Resource Library

[This is an excerpt.] The greatest asset of any EMS agency is its people – the EMS practitioners and other personnel who are there for members of the community during their worst moments,and who ensure their patients receive high-quality, compassionate and life-saving care. However, “being there” for patients and their family members and friends during medical emergencies is inherently stressful. EMS practitioners often work under difficult, unpredictable and rapidly changing circumstances. They may work in harsh environments, with limited information, assistance and resources. In the course of their work, they may be exposed to risks such as infectious disease, physical violence,occupational injury, vehicle crashes and death. They may be called on to help the victims of traumatic events, such as those who have experienced a natural disaster,serious motor vehicle collision, abuse or violence. EMS practitioners also run the risk of becoming victims of violence at the hands of patients who are inebriated or having a mental health crisis. To be able to effectively handle the stress associated with working in EMS, EMS personnel benefit from having good physical, mental and emotional health. [To read more, 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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The past decade has been a time of great change for US physicians. Many physicians feel that the care delivery system has become a barrier to providing high-quality care rather than facilitating it. Although physician distress and some of the contributing factors are now widely recognized, much of the distress physicians are experiencing is related to insidious issues affecting the cultures of our profession, our health care organizations, and the health care delivery system. Culture refers to the shared and fundamental beliefs of a group that are so widely accepted that they are implicit and often no longer recognized. When challenges with culture arise, they almost always relate to a problem with a subcomponent of the culture even as the larger culture does many things well. In this perspective, we consider the role of culture in many of the problems facing our health care delivery system and contributing to the high prevalence of professional burnout plaguing US physicians. A framework, drawn from the field of organizational science, to address these issues and heal our professional culture is considered.

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).

Employees can provide invaluable input to organizations when they can freely express their opinions at work. Employees, however, may not believe that it is safe or efficacious to voice their concerns. How features of communication channels affect employees' safety and efficacy perceptions is largely ignored in existing voice models. Therefore, this study seeks to understand how the anonymity and visibility affordances of a communication channel influence employees' safety and efficacy perceptions, and, thus, their intention to engage in prohibitive voice at work. Two between-subjects experiments were conducted to test how these channel affordances affect voicing behavior in organizations. The results indicate that the more anonymous and less visible participants perceive a voicing channel to be, the safer and the more efficacious they evaluate the channel. Theoretical and practical implications, limitations, and future research directions are discussed.

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

High rates of provider turnover are problematic for our mental health system. Research indicates that supervisory support could alleviate some turnover intention by decreasing emotional exhaustion (a key component of burnout) as well as by increasing job satisfaction. However, the potential mediation mechanisms have not been rigorously tested. Longitudinal data collected from 195 direct clinical care providers at two community mental health centers identified positive effects of supervisory support on reduced turnover intention through reduced emotional exhaustion. Job satisfaction was not a significant mediator. Supervisory support may help mitigate turnover intention through work-related stress reduction.

This paper develops a model of the nursing home industry to investigate the quality effects of policies that either raise regulated reimbursement rates or increase local competition. Using data from Pennsylvania, I estimate the parameters of the model. The findings indicate that nursing homes increase the quality of care, measured by the number of skilled nurses per resident, by 8.7 percent following a universal 10 percent increase in Medicaid reimbursement rates. In contrast, I find that pro-competitive policies lead to only small increases in skilled nurse staffing ratios, suggesting that Medicaid increases are more cost effective in raising the quality of care.

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This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).

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BACKGROUND AND OBJECTIVES: Several factors can compromise patient safety, such as ineffective teamwork, failed organizational processes, and the physical and psychological overload of health professionals. Studies about associations between burn out and patient safety have shown different outcomes. OBJECTIVE: To analyze the relationship between burnout and patient safety. MATERIALS AND METHODS: A systematic review with a meta-analysis performed using PubMed and Web of Science databases during January 2018. Two searches were conducted with the following descriptors: (i) patient safety AND burnout professional safety AND organizational culture, and (ii) patient safety AND burnout professional safety AND safety management. RESULTS: Twenty-one studies were analyzed, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses, and it is associated with external factors such as: high workload, long journeys, and ineffective interpersonal relationships. Good patient safety practices are influenced by organized workflows that generate autonomy for health professionals. Through meta-analysis, we found a relationship between the development of burnout and patient safety actions with a probability of superiority of 66.4%. CONCLUSION: There is a relationship between high levels of burnout and worsening patient safety.

[This is an excerpt.] Only four years into practice, AMA member Kevin Hopkins, MD, was struggling with the clerical burdens of contemporary medicine. He was not a good typist, and he was not particularly good with using electronic devices. Every day was difficult. [To read more, click View Resource.]

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

Public Safety Personnel (PSP; e.g. correctional workers, dispatchers, firefighters, paramedics, police) are frequently exposed to potentially traumatic events (PTEs). Several mental health training program categories (e.g. critical incident stress management (CISM), debriefing, peer support, psychoeducation, mental health first aid, Road to Mental Readiness [R2MR]) exist as efforts to minimize the impact of exposures, often using cognitive behavioral therapy model content, but with limited effectiveness research. The current study assessed PSP perceptions of access to professional (i.e. physicians, psychologists, psychiatrists, employee assistance programs, chaplains) and non-professional (i.e. spouse, friends, colleagues, leadership) support, and associations between training and mental health. Participants included 4,020 currently serving PSP participants. Data were analyzed using cross-tabulations and logistic regressions. Most PSP reported access to professional and non-professional support; nevertheless, most would first access a spouse (74%) and many would never, or only as a last resort, access professional support (43–60%) or PSP leaders (67%). Participation in any mental health training category was associated with lower (p < .01) rates for some, but not all, mental disorders, with no robust differences across categories. Revisions to training programs may improve willingness to access professional support; in the interim, training and support for PSP spouses and leaders may also be beneficial.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Providing a Continuum of Support)

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Mentoring skills are valuable assets for academic medicine and allied health faculty, who influence and help shape the careers of the next generation of healthcare providers. Mentors are role models who also act as guides for students’ personal and professional development over time. Mentors can be instrumental in conveying explicit academic knowledge required to master curriculum content. Importantly, they can enhance implicit knowledge about the “hidden curriculum” of professionalism, ethics, values, and the art of medicine not learned from texts. In many cases, mentors also provide emotional support and encouragement. It must be noted that to be an effective mentor, one must engage in ongoing learning in order to strengthen and further mentoring skills. Thus, learning communities can provide support, education, and personal development for the mentor. The relationship benefits mentors as well through greater productivity, career satisfaction, and personal gratification. Maximizing the satisfaction and productivity of such relationships entails self-awareness, focus, mutual respect, and explicit communication about the relationship. In this article, the authors describe the development of optimal mentoring relationships, emphasizing the importance of different approaches to mentorship, roles of the mentors and mentees, mentor and mentee benefits, interprofessional mentorships for teams, gender and mentorship, and culture and mentorship.

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

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BACKGROUND: Many UK military veterans experiencing mental health and well-being difficulties do not engage with support services to get the help they need. Some mental health clinics employ Peer Support Workers to help veteran patients engage, however it is not known how the role influences UK veteran engagement. AIMS: To gain insight into the role of peer support in UK veteran engagement with mental health and well-being services. METHOD: A qualitative study based on 18 semi-structured interviews with veterans, peer support workers, and mental health clinicians at a specialist veteran mental health and well-being clinic in Scotland. RESULTS: Four themes of the Peer Support Worker role as positive first impression,understanding professional friend, helpful and supportive connector, and an open door were identified across all participants. The Peer Support Workers’ military connection, social and well-being support, and role in providing veterans with an easily accessible route to dis-engage and re-engage with the service over multiple engagement attempts were particularly crucial. CONCLUSIONS: The Peer Support role enhanced veteran engagement in the majority of instances. Study findings mirrored existing peer support literature, provided new evidence in relation to engaging UK veterans, and made recommendations for future veteran research and service provision.

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This resource is found in our Actionable Strategies for Public Safety Organizations: Actionable Strategies (Providing a Continuum of Support)

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[This is an excerpt.] Every day in clinical practice, health care clinicians make difficult decisions about appropriate treatment and care for their patients. Years of training prepare them for this responsibility, to choose the best course of action for a patient based on their clinical knowledge, the patient’s needs and wants, and the clinician’s professional and human values. Such daily decisions may be emotionally laden and are often made in challenging circumstances. There may be pressure from patients and families, burden from chronic understaffing, complicated organizational structures and hierarchies, system inefficiencies that shift attention away from patients, insurance or institutional policies that limit options, differences of opinion about appropriate care, and breakdowns in communication with interprofessional colleagues and administrators. These choices are often complex, and the best course of action may not be clear. [To read more, click View Resource.]

AIM: To identify nurse leaders' strategies to cultivate nurse resilience. BACKGROUND: High nursing turnover rates and nursing shortages are prominent phenomena in health care. Finding ways to promote nurse resilience and reduce nurse burnout is imperative for nursing leaders. METHODS: This is a qualitative descriptive study that occurred from November 2017 to June 2018. This study explored strategies to foster nurse resilience from nurse leaders who in this study were defined as charge nurses, nurse managers and nurse executives of a tertiary hospital in the United States. A purposive sampling method was used to have recruited 20 nurse leaders. RESULTS: Seven strategies are identified to cultivate nurse resilience: facilitating social connections, promoting positivity, capitalizing on nurses' strengths, nurturing nurses' growth, encouraging nurses' self-care, fostering mindfulness practice and conveying altruism. CONCLUSIONS: Fostering nurse resilience is an ongoing effort. Nurse leaders are instrumental in building a resilient nursing workforce. The strategies identified to foster nurse resilience will not only impact the nursing staff but also improve patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: The strategies presented are simple and can be easily implemented in any settings. Nurse leaders have an obligation to model and enable evidence-based strategies to promote nurses' resilience.

BACKGROUND: Assisted living facilities (ALFs), unlike nursing homes, have no federal regulations to monitor quality. States create their own regulations, and little is known about their impact on ALF care outcomes. AIM: The purpose of this study was to examine ALF care deficiencies from one state and explore the relationship among such deficiencies and facility characteristics. METHODS: This study analyzed one state’s ALF inspections data from 2015 through mid-2017, with documented violations of state regulations cited as deficiencies (N = 2,689 ALFs). Associations between severe deficiencies (defined by the state as those with potential for immediate harm to residents [e.g., assault by staff member] or causing a direct threat to resident health [e.g., an unsupervised meal for resident with swallowing difficulties, who then choked]) and facility characteristics (e.g., nursing staff availability, facility size, ownership, geographic location, and Medicaid participation) were explored using multivariate logistic regression analysis. RESULTS: Six percent of ALFs reported at least one or more severe deficiencies. Larger ALFs (26–100 beds = large and >100 beds = extra large) had greater odds of severe deficiencies compared to smaller ALFs (4–10 beds) (large versus small: OR = 2.09, 95% CI [1.37, 3.17]; extra large versus small: OR = 4.10, 95% CI [2.56, 6.55]). For all ALFs, only 31.5% had 24-hour nursing staff availability, which included unlicensed nurse aides, certified nursing assistants, licensed practical/vocational nurses, and/or registered nurses. Within large/extra-large facilities, those with part-time or no nursing staff availability had more than twice the odds of severe deficiencies compared to ALFs with 24-hour availability (OR = 2.35, 95% CI [1.31, 4.23]). CONCLUSION: Results support the importance of nursing staff availability to reduce deficiencies, especially in larger ALFs. Conducting periodic resident assessments could facilitate the availability of ALF outcomes data, which, along with detailed staffing information, are needed to evaluate and monitor quality. Universal regulations could improve ALF oversight and ensure that all states are evaluating ALF care using the same standards.

Burnout is highly prevalent among physicians and has been associated with negative outcomes for physicians, patients, staff, and health-care organizations. Reducing physician burnout and increasing physician well-being is a priority. Systematic reviews suggest that organization-based interventions are more effective in reducing physician burnout than interventions targeted at individual physicians. This consensus review by leaders in the field across multiple institutions presents emerging trends and exemplary evidence-based strategies to improve professional fulfillment and reduce physician burnout using Stanford's tripartite model of physician professional fulfillment as an organizing framework: practice efficiency, culture, and personal resilience to support physician well-being. These strategies include leadership traits, latitude of control and autonomy, collegiality, diversity, teamwork, top-of-license workflows, electronic health record (EHR) usability, peer support, confidential mental health services, work-life integration and reducing barriers to practicing a healthy lifestyle. The review concludes with evidence-based recommendations on establishing an effective physician wellness program.

This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.

[This is an excerpt.] Physician burnout is reaching pandemic levels, with highest incidence among primary care and emergency physicians.¹ Both increased clinical effort and excess time using the electronic health record (EHR) are known contributors to physician burnout.² We assessed whether clinical effort is associated with the amount of time ambulatory care physicians in an academic faculty group practice spend working after work in the EHR. [To read more, click View Resource.]

‍This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Reducing Administrative Burdens).

This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).

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[This is an excerpt.] In 2018, more than 43 million people in the United States held a professional certification or license. The prevalence of occupational licenses, common in fields such as healthcare, law, and education, has risen substantially over the past 50 years.¹ Professional certifications, while less common than licenses, can signal proficiency in fast-changing fields like project management, software development, and financial analysis. Both of these time-limited credentials can serve as alternative forms of educational attainment, demonstrating a level of skill or knowledge needed to perform a specific type of job. As a result, researchers and others have developed an interest in using government surveys to measure the prevalence of certifications and licenses and tying these credentials to labor market outcomes and earnings. To meet this need, in January 2015, the Bureau of Labor Statistics (BLS), working with the federal Interagency Working Group on Expanded Measures of Enrollment and Attainment (GEMEnA), added questions on certifications and licenses to the Current Population Survey (CPS). This article provides an in-depth analysis of CPS data on professional certifications and licenses for 2018. [To read more, click View Resource.]

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This resource is found in our Actionable Strategies for Government: Fair and Meaningful Reward & Recognition (Support Career Development).

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[This is an excerpt.] For more than a decade, the term burnout has been used to describe clinician distress. Although some clinicians in federal health care systems may be protected from some of the drivers of burnout, other federal practitioners suffer from rule-driven health care practices and distant, top-down administration. The demand for health care is expanding, driven by the aging of the US population. Massive information technology investments, which promised efficiency for health care providers, have instead delivered a triple blow: They have diverted capital resources that might have been used to hire additional caregivers, diverted the time and attention of those already engaged in patient care, and done little to improve patient outcomes. Reimbursements are falling, and the only way for health systems to maintain their revenue is to increase the number of patients each clinician sees per day. As the resources of time and attention shrink, and as spending continues with no improvement in patient outcomes, clinician distress is on the rise. It will be important to understand exactly what the drivers of the problem are for federal clinicians so that solutions can be appropriately targeted. The first step in addressing the epidemic of physician distress is using the most accurate terminology to describe it. [To read more, click View Resource.]

This resource is found in our Actionable Strategies for Health Organizations: Aligning Values (Establish a Culture of Shared Commitment).

[This is an excerpt.] The rate of violence against health care workers has reached epidemic proportions. According to a 2012 report by the U.S. Government Accountability Office (GAO), health care workers in inpatient facilities experienced workplace violence-related injuries requiring days off from work at a rate at least five to 12 times higher than the rate of private-sector workers overall. This type of violence includes incidences of violence against registered nurses (RNs) by patients, patients’ family members and external individuals, and it includes physical, sexual and psychological assaults. Workplace violence has a demonstrable negative impact on the nursing profession and the overall health care field. Multiple studies have shown that workplace violence – including other forms such as bullying and incivility as perpetrated by coworkers or supervisors – can adversely affect the quality of patient care and care outcomes, contribute to the development of psychological conditions, and reduce the RN’s level of job satisfaction and organizational commitment. Moreover, the full scope of the problem is not fully known. As the GAO report noted, “Health care workers may not always report such incidents, and there is limited research on the issue, among other reasons.” In fact, research has variously found that only 20 to 60 percent of nurses report incidents of violence. That being said, in order to address a problem, building on the ANA position statement on incivility, bullying and workplace violence, one must first understand its full scope. Therefore, in addressing workplace violence against health care workers, RNs in particular, the reasons for underreporting incidents of violence must be identified and addressed. Because workplace violence events are difficult to substantiate with physical evidence, a systematic reporting mechanism is warranted. [To read more, 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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The current article describes a review of U.S. states and the District of Columbia boards of nursing pre-licensure applications, which were collected, summarized, and evaluated to assess compliance with the Americans With Disabilities Act (ADA). Less than one half (n = 21) of RN licensing boards do not ask questions about mental illness on pre-licensure applications. Of the 30 boards that ask questions about mental illness, eight focus on current disability, which is legal under the ADA. The remaining 22 boards ask non-ADA–compliant questions by targeting specific diagnoses, focusing on historical data in the absence of current impairment, and/or requiring a prediction of future impairment. Nursing boards are urged to join colleagues in law, psychology, and medicine in using ADA–acceptable applications by eliminating mental health questions or limiting them to current impairment queries.