Resource Library

[This is an excerpt.] Trust is a central aspect of improving health care, and its importance in the health care arena is becoming increasingly recognized. The COVID-19 pandemic, along with renewed calls for racial justice, have highlighted the critical role that trust plays in our interactions in health care and beyond. To be effective, it is crucial that relationships between patients, clinicians, and health care organizations be grounded in trust, as trust impacts key health behaviors and outcomes, such as vaccine acceptance, treatment adherence, and patient satisfaction. However, we have seen and continue to see an erosion of trust as the national discourse around issues of health, policy, science, and information is becoming increasingly polarized. To address the critical and underlying importance of trust in health care, the ABIM Foundationand AcademyHealth are partnering to raise the visibility of trust issues within health care and further the evidence base on building trust. As part of this effort, AcademyHealth conducted a review of research on trust that was in progress or recently completed as of September 15, 2021, using the Health Services Research Projects in Progress (HSRProj) database. Funded by the National Library of Medicine, HSRProj has been a joint effort for many years between AcademyHealth and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. HSRProj contains more than 38,000 archived, recently completed, and ongoing projects funded by more than 370 government agencies and philanthropic foundations. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Empowering Worker & Learner Voice).

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[This is an excerpt.] The Fitzhugh Mullan Institute for Health Workforce Equity defines health equity as a world in which there is a diverse health workforce that has the competencies, opportunities, and courage to ensure everyone has a fair opportunity to attain their full health potential.At least six critically important factors drive health workforce equity, as shown in the figure below. These domains apply to workers across the health care spectrum, including home healthcare, support staff, allied health professionals, public health, physicians, nurses, and many others.This series reviews existing literature on the nature and magnitude of each problem, the impact of this problem on health equity, and the policies and programs that affect it. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation) AND  Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Strengthen Worker Compensation and Benefits).

Internet-delivered cognitive behavioral therapy (ICBT) is effective when tailored to meet the needs of public safety personnel (PSP). Nevertheless, there is limited research on the nature of the occupational stressors faced by PSP who seek ICBT and how PSP use ICBT to address occupational stressors. We provided tailored ICBT to PSP (N = 126; 54% women) and conducted a qualitative content analysis on clinicians’ eligibility screening notes, clients’ emails, and clients’ survey responses to understand the occupational stressors faced by PSP and their use of ICBT to address such stressors. Clients described several occupational stressors, including operational stressors (e.g., potentially psychologically traumatic events and sleep/shiftwork issues) and organizational stressors (e.g., issues with leadership, resources, and workload). More clients shared occupational concerns during the screening process (97%) than during treatment (58%). The most frequently cited occupational stressor was exposure to potentially psychologically traumatic events. Clients reported using course skills (e.g., controlled breathing and graduated exposure) to manage occupational stressors (e.g., responding to calls, workplace conflict, and work–family conflict). Thought challenging was the most frequently reported strategy used to manage occupational stressors. The current results provide insights into the occupational stressors PSP experience and endeavor to manage using ICBT, which can inform further efforts to tailor ICBT for PSP (e.g., adapting course materials and examples to take into account these operational and occupational stressors).

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This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Mental Health & Stress/Trauma Supports)

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[This is an excerpt.] Clinician burnout has become a dominant concern for health systems leaders, policymakers, and clinicians. In a 2022 Advisory,United States Surgeon General Dr. Vivek Murthy sounded the alarm and underscored the urgent need to address the rising levelsof burnout in the health care workforce across the country, laying out recommendations for health care organizations, policymak-ers, researchers, and other stakeholders to address this crisis. The Department of Veterans Affairs (VA), Veterans Health Admin-istration (VHA) has similarly acted to address burnout among VA clinicians, establishing the Task Force to Reduce EmployeeBurnout and Optimize Organizational Thriving (REBOOT) in 2021. The REBOOT Task Force worked with VA researchers toreview the existing evidence on burnout and develop a comprehensive set of recommendations for immediate action. At thesame time, recognizing that there are gaps in the existing evidence overall and within VA settings specifically, the VA HealthServices Research and Development (HSR&D) program launched an effort in collaboration with AcademyHealth, the nationalorganization for health services research and policy, to establish a research agenda to guide future investments in research onthe drivers of burnout as well as effective interventions at all levels to prevent, mitigate and eliminate clinician burnout. With overnine million Veterans enrolled, the VHA is the nation’s largest integrated health care system, and its mission is to honor America’sVeterans by providing exceptional health care that improves their health and well-being. As such, VHA is in a unique position toevaluate solutions and interventions across multiple levels of the organization.

Building upon previously published research and activities, AcademyHealth collaborated with a national advisory committee and a multidisciplinary group of experts and stakeholders from across and outside the VA to generate a set of priority research questions to address clinician burnout. Using an adaptation of The Stanford Model of Professional Fulfillment TM resulted in an agenda that includes research questions related to the design, implementation and evaluation at 1) the national level; 2)individual VA Medical Centers (VAMCs) in three domains: (a) enhancing the efficiency of clinical practice; (b) promoting a culture of wellness; and (c) ensuring institutional support for professional well-being; and 3) improving research and its impact. [To read more, click View Resource.]

A key organizational strategy to improving clinician well-being is to measure it, develop and implement interventions, and then re-measure it. A variety of dimensions of clinician well-being can be measured including burnout, engagement, and professional satisfaction. Below is a summary of established tools to measure work-related dimensions of well-being. Each tool has advantages and disadvantages and some are more appropriate for specific populations or settings. This information is being provided by the Research, Data, and Metrics Working Group of the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience.

This resource is found in our Actionable Strategies for Health Organizations: Measurement & Accountability.

[This is an excerpt.] For decades, the level and growth of US health care spending has diverged from both international and domestic norms, leading many to characterize rising health expenditures as “unsustainable.” Between 1970 and 2019, total US health spending grew from 6.9 percent of gross domestic product (GDP) to 17.7 percent of GDP, according to the Centers for Medicare and Medicaid Services (CMS). In 2020, amid unique strain on the health care system and a dramatic economic downturn due to the COVID-19 pandemic, health spending accounted for nearly one-fifth (19.7 percent) of US GDP. According to prepandemic analysis, health spending was not projected to reach this level until 2028, and it remains to be seen how the pandemic will affect the long-term trajectory of health spending. Meanwhile, the Organization for Economic Cooperation and Development (OECD) estimated that total health spending averaged 8.8 percent of GDP among member countries in 2019 compared with 16.8 percent in the US. In 2019 Health Affairs launched the nonpartisan Council on Health Care Spending and Value to study excessive health spending in the US and recommend strategies to address it. The council, which plans to release its recommendations in early 2023, defines excessive spending as that which both diverges from a norm and is not commensurate with the health it produces. This research brief is one in a series of briefs that provides snapshots of key literature that informed the council’s inquiry into health spending drivers and interventions. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Advance Team-Based Care).

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[This is an excerpt.] You might be asking: why do we need "virtual" nurses when we don't even have enough physical nurses at the bedside? That's exactly why we do need them. Virtual RNs can support the team at the bedside to alleviate the workload and provide greater satisfaction for both the patients and the nursing staff. We are all aware of the current and future staffing challenges in healthcare, and this is one way to address it. It also provides opportunities for nurses that are not wanting to leave the workforce but have years of great experience and knowledge to continue their career in a less physical role. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).

BACKGROUND: The mental health of healthcare professionals is reaching a breaking point, and the COVID-19 pandemic has exacerbated current mental health issues to unprecedented levels. Whilst some research has been carried out on the barriers that doctors face when seeking mental health help, there is little research into factors which may facilitate seeking help. We aimed to expand the research base on factors which act as barriers to seeking help, as well as gain insight into facilitators of help-seeking behaviour for mental health in NHS doctors. METHODS: We conducted a systematic literature review which identified the barriers and facilitators to seeking help for mental health in healthcare professionals. Following this, we conducted semi-structured interviews with 31 NHS doctors about their experiences with mental health services. Finally, through thematic analysis, key themes were synthesised from the data. RESULTS: Our systematic literature review uncovered barriers and facilitators from pre-existing literature, of which the barriers were: preventing actions, self-stigma, perceived stigma, costs of seeking treatment, lack of awareness and availability of support, negative career implications, confidentiality concerns and a lack of time to seek help. Only two facilitators were found in the pre-existing literature, a positive work environment and availability of support services. Our qualitative study uncovered additional barriers and facilitators, of which the identified barriers include: a negative workplace culture, lack of openness, expectations of doctors and generational differences. The facilitators include positive views about mental health, external confidential service, better patient outcomes, protected time, greater awareness and accessibility, open culture and supportive supervisors. CONCLUSION: Our study began by identifying barriers and facilitators to seeking mental health help in healthcare workers, through our systematic literature review. We contributed to these findings by identifying themes in qualitative data.. Our findings are crucial to identify factors preventing NHS doctors from seeking help for their mental health so that more can be done on a national, trust-wide and personal level to overcome these barriers. Likewise, further research into facilitators is key to encourage doctors to reach out and seek help for their mental health.

This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Mental Health).

The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.

[This is an excerpt.] The diversity of the health workforce is critical for health equity. It has implications for access, quality, health equity, and job opportunities in low-income communities. This evidence review focuses specifically on racial/ethnic population groups that have been historically identified as underrepresented in healthcare professions that require higher education. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Promoting Diversity, Equity, & Inclusion.

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This study examined whether and how listening in the internal communication context may influence the quality of employee-organization relationships. This study proposed employee psychological need satisfaction as the potential underlying mechanism that mediates the relationship between internal listening and employee relational outcomes. An online survey was conducted with 443 employees across various industries in the United States. The key findings of this study showed that employee perceptions of internal organizational listening were positively associated with employees’ perceived relationships with their organization. In addition, employee psychological need satisfaction positively mediated the effects of both organizational and supervisory listening on the quality of employee-organization relationships. This study advances the theorizing of listening from an internal communication perspective and contributes to the growing body of knowledge in relationship management.

This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).

OBJECTIVE: This study examined the association between workplace exposure and prescription drug misuse in nurses. BACKGROUND: Studies have found RNs and other health providers have higher rates of prescription misuse than the general population and have suggested that workplace exposures along with excessive job demands create circumstances fostering misuse. METHODS: Survey data from 1170 RNs on workplace exposures (availability, frequency of administration, knowledge of substances, and workplace controls) were described by workplace, position, and specialty. Exposures were then related to prescription drug misuse using logistic regression. RESULTS: Each workplace exposure was associated with past year prescription drug misuse. An index combining all exposures was significantly related to misuse (P = 0.001), and odds of misuse increased by 38% for each point increase in the exposure index. CONCLUSIONS: Consideration of the health and well-being of nurses at higher odds of exposure to prescription drugs with misuse potential is warranted. Workplace support to help nurses maintain and restore their health should be a priority.

[This is an excerpt.] Workplace violence against nurses happens every day. In 2022, the rate of assaults in U.S. hospitals increased by 23%. A recent study of RNs found a significant proportion of nurses who cared for patients with COVID-19 experienced more physical violence and verbal abuse, and had more difficulty in reporting the incidents to management. These statistics attest to the magnitude of this serious problem that nurses face every day. Our Presenter is Lynda Enos RN, MS, COHN-S, CPE. Lynda is an occupational health nurse and certified professional ergonomist with over 30 years of work and consulting experience in industrial and health care ergonomics and safety with over 200 companies nationwide. She holds an undergraduate degree in nursing and a graduate degree in human factors/ergonomics from the University of Idaho. In 2017, she completed a 2-year project for the Oregon Association for Hospitals and Health Systems (OAHHS) that included providing assistance to 5 hospitals in Oregon to evaluate and facilitate development of comprehensive workplace violence prevention (WPV) programs. As a result of this project Lynda developed a comprehensive toolkit for prevention violence in healthcare “Oregon Workplace Safety Initiative Workplace Violence in Healthcare: A Toolkit for Prevention and Management” that was published in December 2017 and extensively updated in March 2020. Lynda has since worked with several state hospital associations to conduct WPV prevention workshops that are based on the Oregon WPV toolkit and are offered to hospitals and other healthcare entities throughout a state either in-person and via webinar. In 2019, Lynda assisted the Oregon State Stabilization and Crisis Unit (SACU) to further develop their WPV prevention program for 23 group homes for adults and children. She is a subject matter expert for several regulatory and research entities including, the American Nurses Association and American National Standards Institute and International Standards Organization, and the Joint Commission. [To view, click View Resource.]

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This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Ensuring Physical & Mental Health).

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[This is an excerpt.] It was a typically busy Wednesday night. We had 22 people in the waiting room, with admitted patients boarding in the emergency department (ED) due to difficulties with bed availability and staffing. At 3:40 a.m. an 80-year-old woman arrived from a skilled nursing facility after staff found her unresponsive. Emergency Medical Services (EMS) discovered her to be pulseless and in asystole, and after 4 rounds of epinephrine in the field, she arrived in room 2 of my ED. As she was a “full code,” I intubated her and initiated resuscitation measures. A bedside echo revealed cardiac standstill and after 2 more rounds of epinephrine, calcium chloride, and bicarbonate infusion, she was pronounced dead. After a moment of silence, I attempted to contact family members, called the medical examiner and the organ bank, and began entering data required by our electronic health record (EHR). [To read more, click View Resource.]

BACKGROUND: The Association of American Medical Colleges has identified the humanities as fundamental to medical education across all specialties. Evidence from undergraduate medical education (UME) demonstrates the humanities' positive impacts on outcomes that could be relevant to patient care and trainee well-being in emergency medicine (EM) residency training. However, less is known about the humanities' role in graduate medical education (GME). OBJECTIVES: The objectives were to describe EM residents' self-reported exposure to the humanities and its relationship with their empathy, tolerance of ambiguity, and patient-centeredness, and to assess their attitudes toward the humanities in GME. METHODS: This cross-sectional survey-based study was conducted at six U.S. EM residency programs in 2018–2019. Quantitative analyses included linear regressions testing for trends between humanities exposures and outcomes, adjusted for sex, year in training, and clustering within programs; adjunct analysis of free-text responses was performed using an exploratory constructivist approach to identify themes about views on the humanities' role in medicine. RESULTS: Response rate was 54.8% (153/279). A total of 65% of respondents were male and 28.1% of respondents had a preceding humanities degree. Preceding humanities degree and current self-reported humanities exposure were positively associated with performance on empathy subscales (p = 0.02). Seventy-five percent (n = 114) of respondents agreed humanities are important in GME; free-text responses revealed perceived positive impacts of humanities on generating well-rounded clinicians and enhancing patient care. CONCLUSIONS: Engagement with the humanities may be associated with empathy among EM residents. Although the magnitude of associations was smaller than that seen in UME, this study demonstrates resident interest in humanities and suggests that extracurricular engagement with the humanities may be insufficient to prolong positive impacts seen in UME. Further research is needed to explore how to sustain these benefits through integration or addition of the humanities in existing GME curricula.

This paper describes the nature of today's corporatized health care system in the United States, offering examples of the psychological toll it takes on clinicians at all levels. It details corporate practices that disenfranchise practitioners from exercising their clinical judgment and from offering input to system administrators about problematic patient care experiences. It discusses the sense of frustration, resignation and moral injury that can permeate their work lives and disrupt their sense of effectiveness and well-being in this context. Following this background is a psychoanalytic analysis of narratives from two physicians about their corporate health care experiences. Two case studies follow, in which a nurse and a physician entered psychoanalytic psychotherapy to process the destructive psychological impact of their work environments. A third case illustrates the negative impact of automatized insurance practices on one psychologist and her patient.

Labor-Management Partnerships, a new system for structuring hospital care, are based on the recognition that hospitals are complex organizations requiring multiple levels of communication and exchange, and on the premise that front-line workers are best able to identify and pose solutions to problems in their units and departments. They are structured to form creative problem-solving teams of managers and staff supported in their work together to improve their hospital within both in individual areas and systemically. Four extensive examples of such teams are provided from two different hospital settings, one public and one not-for-profit. Their work is then assessed through the lens of organizational and group psychoanalytic theories.

OBJECTIVES: Burnout occurs frequently in emergency medicine (EM) residents and has been shown to have a negative impact on patient care. The specific effects of burnout on patient care are less well understood. This study qualitatively explores how burnout may change the way EM residents provide patient care. METHODS: Qualitative data were obtained from a sample of 29 EM residents in four semistructured focus groups across four institutions in the United States in early 2019. Transcripts were coded and organized into major patient care themes. RESULTS: Residents described many ways in which feelings of burnout negatively impacted patient care. These detrimental effects most often fit into one of four main themes: reduced motivation to care for patients, poor communication with patients, difficult interactions with health care colleagues, and impaired decision making. CONCLUSIONS: According to EM residents, burnout negatively impacts several important aspects of patient care. Resident engagement with clinical care, communication with patients and colleagues, and clinical care may suffer as a result of burnout.

PURPOSE: While police culture typically refers to the culture among sworn police personnel, there are internal cultural differences between subgroups. This has been documented among sworn personnel, such as the difference between street cops and management cops (Reuss-Ianni, 1983). The divide between professional and sworn staff in a law enforcement context has also been discussed at length (Maguire, 1997; Reiss, 1992), specifically the “us versus them” mentality that stems from feelings of isolation among professional and sworn staff. The relationship between dispatchers and officers is vital to public and officer safety; it is imperative that cultural barriers preventing effective collaboration between two of the most critical components of policing are identified, and recommendations to bridge the gap are provided. DESIGN/METHODOLOGY/APPROACH: The authors use semi-structured interview data from a sample of peer-nominated top dispatch de-escalators (TDDs) considered highly skilled at de-escalation with callers and officers. Reflexive coding techniques were used to identify key themes in an area largely unexamined by research. FINDINGS: The authors find that the police culture creates friction between sworn officers and dispatchers in a number of contexts. This diminishes organizational commitment and increases burnout and frustration. PRACTICAL IMPLICATIONS: There are several policy recommendations for both communications centers and sworn staff to foster understanding and increase collaboration, all of which may result in improved outcomes for community members, dispatchers and officers. ORIGINALITY/VALUE: The authors use qualitative methods to explore the implications of the sworn-civilian divide for police practice, such as more effective de-escalation and incident resolution, as well as the conceptualization of police culture writ large.

BACKGROUND: The COVID-19 pandemic has led to the rapid expansion of telehealth service delivery. We explored the experiences of a multidisciplinary palliative care team delivering telepalliative care for oncology inpatients during a 10-weeks COVID-19 surge in New York City. METHODS/PARTICIPANTS: We conducted semi-structured qualitative interviews with a targeted sample, employing a phenomenological approach with applied thematic text analysis. An interdisciplinary coding team iteratively coded data using a mix of a priori and inductive codes. Team members first independently reviewed each category, then met to reach consensus on recurring themes. The sample (n = 11) included a chaplain (n = 1), social worker (n = 1), pharmacist (n = 1), physicians (n = 3), physician assistant (n = 1), and nurse practitioners (n = 4). RESULTS: Participants described multidimensional clinician distress as a primary experience in delivering telepalliative care during the COVD-19 surge, characterized by competing loyalties (e.g., institutional obligations, ethical obligations to patients, resentment and distrust of leadership) and feelings of disempowerment (e.g., guilt in providing subpar support, decisional regret, loss of identity as a provider). Participants provided explicit recommendations to improve telepalliative care delivery for acute oncology inpatients in the future. CONCLUSION: Palliative care clinicians experienced personal and professional distress providing inpatient telepalliative care during this COVID-19 surge. Clinician strain providing telehealth services must be explored further as the pandemic and utilization of telehealth evolves. Telepalliative care planning must include attention to clinician wellbeing to sustain the workforce and promote team cohesion, and a focus on infrastructure needed to deliver high-quality, holistic care for oncology patients and their families when in-person consultation is impossible.