable to burnout given the professional and personal stressors associated with postgraduate training. Residency programs need to prioritize burnout reduction strategies to support resident health and well-being. This commentary describes a resident-preceptor collaborative approach to encourage wellness and reduce burnout within a large residency program at an academic medical center. Strategies that have been utilized include (1) fostering collaboration among residents and preceptors; (2) assessing resident interests and needs to ensure alignment; (3) leveraging available institutional and community resources; and (4) integrating initiatives within the existing residency program structure. This commentary aims to provide suggestions that can be implemented to address resident burnout for other residency programs, regardless of resource availability.

Training and practicing physicians continue to experience burnout, poor job satisfaction / engagement, high stress, and even depression and suicide. With an understanding of effective and ineffective methods to improve wellness, our team aimed to collect publications with data on the effectiveness of physical activity interventions to address burnout and well-being in physicians. Comprehensive searches for articles related to the impact of exercise on physicians’ well-being were undertaken in March 2022 in PubMed, PsycINFO, and EMBASE. Of 2496 records identified in the databases, the team screened 1,287 and finalized 12 papers for inclusion and review. This study reviews the overall positive benefits of physical activity and exercise interventions in physicians. Despite the wide-ranging utility of an exercise prescription and despite clear evidence that physicians' personal exercise habits affect their patient counseling about exercise, this review shows that (often overburdened) physicians have insufficient physical activity, and are rarely included in studies targeting exercise. Many of the included studies had small sample sizes, leaving possibilities for future research aiming to augment physician wellness.

BACKGROUND: Burnout is a growing problem among medical professionals, reaching a crisis proportion. It is defined by emotional exhaustion, cynicism, and career dissatisfaction and is triggered by a mismatch between the values of the person and the demands of the workplace. Burnout has not previously been examined thoroughly in the Neurocritical Care Society (NCS). The purpose of this study is to assess the prevalence, contributing factors, and potential interventions to reduce burnout within the NCS. METHODS: A cross-sectional study of burnout was conducted using a survey distributed to members of the NCS. The electronic survey included personal and professional characteristic questions and the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). This validated measure assesses for emotional exhaustion (EE), depersonalization (DP), and personal achievement (PA). These subscales are scored as high, moderate, or low. Burnout (MBI) was defined as a high score in either EE or DP or a low score in PA. A Likert scale (0–6) was added to the MBI (which contained 22 questions) to provide summary data for the frequencies of each particular feeling. Categorical variables were compared using χ2 tests, and continuous variables were compared using t-tests. RESULTS: A total of 82% (204 of 248) of participants completed the entire questionnaire; 61% (124 of 204) were burned out by MBI criteria. A high score in EE was present in 46% (94 of 204), a high score in DP was present in 42% (85 of 204), and a low score in PA was present in 29% (60 of 204). The variables feeling burned out now, feeling burned out in the past, not having an effective/responsive supervisor, thinking about leaving one’s job due to burnout, and leaving one’s job due to burnout were significantly associated with burnout (MBI) (p < 0.05). Burnout (MBI) was also higher among respondents early in practice (currently training/post training 0–5 years) than among respondents post training 21 or more years. In addition, insufficient support staff contributed to burnout, whereas improved workplace autonomy was the most protective factor. CONCLUSIONS: Our study is the first to characterize burnout among a cross-section of physicians, pharmacists, nurses, and other practitioners in the NCS. A call to action and a genuine commitment by the hospital, organizational, local, and federal governmental leaders and society as a whole is essential to advocate for interventions to ameliorate burnout and care for our health care professionals.

INTRODUCTION: The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. METHODS: An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. RESULTS: Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. CONCLUSION: This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.