Strategies for Health Organizations

Measurement & Accountability

Measurement of worker well-being is a critical component of understanding and addressing burnout and moral injury, as well as establishing accountability for organization-level Commitment and Governance. Organizations must understand what to measure, when to measure, and what to do with what they learn. Organizations are moving to:

  • Measure worker and learner retention, turnover, burnout, and moral injury
  • Measure leader behaviors, teamwork, and the organizational environment 
  • Move from one-time to recurring, closer to “real-time” measurement (e.g., annual or more frequent pulse surveys)
  • Ensure that data protects confidentiality, while being at a sufficient level of detail (e.g., department-level) 
  • Share results with workers/learners and executive leadership, and utilize data to develop and evaluate interventions, using strategies such as quality improvement 


Measurement is generally one part of larger organizational strategies to improve worker and learner well-being, and therefore studies rarely examine the impact of measurement alone. However, there is a growing body of research examining and validating measurement instruments, such as the Maslach Burnout Inventory, Copenhagen Burnout Inventory, and Mini-Z. We provide resources below that identify and examine the evidence base for different measurement instruments


The National Academy of Medicine provides a number of resources to support measurement:

The HRSA Health Center Program conducted a literature review of measurement instruments to support the identification and selection of measures for a Health Center Workforce Well-Being Survey (instrument available in English and Spanish). The report examines measures of burnout, job satisfaction, leadership, team dynamic, workplace culture, psychological safety, moral distress, job demands/workload, job stress, decision latitude, workflow, HIT, training, social supports, empowerment, and work-life integration.

AcademyHealth's Assessing Trust in Health Care: A Compendium of Trust Measures outlines a framework for conceptual clarity in trust research, enabling healthcare leaders to explain the rationale for measuring trust, identify key attributes to prioritize in trust measurements, and understand trust measures' strengths and weaknesses.

The WCC team has compiled a Measurement Instrument Inventory of the metrics and instruments used by the HRSA grantees. This inventory includes details on each measurement tool, including focus (e.g., moral injury, anxiety, substance use), cost, and where to find it.   

Mantri et al.’s (2020) Moral Injury Symptom Scale-Healthcare Professionals (MISS-HP), a 10-item instrument to measure moral injury’s psychological and religious symptoms

The Center for Equity provides this Good Jobs Measures Toolkit, which covers seven areas of job quality including compensation, workforce voice, career advancement, and others. 


The VA Employee Survey includes a moral distress question: “In the past year, how often did you experience moral distress at work (i.e., you were unsure about the right thing to do or could not carry out what you believed to be the right thing)?”

Seeholzer et al. (2022) describe their work at MetroHealth System in Ohio where they conducted a census survey, with responses from over 1,900 employees, that found many struggled with social determinants (e.g., food security, transportation, housing and utilities). They recommend the following for health systems: screen employees for social determinants in ways that are voluntary and anonymous, develop employee assistance for social determinants (e.g., food pantries, on-site child care, transportation assistance, pay advances for unpredictable financial challenges) or form external partnerships to address these needs, assess whether salaries and benefits are sufficient for cost of living, and work with businesses, non-profits, and government leaders to improve community-level determinants of health. MetroHealth hired a social worker to help employees, established a minimum wage of $15 per hour, and about a quarter of workers are unionized.
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