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There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we’re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet. Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med’s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms. In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised. This is an essential read for understanding the current state of the health care system in America—and the steps urgently needed to create an environment of better care for all of us.

BACKGROUND: Transplant surgery fellowship is physically and emotionally demanding. The objective of this study was to characterize biophysiological stress and sleep patterns among transplant surgery fellows. METHODS: Participating fellows wore a biophysical monitor over a 28-day period and completed biweekly surveys. Sleep patterns were dichotomized as normal or sleep deprived, and heart rate variability (HRV) was used to assess stress. RESULTS: Seventeen fellows participated. Fellows were frequently sleep deprived (43.9% of nights) and stress was near universal (87.2% of days). Burnout was reported by 2 fellows (11.8%). Only 4 fellows (23.5%) reported compliance with the Transplant Accreditation and Certification Council managed time policy; these fellows experienced fewer days of stress than non-compliant fellows (79.8% vs 89.2% p = 0.02). CONCLUSIONS: This is the first study to quantify sleep deprivation and stress among transplant fellows. Future work is needed to evaluate the effects of sleep deprivation, and stress on burnout and patient outcomes.

This thesis examines the impact of work experiences on empathy among people employed in the law enforcement profession. It is hard to imagine that what law enforcement officers (LEOs) go through would not affect how they relate to the public or handle themselves for career longevity. It is possible that the mere exposure both physically and mentally experienced by LEOs erodes the very empathy needed to navigate such a profession and is not only detrimental to the community they serve but to themselves. Data were collected using a voluntary, anonymous survey which was distributed to LEOs across the United States over an eight-month period. The analysis probes whether empathy is diminished by what a LEO encounters while on-the-job. The results suggest that the regular day to day activities of a LEO do not noticeably reduce empathy as I first thought they would. Upon further review however, certain experiences like the physical stressors associated with police work do predict increased anger, and symptoms of depression and PTSD. Conversely, I found that the more the LEO feels supported by their family, friends, community, and department, the less they experience anger, depression, and PTSD. It should be noted that empathy actually increases if the LEO experiences an injury or illness that affects their job. This was unexpected and may be a starting point to be explored by further studies. Studies involving LEOs are far from new and often follow a more common theme where a LEO feels “burnout.” Unfortunately, there have been few studies that attempt to capture the feeling of empathy in general and even less with its relation to the law enforcement profession. Although the original survey designed for this thesis was very comprehensive, participation was lower than expected. Thus, the results only paint a partial picture of how experiences LEOs encounter on the job affect how they feel. Further research should examine how LEOs’ feelings and experiences might improve positive relations with the community and increase wellness for the LEOs that serve it.

BACKGROUND AND OBJECTIVE: There are high rates of professional burnout among family physicians and trainees. We undertook this study to investigate whether a brief mindfulness intervention could help manage burnout and improve well-being among family physicians in a residency program. METHODS: A total of 21 family physicians participated in a brief, 8-week mindfulness program. We used a single-sample, pre/post design at a Midwestern family medicine residency program. At two points in time (baseline and postintervention), participants completed an online survey measuring burnout, depression, anxiety, stress, perceived resilience, and compassion. We used linear mixed models to estimate the effect of the intervention on the outcome measures. RESULTS: Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on anxiety (P<.004), stress (P<.001), perceived resilience (P<.001), and compassion (P<.001). There were no significant changes on the personal accomplishment, emotional exhaustion, and depersonalization subscales of either the abbreviated Maslach Burnout Inventory or the depression subscale of the Depression Anxiety Stress Scales-21. CONCLUSION: This brief mindfulness program was associated with significant reduction in the scores of anxiety and stress as well as significant improvement in perceived resilience and compassion scores. Brief mindfulness interventions may be a convenient and effective approach to support and improve health and well-being among family physicians.

INTRODUCTION: Bullying behavior in residency is common, with prevalence rates ranging from 10% to 48%. Negative acts adversely impact junior physicians. The aims of this study were to examine (a) gender differences in experiences of bullying and/or negative acts while working as a medical resident, (b) residents’ perceptions of injunctive (ie, approval of) and descriptive (ie, behavior) norms related to reporting bullying behaviors, and (c) whether greater self-other differences predict greater engagement in reporting bullying behavior by others in the workplace.

METHODS: Self-report surveys were administered to family medicine, internal medicine, surgical, and emergency medicine residents (N=61).

RESULTS: Female residents reported experiencing significantly more bullying than males. Overall, resident physicians held inaccurate beliefs, and thought other residents reported bullying more often than they did. Finally, the degree of inaccuracy was associated with reporting bullying behavior.

CONCLUSION: These findings are an initial indication that normative interventions may be applicable with this population. In a field that struggles with high rates of burnout, finding ways to improve the culture of an organization may assist with addressing at least part of these systemic issues.

AIMS: This study aimed to examine the degree and severity of workplace bullying in nurses and to assess the relationship between bullying and work environment factors. BACKGROUND: Workplace bullying occurs in nursing at an alarming rate and may escalate with more adverse working conditions. METHODS: Online survey data from a nationally representative sample of 1,170 U.S. registered nurses, collected between 2020 and 2021, were analysed. Five items measuring workplace bullying were used to identify bullying subgroups (unbullied, bullied but unrecognized, moderate bullying and severe bullying) using latent profile analysis. Ordinal logistic regression examined relationships between workplace factors and bullying. RESULTS: Over 40% of nurses reported being bullied in the past year. Four bullying subgroups were distinguished. Inadequate staffing, lack of time to get the job done and lack of breaks away from the work area were all significantly associated with severe bullying. CONCLUSION: Ensuring adequate staffing based on patient needs and nurse competency can mitigate workplace bullying in nurses. Further studies are needed to examine the effectiveness of stress reduction programmes on bullying using longitudinal designs. IMPLICATIONS FOR NURSING MANAGEMENT: This result indicates a critical need to improve nursing work environments, which could provide many benefits for nursing workforces, including potential to lessen bullying severity that adversely affects nurse well-being.

BACKGROUND: Burnout is a growing problem among health care professionals, with consequences for patient safety and personal satisfaction. The prevalence of burnout among hospital pharmacists in Canada is unknown; however, it has been documented at over 60% in other countries.  OBJECTIVES: To assess the prevalence of burnout and variables associated with burnout among hospital pharmacists in Canada. METHODS: This cross-sectional cohort study was based on a survey made available to more than 2600 Canadian hospital pharmacists from February 10 to April 2, 2020, through the Canadian Society of Hospital Pharmacists QID platform. The questionnaire collected data for the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI-HSSMP), demographic data, employment characteristics, and workplace factors; it also included an open-ended question about burnout. RESULTS: A total of 171 respondents provided data suitable for analysis. Of these, only 13 (7.6%) met the criteria for burnout on all 3 subscales of the burnout inventory; however, 105 respondents (61.4%) surpassed the threshold for burnout on the emotional exhaustion subscale. In univariate analyses, not working to one’s full scope of practice was associated with meeting the criteria for burnout on all 3 scales. Linear regression highlighted associations between scores on the emotional exhaustion subscale and gender identity, perceived excessive on-call duties, area of practice, and positivity of workplace culture. Content analysis of the open-ended question supported the quantitative findings and pointed to 3 major themes: workload quantity, workload quality, and workplace culture.  CONCLUSIONS: Results on the emotional exhaustion subscale of the MBI-HSSMP and responses to the open-ended question suggested a relatively high prevalence of burnout among Canadian hospital pharmacists, and indicated potential links between burnout and certain workplace characteristics.

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).

Rates of burnout among clinicians have been exacerbated by the COVID-19 (COVID)pandemic. A survey of Missouri primary care professionals at federally qualified health centers was conducted during a COVID surge in August 2021 to assess burnout, stress, and job satisfaction as well as if respondents had sought assistance for burnout or attended resiliency training. Despite respondents reporting rates of burnout (56%) that exceed those reported nationally (48%), only 17% sought help for burnout. Most (81%) had not attended resiliency training; of those who did, 16% said sessions “make me feel less alone,” while an equivalent number found sessions not useful, identifying an absence of resources within their organization. Comments focused on the need for dedicated time to receive support, including time to seek assistance during working hours, time to take breaks, and time for self-care. The data suggest one path forward to remediate burnout: provide the workforce with time to access support.

OUTCOMES:
1. Understand the components of the Maslach Burnout Inventory and use it to describe the severity of burnout among oncology infusion room nurses
2. Evaluate the effects of a nurse-led primary palliative care intervention on burnout among oncology nurses and identify potential influencing factors

IMPORTANCE: Palliative care clinicians display less burnout than oncology clinicians, but little is known about the impact of providing oncology care and primary palliative care in the same setting.

OBJECTIVE(S): We hypothesized that nurses providing primary palliative care in addition to oncology care would experience less burnout over time compared to nurses providing oncology care only.

METHOD(S): Secondary analysis of a cluster randomized trial of an oncology nurse-led primary palliative care intervention (CONNECT). Three groups of nurses were evaluated: nurses at intervention clinics who provided palliative care in addition to oncology care, nurses at intervention clinics who did not provide palliative care, and nurses at standard care sites. Upon study enrollment and 1 year following, nurses completed the Maslach Burnout Inventory (subscales: emotional exhaustion [EE; range 0-54, higher scores indicating more burnout], depersonalization [DP; range 0-40, higher scores indicating more burnout], and personal accomplishment [PA; range 0-48, lower scores indicating more burnout]). Multivariable regression analyses were performed to test differences in follow-up burnout scores between nurse groups.

RESULTS: Overall burnout rates were low at enrollment for all groups (EE 17.0 ± 12.0, DP 2.6 ± 3.5, PA 41.7 ± 5.2). Nurses who provided palliative care did not report lower burnout scores than nurses in the other two groups at 1 year. Nurses at intervention sites who did not provide palliative care reported greater emotional exhaustion than nurses at standard care sites (adjusted mean difference=6.85; 95% CI, 0.92 to 12.79; p=0.02).

CONCLUSION(S): Providing primary palliative care in addition to oncology care does not appear to impact burnout among oncology infusion room nurses. Impact: As oncology practice evolves to encompass primary palliative care, delivery models must be constructed in ways that safeguard clinician well-being.

Burnout is a state of emotional, physical, and mental exhaustion often caused by excessive and prolonged stress. Given the emotionally and often physically demanding nature of the work of correctional professionals, they are at substantial risk of suffering the adverse consequences of burnout. We systematically reviewed (Stage 1) the influence of burnout amongst forensic psychologists, psychiatrists, case workers, nurses, and correction officers. Interventions were then reviewed (Stage 2) at the individual and collective level to examine the effectiveness or efficacy of treatments for burnout among professionals working in corrections.

BACKGROUND: Burnout is a syndrome of emotional exhaustion and depersonalization that reduces efficiency at work. No studies have been reported focusing only on residency burnout and risk factors from our country until now. This study aimed to find out the impact and the association of specific demographic and practice characteristics with burnout among resident doctors. METHODS: A prospective cross-sectional survey of all resident doctors under training at that point of time in 2019 in the National Academy of Medical Sciences, Nepal in different specialties was done. We evaluated demographic variables, practice characteristics, and assessed burnout through validated Maslach burnout inventory (MBI) tools, and data were analyzed. RESULTS: A total 347 among 410 resident doctors (227 male) responded to the survey. Median age was 30 years (range 25-44). Overall, 147 (42.4%) of responding residents were burned out with high emotional exhaustion in 58 (16.6%), high depersonalization in 55 (15.9%), and low personal achievement in 34 (9.8). In regression analysis, out of independent variables gender, marital status, having children, specialty, hours of work per week and year of residency, specialties (general surgery odds ratio [OR]; 12.595, confidence interval [CI],[ 1.037-152.9], P; 0.047), obstetrics, and gynecology (odds ratio [OR]; 13.977, confidence interval [CI]; [1.324-147.5], P; 0.028), and anesthesiology (odds ratio [OR]; 11.54, confidence interval [CI]; [1.014-131.4], P; 0.049)) and hours of work per week (?80 h) (odds ratio [OR]; 2.511, confidence interval [CI]; [1.128-5.589], P; 0.024), were significantly associated with high burnout. CONCLUSIONS: Burnout is common among trainee resident doctors which is possibly preventable. Thus, the concern should be to prepare strategies to identify and minimize burnout from the individual, institutional, and societal sides. It is essential to preserve and promote the mental health of trainee residents to prevent serious consequences in the personal lives of resident doctors and as well as on patient outcomes.

BACKGROUND: Respiratory therapists (RTs) faced many unpredicted challenges and higher stress levels while managing critically ill patients with the coronavirus disease (COVID-19). This study's primary objective was to evaluate the compassion satisfaction and compassion fatigue among RTs in the United States during the COVID-19 pandemic. METHODS: This cross-sectional, descriptive, survey-based study conducted from July 2020 to August 2020 was administered to all active members of the American Association of Respiratory Care via AARConnect. RTs' characteristics including personal, job-specific, and organizational factors were collected. Professional Quality of Life Scale (ProQOL, version 5) was used to measure compassion satisfaction and fatigue. RESULTS: A total of 218 participants fully completed the survey, 143 (65.6%) were female, 107 (49.1%) were between 35 and 54 years of age and 72 (33%) were above 55 years of age. Compassion satisfaction was moderate in 123 (56.4%) and high in 93 (42.7%) RTs. Higher compassion satisfaction was found in RTs who have a higher salary (P = 0.003), work overtime (P = 0.01), hold leadership positions (P < 0.001), work in research/education (P < 0.001) and work for departments that provide help in managing burnout and stress (P = 0.007) and that promote a positive work environment (P < 0.001). Burnout score was low in 90 (41.3%) and moderate in 127 (58.3%) RTs. Higher burnout was found among younger RTs (P = 0.019), those with fewer years of experience (P = 0.013) and those with less than a year at their current job (P = 0.045). Secondary traumatic stress (STS) was low in 106 (48.6%) and moderate in 112 (51.4%) RTs. Higher STS levels were noted among younger RTs (P = 0.02) and RTs with lower education levels (P = 0.016). CONCLUSION: This survey study identified various personal, job and organizational related factors associated with increased compassion satisfaction as well as compassion fatigue among RTs.

BACKGROUND: Burnout is an occupational hazard in medicine and affects more than one-quarter of US cardiologists and fellows in training. The absence of burnout does not indicate well-being; however, along the continuum of clinician well-being, burnout is one of the more severe negative components. Clinician well-being is an imperative component of health care and can be broadly defined as experiencing wellness (optimized physical and mental health), resiliency, and professional fulfillment. Burnout is not the result of an individual’s weakness but is due to work-related stresses, including excessive workload, moral injury, and cognitive dissonance. Strategies must be developed both to address burnout and to improve and sustain clinician well-being. Similar to the concept of cardiovascular disease prevention, secondary prevention is accomplished with tactics directed to prevent recurrent burnout; however, targeted investment in primordial and primary prevention is also crucial to mitigate burnout and to cultivate esprit de corps. PURPOSE: To assess burnout syndrome prevalence amongst cardiology fellows and internal medicine residents in tertiary cardiac centres. METHODS: This is a multicenter cross-sectional study conducted in three major cardiac tertiary hospitals. The Maslach Burnout Inventory - Human Services Survey for Medical Personnel (MBI-HSS (MP)) with its three elements of Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA), was used to assess burnout in cardiology fellows and internal medicine (IM) residents rotating in cardiology in three tertiary cardiac centres from March to June 2021. Questionnaires were entered online using Google docs application and then analyzed using SPSS (Version 25). RESULTS: Of 47 respondents, 66% were IM residents, while 34% were cardiology fellows. The mean age was 31.53(+/- 3.694) years. High burnout scores in the three elements of the questionnaire, namely EE, DP, and PA, were recorded in 23.4%, 61.7%,46.8% of the respondents, respectively. Burnout was recorded in 10.6% of the participants. No significant correlation was seen between high burnout scores and gender, marital status, study location, or whether the respondent was a fellow or IM resident. CONCLUSION: Prevalence of burnout is high in our study population, especially in the sphere of emotional exhaustion and depersonalization, and was not related to marital status, gender, hospital location, or level of training.

BACKGROUND: Consequences of physician burnout include medical errors, higher rate of staff turnover, and decreased patient satisfaction. We examined the prevalence of burnout and identified the contributing factors in gastroenterologists and fellows in training. METHODS: We performed 3 separate surveys through the American College of Gastroenterology. (1) A national survey of practicing gastroenterologists in the United States that measured burnout and contributing factors, (2) a survey of gastroenterology fellows in training to determine self-identified burnout, as well as mitigating and exacerbating factors, and (3) a follow-up survey of fellows during the COVID-19 pandemic. RESULTS: One thousand and twenty-one persons responded (9.2% response rate) to the first survey, including 756 individuals who completed the Maslach Burnout Inventory survey. Overall, the prevalence of high burnout was 49.3%. Factors associated with high burnout included female sex, younger age, shorter duration in practice, considering the electronic health record non-user-friendly, 2 or more hours of patient-related work at home per day, 8 or more hours of outpatient time per day, 6 or more inpatient consults per day, taking call with procedures 10 or more times per year, and having children at home. With regard to lifestyle factors, taking 20 days or more of vacation time was associated with a lower rate of burnout. The level of burnout for fellows was observed to be high (42.7% in survey 2 and 35.3% in survey 3). CONCLUSIONS: Burnout is high in gastroenterologists and fellows in training. Specific contributing factors were both systems based and personal and provide insight into changes that can be made to address burnout.

INTRODUCTION: The influence of burnout, academic engagement, and their interaction in dropout intention among medical students should be further studied. Current research shows its consequences are relevant, however, there is little understanding on burnout and academic engagement moderation in dropout intention. The current study tested a model that relates the effects of coping strategies, social support satisfaction, general distress on academic engagement, burnout, and dropout intention, on medical students. METHODS: Through an online survey a non-probabilistic sample of one Medical Faculty’s 1st- and 2nd-year students was recruited. Cross-sectional data were collected using psychometric instruments (Maslach Burnout Inventory – Student Survey, Social Support Satisfaction Scale for College Students, Brief COPE Scale for College Students, University Student Engagement Inventory, and Depression, Anxiety and Stress Scale), sociodemographic and academic variables, and analyzed using structural equation modeling. RESULTS: 532 students (76% response rate) enrolled in the study. Latent variables structural model presented a satisfactory fit to the data and confirmed the expected negative path between burnout and dropout intention (βDI<-SB=0.430; p<.001) and the latent moderation burnout x engagement (βDI<-SB*SE=-0.218; p<.001). CONCLUSION: Academic engagement attenuates the impact of burnout on dropout intention, working as a protective factor. Social support satisfaction and adaptive coping are associated with increased levels of academic engagement, and general distress and maladaptive coping are associated with burnout. Medical Schools should develop interventions to prevent dropout intention, tackle students’ stress and academic challenges, and develop their academic engagement levels.

Previous research has found higher rates of burnout among mental health professionals (MHPs) working in correctional settings and among those treating sex offenders, but it is not clear whether the setting or the client type is associated with greater burnout. Burnout has been linked with decreased empathy among healthcare providers, but this relationship has not been explored in MHPs. The present study explored differences in burnout and empathy among 219 MHPs working in correctional or community settings and among those primarily treating sex offenders versus other types of clients in the United States. Those working in correctional settings had higher levels of burnout than those working in community settings, but no differences in burnout were found for those treating sex offenders versus other types of clients, regardless of setting. No differences in empathy were found across the four groups, but self-reported empathy was inversely associated with levels of burnout. This research suggests that correctional settings may be more likely to result in burnout as compared to working with offender populations more generally. Implications for training professionals who desire to work in correctional settings are discussed. Interventions for preventing and reducing burnout are also discussed.

IMPORTANCE: The perspectives of gay, lesbian, bisexual (sexual minority [SM]) students about their medical school learning environment and how they relate to burnout is poorly understood. OBJECTIVE: To understand SM medical students’ perceptions of the medical school learning environment and how this is associated with reported burnout. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included medical students graduating from Association of American Medical Colleges (AAMC)–accredited allopathic US medical schools in 2016 and 2017 and responding to the AAMC Graduation Questionnaire. Data analysis was conducted from June 2021 to March 2022. EXPOSURES: Sexual orientation, based on self-identification, and categorized as bisexual, gay or lesbian, or heterosexual or straight. MAIN OUTCOMES AND MEASURES: Primary outcomes included burnout as measured by Oldenburg Burnout Inventory for Medical Students (OLBI-MS; two 24-point scales [range, 0-48], with higher scores indicating greater burnout) and student perceptions of the medical school learning environment (0-5–point scales for emotional climate [range, 0-20] and student-faculty interactions [range, 0-15], with higher scores indicating more positive perceptions). Logistic regression was used to model the association between burnout, SM status, and learning environment while controlling for demographic characteristics. RESULTS: A total of 25 757 respondents (12 527 [48.6%] women; 5347 [20.8%] Asian; 2255 [8.8%] underrepresented in medicine; 15 651 [60.8%] White; 10 726 [41.6%] aged ≤26 years) were included in the analysis: 568 (2.2%) self-identified as bisexual, 854 (3.3%) as gay or lesbian, and 24 335 (94.5%) as heterosexual or straight. Both bisexual students and gay or lesbian students reported less favorable perceptions of their learning environments than heterosexual students (mean [SD] emotional climate score, bisexual students: 8.56 [3.29]; gay or lesbian students: 9.22 [3.33]; heterosexual or straight students: 9.71 [3.20]; P < .001; mean [SD] faculty-student interaction score, bisexual students: 13.46 [3.69]; gay or lesbian students: 14.07 [3.45]; heterosexual or straight students: 14.32 [3.37]; P < .001). Bisexual and gay or lesbian students were more likely to be in the top quartile for burnout scores (bisexual: odds ratio [OR], 1.71; 95% CI, 1.42-2.07; P < .001; gay or lesbian: OR, 1.53; 95% CI, 1.31-1.79; P < .001). This association was attenuated when accounting for student perceptions of the learning environment (bisexual: OR, 1.37; 95% CI, 1.11-1.67; P < .001; gay or lesbian: OR, 1.42; 95% CI, 1.19-1.68; P < .001), with poorer perceptions of the medical school learning environment associated with higher burnout symptoms. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, SM students had less favorable perceptions of the medical school learning environment compared with heterosexual students. Results suggest the medical school environment may be associated with higher rates of burnout in SM students. Future research should explore interventions to improve the learning environment for SM students.

OBJECTIVE: The primary objective was to assess presence of community-based pharmacist practitioner burnout and workplace stress through administration of validated tools. METHODS: Pharmacists licensed in Ohio received an invitation to participate in the anonymous online assessment via Qualtrics™ using emails available via the State Board of Pharmacy listserv. The survey assessed emotional exhaustion, depersonalization, and personal accomplishment using a validated tool, the Maslach Burnout Inventory (MBI). The Areas of Worklife Survey (AWS) was used to assess stressors as they relate to burnout and job stress. This study was approved by The Ohio State University Institutional Review Board. RESULTS: There were 1,425 complete responses. Based on the study sample, 67.2% of community-based pharmacists are experiencing burnout. When asked to self-identify workplace stressors, respondents primarily described the Workload, Control, and Reward dimensions of the AWS. The most commonly reported coping mechanisms were self-care strategies (28.4%), mindfulness (17.6%), and personal time/time off (15.3%). Respondents suggested that organizations address staffing (50.2%) and development of a culture of well-being (17.2%) to promote well-being. CONCLUSION: This study allowed insight into workplace stressors for community-based pharmacists and strategies organizations can employ to improve their well-being. Future studies are needed to assess the efficacy of these interventions.

Recent research has explored computational tools to manage workplace stress via personal sensing, a measurement paradigm in which behavioral data streams are collected from technologies including smartphones, wearables, and personal computers. As these tools develop, they invite inquiry into how they can be appropriately implemented towards improving workers' well-being. In this study, we explored this proposition through formative interviews followed by a design provocation centered around measuring burnout in a U.S. resident physician program. Residents and their supervising attending physicians were presented with medium-fidelity mockups of a dashboard providing behavioral data on residents' sleep, activity and time working; self-reported data on residents' levels of burnout; and a free text box where residents could further contextualize their well-being. Our findings uncover tensions around how best to measure workplace well-being, who within a workplace is accountable for worker stress, and how the introduction of such tools remakes the boundaries of appropriate information flows between worker and workplace. We conclude by charting future work confronting these tensions, to ensure personal sensing is leveraged to truly improve worker well-being.

BACKGROUND: Recently, there has been increasing evidence that reducing burnout in healthcare providers requires significant organizational efforts that include the integration of leadership strategies. METHODS: Focus groups were conducted across four health systems within the University of Colorado Department of Medicine in four affinity groups (administrative staff, medical trainees, research faculty, and clinical faculty). Authentic leadership theory was used for analysis to advance the understanding of the role of leadership style upon participants’ work experiences and preferences, and to identify opportunities for translation of site-specific results to other academic medical settings. RESULTS: Study participants from each affinity group believed their clinical leaders lacked objectivity with decision-making (lacking “balancing processing”), which contributed to their overall feeling of powerlessness. The experience of increasing work demands was salient throughout all twelve focus groups, and participants identified leadership that interacted in a more open and self-disclosing manner (“relational transparency”) as alleviating at least some of this burden. Strong preference discernable alignment between their leaders’ decision-making and their internal moral compass of values (demonstrating “internalized moral perspective”) was described, as was clinical leaders demonstrating “self-awareness” (having a self-reflective process that informs the leader’s decision-making). Comparing affinity group experiences within each authentic leadership theory construct identified the relevance of contextual factors, such as work setting and roles, upon employees’ perceptions and expectations of their leaders. CONCLUSIONS: Use of authentic leadership theory advanced the understanding of the association between leadership traits and experiences of burnout amongst a large group of academic clinicians, researchers, trainees, and administrative staff. Leadership styles that promoted relationship transparency, openness, and support were preferred and fostering these traits may help address the demands in academic medicine, including symptoms of burnout.