PURPOSE: The purpose of this paper is: first, to present a qualitative descriptive case study of the Mayo Clinic leadership and organization development philosophy and approach; second, to summarize a strategy for using intentional organization design as a foundation for culturally aligned physician leadership development and third, to describe the Mayo Clinic Leadership Model. DESIGN/METHODOLOGY/APPROACH: This manuscript is a qualitative descriptive case study of the Mayo Clinic leadership development philosophy and approach. The authors reviewed the organization design and leadership development programs of a leading healthcare institution. In the systematic appraisal, the authors sought to understand the key features and elements of team-based leadership development and the supporting organizational characteristics that guide development with the use of a customized institutional leadership model. FINDINGS: The authors identified four intentional characteristics of the multi-specialty group practice structure and culture that organically facilitate the development of leaders with the qualities required for the mission. The four characteristics are: patient-centered organizational design, collaborative leadership structure, egalitarian leader selection process and team-based development system. The authors conclude that organization culture and design are important foundations of leadership development. Leadership development cannot be separated from the context and culture of organizational design. Mayo Clinic’s organizational and governance systems are designed to develop culturally aligned leaders, build social capital, grow employee engagement, foster collaboration, nurture collegiality and engender trust. Effective organization design aligns the form and functions of the organization with leadership development and its mission. ORIGINALITY/VALUE: This qualitative descriptive case study presentation and analysis offers a unique perspective on physician leadership and organization development in healthcare.
Leadership by Design: Intentional Organization Development of Physician Leaders
[This is an excerpt.] In this study we continue our analysis of the National Health Service Corps (NHSC) with the purpose of gaining new insights into the program’s performance regarding the distribution of providers in high-need areas. The objective of this study is threefold. First, we focus on the recent retention trends of NHSC program alumni in Health Professional Shortage Areas(HPSAs). Second, we analyze the retention patterns of those NHSC participants who serve in Indian Health Service (IHS) sites and compare them with that of all NHSC participants, and third, we examine the recruiting and retention effects of the program.
In a previous project (Lewin, 2014), we examined short- and long-term retention in HPSAs of providers who participated in NHSC LRP and SP and compared their retention with the retention of non-participants working in those areas, using data from the period 2000-2013. In the current study we increase the timeframe by adding two more years of NHSC administrative data (2014 and 2015) to determine whether the retention patterns changed over the more recent years, given the important recent program growth and changes. We update and expand the data infrastructure we constructed for the previous project, and as before, we rely on dataon NHSC program participants, Provider 360 data, Medicare data and data on HPSA designations. Our current NHSC data covers the period between 2000 and 2015, the Provider 360 data is recorded as of January 2015, and the Medicare data spans the period between 2005 and 2014. The Provider 360 and the Medicare data allow us to observe NHSC participants and their location after their separation from service. Combining their post-servicelocation with information on whether that location is a HPSA or not, we construct HPSA retention statistics for all the program participants that we identified in Provider 360 or Medicare data. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Government: Optimizing Workload & Workflows (Support & Ensure Safe Staffing).
National Health Service Corps – An Extended Analysis
BACKGROUND: The process of documentation in electronic health records (EHRs) is known to be time consuming, inefficient, and cumbersome. The use of dictation coupled with manual transcription has become an increasingly common practice. In recent years, natural language processing (NLP)–enabled data capture has become a viable alternative for data entry. It enables the clinician to maintain control of the process and potentially reduce the documentation burden. The question remains how this NLP-enabled workflow will impact EHR usability and whether it can meet the structured data and other EHR requirements while enhancing the user’s experience. OBJECTIVE: The objective of this study is evaluate the comparative effectiveness of an NLP-enabled data capture method using dictation and data extraction from transcribed documents (NLP Entry) in terms of documentation time, documentation quality, and usability versus standard EHR keyboard-and-mouse data entry. METHODS: This formative study investigated the results of using 4 combinations of NLP Entry and Standard Entry methods (“protocols”) of EHR data capture. We compared a novel dictation-based protocol using MediSapien NLP (NLP-NLP) for structured data capture against a standard structured data capture protocol (Standard-Standard) as well as 2 novel hybrid protocols (NLP-Standard and Standard-NLP). The 31 participants included neurologists, cardiologists, and nephrologists. Participants generated 4 consultation or admission notes using 4 documentation protocols. We recorded the time on task, documentation quality (using the Physician Documentation Quality Instrument, PDQI-9), and usability of the documentation processes. RESULTS: A total of 118 notes were documented across the 3 subject areas. The NLP-NLP protocol required a median of 5.2 minutes per cardiology note, 7.3 minutes per nephrology note, and 8.5 minutes per neurology note compared with 16.9, 20.7, and 21.2 minutes, respectively, using the Standard-Standard protocol and 13.8, 21.3, and 18.7 minutes using the Standard-NLP protocol (1 of 2 hybrid methods). Using 8 out of 9 characteristics measured by the PDQI-9 instrument, the NLP-NLP protocol received a median quality score sum of 24.5; the Standard-Standard protocol received a median sum of 29; and the Standard-NLP protocol received a median sum of 29.5. The mean total score of the usability measure was 36.7 when the participants used the NLP-NLP protocol compared with 30.3 when they used the Standard-Standard protocol. CONCLUSIONS: In this study, the feasibility of an approach to EHR data capture involving the application of NLP to transcribed dictation was demonstrated. This novel dictation-based approach has the potential to reduce the time required for documentation and improve usability while maintaining documentation quality. Future research will evaluate the NLP-based EHR data capture approach in a clinical setting. It is reasonable to assert that EHRs will increasingly use NLP-enabled data entry tools such as MediSapien NLP because they hold promise for enhancing the documentation process and end-user experience.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload &Workflows (Using Technology to Improve Workflows)
Natural Language Processing–Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study
OBJECTIVE: To identify and describe new roles for medical assistants (MAs) in innovative care models that improve care while providing training and career advancement opportunities for MAs. DATA SOURCES/STUDY SETTING: Primary data collected at 15 case study sites; 173 key informant interviews and de-identified secondary data on staffing, wages, patient satisfaction, and health outcomes. STUDY DESIGN: Researchers used snowball sampling and screening calls to identify 15 organizations using MAs in new roles. Conducted site visits from 2010 to 2012 and updated information in 2014. DATA COLLECTION/EXTRACTION METHODS: Thematic analysis explored key topics: factors driving MA role innovation, role description, training required, and wage gains. Categorized outcome data in patient and staff satisfaction, quality of care, and efficiency. PRINCIPAL FINDINGS: New MA roles included health coach, medical scribe, dual role translator, health navigator, panel manager, cross-trained flexible role, and supervisor. Implementation of new roles required extensive training. MA incentives and enhanced compensation varied by role type. CONCLUSIONS: New MA roles are part of a larger attempt to reform workflow and relieve primary care providers. Despite some evidence of success, spread has been limited. Key challenges to adoption included leadership and provider resistance to change, cost of additional MA training, and lack of reimbursement for nonbillable services.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).
New Roles for Medical Assistants in Innovative Primary Care Practices
As a result of a collaboration between the NAM and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds upon a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision-making, and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of clinical decision support.
This resource is found in our Actionable Strategies for Other Private Organizations: Health IT Companies.
Optimizing Strategies for Clinical Decision Support
PURPOSE: The chapter elaborates how organizational governance can optimally address workplace bullying, a synergy possible because organizational governance seeks to promote ethical functioning while workplace bullying is considered an unethical behavior. Through its suggestions, the chapter aims at furthering employee dignity and well-being, cohering with international calls for human rights at work. METHODOLOGY/APPROACH: A review of two literatures was conducted: (a) workplace bullying differentiated on the basis of its situatedness and level into internal bullying—of an interpersonal and depersonalized nature—and external bullying; and (b) organizational governance including its theoretical perspectives, especially the societal lens, and international, national, and firm codes. FINDINGS: Several organizational governance measures at institutional level—both international and national in scope—and at firm level are proposed to deal with varieties of workplace bullying encompassing primary, secondary, and tertiary prevention. Accordingly, a shift in organizational effectiveness from goal-based models to process-oriented frameworks so that economic and non-economic objectives are balanced, following the stakeholder approach, is advocated. The political dynamics involved in such an initiative are alluded to. PRACTICAL IMPLICATIONS: Application, drawing on secondary rather them primary data, is the essential thrust of the chapter, with recommendations anchored in organizational governance, particularly its societal perspective, conceptualized to address workplace bullying in a holistic manner. ORIGINALITY/VALUE: First, despite the clear relevance of organizational governance to workplace bullying, the prospect of interventions from this standpoint has never been previously explored. Second, the term "varieties of workplace bullying" is propounded to capture the different types of emotional abuse at work known so far.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Workplace Violence Prevention).
Organizational Governance: A Promising Solution for Varieties of Workplace Bullying
The high stress environment of law enforcement places officers at risk for a variety of mental and physical health problems; however, officers are reluctant to seek out treatment. The purpose of this study was to identify which factors associated with law enforcement officers had predictive value in the level of stigma perceived in seeking mental health treatment by currently employed, certified peace officers in Arizona. The factors included sex, age, race/ethnicity, years employed as an officer, size of the department, current rank/position within the department, the type of government operating the agency, and payment of union dues. The study included 454 participants. Participation included the completion of demographic data, the Self-Stigma of Seeking Psychological Help (SSOSH), and the Perceptions of Stigmatization by Others for Seeking Help (PSOSH). Using standard multiple regression, the most significant finding was the relationship between the size of the department and levels of stigma (p = .014); such that, the size was inversely related to the levels of perceived stigma. As the agency size increased, the perceptions of stigma decreased. Such a finding has several implications for law enforcement agencies related to preparedness and training.
This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Operational Breakdown)
Perceptions of Law Enforcement Officers in Seeking Mental Health Treatment in a Right-to-Work State
The process of creating healthy organization-physician relationships is critical to organizational success. Partnerships in process improvement can nurture these relationships and mitigate burnout by meeting physicians' psychological needs. To flourish, physicians need some degree of choice (control over their lives), camaraderie (social connectedness), and an opportunity for excellence (being part of something meaningful). Organizations can provide these opportunities by establishing constructive organization-physician relationships and developing physician leaders. We present a case study from the Mayo Clinic that supports the foundational principles of a physician-engagement model. We developed the Listen-Act-Develop model as an integrated strategy to reduce burnout and engage physicians in the mission of the organization. The intent of the model is to maximize physician wellness by fostering engagement and mitigating the drivers of burnout. This model provides a path to increase physician satisfaction and meaning in work and to improve organizational effectiveness.
This resource is found in our Actionable Strategies for Health Organizations: Strengthening Leadership.
Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience
[This is an excerpt.] In the healthcare arena, change happens at a rapid pace. Healthcare leaders face the continual challenge of delivering high-quality patient care while managing costs. A growing body of evidence shows that patient acuity driven staffing is an effective way to optimize nurse staffing to improve patient outcomes and promote clinical and organizational excellence. How do we turn that evidence into a transformative reality? On July 14, 2016, American Nurse Today and GE Healthcare cohosted a webinar that addressed that question. Four nurse leaders—all of them pioneers in acuity-based staffing research and implementation— presented a strong case detailing why acuity-based staffing is imperative, not just for patients and nurses but also for healthcare organizations as a whole. They offered practical guidelines on how nurses can foster change, both across the profession and within their local organizations. [To read more, click View Resource.]
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Safe & Appropriate Staffing).
Practical Steps for Applying Acuity-Based Staffing
PURPOSE: To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies, DESIGN AND METHODS: Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics. RESULTS: Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job. IMPLICATIONS: This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them.
This resource is found in our Actionable Strategies for Health Organizations: Meaningful Rewards& Recognition (Adequate Compensation)
Predictors of Intent to Leave the Job Among Home Health Workers: Analysis of the National Home Health Aide Survey
OBJECTIVE: To evaluate associations between the electronic environment, clerical burden, and burnout in US physicians. PARTICIPANTS AND METHODS: Physicians across all specialties in the United States were surveyed between August and October 2014. Physicians provided information regarding use of electronic health records (EHRs), computerized physician order entry (CPOE), and electronic patient portals. Burnout was measured using validated metrics. RESULTS: Of 6375 responding physicians in active practice, 5389 (84.5%) reported that they used EHRs. Of 5892 physicians who indicated that CPOE was relevant to their specialty, 4858 (82.5%) reported using CPOE. Physicians who used EHRs and CPOE had lower satisfaction with the amount of time spent on clerical tasks and higher rates of burnout on univariate analysis. On multivariable analysis, physicians who used EHRs (odds ratio [OR]=0.67; 95% CI, 0.57-0.79; P<.001) or CPOE (OR=0.72; 95% CI, 0.62-0.84; P<.001) were less likely to be satisfied with the amount of time spent on clerical tasks after adjusting for age, sex, specialty, practice setting, and hours worked per week. Use of CPOE was also associated with a higher risk of burnout after adjusting for these same factors (OR=1.29; 95% CI, 1.12-1.48; P<.001). Use of EHRs was not associated with burnout in adjusted models controlling for CPOE and other factors. CONCLUSION: In this large national study, physicians' satisfaction with their EHRs and CPOE was generally low. Physicians who used EHRs and CPOE were less satisfied with the amount of time spent on clerical tasks and were at higher risk for professional burnout.
Relationship Between Clerical Burden and Characteristics of the Electronic Environment With Physician Burnout and Professional Satisfaction
INTRODUCTION: Lack of work engagement in emergency nurses has been linked to increased job turnover, burnout, and lack of job satisfaction. Shared governance is a vehicle that can be used by emergency nursing leaders to increase work engagement among emergency nurses. Research is lacking about the relationship between perceptions of shared governance and work engagement in emergency nurses. In this study we examined the relationship between ED nurses’ perceptions of shared governance and work engagement.
METHODS: A descriptive correlation design was used with a convenience sample of 43 emergency nurses recruited through the ENA Web site. Participants completed a demographic questionnaire, the Index of Professional Nursing Governance Tool, and the Utrecht Work Engagement Scale.
RESULTS: The mean total work engagement score indicated average engagement (M = 4.4, standard deviation = 1.2). A significant positive relationship was found between shared governance and work engagement, indicating that as perceptions of shared governance increase, work engagement increases (r (41) = 0.62, P < .001).
DISCUSSION: The study provides beginning evidence on the relationship of shared governance and work engagement in emergency nurses. Understanding the relationship between perceptions of shared governance and work engagement in emergency nurses may assist emergency nursing leaders in developing and testing interventions to enhance it.
This resource is found in our Actionable Strategies for Health Organizations: Establishing Commitment & Shared Governance (Shared Governance).
Shared Governance and Work Engagement in Emergency Nurses
Due to stressors in the police profession, officers may be at risk for a variety of personal and mental health–related concerns. However, they have historically refrained from seeking professional mental health services. Several factors have been identified to explain their hesitance, including stigma regarding mental health issues. In this study, 248 police officers completed a 62-item online survey related to their attitudes toward seeking mental health services, mental health stigma, and perceptions of other officers’ willingness to seek services. The results indicate that public stigma and self-stigma were negatively correlated with attitudes toward seeking psychological help. Self-stigma fully mediated the relationship between public stigma and attitudes toward seeking help, and the model explained 56% of the variance in attitude scores. The results also suggest that police officers tended to believe that their peers were less willing to seek mental health services for several common presenting issues than they actually were.
This resource is found in our Actionable Strategies for Public Safety Organizations: Drivers (Operational Breakdown)
Stigma, Pluralistic Ignorance, and Attitudes Toward Seeking Mental Health Services Among Police Officers
Many primary care practices have created a team structure in which a clinician and medical assistant "teamlet" form the core of a larger team. The larger team comprises a few teamlets supported by other clinical personnel. Patients are empaneled to a particular teamlet. The teamlet structure, which turns large practices into small units, is attractive to patients, most of whom prefer small rather than large practices. Clinicians working in stable teamlets, with the same medical assistant every day, have less burnout than clinicians working with different medical assistants on different days. The teamlet model can thus create positive experiences for clinicians and patients alike.
This resource is found in our Actionable Strategies for Health Organizations: Improving Workload & Workflows (Optimizing Teams).
Teamlets in Primary Care: Enhancing the Patient and Clinician Experience
BACKGROUND: Nurses' attitudes toward workplace violence are still inadequately explored, and possess an impact in preventing, and managing the violent incidents and the quality of nursing care. Creating a demand for an effective intervention program to improve nurses' knowledge of and attitudes toward workplace violence. OBJECTIVE: To study the impact of the training program on nurses' attitudes toward workplace violence in a military hospital in Jordan. METHODS: One group before-after design was employed. A stratified random sample of 100 nurses working in three shifts was recruited. Data were collected earlier and after the preparation program using the Attitudes Toward Patient Physical Assault Questionnaire. "The Framework Guidelines for addressing workplace violence in the health sector", was adopted in this work. The preparation sessions were for one day each week over five weeks. The post-test assessment was over five weeks using the same questionnaire. RESULTS: A total of 97 nurses completed the survey. The outcomes demonstrated the significant impact of the training program on nurses' attitudes towards workplace violence (t=6. 62, df=96, p=0.000). The prevalence of verbal abuse by patients and visitors was 63.9% and for physical abuse, 7.2% were from patients and 3.1% of visitors. Most violent incidents occurred during day duty and during delivering nursing care (40.2% and 32%, respectively). Major source of emotional support for abused nurses was from the nursing team (88.7%), while the legal support was from nursing management (48.5%). CONCLUSION: The study highlights a general concern among nursing staff about workplace violence. Confirming that violence prevention education for staff is a necessary step forward to deescalate the problem. A significant effect of the training program was evident in this study.
This resource is found in our Actionable Strategies for Health Organizations: Ensuring Physical & Mental Health (Workplace Violence Prevention).
The Impact of Training Program on Nurses' Attitudes Toward Workplace Violence in Jordan
BACKGROUND: Firefighters participate in activities with intense physical and psychological stress. AIMS: To examine the correlation between work-related injuries (WRIs), burnout and post-traumatic stress disorder (PTSD) symptoms in firefighters. METHODS: The method used for the recording of the elements was the collection of self-report anonymous questionnaires, the completion of which was optional. The questionnaires used were: (i) a WRIs questionnaire, (ii) the Maslach Burnout Inventory (MBI) and (iii) the Impact of Event Scale-Revised-Greek version. Descriptive statistics along with univariate and multivariate logistic regression analyses were applied. RESULTS: The study population consisted of 3289 firefighters. There was a significant association between WRIs, burnout syndrome, PTSD symptoms and age, work experience and physical condition. Relationships were found between PTSD symptoms, the MBI–emotional exhaustion dimension and WRIs and between MBI–depersonalization dimension and PTSD symptoms. The most traumatic event was the ‘dealing with death or rescue of a child’ and the top stress factor was ‘depression about the responsibility for quality of victims’ life’. CONCLUSIONS: The occupational obligations may be responsible for the psychological and musculoskeletal problems experienced by firefighters. Early recognition and response to psychosomatic issues in firefighters is of high importance.
This resource is found in our Actionable Strategies for Public Safety Organizations: Status of Burnout & Moral Injury
The Relationship Between Burnout, PTSD Symptoms and Injuries in Firefighters
We sought to portray how collective bargaining contracts promote public health, beyond their known effect on individual, family, and community well-being. In November 2014, we created an abstraction tool to identify health-related elements in 16 union contracts from industries in the Pacific Northwest. After enumerating the contract-protected benefits and working conditions, we interviewed union organizers and members to learn how these promoted health. Labor union contracts create higher wage and benefit standards, working hours limits, workplace hazards protections, and other factors. Unions also promote well-being by encouraging democratic participation and a sense of community among workers. Labor union contracts are largely underutilized, but a potentially fertile ground for public health innovation. Public health practitioners and labor unions would benefit by partnering to create sophisticated contracts to address social determinants of health.
This resource is found in our Actionable Strategies for Government: Empowering Workers & Strengthening Leadership and Governance (Strengthening Protections to Speak Up)
The Role of Labor Unions in Creating Working Conditions That Promote Public Health
The experience of burnout has been the focus of much research during the past few decades. Measures have been developed, as have various theoretical models, and research studies from many countries have contributed to a better understanding of the causes and consequences of this occupationally‐specific dysphoria. The majority of this work has focused on human service occupations, and particularly health care. Research on the burnout experience for psychiatrists mirrors much of the broader literature, in terms of both sources and outcomes of burnout. But it has also identified some of the unique stressors that mental health professionals face when they are dealing with especially difficult or violent clients. Current issues of particular relevance for psychiatry include the links between burnout and mental illness, the attempts to redefine burnout as simply exhaustion, and the relative dearth of evaluative research on potential interventions to treat and/or prevent burnout. Given that the treatment goal for burnout is usually to enable people to return to their job, and to be successful in their work, psychiatry could make an important contribution by identifying the treatment strategies that would be most effective in achieving that goal.
Understanding the Burnout Experience: Recent Research and Its Implications for Psychiatry
BACKGROUND: Work conditions in primary care are associated with physician burnout and lower quality of care. OBJECTIVE: We aimed to assess if improvements in work conditions improve clinician stress and burnout. SUBJECTS: Primary care clinicians at 34 clinics in the upper Midwest and New York City participated in the study. STUDY DESIGN: This was a cluster randomized controlled trial. MEASURES: Work conditions, such as time pressure, workplace chaos, and work control, as well as clinician outcomes, were measured at baseline and at 12–18 months. A brief worklife and work conditions summary measure was provided to staff and clinicians at intervention sites. INTERVENTIONS: Diverse interventions were grouped into three categories: 1) improved communication; 2) changes in workflow, and 3) targeted quality improvement (QI) projects. ANALYSIS Multilevel regressions assessed impact of worklife data and interventions on clinician outcomes. A multilevel analysis then looked at clinicians whose outcome scores improved and determined types of interventions associated with improvement. RESULTS: Of 166 clinicians, 135 (81.3 %) completed the study. While there was no group treatment effect of baseline data on clinician outcomes, more intervention clinicians showed improvements in burnout (21.8 % vs 7.1 % less burned out, p = 0.01) and satisfaction (23.1 % vs 10.0 % more satisfied, p = 0.04). Burnout was more likely to improve with workflow interventions [Odds Ratio (OR) of improvement in burnout 5.9, p = 0.02], and with targeted QI projects than in controls (OR 4.8, p = 0.02). Interventions in communication or workflow led to greater improvements in clinician satisfaction (OR 3.1, p = 0.04), and showed a trend toward greater improvement in intention to leave (OR 4.2, p = 0.06). LIMITATIONS: We used heterogeneous intervention types, and were uncertain how well interventions were instituted. CONCLUSIONS Organizations may be able to improve burnout, dissatisfaction and retention by addressing communication and workflow, and initiating QI projects targeting clinician concerns.
This resource is found in our Actionable Strategies for Health Organizations: Empowering Worker & Learner Voice (Worker & Learner Engagement).
A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study
The high level of stress experienced by nurses leads to moral distress, burnout, and a host of detrimental effects. To support creation of healthy work environments and to design a 2-phase project to enhance nurses' resilience while improving retention and reducing turnover. In phase 1, a cross-sectional survey was used to characterize the experiences of a high-stress nursing cohort. A total of 114 nurses in 6 high-intensity units completed 6 survey tools to assess the nurses' characteristics as the context for burnout and to explore factors involved in burnout, moral distress, and resilience. Statistical analysis was used to determine associations between scale measures and to identify independent variables related to burnout. Moral distress was a significant predictor of all 3 aspects of burnout, and the association between burnout and resilience was strong. Greater resilience protected nurses from emotional exhaustion and contributed to personal accomplishment. Spiritual well-being reduced emotional exhaustion and depersonalization; physical well-being was associated with personal accomplishment. Meaning in patient care and hope were independent predictors of burnout. Higher levels of resilience were associated with increased hope and reduced stress. Resilience scores were relatively flat over years of experience. These findings provide the basis for an experimental intervention in phase 2, which is designed to help participants cultivate strategies and practices for renewal, including mindfulness practices and personal resilience plans. ©2015 American Association of Critical-Care Nurses.
