Resource Library

Healthcare literature suggests that leadership behavior has a profound impact on nurse work-related well-being. Yet, more research is needed to better conceptualize, measure, and analyse the concepts of leadership and well-being, and to understand the psychological mechanisms underlying this association. Combining Self-Determination and Job Demands-Resources theory, this study aims to investigate the association between engaging leadership and burnout and work engagement among nurses by focusing on two explanatory mechanisms: perceived job characteristics (job demands and resources) and intrinsic motivation.

Ethics ratings of a diverse list of 23 professions are less positive than they have been in recent years, with eight establishing or tying record lows.

Burnout causes decreased job satisfaction, mental health issues, and leads to poor patient care. A large contributor is the electronic health record. Primary care providers from a medical group completed the Professional Fulfillment and Burnout Index survey showing high rates of burnout, and a scribe program was initiated. This quality improvement project evaluated the scribe program and its effects on burnout, documentation burden, and productivity for primary care physicians and nurse practitioners. Most participants had burnout. After using scribes, most had improved work-life balance. The scribe program was an important resource to prevent burnout related to the electronic health record.

OBJECTIVE: Burnout is a prevalent issue in healthcare. However, investigations into experiences of burnout among mainly administrative health systems’ personnel have not been conducted. Therefore, the purpose of this study is to evaluate burnout experiences among health systems’ personnel in administrative positions who do not medically treat patients as part of their daily work. METHODOLOGY: This is a mixed-methods study measuring burnout using an 18-question burnout scale and by conducting 23 semi-structured interviews. Mean responses and a correlation analysis of the survey results were conducted. Interview transcripts were coded using ATLAS.ti 22. FINDINGS: The quantitative results show low burnout scores. However, the interviews show that all administrative personnel had experienced burnout or stress, particularly during the COVID-19 pandemic. The COVID-19 pandemic, workload, and volatility drove burnout. Recognizing employees, promoting a strong work/life balance, and self-care practices may alleviate burnout. IMPLICATIONS: Similar to nurses and physicians, administrative health systems’ personnel are susceptible to burnout. Therefore, health systems’ leaders should cultivate strategies to mitigate and prevent burnout among administrative personnel. Additionally, this study uses interviews to obtain a context for survey results, unlike previous studies. Leaders should recognize not only clinicians but also administrative employees for their work to alleviate burnout. Additionally, leaders should promote work/life balance, especially among remote workers and attempt to reduce workload to mitigate burnout. ORIGINALITY: This research is unique because it focuses on experiences of burnout among health systems’ employees who do not treat patients as part of their daily work. Previous studies have focused on mainly nurses and physicians. However, this study shows that non-patient-facing health systems’ employees can also suffer from burnout.

IMPORTANCE: The murder of George Floyd in 2020 spurred an outpouring of calls for racial justice in the United States, including within academic medicine. In response, academic health centers announced new antiracism initiatives and expanded their administrative positions related to diversity, equity, and/or inclusion (DEI). OBJECTIVE: To understand the experiences of DEI leaders at US allopathic medical schools and academic health centers, ie, the structure of their role, official and unofficial responsibilities, access to resources, institutional support, and challenges. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study used key informant interviews with participants who held formal DEI positions in their school of medicine, health system, or department. Interviews were conducted from December 2020 to September 2021. Transcripts were coded using a phenomenographic approach, with iterative concurrent analysis to identify thematic categories across participants. Data were analyzed from January to December 2021. EXPOSURE: Formal DEI role. MAIN OUTCOMES AND MEASURES: Questions elicited reflection on the responsibilities of the role and the strengths and challenges of the unit or office. RESULTS: A total of 32 participants (18 of 30 [56%] cisgender women; 16 [50%] Black or African American, 6 [19%] Latinx or Hispanic, and 8 [25%] White) from 27 institutions with a mean (range) of 14 (3-43) years of experience in medical education were interviewed. More than half held a dean position (17 [53%]), and multiple participants held 2 or more titled DEI roles (4 [13%]). Two-thirds self-identified as underrepresented in medicine (20 [63%]) and one-third as first generation to attend college (11 [34%]). Key themes reflected ongoing challenges for DEI leaders, including (1) variability in roles, responsibilities, and access to resources, both across participants and institutions as well as within the same position over time; (2) mismatch between institutional investments and directives, including insufficient authority, support staff, and/or funding, and reduced efficacy due to lack of integration with other units within the school or health system; (3) lack of evidence-based practices, theories of change, or standards to guide their work; and (4) work experiences that drive and exhaust leaders. Multiple participants described burnout due to increasing demands that are not met with equivalent increase in institutional support. CONCLUSIONS AND RELEVANCE: In this qualitative study, DEI leaders described multiple institutional challenges to their work. To effectively address stated goals of DEI, medical schools and academic centers need to provide leaders with concomitant resources and authority that facilitate change. Institutions need to acknowledge and implement strategies that integrate across units, beyond one leader and office. Policymakers, including professional organizations and accrediting bodies, should provide guidance, accountability mechanisms, and support for research to identify and disseminate evidence for best practices. Creating statements and positions, without mechanisms for change, perpetuates stagnation and injustice.

Between 2020-2023, many health systems and organizations created formal positions to improve diversity, equity, and inclusion (DEI) and health equity in response to social and health injustices and public demands for diversity and equity among executive level leadership. The National Academies Roundtable on the Promotion of Health Equity hosted an October 2023 public hybrid workshop to explore the successes and challenges of DEI and health equity C-suites, dimensions of DEI and health equity commitments, strategies for achieving internal and external goals, and potential metrics for measuring success.

GOAL: Clinician stress and resilience have been the subjects of significant research and interest in the past several decades. We aimed to understand the factors that contribute to clinician stress and resilience in order to appropriately guide potential interventions. METHODS: We conducted a scoping review (n = 42) of published reviews of research on clinician distress and resilience using the methodology of Peters and colleagues (2020). Our team examined these reviews using the National Academy of Medicine's framework for clinician well-being and resilience. PRINCIPAL FINDINGS: We found that organizational factors, learning/practice environment, and healthcare responsibilities were three of the top four factors identified in the reviews as contributing to clinician distress. Learning/practice environment and organizational factors were two of the top four factors identified in the reviews as contributing to their resilience. PRACTICAL APPLICATIONS: Clinicians continue to face numerous external challenges that complicate their work. Further research, practice, and policy changes are indicated to improve practice environments for healthcare clinicians. Healthcare leaders need to promote resources for organizational and system-level changes to improve clinician well-being.

Healthcare professionals, including occupational therapy practitioners, are experiencing epidemic levels of burnout. Professional organizations have prioritized research and programming to address burnout. This study evaluated the feasibility of an evidence-based virtual mindfulness continuing education program, Mindfulness at Work, and the mindfulness strategies participants learned and embedded into their workday. This program was developed and facilitated by an occupational therapist who is also a registered advanced yoga teacher. A total of 11 occupational therapy practitioners experiencing burnout met with the facilitator for once-weekly synchronous sessions over three weeks. OT practitioners were taught mindfulness strategies to use throughout their workday. Participants practiced the strategies at work between sessions and discussed their experiences during subsequent sessions. Aspects of the feasibility of both the program and the mindfulness strategies were measured post-only. Participant burnout was measured pre and post. Participants rated the virtual mindfulness continuing education program and mindfulness strategies as acceptable, appropriate, and feasible. There were significant decreases in pre- and post-test burnout scores during this preliminary evaluation. Attendance and retention rates were high. Eligibility criteria challenged recruitment capability.

PURPOSE OF REVIEW: Although financial wellness is a predictor of physician burnout, we are yet to optimize financial education or wellness of Urology trainees. We assessed existing studies, compared them to those of other specialties, and discussed resources and methods to address this deficiency. RECENT FINDINGS: Urology residents tend to be less fiscally savvy (carry significant debt, and lack retirement savings or disability insurance), and 90% of trainees and young Urologists do not feel comfortable with the business of practice, including skills like coding and billing, contract negotiation, and self-value assessment. SUMMARY: Financial and business literacy are deficiencies of Urology training, as in other specialties. Eventually, the goal should be universal adoption of a formal curriculum that is graded in nature. In the interim, we need to propose and endorse adoption of a formal curriculum, and we should support trainees by promoting a space for easily accessible and transparent information regarding best practices in personal finance and the business of healthcare.

[This is an excerpt.] Studies of physician well-being commonly use narrow measures like happiness, life satisfaction, mental health, or burnout. However, well-being is a complex and multifaceted construct. Flourishing offers promise as a holistic conceptualization of well-being, as it integrates eudaimonic, hedonic, psychological, social, and physical aspects of well-being. [To read more, click View Resource.]

Recent literature has explored the psychological well-being of physicians, addressing conditions like perfectionism, imposter phenomenon/syndrome (IP), depression, burnout, and, less frequently, magical thinking. But recognizing the connections among these psychological factors is vital for developing targeted interventions to prevent or alleviate their impact. This article examines the often-sequential emergence of these five conditions within a physician's career, with a specific emphasis on their prevalence among emergency physicians (EPs), who must manage a diverse array of acute illnesses and injuries. The descent into psychological distress initiates with magical thinking—in this case, the belief that perfection is possible despite evidence to the contrary—leading to the pursuit of maladaptive perfectionism. If unaddressed, this trajectory may lead to depression, burnout, and in some cases, suicide. Understanding this continuum lays the groundwork for devising a systematic approach to enhance physicians' mental health. The article delves into detailed descriptions of these psychological conditions, encompassing their prevalence, individual impact, how they are integrated into this continuum and potential preventive or corrective methods. Recognizing unrealistic expectations as a major contributor to burnout, depression, and even suicide within the medical profession, the article advocates for the development of targeted interventions and support structures to assist medical students and professionals in managing IP. Practical strategies involve acknowledging unrealistic expectations, setting attainable goals, seeking support, taking breaks, and prioritizing self-care. Addressing this pervasive issue aims to cultivate a culture where medical professionals can thrive, ensuring optimal care for patients.

COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In this perspective, which draws on a Policy Brief prepared for the WHO Fifth Global Forum on Human Resources for Health, we present findings from a scoping review of global emergency workforce strategies implemented during the pandemic and consider what we can learn from them for the long-term sustainability of the HCWF. Our review shows that strategies to strengthen HCWF capacity during COVID-19 fell into three categories: (1) surging supply of health and care workers (HCWs); (2) optimizing the use of the workforce in terms of setting, skills and roles; and (3) providing HCWs with support and protection. While some initiatives were only short-term strategies, others have potential to be continued. COVID-19 demonstrated that changes to scope-of-practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce. Additionally, the use of technology and digital tools increased rapidly during COVID-19 and can be built on to enhance access and efficiency. The pandemic also highlighted the importance of prioritizing the security, safety, and physical and mental health of workers, implementing measures that are gender and equity-focused, and ensuring the centrality of the worker perspective in efforts to improve HCWF retention. Flexibility of regulatory, financial, technical measures and quality assurance was critical in facilitating the implementation of HCWF strategies and needs to be continued. The lessons learned from COVID-19 can help countries strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.

COVID-19 placed unprecedented strain on the health workforce, raising concerns of increasing worker turnover and attrition. This study explores the use of 2 publicly available Medicare datasets—Provider Enrollment, Chain, and Ownership System (PECOS) and Doctors and Clinicians—to track provider movement across states and organizations from 2017 to 2023. We found an increase in state-to-state movement of providers post–COVID-19, with an initial spike in physician movement in the first year (April 2020 to March 2021). Movement varied across specialties and professions. Between organizations, we saw an initial increase in movement for family physicians but not internal medicine physicians. Overall, provider movement was generally to larger organizations. Our study finds increasing movement of providers in the post–COVID-19 period through the novel use of 2 publicly available Medicare datasets. Tracking health care workforce movement closer to real time is important to understand a changing workforce—with differences across communities—and to guide policies to ensure sufficient workforce and prevent worsening disparities over time.

[This is an excerpt.] Health insurance plans are committed to working together to improve access to mental health and SUD care for every patient who needs it. Below are just a few examples of the work health insurance plans are doing every day. AmeriHealth Caritas offers mental health support through PerformCare. Services include Intellectual and Development Disability (I/DD), emergency interventions and screening, substance use treatment, suicide prevention, housing support, and family resources. The program offerings are focused on member recovery and resiliency and are family and community oriented. [To read more, click View Resource.]

‍

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

‍

Healthcare workers’ mental health has been a topic of growing interest. However, despite the significant prevalence of mental health disorders in this population, there are many barriers to care. The recent development of e-Health might present solutions to these challenges, allowing the prevention and early detection of mental health disorders. This paper aims to provide an overview of the existing research on e-Health applications focused on healthcare workers’ mental health. A scoping review was conducted based on PRISMA-ScR guidelines. A total of 6 databases (PubMed, Science Direct, Web of Science, Scopus, IEEE Explore, ACM Digital Library) were searched from inception to December 2022 without limits on the dates and types of publications. Studies were included in the review if they had incorporated e-Health in any application to healthcare workers’ mental health and had been published in English, Portuguese, or Spanish. In addition, publication-related information, mental health disorders studied, population profession, method of recruitment, and type of e-Health intervention or usage were extracted from each study. A total of 7 articles were included in this review. Two types of studies were found. The first type of study was strictly observational, while the other involved interventions utilizing e-Health to promote mental health improvement. There is a small number of studies pointing to a gap in the literature on this topic, with a necessity of further studies, considering studies design that mitigates the heterogeneities observed in this review.

This study aimed to use a coach-led digital health platform to mitigate burnout and enhance wellbeing among hospital workers. Individual interviews were conducted with 11 healthcare workers to explore their experiences of working with a coach through text-based communication on a digital support platform. Interviews were analysed using thematic analysis. Three overarching themes were identified: (1) Human-centred Conversation, Facilitated Awareness, (2) Learning and Growth, (3) Forward Momentum in the pillars of Lifestyle Medicine. Participants had a positive human-centered connection with their coach and felt safe to communicate openly with her via online chat messages. The coach facilitated participants’ awareness, learning and growth by helping them to identify the goals they wanted to achieve. Participants experienced forward momentum in the pillars of Lifestyle Medicine, including sleep, relationships, meaning and purpose in life, exercise, eating well, along with reduced loneliness and burnout. This study found that participants can experience an inherently human-centred connection through text-based communication with an online coach. There were some limits to this connection, including individual preferences and beliefs in relation to the digital means of communication. Participants felt connected to their coach and experienced benefits that extended beyond achieving individual goals to improving their lifestyle and wellbeing.

BACKGROUND: The COVID-19 pandemic exacerbated existing stressors and created additional challenges for healthcare workers, such as increased workload, rapidly changing policies and procedures, resource and workforce shortages and work-life imbalance. This study examined what frontline healthcare workers consider to be the organisational strategies needed to support their mental health and wellbeing during crisis events. METHODS: The Australian COVID-19 Frontline Health Workers Survey, a national, anonymous online survey of HCWs, was conducted between August-October 2020, during the second wave of the Australian COVID-19 outbreak. Drawing on participant responses collected as part of this survey, we analysed thematically the free-text question, ‘What strategies might be helpful to assist frontline healthcare workers during future crisis events like pandemics, disasters, etc.?’ RESULTS: A total of 5527 healthcare workers responded to the free-text question asking about support strategies for future crises. Findings highlighted the challenges experienced by frontline workers during the COVID-19 pandemic and outlined suggestions for organisational strategies to support the mental health of the health workforce long-term. Specifically, four key themes that linked organisational support strategies to organisational culture were identified. These were: Workplace structures to support a mentally healthy work environment; Supportive leadership and management; Strengthening a sense of community to support mental health; and Organisational culture normalising mental health support. CONCLUSIONS: The key message from this research is that organisational strategies that enact a supportive work culture, rather than a focus on individuals alone, are required to protect the mental health of healthcare workers in the future.

BACKGROUND: There is little research providing critical understanding of how healthcare professionals perceive and manage work-related stress. This study aims to understand healthcare workers’ perspectives regarding work-related stress and burnout, strategies and barriers for self-care, and organizational support for self-care and resiliency. METHODS: A qualitative descriptive approach was used. Individual, semi-structured interviews were conducted with healthcare workers from 5 organizations in New York State. Data was analyzed using Braun and Clarke’s Thematic Analysis. RESULTS: Interviews were conducted with 27 healthcare workers from various disciplines. Findings indicated that healthcare workers experienced high levels of stress and burnout, which negatively impacts their mental health, quality of work, relationships with coworkers, and patient care. Many participants expressed an interest in self-care activities, and there were apparent differences among respondents regarding perceived organizational support. Five themes were identified, including: staff shortages, coworker conflict and interactions, strategies to mitigate stress, impacts of work-related stress, and managing stress and burnout in the workplace. CONCLUSION: Workplace stress affects patient care, but workers feel that there is limited support from leadership. It is critical that healthcare organizations and governments prioritize providing support along with other resources to healthcare workers to address burnout and assist with mental health concerns.

Maladaptive responses to stressors are ingrained in our profession, but we can unlearn them and embrace a culture of well-being.

Improving professional wellbeing for all healthcare workers is key to the success of hospitals and healthcare systems. Benefits range from boosting staff morale to ensuring a safe and supportive work environment for both healthcare workers and patients.

To help hospital leaders make meaningful changes to improve professional wellbeing, NIOSH and the Dr. Lorna Breen Heroes’ Foundation designed the Impact Wellbeing Guide: Taking Action to Improve Healthcare Worker Wellbeing. The Guide is designed to help hospital leaders and executives accelerate or supplement professional wellbeing work in their hospitals at the operational level.

This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Organizational Infrastructure for Well-Being).