Police officers are continuously involved in various roles that prove to be highly stressful and require a developed skill set. Consequently, demands from this career put officers at an increased risk for a range of mental-health related concerns. Although officers who suffer from these mental health concerns may need to seek psychological services, there is, unfortunately, a stigma that surrounds mental health causing officers to be reluctant to seek help. This research examines public perceptions and attitudes toward law enforcement professionals seeking mental health treatment. Findings suggest that when a higher level of self-stigma toward mental health is reported, there is also a higher level of stigma toward law enforcement. Males also showed higher levels of stigma toward officers. Implications of the findings and limitations of the study are discussed.
This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Operational Breakdown)
Stigmatizing Attitudes Toward Police Officers Seeking Psychological Services
[This is an excerpt.] Similar to physical stress, psychological stress can cause injury to the mind and body. These injuries go beyond burnout: a stress injury is any severe and persistent distress or loss of ability to function caused by damage to the brain, mind, or spirit after exposure to the overwhelming stressors of fatigue (burnout), trauma, loss, or moral injury. In particular, there is a significant risk of moral injury in high-stress, service-oriented professions where valued qualities such as selflessness, loyalty, a strong moral code, and excellence can also create vulnerabilities, such as prioritizing the needs of others above one's own needs. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Stress/Trauma & Resilience) AND Actionable Strategies for Workers & Learners: What Workers & Learners Can Do
Stress First Aid for Health Care Professionals: Recognize and Respond Early to Stress Injuries
The COVID-19 pandemic has dramatically altered the 2020 residency application cycle and resulted in many changes to the usual application processes. Particular attention should be placed on the obstacles faced by applicants who are underrepresented in medicine (URiM) as they may be disproportionately affected by the changes in 2020. These challenges are especially relevant in competitive surgical specialties, where racial and gender diversity already lags behind other medical specialties. Inclusive excellence is a guiding philosophy in creating equitable resident selection processes. It focuses on the multilayered processes that form the foundation of inclusive institutional culture, while recognizing that excellence and inclusivity are mutually reinforcing and not mutually exclusive. A key tenant in inclusive excellence for resident recruiting involves applying an equity lens in all decision making. An equity lens allows programs to continuously evaluate resident selection policies and processes through an intentional equity-forward approach. In addition to using an equity lens, programs should emphasize the importance of equity-focused skill building, which ensures that all individuals engaged in the resident selection process have the tools and knowledge to recognize biases. Finally, institutions should implement specific programming for URiM applicants to provide them with information about key aspects of department culture and mechanisms of support for URiM trainees. Every residency program should adopt a sustained perspective of inclusive excellence, in this application cycle and beyond. The status quo has existed for far too long, and COVID-19 offers institutions and their residency programs a unique opportunity to try new and innovative equity-forward practices.
Striving for Inclusive Excellence in the Recruitment of Diverse Surgical Residents During COVID-19
Clinical workflow represents the instantiation of all clinical activities. The transition from paper to electronic health records (EHRs) over the past decade has been characterized by profound challenges supporting clinical workflow, impeding frontline clinician ability to deliver safe, efficient, and effective care. In response, there has been substantial effort to study clinical workflow as well as workarounds – exceptions to routine workflow – in order to identify opportunities for improvement. In this paper, we describe predominant methods of studying workflow and workarounds as well as provide examples of the applications of these methods along with the resulting insights. We also present challenges to studying workflow and workarounds, along with recommendations for how to approach such studies. While there is not yet a set of standard approaches, our work helps advance workflow research that ultimately serves to inform how to coevolve the design of EHR systems and organizational decisions about processes, roles, and responsibilities in order to support clinical workflow that more consistently delivers on the potential benefits of a digitized healthcare system.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
Studying Workflow and Workarounds in EHR-Supported Work to Improve Health System Performance
OBJECTIVE: To evaluate the prevalence of suicidal ideation (SI) and attitudes regarding help seeking among US physicians relative to the general US working population. PARTICIPANTS AND METHODS: A secondary analysis of a cross-sectional survey of US physicians and a probability-based sample of the US working population was conducted between October 12, 2017, and March 15, 2018. Among 30,456 invited physicians, 5197 (17.1%) completed the primary survey. Suicidal ideation in the last year, attitudes regarding help seeking, symptoms of depression, and burnout were assessed by standardized questions. RESULTS: Among the 4833 physicians who responded regarding SI, 316 (6.5%) reported having suicidal thoughts in the last 12 months. Most physicians (3527 [72.9%]) reported that they would seek professional help if they had a serious emotional problem. Physicians with SI were less likely to report that they would seek help (203/316 [64.2%]) than physicians without SI (3318/4517 [73.5%]; P¼.001). On multivariable analysis, symptoms of depression (odds ratio [OR], 4.42; 95% CI, 1.89 to 11.52), emotional exhaustion (OR, 1.07 each 1-point increase; 95% CI, 1.03 to 1.11), and selfvaluation (OR, 0.84 each 1-point increase; 95% CI, 0.70 to 0.99) were associated with SI. Among individuals aged 29 to 65 years, physicians were more likely than workers in other fields to report SI (7.1% vs 4.3%; P<.001), a finding that persisted on multivariable analysis. CONCLUSION: In this national study conducted before the COVID-19 pandemic, 1 in 15 US physicians had thoughts of taking their own life in the last year, which exceeded the prevalence of SI among US workers in other fields.
Suicidal Ideation and Attitudes Regarding Help Seeking in US Physicians Relative to the US Working Population
The COVID-19 pandemic has taken a heavy toll on health care workers. At the onset of the pandemic, there was a limited understanding of the unique experiences of minoritized and marginalized physicians* during this national health crisis. This was concerning because of the anecdotal and media reports documenting that Black, Indigenous and other physicians of color, LGBTQ+ physicians, and physicians with disabilities experienced unique negative experiences and undue burden during this public health crisis. Early in the epidemic it became clear that Black, American Indian and Indigenous, Latino/Latina/Latinx† and Hispanic and Pacific Islander communities, as well as historically marginalized and medically vulnerable populations, were disproportionately affected by COVID-19. Minoritized and marginalized physicians are more likely to serve other marginalized patients, practice primary care, and serve in medically marginalized areas.1,2 They therefore often bear a larger portion of the toll of this pandemic, compared to their counterparts. This study aims to center the unique experiences of these physicians and to explore the specific ways that the epidemic impacted them more negatively than their non-minoritized nonmarginalized counterparts. Understanding these unique experiences is essential to making the field of medicine more inclusive and aware of the unique tolls these physicians face. Various factors have historically contributed to the increased burden and negative experiences of minoritized and marginalized physicians. This study focused specifically on discrimination and burnout, as these factors have emerged as areas of necessary attention over the course of the pandemic, specifically as they relate to direct experiences of discrimination, mental health and well-being, physician practice sustainability, and availability of and access to telehealth services. Themes that emerged from the survey responses demonstrate that the COVID-19 pandemic has exacerbated existing health inequities in the U.S.; Black physicians were negatively impacted by the epidemic in various ways; physician burnout remains a primary concern for all physicians regardless of race; and the increase in telehealth use, although accompanied by challenges, has been a positive development of the pandemic. These and other compelling findings are described in further detail in this report.
Summary Report: Experiences of Race and Ethnic Minoritized and Marginalized Physicians in the U.S. During the COVID-19 Pandemic
Organizational factors impacting burnout have been underexplored among providers in low-income, minority-serving, safety-net settings. Our team interviewed 14 health care administrators, serving as key decision makers in Federally Qualified Health Center primary care clinics. Using a semistructured interview guide, we explored burnout mitigation strategies and elements of organizational culture and practice. Transcribed interviews were coded and analyzed using the Braun and Clark (2006) Thematic Analysis method. Mission-Driven Ethos to Mitigate Provider Burnout emerged as the primary theme with 2 categories: (1) Promoting the Mission: "Bleeders" and (2) Competing Priorities: "Billers." These categories represent various properties and reflect administrators' use of organizational mission statement as a driver of staff recruitment, training, retention, and stratification. Data collection occurred before and during the COVID-19 global pandemic, as such additional themes associated with administrative behaviors during a prolonged, clinical crisis provide insight into possible strategies that may mitigate burnout in this setting.
This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Invest/Advocate for Patients, Communities, & Workers).
Supporting "Bleeders" and "Billers": How Safety-Net Administrators Mitigate Provider Burnout During the COVID-19 Pandemic and Beyond
Essential workers, including the health workforce, were under increased stress and mental health risks in addition to infection risk during the COVID-19 pandemic.Aggravated levels of psychological distress ought to be recognised as a public health priority, and solutions are needed to address the consequences so that the potential current mental health conditions do not become disabilities. Therefore, the Expert Panel on effective ways of investing in health (EXPH) was requested by the European Commission to provide an opinion on supporting the mental health of the health workforce and of other essential workers.
The Opinion identifies the specific factors influencing the mental health of the health workforce and of other essential workers. It describes the evidence on effective and/or promising interventions, and provides evidence on cost-effectiveness, where available.Due consideration was given to providing for the needs of those with pre-existing mental health issues. The characteristics of those interventions are described, elaborating on the necessary preconditions to ensure the efficient delivery of these interventions in an effective, cost-effective, affordable and inclusive manner, across settings and jurisdictions. On the basis of this evidence, recommendations and action points were developed, emphasising the importance of involving both EU and national policy makers alike, raising awareness and engaging senior managers in sectors with a high share of essential workers, and, potentiating the role of mental health and occupational health practitioners in supporting the mental health of workers.
Mental health, defined as lack of mental illness and high levels of mental wellbeing, is influenced by a complex interplay of determinants. At work, occupation-specific determinants of mental health interact with non-occupational-specific characteristics. A conceptual framework was developed to represent the state of mental health,determinants / factors, and possible mental health trajectories over time in the face of a given stressor. The conceptual framework illustrates the potential impact of primary,secondary and tertiary prevention interventions occurring at different levels. These include: the health and social/community care sectors, workplace-level interventions(such as occupational health programmes and managerial-level changes), and economic/social policy measures. Mental health of essential workers can therefore be supported by interventions enacted within and outside of the health sector at primary,secondary, and tertiary prevention levels. Interventions in multiple settings at various levels can work synergistically to address a wide range of risk factors and potentiate awide range of protective factors. The Swiss cheese model of accident causation is a helpful heuristic to illustrate this synergy. This model demonstrates the need for multiple interventions targeting multiple risk and protective factors occurring at multiple levels to ensure that all individuals benefit from them and no one individual is left behind. It suggests the priorities of different levels of interventions, from large scale interventions supporting the largest share of essential workers, to the interventions targeting organisational and team characteristics, job characteristics and lastly targeting modifiable individual characteristics. Specifically, post-traumatic stress disorder, burnout and moral injury are associated with working in stressful conditions, and could be anticipated and prevented in the workplace, or addressed when present.
Based on available evidence and identified limitations, gaps and challenges, eight recommendations with several action points are developed: change focus to mental wellbeing; treat mental wellbeing as an inherent part of the workplace and its organisation; create a supportive environment at EU-level; create an appropriate cost-effectiveness methodology; build and share knowledge on interventions; have a common EU-wide view of mental health care; prepare organisations and their leaders to address mental wellbeing of workers; and provide timely and adequate access to care when preventive efforts are not effective.
This resource is found in our Actionable Strategies for Government: Ensuring Workers' Physical and Mental Health (Support Workers' and Learners' Mental Health & Well-Being).
Supporting Mental Health of Health Workforce and Other Essential Workers: Opinion of the Expert Panel on Effective Ways of Investing in Health (EXPH)
[This is an excerpt.] Increases in mental health conditions have been documented among the general population and health care workers since the start of the COVID-19 pandemic (1–3). Public health workers might be at similar risk for negative mental health consequences because of the prolonged demand for responding to the pandemic and for implementing an unprecedented vaccination campaign. The extent of mental health conditions among public health workers during the COVID-19 pandemic, however, is uncertain. A 2014 survey estimated that there were nearly 250,000 state and local public health workers in the United States (4). To evaluate mental health conditions among these workers, a nonprobability–based online survey was conducted during March 29–April 16, 2021, to assess symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), and suicidal ideation among public health workers in state, tribal, local, and territorial public health departments. Among 26,174 respondents, 52.8% reported symptoms of at least one mental health condition in the preceding 2 weeks, including depression (30.8%), anxiety (30.3%), PTSD (36.8%), or suicidal ideation (8.4%). The highest prevalence of symptoms of a mental health condition was among respondents aged ≤29 years (range = 13.6%–47.4%) and transgender or nonbinary persons (i.e., those who identified as neither male nor female) of all ages (range = 30.4%–65.5%). Public health workers who reported being unable to take time off from work were more likely to report adverse mental health symptoms. Severity of symptoms increased with increasing weekly work hours and percentage of work time dedicated to COVID-19 response activities. Implementing prevention and control practices that eliminate, reduce, and manage factors that cause or contribute to public health workers’ poor mental health might improve mental health outcomes during emergencies. [To read more, click View Resource.]
Symptoms of Depression, Anxiety, Post-Traumatic Stress Disorder, and Suicidal Ideation Among State, Tribal, Local, and Territorial Public Health Workers During the COVID-19 Pandemic — United States, March–April 2021
In the midst of the Spring 2020 initial surge of the COVID-19 pandemic in New York, members of the Psychiatry Department of Weill Cornell Medicine/NewYork-Presbyterian Hospital rapidly created and implemented a brief, behavioral skills-based intervention program, “CopeNYP”, to address the immediate mental health needs of the employees of the hospital and medical school. We describe the development, implementation and evolution of this telehealth-delivered program staffed primarily by in-house clinical psychologists, postdoctoral fellows, pre-doctoral interns and counselors who were redeployed or volunteered their time to provide urgent support for employees. We discuss the challenges and lessons learned in providing brief, skills-based psychological interventions for employees subjected to chronic stress. As the impact of the pandemic became prolonged, employees faced compounding stressors including social isolation, fear of infection, grief and loss, and sequelae of COVID-19-related illness combined with work-related demands. Our goal is to present our program design, implementation, and utilization as a blueprint for other institutions that would like to develop an evidence-based clinician-staffed psychological intervention program to support ongoing employee mental health needs.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Mental Health).
The CopeNYP Program: A Model for Brief Treatment of Psychological Distress Among Healthcare Workers and Hospital Staff
[This is an excerpt.] This report explores the race, ethnicity, gender, language, and disability makeup of Oregon’s licensed health care professionals compared with that of the state. Across the country, health access and outcomes remain inequitable by race/ethnicity, gender, disability, language and other characteristics.1 For instance, life expectancy, infant mortality and preterm birth rates, as well as prevalence of obesity and hypertension all differ by race and ethnicity. Additionally, there are differences in access to care between racial and ethnic groups. People of color are less likely to have insurance coverage and receive needed dental care. Individuals with physical disabilities or cognitive limitations have higher prevalence of chronic conditions compared with individuals with no disabilities,2 and patients with limited English proficiency are more likely to experience adverse events in six US hospitals (including higher levels of physical harm) compared with patients who speak English.3 The COVID-19 pandemic had a disproportionate impact on communities of color,tribal communities, and other historically underrepresented communities, and many historical inequities widened during that time. Evidence suggests that greater diversity in the health care workforce advances cultural competency and increases access to high-quality health care.4,5 Accordingly, increasing the proportion of underrepresented US racial and ethnic groups among health care professionals in the workforce may improve quality of care. Given these health inequities, it is important to foster a workforce that is culturally and linguisticallyrepresentative of the communities it serves. This report aims to examine the current makeup of the workforce inOregon and the extent to which it is representative of Oregon’s population. [To read more, click View Resource.]
The Diversity of Oregon’s Licensed Health Care Workforce
AIM: Aim of this study is to systematically review and synthesize available evidence to identify the association between nurse staffing methodologies and nurse and patient outcomes. DESIGN: Systematic review and narrative synthesis. Data sources: A search of MEDLINE (EBSCO), CINAHL (EBSCO) and Web of Science was conducted for studies published in English between January 2000 and January 2020. REVIEW METHODS: The reporting of this review and narrative synthesis was guided by the preferred reporting items for systematic and meta-analysis guidelines (PRISMA) statement and data synthesis guided by the Synthesis Without Meta-analysis (SWiM) guideline. The quality of each article was assessed using the Mixed Methods Appraisal Tool. RESULTS: Twenty-two studies met the inclusion criteria. Twenty-one used the mandated minimum nurse-to-patient ratio methodology and one study assessed the number of nurse hours per patient day staffing methodology. Both methodologies were mandated. All studies that reported on nurse outcomes demonstrated an improvement associated with the implementation of mandated minimum nurse-to-patient ratio, but findings related to patient outcomes were inconclusive. CONCLUSIONS: Evidence on the impact of specific nurse staffing methodologies and patient and nurse outcomes remains highly limited. Future studies that examine the impact of specific staffing methodologies on outcomes are required to inform this fundamental area of management and practice.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
The Impact of Nurse Staffing Methodologies on Nurse and Patient Outcomes: A Systematic Review
Despite many studies on police stress, there is little research on interventions to promote their well-being. Moreover, most studies of police stress have been predominately on male samples, with female police officers often being neglected. On this premise, the purpose of the present study was to develop and determine the efficacy of resilience training program by evaluating its impact on occupational stress, resilience, job satisfaction, and psychological well-being. Two hundred and fifty female police officers from the Southern part of India were recruited for the study. The study adopted a pre-post-follow-up research design. Resilience training with components such as self-awareness, positive attitude, emotional management, and interpersonal skills were developed uniquely for this study, based on protective model of resilience. Sixty-three female police officers, who fulfilled the criteria, were randomly assigned into two groups namely, experimental (n = 33) and control group (n = 30). Resilience training was given to the experimental group thrice a week for nearly 2 months, and control group was not given any training. Data were collected at three time periods, i.e., before training, a week after training, and 2 months after training. The statistical analysis, using repeated measures analysis of variance (RMANOVA) was carried out. The results revealed that resilience training was effective in enhancing resilience, job satisfaction, and psychological well-being of female police officers and in reducing occupational stress. Medium effect sizes were reported. The qualitative feedback was positive regarding the resilience training program, supporting the empirical evidence for the effectiveness of resilience training program. The study had implications for theory and practice in police research.
This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Mental Health & Stress/Trauma Supports)
The Impact of Resilience Training on Occupational Stress, Resilience, Job Satisfaction, and Psychological Well-being of Female Police Officers
BACKGROUND: During the COVID-19 pandemic, numerous concerns about the nursing workforce have been reported. This study used data from two surveys conducted in California to assess the current and future supply and demand of RNs and to learn how the coronavirus pandemic is affecting this essential workforce. METHODS: Preliminary data from the 2020 Survey of California Registered Nurses and final data from the 2019-20 Annual Schools Survey were analyzed. These surveys provided data that were used to produce a preliminary update to the forecasts of RN supply and demand in California. The supply projections are based on a stock-and-flow modeland the demand projections are based on historic RN employment and rates of hospital utilization by population age group. RESULTS: The preliminary data from the 2020 Survey of Registered Nurses indicate that many older RNs have left nursing,and a large number intend to retire or quit within the next two years. At the same time, unemployment among younger RNs increased and there were (small) decreases in new enrollments in RN education programs during the 2019-20 and 2020-21 academic years. Together, these changes have led to a reduction in the supply of RNs compared with previous projections. A shortage of RNs is estimated to exist in 2021. RN education enrollments are projected to surpass pre-pandemic levels during the 2022-23 academic year, which will lead to a closing of the shortage by 2026. DISCUSSION: With a shortage of RNs likely underway now, employers need to redouble their efforts to retain RNs and develop career paths for newly-graduated RNs. They also need to rapidly develop and implement strategies to mitigate the potential harm of shortages over the next five years.
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).
The Impact of the COVID-19 Pandemic on California’s Registered Nurse Workforce: Preliminary Data
BACKGROUND: While burnout is not a new concept, combating it is becoming an increasingly important focus for organizations across all industries. Recently, the World Health Organization recognized burnout as an “occupational phenomenon” (WHO, 2019), and it was included in the 11th Revision of the International Classification of Diseases, where it is defined as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” The University of Texas MD Anderson Cancer Center addresses burnout at the institutional level in support of all 22,000 workforce members. One avenue of this work focuses on mentoring. Mentorship, both formal and informal, has demonstrated positive effects to include empirical investigations that demonstrate its benefit in reducing risk of burnout in multiple settings for a variety of audiences (Qian et al., 2014; Thomas & Lankau, 2009; van Emmerik, 2004; Varghese at al., 2020). Although mentoring is not as flashy as other interventions, what the last year has shown is that people need human connection now more than ever. METHODS: In order to investigate the relationship between burnout and mentoring in our organization, we analyzed responses to our biennial voluntary employee survey, in which all employees were asked whether they are involved in a mentoring relationship and completed a single-item burnout scale. We analyzed the survey data using a chi-square test and found that employees participating in mentoring relationships were less likely to report burnout than employees who are not participating in a mentoring relationship, χ2 (1, 14,486) = 17.431, p < 0.005. The same pattern held for all types of employees; faculty, classified staff, leaders, clinical employees, and non-clinical employees, indicating that the experience of mentorship may be universal regardless of role, rank, and type of work. We suspect that the benefits of mentoring are bi-directional for mentors and mentees, though this should be investigated directly.Both formal and informal types of mentoring programs exist within MD Anderson to support retention, professional fulfillment, and reduce burnout. All employees have access to a centralized online mentoring platform to find a mentor. Formal mentoring support is also provided through various programs developed for specific professional cohorts, including physicians, advanced practice providers, and registered nurses. In addition, informal mentoring support is offered in the form of employee volunteer wellness champions. Together, these formal and informal mentoring programs have positively influenced burnout across the organization.
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Career Supports and Development)
The Positive Impact of Mentoring on Burnout: Organizational Research and Best Practice Interventions for Cancer Hospital Employees
INTRODUCTION: Psychological safety is the shared belief that the team is safe for interpersonal risk taking. Its presence improves innovation and error prevention. This evidence synthesis had 3 objectives: explore the current literature regarding psychological safety, identify methods used in its assessment and investigate for evidence of consequences of a psychologically safe environment. METHODS: We searched multiple trial registries through December 2018. All studies addressing psychological safety within healthcare workers were included and reviewed for methodological limitations. A thematic analysis approach explored the presence of psychological safety. Content analysis was utilised to evaluate potential consequences. RESULTS: We included 62 papers from 19 countries. The thematic analysis demonstrated high and low levels of psychological safety both at the individual level in study participants and across the studies themselves. There was heterogeneity in responses across all studies, limiting generalisable conclusions about the overall presence of psychological safety. A wide range of methods were used. Twenty-five used qualitative methodology, predominantly semi-structured interviews. Thirty quantitative or mixed method studies used surveys. Ten studies inferred that low psychological safety negatively impacted patient safety. Nine demonstrated a significant relationship between psychological safety and team outcomes. The thematic analysis allowed the development of concepts beyond the content of the original studies. This analytical process provided a wealth of information regarding facilitators and barriers to psychological safety and the development of a model demonstrating the influence of situational context. DISCUSSION: This evidence synthesis highlights that whilst there is a positive and demonstrable presence of psychological safety within healthcare workers worldwide, there is room for improvement. The variability in methods used demonstrates scope to harmonise this. We draw attention to potential consequences of both high and low psychological safety. We provide novel information about the influence of situational context on an individual's psychological safety and offer more detail about the facilitators and barriers to psychological safety than seen in previous reviews. There is a risk of participation bias - centres involved in safety research may be more aligned to these ideals. The data in this synthesis are useful for institutions looking to improve psychological safety by providing a framework from which modifiable factors can be identified.
This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Psychological Safety).
The Presence and Potential Impact of Psychological Safety in the Healthcare Setting: An Evidence Synthesis
BACKGROUND: Clerical burdens have strained primary care providers already facing a shifting health care landscape and workforce shortages. These pressures may cause burnout and job dissatisfaction, with negative implications for patient care. Medical scribes, who perform real-time electronic health record documentation, have been posited as a solution to relieve clerical burdens, thus improving provider satisfaction and other outcomes.
OBJECTIVE: The purpose of this study is to identify and synthesize the published research on medical scribe utilization in primary care and safety net settings.
RESEARCH DESIGN: We conducted a review of the literature to identify outcomes studies published between 2010 and 2020 assessing medical scribe utilization in primary care settings. Searches were conducted in PubMed and supplemented by a review of the gray literature. Articles for inclusion were reviewed by the study authors and synthesized based on study characteristics, medical scribe tasks, and reported outcomes.
RESULTS: We identified 21 publications for inclusion, including 5 that examined scribes in health care safety net settings. Scribe utilization was consistently reported as being associated with improved productivity and efficiency, provider experience, and documentation quality. Findings for patient experience were mixed.
CONCLUSIONS: Published studies indicate scribe utilization in primary care may improve productivity, clinic and provider efficiencies, and provider experience without diminishing the patient experience. Further large-scale research is needed to validate the reliability of study findings and assess additional outcomes, including how scribes enhance providers’ ability to advance health equity.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).
The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis
The COVID-19 pandemic has prompted concern about the integrity of the US public health infrastructure. Federal, state, and local governments spend $93 billion annually on public health in the US, but most of this spending is at the state level. Thus, shoring up gaps in public health preparedness and response requires an understanding of state spending. We present state spending trends in eight categories of public health activity from 2008 through 2018. We obtained data from the Census Bureau for all states except California and coded the data by public health category. Although overall national health expenditures grew by 4.3 percent in this period, state governmental public health spending saw no statistically significant growth between 2008 and 2018 except in injury prevention. Moreover, state spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.
US Public Health Neglected: Flat or Declining Spending Left States Ill Equipped to Respond to COVID-19: Study Examines US Public Health Spending
Implicit racial bias is a persistent and pervasive challenge within healthcare education and training settings. A recent systematic review reported that 84% of included studies (31 out of 37) showed evidence of slight to strong pro-white or light skin tone bias amongst healthcare students and professionals. However, there remains a need to improve understanding about its impact on healthcare students and how they can be better supported. This narrative review provides an overview of current evidence regarding the role of implicit racial bias within healthcare education, considering trends, factors that contribute to bias, and possible interventions. Current evidence suggests that biases held by students remain consistent and may increase during healthcare education. Sources that contribute to the formation and maintenance of implicit racial bias include peers, educators, the curriculum, and placements within healthcare settings. Experiences of implicit racial bias can lead to psychosomatic symptoms, high attrition rates, and reduced diversity within the healthcare workforce. Interventions to address implicit racial bias include an organizational commitment to reducing bias in hiring, retention, and promotion processes, and by addressing misrepresentation of race in the curriculum. We conclude that future research should identify, discuss, and critically reflect on how implicit racial biases are enacted and sustained through the hidden curriculum and can have detrimental consequences for racial and ethnic minority healthcare students.
Understanding Healthcare Students’ Experiences of Racial Bias: A Narrative Review of the Role of Implicit Bias and Potential Interventions in Educational Settings
OBJECTIVE: The American Academy of Family Physicians has launched a series of Innovation Labs to identify and demonstrate innovations essential to optimizing the family medicine experience. Our initial lab provided proof that using an Al Assistant can significantly reduce documentation burden and family physician burnout. Ten clinicians in 3 practices showed that this innovation dramatically reduced documentation time by 62% during clinic, 76% during after-hours, and was called "a breakthrough" by some clinicians. This report is on the second phase of the lab, which included family physicians and primary care clinicians across the country. It studied the adoption, use, and impact of the Al Assistant by primary care clinicians. The goal was to assess whether an Al assistant is essential to and readily adopted by family physicians. PARTICIPANTS AND METHODS: The lab studied the adoption and impact of an Al Assistant used for visit note completion for 30 days by over 132 family physicians and primary care clinicians. Adoption was assessed based on the number of participants agreeing to buy the solution and the impact realized during the lab trial. The effect was evaluated by a quantitative assessment of documentation time (n = 132) and a qualitative participant survey (n = 40). RESULTS: The lab participants represented family medicine and other primary care clinicians. Of the 132 studied, 102 completed the trial, 61 participants fully adopted the solution as paying customers after the lab, representing a 60% adoption rate. These adopters saw a 72% reduction in their median documentation time per note. This resulted in a calculated time savings of 3.3 hours per week per clinician. In addition, participants reported improved satisfaction with their workload and overall with their practice. CONCLUSION: An Al Assistant for Documentation significantly reduced documentation time and burden; it provided more time, flexibility, and freedom for adopters. Clinicians were more satisfied with their notes, saying they were more meaningful and professional. Lab participants who did not adopt fell into four categories: (1) they did not have a significant documentation burden at the start, (2) their EMR workflow worked well for them, (3) their EMR did not yet integrate with the solution, or (4) they were too challenged to trial the Al Assistant fully. We conclude that an Al assistant for Documentation is an essential innovation for all family physicians who have documentation burden and experience burnout. It can help optimize their family medicine experience. The Labs will now enter phase 3, where the goal is to educate the membership on the category of solutions: Al Assistants for Documentation. Our webinars and toolkit will help the membership understand who the innovation works for and who it does not and how it works and its best practices
