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OBJECTIVE: To analyze the role of short (<30 minutes) and frequent (quarterly) check-ins between clinic leaders and employees in reducing emotional exhaustion. METHODS: Three interrelated studies were conducted: a 3-year repeated cross-sectional survey at 10 primary care clinics (n=505; we compared emotional exhaustion, perceived stress, and values alignment among employees of a clinic where check-ins were conducted vs 9 control clinics); interviews with leaders and employees (n=10) regarding the check-ins process and experiences; and interviews with leaders and employees (n=10) after replicating the check-ins at a new clinic. RESULTS: Outcomes were similar at baseline. After a year, emotional exhaustion was lower at the check-ins compared with control clinics (standardized mean difference, d, -0.71 [P<.05]). After 2 years, emotional exhaustion remained lower at the check-ins clinic, but this difference was not significant. The check-ins were associated with an increment in values alignment (2018 vs 2017, d=0.59 [P<.05]; 2019 vs 2017, d=0.76 [P<.05]). There were no differences for perceived job stress. Interviews indicated that work-life challenges were discussed in the check-ins. However, employees need confidentiality and to feel safe to do so. The replication suggested that the check-ins are feasible to implement even amid turbulent times. CONCLUSION: Periodic check-ins wherein leaders acknowledge and address work-life stressors might be a practical tactic to reduce emotional exhaustion in primary care clinics.

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

Continuity of care is a critical element for delivering quality of care in inpatient units, however it has rarely been considered in nurse-patient assignment (NPA) models. The nursing literature suggests that continuity of care helps reduce medical errors and readmissions and increases patient satisfaction. Balancing patient assignments to nursing staff is also critical to avoid overwork and burnout. This study investigates the relationship between continuity of care and workload balance in NPA decisions in hospital inpatient units. We develop an NPA heuristic to guide continuity-care assignment while addressing the trade-off with workload balance. The heuristic prioritizes higher-acuity patients to the objective of continuity of care, while assignment of lower acuity patients seeks to minimize workload imbalance. A discrete event simulation model of an inpatient hospital unit is used to evaluate how the heuristic addresses the tradeoff between the two objectives under distinct work design scenarios. The heuristic enables significant increases in continuity of care for specific patient segments while limiting the impact on workload balance. We discuss implications for theory and managerial practice.

Healthcare delivery is increasingly complex, with frontline leader roles, especially the nurse manager (NM), pivotal for success. This role is highly stressful, often leading to burnout influencing job satisfaction and leadership effectiveness. A quality improvement project, including preintervention and postintervention assessment with a focused improvement event for NMs, in a large children's hospital was completed. Organization strategies to support professional well-being and enhance support for the NMs were identified and implemented.

Education in self care is a core focus for beginning generalist social work trainees to boost trauma awareness, or the ability to recognize and respond to emotional responses from direct practice with clients with a history of trauma, and oppression, as well as for diminishing worker burnout. This paper presents a description and assessment of an asynchronous teaching module comprised of a video lecture, quiz and assignment piloted with beginning graduate-level social work students in the United States to situate self care as a component of professional development toward trauma-informed and ethical care. The module aimed to translate knowledge and skills in self care directly to practice and framed targets of self care including emotional regulation, and meaning-making. It provided students opportunities to identify self care practices at the individual level on their own, as well as agency-based self care practices in consultation with their field supervisors. The module was piloted with 57 master’s students enrolled in beginning generalist practice courses and the outcomes of a survey and thematic analysis suggests it warrants consideration as a tool for promoting competency regarding self care in an asynchronous, easily transportable format for online or hybrid learning.

This study aims to identify the determinants of burnout in police officers. We considered a wide range of psychosocial risk factors, individual variables that have been previously found to be associated with burnout in police officers (affective and cognitive empathy, self-care), and variables whose unique impact on burnout of police officers needs further clarification (organizational justice and organizational identification). The study was conducted in Portugal, and the sample was constituted by 573 members of the National Republican Guard (GNR—Guarda Nacional Republicana). The participants were invited to answer an online anonymous survey, which included previously validated measures of the following variables: burnout (exhaustion and disengagement), psychosocial risk factors, self-care, empathy (cognitive and affective), organizational justice, and organizational identification. Furthermore, we controlled for the potential impact of demographic variables (age, gender, years of professional experience, religiosity, political orientation, and income). Multiple regression analysis showed that when taken together, only a few of the variables associated with burnout had a unique impact on both exhaustion and disengagement: quantitative demands and affective empathy were burnout risk factors; meaningful work, organizational justice (distributive justice, procedural justice, and interactional justice), and organizational identification were burnout protective factors. Our results highlight the importance of developing theoretical models and planning interventions to prevent burnout in police officers, focusing mainly on the above-mentioned variables.

An experiment reveals interventions that managers can use to increase employees’ comfort with speaking up and raising concerns.

The demanding activity of firefighters has a significant impact on their psychological state. This study aimed to analyse the prevalence of anxiety, Burnout, depression, and post-traumatic stress in firefighters. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used for the systematic literature review. The research was developed in SCOPUS, Web of Science, and Pubmed scientific databases. Fifty-three articles were included in the present study and were distributed in subthemes: Prevalence of Anxiety, Burnout and Depression; Prevalence of post-traumatic stress. Firefighters’ psychological disorders were associated with exposure to traumatic events during activity. Age and years of experience related to the prevalence of post-traumatic stress. It is necessary to develop further studies in this area of research, finding ways to reduce the psychological impacts caused by the activity.

Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.

BACKGROUND: The specific factors that may influence burnout levels in police officers are not yet clear. Our aim was to systematically identify the psychosocial risk and protective factors associated with burnout among police officers. METHODS: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A protocol was registered in PROSPERO. A search strategy was applied to Medline via OvidSP, PsycInfo, Scopus and Web of Science. The quality assessment entailed the use of the CASP checklist for cohort studies. The data was reported through a narrative synthesis. RESULTS: After removing studies based on the selection criteria, 41 studies were included in this review. The findings were synthesized under the following subheadings: socio-demographic factors; organisational factors; operational factors; personality variables and coping strategies. Organisational and operational factors were found to be the most predominant risk factors for burnout. Personality variables and coping strategies appeared as both risk and protective factors. Socio-demographic factors were weak in explaining burnout. LIMITATIONS: Most studies are from high-income countries. Not all used the same burnout measurement tool. All relied on self-reported data. Since 98 % had a cross-sectional design, causal inferences could not be made. CONCLUSIONS: Burnout, despite being strictly defined as an occupational phenomenon, is related to factors outside of this context. Future research should focus on examining the reported associations by using more robust designs. More attention must be paid to police officers' mental health by investing in developing strategies to mitigate adverse factors and maximise the effects of protective factors.

Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort–reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort–reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.

OBJECTIVE(S): To describe PHNs' perceptions and experiences of the COVID-19 pandemic, including training, response activities, and work-related challenges. DESIGN: This was a qualitative study using interpretive description for analysis. SAMPLE: PHN participants who worked in public health departments in Wisconsin were recruited using purposive sampling. A total of 15 PHNs participated in the study, including both general and supervisor-level PHNs. MEASUREMENTS: Data were collected via semi-structured interviews from March to May 2021. Interview questions focused on PHNs' perceptions, experiences, response activities, and burnout in relation to the current pandemic as well as perceptions and experiences of emergency preparedness and response in general. RESULTS: Five themes emerged in the study. These were: (1) experiences and observations of the COVID-19 pandemic, (2) organizational changes and their impacts, (3) public health emergency preparedness and response, (4) public health emergency response activities, and (5) role strain and burnout. CONCLUSIONS: Findings presented here have important implications for PHN training and support in emergency preparedness and response. A wide array of strategies focused on developing and supporting the PHN workforce in response to the public health crisis this area need to be implemented at the organizational, community, and policy levels.

IMPORTANCE: Emergency nurses experience high levels of workplace violence during patient interactions. Little is known about the efficacy of behavioral flags, which are notifications embedded within electronic health records (EHRs) as a tool to promote clinician safety. OBJECTIVE: To explore the perspectives of emergency nurses on EHR behavioral flags, workplace safety, and patient care. DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, semistructured interviews were conducted with emergency nurses at an academic, urban emergency department (ED) between February 8 and March 25, 2022. Interviews were audio recorded, transcribed, and analyzed using thematic analysis. Data analysis was performed from April 2 to 13, 2022. MAIN OUTCOMES AND MEASURES: Themes and subthemes of nursing perspectives on EHR behavioral flags were identified. RESULTS: This study included 25 registered emergency nurses at a large academic health system, with a mean (SD) tenure of 5 (6) years in the ED. Their mean (SD) age was 33 (7) years; 19 were women (76%) and 6 were men (24%). Participants self-reported their race as Asian (3 [12%]), Black (3 [12%]), White (15 [60%]), or multiple races (2 [8%]); 3 participants (12%) self-reported their ethnicity as Hispanic or Latinx. Five themes (with subthemes) were identified: (1) benefits of flags (useful advisory; prevents violence; engenders compassion), (2) issues with flags (administrative and process issues; unhelpful; unenforceable; bias; outdated), (3) patient transparency (patient accountability; damages patient-clinician relationship), (4) system improvements (process; built environment; human resources; zero-tolerance policies), and (5) difficulties of working in the ED (harassment and abuse; unmet mental health needs of patients; COVID-19–related strain and burnout). CONCLUSIONS AND RELEVANCE: In this qualitative study, nursing perspectives on the utility and importance of EHR behavioral flags varied. For many, flags served as an important forewarning to approach patient interactions with more caution or use safety skills. However, nurses were skeptical of the ability of flags to prevent violence from occurring and noted concern for the unintended consequences of introducing bias into patient care. These findings suggest that changes to the deployment and utilization of flags, in concert with other safety interventions, are needed to create a safer work environment and mitigate bias.

[This is an excerpt.] As improvers and leaders of improvement, many of us are very familiar with the three questions of the Model for Improvement, developed by Associates in Process Improvement: What are we trying to accomplish? , How will we know that a change is an improvement? , What change can we make that will result in improvement? [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).

OBJECTIVES: The goals of this study were to characterize clinical coordinators compared to other Physician Assistant (PA) faculty, and investigate factors associated with intent to leave their position, institution, and academia in the U.S. METHODS: This was a secondary analysis of data obtained from the 2019 Physician Assistant Education Association (PAEA) Faculty and Directors Survey. We examined bivariate associations with faculty role and conducted multiple logistic regression to identify predictors of intent to leave among clinical directors. RESULTS: Clinical directors indicated an intention to leave their position more often than other faculty. Factors influencing intent to leave were a lack of satisfaction with professional development and moderate to high levels of burnout. Clinical directors with severe burnout had 27x the odds of intending to leave academia. CONCLUSIONS: Our results suggest why clinical directors intend to leave and underscore the need for professional development opportunities and faculty mentoring. Faculty-centered work arrangements are needed to reduce burnout among clinical directors.

The COVID-19 pandemic caused hospitals to make changes to workflow that exacerbated emotional exhaustion and burnout among health care workers. This article examines one of those changes, restricted visitation, showing how it changed the social organization of work by upending established interactional patterns and relationships between health care workers, patients, and patients' families. Based on 40 interviews with intensive care unit (ICU) workers in units that were full of COVID-19 patients and had fully restricted visitation, study findings show that staff took on emotional support roles with patients that had typically been done by families at the bedside. They also faced increased anger, distrust, and misunderstandings from families who were not allowed to see their dying loved one. With each other, staff bonded together with dark humor and candid talk about the scale of deaths, constructing a shared understanding and solidarity amidst the tragedy of the pandemic.

This paper examines hospital competition and restrictions on physician-owned hospital; it proceeds as follows. Part I provides an overview of the seemingly inexorable trends towards further consolidation among healthcare providers and the related competition concerns this consolidation raises. Part II discusses the factors which position POHs well as potential market entrants. Part III describes how the accrual of market power by incumbent hospitals and health systems accentuates the incentives and importance of physicians to identify opportunities for market entry and innovation. Part IV describes the growth of POHs and the subsequent ban on further growth and expansion. Part V then discusses the effects of the POH ban on competition in healthcare markets, potential benefits of relaxing the ban, and more narrowly tailored policy options for addressing concerns associated with physician ownership short of an outright ban. Lastly, Part VI concludes the paper with our recommendation that Congress consider removing the ban on POHs or at least relaxing it.

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This resource is found in our Actionable Strategies for Government: Aligning Values & Improving Diversity, Equity & Inclusion (Aligning Values).

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All surgical fields that lead to a career in Hand Surgery have a stark lack of diversity of sex/gender and race, at every level of the workforce, from trainees to practicing physicians. Despite consistent statistics in publications on lack of diversity in surgical fields, a guide to effective recruitment and retention is lacking. Although we recognize that a strategy cannot be applied in all practices, this article provides actionable items to consider in the commitment and work toward a more just and equitable practice of Hand Surgery.

Retention and burnout have always been a challenge for nurse leaders, but the pandemic brought these concerns to a whole new level. And now the Great Resignation is affecting health care. So how can nurse leaders at hospitals and health care systems create a supportive environment for staff during a public health emergency? Structured support groups are a viable option for emphasizing self-care and wellness. We explain why we decided to form a structured support group for our intensive care unit nurses and illustrate the results from our clinical research team. In addition, we share feedback we received from participating nurses and offer advice on forming a structured support group in acute care settings. This strategy resulted in a change in the participant's behaviors after attending the structured emotional support group. This finding aligns with the literature, which supports strategies to protect nurses' mental well-being and to take preventive measures in critical situations. Using this as a foundation, a structured emotional support group can change nurse engagement and involvement in their process and practice, during times of crisis. Many other benefits could be realized from this strategy such as improved nursing practice and processes, improved nurse satisfaction, and improved recruitment and retention.

[This is an excerpt.] The healthcare landscape is evolving, generating new and unprecedented challenges for health systems to manage, such as fallout from a global pandemic, workforce and drug shortages, clinician burnout, and more. But The Joint Commission’s dedication to improving patient care remains steadfast. This means we must evolve, too, meeting the moment and partnering with stakeholders to drive optimal care and value – a top priority of Joint Commission President and Chief Executive Officer Dr. Jonathan Perlin. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Invest/Advocate for Patients, Communities, & Workers) AND Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Aligning Values).

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Accurately quantifying clinician time spent on electronic health record (EHR) activities outside the time scheduled with patients is critical for understanding occupational stress associated with ambulatory clinic environments. We make 3 recommendations regarding EHR workload measures that are intended to capture time working in the EHR outside time scheduled with patients, formally defined as work outside of work (WOW): (1) separate all time working in the EHR outside of time scheduled with patients from time working in the EHR during time scheduled with patients, (2) do not exclude any time before or after scheduled time with patients, and (3) encourage the EHR vendor and research communities to develop and standardize validated, vendor-agnostic methods for measuring active EHR use. Attributing all EHR work outside time scheduled with patients to WOW, regardless of when it occurs, will produce an objective and standardized measure better suited for use in efforts to reduce burnout, set policy, and facilitate research.