Resource Library

[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.]

‍

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

‍

[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: Trainees in graduate medical education are affected by burnout at disproportionate rates. Trainees experience tremendous growth in clinical skills and reasoning, however little time is dedicated to metacognition to process their experiences or deliberate identity formation to create individualized definitions of success and wellbeing. The purpose of this study was to understand the perspectives and experiences of trainees who participated in a 6-month, web-based, group coaching program for women residents in training. METHODS: Better Together Physician Coaching is a six-month, self-paced, online, asynchronous, coaching program with multiple components including live coaching calls, unlimited written coaching, and self-study modules. Semi-structured interviews of seventeen participants of Better Together from twelve GME programs within a single institution in Colorado were conducted from May to June of 2021. All identified as women and had participated in a 6-month coaching program. Both inductive and deductive methods were used in collecting and analyzing the data with an aim to understand learners’ perceptions of the coaching program, including “how and why” the coaching program affected training experiences and wellbeing. RESULTS: Three main themes emerged as benefits to the coaching program from the data: 1) practicing metacognition as a tool for healthy coping 2) building a sense of community, and 3) the value of a customizable experience. CONCLUSIONS: Female trainees who participated in a group coaching program expressed that they found value in learning how to cope with stressors through metacognition-focused coaching. They also described that building a community and being able to customize the experience were positive aspects of the program.

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).

BACKGROUND: Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE: To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN: A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS: Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH: Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS: Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS: More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.

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.

‍

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.]

‍

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

‍

‍

Highlights
• Burnout impacts 50-55% of emergency department nurses; nurse burnout cultural impacts in this setting are under-explored.
• This ethnography revealed an explanatory model of nurse burnout impacts, “The Pathway of Burnout”.
• Cultural clash was identified between pervasive nurse burnout culture and a culture of patient safety.

[This is an excerpt.] Member Boards showed their support for the new Standards for Continuing Certification (Standards) following their approval by the American Board of Medical Specialties (ABMS) Board of Directors during its October meeting, with many issuing statements explaining the new Standards, their implications for board certified physicians, and how changes made or those underway are already in alignment with the new Standards. Some boards had already started making substantial changes to their continuing certification programs following the release of the recommendations made by the Continuing Board Certification: Vision for the Future Commission, which met through 2018 to provide strategic guidance to the ABMS Board of Directors and Member Boards. A few of them predate the recommendations. These programmatic changes reflect the Commission recommendations and the new Standards whose release represents the culmination of three years of development and consultation with myriad stakeholders from across the health care spectrum. As an example, the new Standards reinforce the transition to innovative assessment programs that support and direct physician learning. [To read more, click View Resource.]

‍

This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Operational Strategies (Workloads and Workflows).

‍

BACKGROUND: Academic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region. METHODS: A systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the "Advancing Healthcare Transformation: a New Era for Academic Nursing Report" and the Pan American Health Organization "Strategic Directions for Nursing." RESULTS: A total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed. CONCLUSIONS: ASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.

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

[This is an excerpt.] Addressing clinician well-being has reached a new level of urgency during the COVID-19 pandemic. Record numbers of clinicians are experiencing moral distress from critical resource shortages, emotional distress from delivering care to profoundly ill patients while being socially isolated, and role stress from the loss of child care or other supports. These stressors have been compounded by the deaths of Breonna Taylor, George Floyd, and others, heightening awareness of long-standing, unaddressed structural racism that impacts both clinicians and patients.Work culture heavily influences clinician well-being, and changes that improve organizational work culture and create seamless workflows have been successfully implemented to reduce burnout and increase well-being. Similar arguments can and must be made for health care organizations to adopt antiracist practices that result in sustained meaningful change, because for too many clinicians, racism is a defining component of work culture. [To read more, click View Resource.]

Discrimination towards individuals with disabilities is problematic within nursing. There have been calls to increase diversity in nursing and this includes embracing nurses with disabilities. Increasing diversity in nursing requires increasing diversity among nursing students; in this way, nurse educators are gatekeepers to the profession. Clinical education is a crucial element of nursing education, yet there have been very few studies related to the clinical education of nursing students with disabilities. There have been no studies of attitudes of acute care nurse preceptors toward students with disabilities in the United States. This gap is important as the majority of clinical experiences occur in the acute care environment. Utilizing a focused ethnography, semi-structured interviews were conducted with 20 acute care nurses with at least two years’ experience precepting students. While positive feelings about nursing students with disabilities were shared, thoughts and behavioral intentions remained negative. Six themes emerged: safety, barriers, otherness, communicating to meet needs, disclosure, and student versus colleague. Attitudinal barriers are the primary barriers faced by individuals with disabilities in becoming and practicing as nurses. Nurses in practice and education must embrace more inclusive attitudes towards individuals with disabilities.

BACKGROUND: A variety of stressors throughout medical education have contributed to a burnout epidemic at both the undergraduate medical education (UGME) and postgraduate medical education (PGME) levels. In response, UGME and PGME programs have recently begun to explore resilience-based interventions. As these interventions are in their infancy, little is known about their efficacy in promoting trainee resilience. This systematic review aims to synthesize the available research evidence on the efficacy of resilience curricula in UGME and PGME. METHODS: We performed a comprehensive search of the literature using MEDLINE, EMBASE, PsycINFO, Educational Resources Information Centre (ERIC), and Education Source from their inception to June 2020. Studies reporting the effect of resilience curricula in UGME and PGME settings were included. A qualitative analysis of the available studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the ROBINS-I Tool. RESULTS: Twenty-one studies met the inclusion criteria. Thirteen were single-arm studies, 6 quasi-experiments, and 2 RCTs. Thirty-eight percent (8/21; n = 598) were implemented in UGME, while 62 % (13/21, n = 778) were in PGME. There was significant heterogeneity in the duration, delivery, and curricular topics and only two studies implemented the same training model. Similarly, there was considerable variation in curricula outcome measures, with the majority reporting modest improvement in resilience, while three studies reported worsening of resilience upon completion of training. Overall assessment of risk of bias was moderate and only few curricula were previously validated by other research groups. CONCLUSIONS: Findings suggest that resilience curricula may be of benefit to medical trainees. Resilience training is an emerging area of medical education that merits further investigation. Additional research is needed to construct optimal methods to foster resilience in medical education.

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

[This is an excerpt.] Demographic and policy trends in the United States have combined to create unprecedented demand for home-based, long-term care services for the elderly, with expected growth for decades to come. Home care workers like home health and personal care aides provide most of the care for the increasing elderly population, many of whom have chronic and complex medical and social needs and prefer to age at home. Despite the critical role of those providing this care,home care workers are undervalued, underpaid, and rarely acknowledged as members of client health care teams. This undervaluation contributes to low job satisfaction and high home care worker turnover and attrition, which may negatively affect clients’ health and employers’ bottom lines. As a result, advocates argue that opportunities for skill and career advancement for homecare workers can improve their job quality, satisfaction, and livelihoods while also contributing to positive downstream outcomes for clients, employers, and even health systems. This report, Advancing the Home Care Workforce: A Review of Program Approaches, Evidence,and the Challenges of Widespread Adoption, was commissioned by the Ralph C. Wilson, Jr.Foundation with an objective to examine program approaches to advance the roles of home care workers with a deeper dive into some of the contextual factors that may impact uptake specifically in in Western New York and Southeast Michigan due to the Foundation’s geographic focus in these two regions. Findings emerged from a literature review and interviews with content experts representing a range of stakeholder groups. [To read more, click View Resource.]

‍

This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Career Supports and Development)

‍

[This is an excerpt.] The field of occupational therapy utilizes a variety of frameworks and models to inform the occupational therapy (OT) process for assessment and goal development, and to provide intervention and guidelines for practitioners. This document applies the Occupational Adaptation (OA) model to address diversity, equity, and inclusion within the field of occupational therapy. The model provides a method to identify areas of need and supports the growth of our students, practitioners, and those in academia. The purpose of this framework is to provide a tool for increasing awareness of the diverse needs of individuals in our professional communities and to provide inclusive occupational therapy practice for all. The occupational adaptational model provides the framework for exploring our own needs as we press for mastery as an occupational therapy practitioner, a student, a fieldwork educator, or a faculty member. This framework guides individuals through understanding their own perspectives as occupational therapy practitioners, fieldwork students, fieldwork educators, or faculty in occupational therapy education. As we press for practice from a perspective of cultural humility, we must recognize the implicit and explicit biases that impact our interactions.The framework also allows understanding the perspective of others and considering the influence of environment and contexts on providing inclusive occupational therapy services. [To read more, click View Resource.]

‍

This resource is found in our Actionable Strategies for Professional Associations: Spotlights: Professional Associations Relational Strategies (Improving Diversity, Equity, & Inclusion).

‍