More than half of U.S. physicians have experienced burnout, and burnout remains one of the key issues facing health care systems today. This is largely due to practice inefficiencies (e.g., system inefficiencies, administrative burdens, workplace chaos, and reporting requirements) and organizational culture (e.g., lack of connectedness, reduced control, diminished meaning in work, lack of trust). Reducing burnout can have a positive impact on your organization’s professional satisfaction, financial well-being, and workflow efficiency and is essential to high-quality patient care.
Organizational Well-Being Assessment
Maintaining a healthy and productive health and care workforce is not only a moral imperative – it is essential to delivering safe, high-quality, patient-centered care to populations worldwide. Yet the COVID-19 pandemic has shown that our health systems are not providing adequate support for the mental health of our health and care workers. This is resulting in a growing workforce crisis that also threatens the delivery of care to entire populations. This report looks at how policymakers can address the crisis and seize the moment to redesign how health is delivered, for the benefit of all communities. The report is presented in two main sections to examine: 1) the burden of COVID-19 on the mental health of health and care workers; and 2) interventions to support the mental health of health and care workers. The final section presents recommended policy actions.
Our Duty of Care: A Global Call to Action to Protect the Mental Health of Health and Care Workers
Researchers find that workplace safety and public health policies, along with paid leave policies that cover all workers, could help reduce the spread of COVID and protect workers from missed wages.
Out Sick Without Pay
This study evaluated a practice redesign to improve access into a specialty practice. The secondary goal was to improve financial performance, while avoiding an increase in physician burnout. Historical demand was utilized to calculate capacity. Next, data-driven schedules were developed for this practice. We also transitioned schedules from five 8-hour to four 10-hour workdays. Access was improved for news (100% increase), consultations (16% increase), and procedures (70% increase). Gross revenue increased by 10.62% and physician burnout reduced by 25%. This project offers insights into improving the efficiency of a resource-constrained practice, while improving financial performance and reducing burnout.
Outcomes of a Data-Driven Physician Practice Redesign
BACKGROUND: Medical scribes have been widely employed as documentation assistants in emergency departments (EDs) and outpatient clinics to increase productivity and clinician satisfaction. Little data exists on the utilization of scribes in the field of hospital medicine. METHODS: We attempted to address a demand-capacity mismatch by pairing a medical scribe with a hospitalist physician performing serial admissions during a 12-hour shift. Performance of the clinician was measured by total encounters, documentation completeness, and Decision to Admit to First Order time. Return on investment (ROI) was calculated by comparing incremental revenue from additional admissions seen prior to midnight, improved documentation, and removal of additional admitting hours provided by a nurse practitioner, with incremental scribe cost. Clinician satisfaction surveys were administered before and after the pilot. RESULTS: Data collected over a 6-week period demonstrated improved clinician satisfaction, increased productivity, and a ROI. The participating clinicians reported more work capacity, less time spent on documentation, and more job satisfaction. The average number of admission encounters seen per shift increased by 37%. The average number of admission encounters seen before midnight increased by 88%. The Decision to Admit to First Order time fell by 23%. The total ROI was calculated at approximately 322%. CONCLUSIONS: Pairing a medical scribe with an admitting hospitalist physician led to increased clinician satisfaction, decreased burnout symptoms, and improved productivity. The financial value was demonstrated by a generous ROI. This study suggests that the pairing of a medical scribe with an admitting hospitalist physician can add significantly more value than expense. © 2022 The authors.
Pairing a Medical Scribe with a Hospitalist Physician Improved Clinician Satisfaction, Increased Productivity and Provided a Return on Investment
OBJECTIVES: Moral distress is associated with adverse outcomes contributing to health-care professionals’ worsened mental and physical well-being. Medical social workers have been frontline care providers throughout the COVID-19 pandemic, and those specializing in palliative and hospice care have been particularly affected by the overwhelming numbers of those seriously ill and dying. The main objectives of this study were (1) to assess palliative and hospice social workers’ experiences of moral distress during COVID-19 and (2) to identify and describe participants’ most morally distressing scenarios. METHODS: Using a mixed-methods approach, participants completed an online survey consisting of the Moral Distress Thermometer (MDT) and open-ended text responses. RESULTS: A total of 120 social work participants responded to the study, and the majority of participants (81.4%) had experienced moral distress with an average MDT score of 6.16. COVID-19 restrictions emerged as the main source of moral distress, and an overlap between the clinical and system levels was observed. Primary sources of moral distress were grounded in strict visitation policies and system-level standards that impacted best practices and personal obligations in navigating both work responsibilities and safety. SIGNIFIGANCE: In the first year of the COVID-19 pandemic, palliative and hospice social work participants indicated high levels of moral distress. Qualitative findings from this study promote awareness of the kinds of distressing situations palliative and hospice social workers may experience. This knowledge can have education, practice, and policy implications and supports the need for research to explore this aspect of professional social work.
Palliative and Hospice Social Workers’ Moral Distress During the COVID-19 Pandemic
Police officers, firefighters, and paramedics are on the front lines of crises and emergencies, placing them at high risk of COVID-19 infection. A deeper understanding of the challenges facing first responders during the COVID-19 pandemic is necessary to better support this important workforce. We conducted semi-structured interviews with 21 first responders during the COVID-19 pandemic, asking about the impact of COVID-19. Data collected from our study interviews revealed that, despite large numbers of COVID-19 infections among the staff of police and fire departments, some—but not all—first responders were concerned about COVID-19. A similar divide existed within this group regarding whether or not to receive a COVID-19 vaccination. Many first responders reported frustration over COVID-19 information because of inconsistencies across sources, misinformation on social media, and the impact of politics. In addition, first responders described increased stress due to the COVID-19 pandemic caused by factors such as the fear of COVID exposure during emergency responses, concerns about infecting family members, and frustration surrounding new work policies. Our findings provide insight into the impact of COVID-19 on first responders and highlight the importance of providing resources for education about COVID-19 risks and vaccination, as well as for addressing first responders’ mental health and well-being.
Pandemic Experience of First Responders: Fear, Frustration, and Stress
OBJECTIVES: To characterize the experience and impact of pandemic-related workplace violence in the form of harassment and threats against public health officials. METHODS: We used a mixed methods approach, combining media content and a national survey of local health departments (LHDs) in the United States, to identify harassment against public health officials from March 2020 to January 2021. We compared media-portrayed experiences, survey-reported experiences, and publicly reported position departures. RESULTS: At least 1499 harassment experiences were identified by LHD survey respondents, representing 57% of responding departments. We also identified 222 position departures by public health officials nationally, 36% alongside reports of harassment. Public health officials described experiencing structural and political undermining of their professional duties, marginalization of their expertise, social villainization, and disillusionment. Many affected leaders remain in their positions. CONCLUSIONS: Interventions to reduce undermining, ostracizing, and intimidating acts against health officials are needed for a sustainable public health system. We recommend training leaders to respond to political conflict, improving colleague support networks, providing trauma-informed worker support, investing in long-term public health staffing and infrastructure, and establishing workplace violence reporting systems and legal protections.
Pandemic-Related Workplace Violence and Its Impact on Public Health Officials, March 2020‒January 2021
BACKGROUND: Patient and health care worker safety is an interconnected phenomenon. To date, few studies have examined the relationship between patient and worker safety, specifically with respect to work safety culture. Therefore, we examined patient safety culture, workplace violence (WPV), and burnout in health care workers to identify whether patient safety culture factors influence worker burnout and WPV. METHODS: This cross-sectional study used secondary survey data sent to approximately 7,100 health care workers at a large academic medical center in the United States. Instruments included the Hospital Survey on Patient Safety Culture, a WPV scale measuring physical and verbal violence perpetrated by patients or visitors, and the Emotional Exhaustion scale from the Maslach Burnout Inventory. FINDINGS: These analyses included 3,312 (47%) hospital staff who directly interacted with patients. Over half of nurse (62%), physician (53%), and allied health professional respondents (52%) reported experiencing verbal violence from a patient, and 39% of nurses and 14% of physicians reported experiencing physical violence from a patient. Burnout levels for nurses (2.67 ± 1.02) and physicians (2.65 ± 0.93) were higher than the overall average for all staff (2.61 ± 1.0). Higher levels of worker-reported patient safety culture were associated with lower odds of WPV (0.47) and lower burnout scores among workers (B = -1.02). Teamwork across units, handoffs, and transitions were dimensions of patient safety culture that also influenced WPV and burnout. CONCLUSIONS/APPLICATION TO PRACTICE: Our findings suggest that improvements in hospital strategies aimed at patient safety culture, including team cohesion with handoffs and transitions, could positively influence a reduction in WPV and burnout among health care workers.
Patient Safety Culture: The Impact on Workplace Violence and Health Worker Burnout
Psychological safety is the concept that an individual feels comfortable asking questions, voicing ideas or concerns, and taking risks without undue fear of humiliation or criticism. In health care, psychological safety is associated with improved patient safety outcomes, increased clinician engagement, and greater creativity. A culture of psychological safety is imperative for physician well-being and satisfaction, which in turn directly affect delivery of care. For health care professionals, psychological safety creates an environment conducive to trust and openness, enabling the team to focus on high-quality care. In contrast, unprofessional behavior reduces psychological safety and threatens the culture of the organization. This patient safety/quality improvement primer considers the barriers and facilitators to psychological safety in health care; outlines principles for creating a psychologically safe environment; and presents strategies for managing conflict, microaggressions, and lapses in professionalism. Individuals and organizations share the responsibility of promoting psychological safety through proactive policies, conflict management, interventions for microaggressions, and cultivation of emotional intelligence.
Patient Safety/Quality Improvement Primer, Part IV: Psychological Safety—Drivers to Outcomes and Well-being
Patient satisfaction (PS) surveying has become a commonly used measure of physician performance, but little is known about the impact on pediatricians. To investigate our hypothesis that PS surveys negatively impact pediatricians, we conducted a survey at an academic children's medical center. Of 155 eligible physicians, 115 responded (response rate 74%). Two-thirds (68%) did not find the PS score report useful and 88% did not feel that PS scores accurately reflect the physician's clinical ability. A third reported ordering tests, medications, or consultations due to pressure for higher PS scores. In addition, one-third agreed that PS surveys contribute to burnout and make it difficult to practice meaningful medicine. Overall, PS score reporting has a negative impact on pediatricians, especially those who are female, BIPOC (Black, Indigenous, and People of color), subspecialists, younger, and attended non-US medical schools. Further investigation into improved methods for providing feedback to pediatric physicians is warranted.
Patient Satisfaction Scores Impact Pediatrician Practice Patterns, Job Satisfaction, and Burnout
[This is an excerpt.] Physicians are typically formally addressed as “Doctor” by patients, acknowledging the physician-patient relationship, signifying respect for physicians, and following established social norms. In a previous survey of 333 physicians, almost three-quarters of respondents reported being called by their first (given) name, with annoyance reported in 61%.1 A recent study revealed that having “DOCTOR” identification badge labels were associated with female physicians and physicians underrepresented in medicine experiencing substantially fewer episodes of bias from misidentification.2 Here, we aim to determine factors that are associated with whether patients addressed physicians differently through electronic messaging. [To read more, click View Resource.]
Patient Use of Physicians’ First (Given) Name in Direct Patient Electronic Messaging
INTRODUCTION: Patient satisfaction and experience are important measures of overall quality of care. In 2017, the National Association of Community Health Centers (NACHC) launched an initiative to facilitate changes across organizational systems within Federally Qualified Health Centers (FQHCs) with the goal of improving value-driven care. METHODS: NACHC worked with eight health centers, four in Georgia and four in Iowa, along with their state Primary Care Associations, to apply the Value Transformation Framework (VTF). This framework distills evidence-based practices into practical knowledge for goal-driven systems change. It provides actionable steps to help health centers reach value-driven goals of improved health outcomes, improved patient and staff experience, reduced costs, and improved equity (referred to as the Quintuple Aim goals). This paper reports on the patient and staff experience when applying VTF systems changes to improve colorectal cancer screening rates. RESULTS: Patient and staff satisfaction and experience remained highly rated even after extensive organizational changes were implemented as part of this project. Implementation of a systems-approach to organizational change, through application of the VTF, did not negatively impact patient or staff experiences. CONCLUSION: Patient and staff satisfaction and experience were positive despite the application of the VTF and systems-wide organizational changes. These experience results were alongside improved cancer screening rates, as observed from full project results. Investigators are encouraged that the application of systems change using the VTF may result in the achievement of Quintuple Aim goals without disrupting the experience of patients and staff. Investigators recommend continued exploration of this transformation approach.
Patient and Staff Satisfaction and Experience While Transforming Health Center Systems
BACKGROUND: Clinical effectiveness of video consultations in the mental health services is comparable with in-person consultations. Acceptance has typically been rated in surveys that do not give a deeper understanding behind the phenomenon. The aim of this synthesis is to explore mental health patients’ perceptions of factors that influence their acceptance of video consultations viewed from the perspective of the patient. METHODS: A literature search in scientific databases was conducted. Peer-reviewed reports of qualitative research exploring patients’ experiences with video consultations from the patients’ perspectives were included. Then a meta-summary and a taxonomic analysis were conducted. RESULTS: A total of 11 reports met the inclusion criteria. Through the analysis, a model was generated with five factors that precede each other and interact with each other. Patients thought video consultations were acceptable when (1) they experienced barriers and inconvenience to accessing the location of services, (2) they had already established a trustful relationship with their therapist, (3) technical interferences were minor and problems were resolved quickly, (4) patients expected a less personal meeting, and (5) the degree of the patients’ issues were less complex. DISCUSSION: This model is intended to help clinicians identify circumstances where offering video consultations make best sense to patients and help sustain meaningful use prospectively. When patients encounter barriers to in-person services, clinicians should consider offering video consultations when the technology is adequately integrated in practice, and it is perceived not to intervene with treatment or the therapeutic process.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Using Technology to Improve Workflows)
Patients’ Acceptance of Video Consultations in the Mental Health Services: A Systematic Review and Synthesis of Qualitative Research
BACKGROUND: Moral injury has primarily been studied in combat veterans but might also affect healthcare workers (HCWs) due to the COVID-19 pandemic. OBJECTIVE: To compare patterns of potential moral injury (PMI) between post-9/11 military combat veterans and healthcare workers (HCWs) surveyed during the COVID-19 pandemic. DESIGN: Cross-sectional surveys of veterans (2015–2019) and HCWs (2020–2021) in the USA. PARTICIPANTS: 618 military veterans who were deployed to a combat zone after September 11, 2001, and 2099 HCWs working in healthcare during the COVID-19 pandemic. MAIN MEASURES: Other-induced PMI (disturbed by others’ immoral acts) and self-induced PMI (disturbed by having violated own morals) were the primary outcomes. Sociodemographic variables, combat/COVID-19 experience, depression, quality of life, and burnout were measured as correlates. KEY RESULTS: 46.1% of post-9/11 veterans and 50.7% of HCWs endorsed other-induced PMI, whereas 24.1% of post-9/11 veterans and 18.2% of HCWs endorsed self-induced PMI. Different types of PMI were significantly associated with gender, race, enlisted vs. officer status, and post-battle traumatic experiences among veterans and with age, race, working in a high COVID-19–risk setting, and reported COVID-19 exposure among HCWs. Endorsing either type of PMI was associated with significantly higher depressive symptoms and worse quality of life in both samples and higher burnout among HCWs. CONCLUSIONS: The potential for moral injury is relatively high among combat veterans and COVID-19 HCWs, with deleterious consequences for mental health and burnout. Demographic characteristics suggestive of less social empowerment may increase risk for moral injury. Longitudinal research among COVID-19 HCWs is needed. Moral injury prevention and intervention efforts for HCWs may benefit from consulting models used with veterans.
Patterns of Potential Moral Injury in Post-9/11 Combat Veterans and COVID-19 Healthcare Workers
The healthcare workers, mostly in emergency departments, are exposed to emotionally strong situations that can lead to psychological trauma. Often those who experience the "second victim" phenomenon find comfort in dealing with Peers that can help to understand emotions and normalize lived experiences. A scoping review was conducted to clarify the key concepts available in the literature and understand Peer Support characteristics and methods of implementation. Methods. Scoping review J.B.I. approach was used. The reviewers analyzed the last twenty-one years of literature and extracted data from relevant studies. Results. The research revealed 49 articles that discuss Peer Support in the healthcare system. Often articles involve healthcare workers without work area and role distinctions. 56% of the articles have been published in the last two years and the Anglo-Saxon countries are the main geographical area of ??origin (82%). Peer support emerges as a preclinical psychological support for people involved in tiring situations. It's based on mutual respect and on voluntary and not prejudicial help. Peers are trained to guide the support relationship and identify the signs of possible pathologies. Peer Support can be proposed as one to one/group peer support, or through online platforms. Conclusion. It can be said that Peer Support programs had an important development in the years of the Covid 19 pandemic. Many of the studies affirm that the personnel involved have benefited from the programs available. It is necessary to carry out further research to determine the pre and post intervention benefits.
Peer Support Between Healthcare Workers in Hospital and Out-of-Hospital Settings: A Scoping Review
In August 2012 the White House issued a Presidential Executive Order to address mental health challenges. Following that order, an interagency task force was formed and co-chaired by the U.S. Department of Defense, U.S. Department of Veterans Affairs, and U.S. Department of Health and Human Services. The administration outlined three cross-agency priority goals focused on reducing barriers to mental health care; enhancing access for service members, veterans, and their families with mental health needs; and supporting research on effective treatments. The agencies have each implemented one or more public awareness campaigns. Achievement of these goals requires high-functioning health care providers who are able to respond to the mental health needs of their patients. Prior research suggests that provider burnout, stress, and mental health conditions such as post-traumatic stress, depression, and anxiety can hinder provider and team functioning. The project described here focused on the evidence for peer-to-peer interventions for health care providers to determine whether these intervention have beneficial impacts on workforce outcomes. The findings will be of interest to health care systems, policymakers, and practitioners wishing to add peer-to-peer interventions to their efforts and/or to improve mental health of health care practitioners. None of the authors has any conflict of interest to declare. The research reported here was completed in July 2021 and underwent security review with the sponsor and the Defense Office of Prepublication and Security Review before public release.
Peer-to-Peer Support Interventions for Health Care Providers: A Series of Literature Reviews
It's crucial to understand the perspective of nurses during the pandemic to determine actionable steps for moving forward. This analysis looks at nurses' perceptions of their organizations' effectiveness during the first surge of the COVID-19 pandemic and its impact on moral injury and moral resilience.
This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Acknowledge/Address Moral Distress & Moral Injury).
Perceived Organizational Effectiveness, Moral Injury, and Moral Resilience Among Nurses During the COVID-19 Pandemic: Secondary analysis
It's crucial to understand the perspective of nurses during the pandemic to determine actionable steps for moving forward. This analysis looks at nurses' perceptions of their organizations' effectiveness during the first surge of the COVID-19 pandemic and its impact on moral injury and moral resilience.
Perceived Organizational Effectiveness, Moral Injury, and Moral Resilience among Nurses During the COVID-19 Pandemic: Secondary Analysis
We use data from a health center serving primarily low-income patients to examine medical providers’ output responses to a change from a salary-based compensation plan to one that rewards providers for seeing more patients each month. Providers working for piece rates produce 18 percent more patient encounters, but only a small portion of this increase was due to individual responses to the incentives. The remainder resulted from changes in workforce composition and from providers’ strategic choices about when to join the piece-rate plan. The small incentive effect is consistent with experimental evidence that effort is less sensitive to financial incentives when individuals work for an organization whose mission is aligned with their values.
