Clinician well-being is essential for safe, high-quality patient care.
However, clinicians of all kinds, across all specialties and care settings, are experiencing alarming rates of burnout. Among the most telling of statistics, more than 50 percent of U.S. physicians report significant symptoms. Burnout is a syndrome characterized by a high degree of emotional exhaustion and depersonalization (i.e., cynicism), and a low sense of personal accomplishment at work.
Clinician burnout can have serious, wide-ranging consequences, from reduced job performance and high turnover rates to—in the most extreme cases—medical error and clinician suicide. On the other hand, clinician well-being supports improved patient-clinician relationships, a high-functioning care team, and an engaged and effective workforce. In other words, when we invest in clinician well-being, everyone wins.
Supporting clinician well-being requires sustained attention and action at organizational, state, and national levels, as well as investment in research and information-sharing to advance evidence-based solutions.
In the face of the unprecedented challenges created by the COVID-19 pandemic and the accompanying global public health emergency, the Action Collaborative on Clinician Well-Being and Resilience must acknowledge the toll that the current crisis is taking on the well-being of clinicians. We know that the health care and public health community needs our support as they navigate the difficult challenges arising in this unprecedented moment. We have therefore compiled a list of strategies and resources to support the health and well-being of clinicians providing health care during the COVID-19 outbreak.
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About the Action Collaborative
In 2017, the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience, a network of more than 60 organizations committed to reversing trends in clinician burnout. The Collaborative has three goals:
- Raise the visibility of clinician anxiety, burnout, depression, stress, and suicide
- Improve baseline understanding of challenges to clinician well-being
- Advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.
The Action Collaborative is composed of six working groups that will meet over the course of four years to identify evidence-based strategies to improve clinician well-being at both the individual and systems levels. Products and activities of the Action Collaborative include an online knowledge hub, a series of NAM Perspectives discussion papers, and an all-encompassing conceptual model that reflects the domains affecting clinician well-being.
Questions? Contact us at ClinicianWellBeing@nas.edu.
Action Collaborative Leadership
Victor Dzau, Chair
Darrell Kirch, Co-Chair
Thomas Nasca, Co-Chair
Action Collaborative Working Groups
Please click here to view members of our six working groups.
Action Collaborative Staff
Candace Webb, Program Officer
Micheline Toure, Senior Program Assistant
Samantha Phillips, Communications Officer
Sharyl Nass, Board Director
Resources from the Action Collaborative
Clinician Well-Being Knowledge Hub
The Clinician Well-Being Knowledge Hub is a comprehensive resource repository for those seeking to promote clinician well-being at their organizations and in their personal lives. The repository contains peer-reviewed research, personal stories, toolkits, presentations, blog posts and other resources that health system administrators and clinicians can use to build a better system that helps clinicians thrive.
Case Studies
These case studies highlight organizational initiatives that have demonstrated success in supporting well-being and reducing burnout among practicing clinicians, trainees, and/or students. The case studies are intended to inform and inspire organizations facing similar challenges and seeking similar outcomes. Although there is no one-size-fits-all solution for clinician well-being, techniques and resources described in the case studies may provide a useful starting point for other groups.
Validated Instruments to Assess Work-Related Dimensions of Well-Being
A key organizational strategy to improving clinician well-being is to measure it, develop and implement interventions, and then re-measure it. A variety of dimensions of clinician well-being can be measured including burnout, engagement, and professional satisfaction. Click below for a summary of established tools to measure work-related dimensions of well-being. Each tool has advantages and disadvantages and some are more appropriate for specific populations or settings.
Conceptual Model – Factors Affecting Clinician Well-Being and Resilience
This conceptual model depicts the factors associated with clinician well-being and resilience; applies these factors across all health care professions, specialties, settings, and career stages; and emphasizes the link between clinician well-being and outcomes for clinicians, patients, and the health system. The model should be used to understand well-being, rather than as a diagnostic or assessment tool. The model will be revised as the field develops and more information becomes available.
Expressions of Clinician Well-Being
Expressions of Clinician Well-Being is an art exhibit that collects insights directly from clinicians, patients, loved ones, and organizations working to prevent burnout and promote well-being. By allowing people to creatively express their experiences with burnout, this gallery captures critical moments in the journey to well-being.
We hope this art will offer an entry point for conversations that can be difficult to have and shed light on the joys and challenges experienced by so many. We hope that the stories captured through this art will allow you to more fully understand why clinician well-being is so essential to the vitality of our health system.
Publications from the Action Collaborative
Clinician Well-Being at Virginia Mason Kirkland Medical Center: A Case Study
The following case study provides an overview of initiatives that support well-being and reduce burnout in clinicians who work at the Virginia Mason Kirkland Medical Center (Kirkland Medical Center). The purpose of this case study is to provide readers with tangible information to understand how Kirkland Medical Center has adopted programs and policies that support wellbeing. This case study is not a prescriptive roadmap. Rather, the authors hope that this case study will serve as an idea-generating resource for leaders working to improve the well-being of our nation’s clinicians, trainees, and students. The development of this case study was informed by extensive interviews with Kirkland Medical Center health professionals and their leadership team.
Clinician Well-Being at The Ohio State University: A Case Study
The purpose of this case study is to provide readers with tangible information to understand how The Ohio State University (Ohio State) has adopted programs and policies that support well-being. This case study is not a prescriptive roadmap. Rather, the authors hope that this case study will serve as an idea-generating resource for leaders working to improve the well-being of our nation’s clinicians, trainees, and students. This case study provides an overview of well-being initiatives at Ohio State’s College of Medicine, College of Nursing, Emergency Medicine Residency Program, and the Wexner Medical Center. The development of this case study was informed by extensive interviews with Ohio State leadership, faculty, staff, and students.
Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care
The US health care system is rapidly changing in an effort to deliver better care, improve health, and lower costs while providing care for an aging population with high rates of chronic disease and co-morbidities. Among the changes affecting clinical practice are new payment and delivery approaches, electronic health records, patient portals, and publicly reported quality metrics—all of which change the landscape of how care is provided, documented, and reimbursed. Navigating these changes are health care professionals (HCPs), whose daily work is critical to the success of health care improvement. Unfortunately, as a result of these changes and resulting added pressures, many HCPs are burned out, a syndrome characterized by a high degree of emotional exhaustion and high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work.
Nurse Suicide: Breaking the Silence
Although burnout, depression, and suicide in nurses are beginning to be recognized as a significant threat to our health care system, we cannot report the rate at which nurses die by suicide because this data is not accurately tracked. We also know through first-hand accounts that nurse suicide is rarely discussed and not often addressed institutionally. In our new discussion paper, the authors share their insights and the insights of those who have been personally affected by the loss of a colleague, relative, or friend in an effort to encourage formal tracking of data on nurse suicide, as well as focus attention on this critical issue.
Gender-Based Differences in Burnout: Issues Faced by Women Physicians
Individual, institutional, and societal risk factors for the development of burnout can differ for women and men physicians. While some studies on physician burnout report an increased prevalence among women, this finding may be due to actual differences in prevalence, the assessment tools used, or differences between/among the genders in how burnout manifests. In the following discussion paper, we review the prevalence of burnout in women physicians and contributing factors to burnout that are specific for women physicians. Understanding, preventing, and mitigating burnout among all physicians is critical, but such actions are particularly important for the retention of women physicians, given the increasing numbers of women in medicine and in light of the predicted exacerbation of physician shortages.
A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience
Why are so many clinicians experiencing burnout? The answer is complex but a new discussion paper from the National Academy of Medicine aims to shed light on the issues contributing to of clinician burnout and well-being. Taking a holistic view of the external, systemic, and internal factors that impact clinician well-being and burnout, the authors of this discussion paper provide a first look at a comprehensive model that highlights and illustrates the interrelated factors affecting clinician burnout on a daily basis. Individuals and organizations can use this model to identify methods to increase well-being and decrease burnout for clinicians at any stage of their careers.
Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout
Electronic health records are not living up to their full potential. The authors of our most recent discussion paper attest that electronic health records (EHRs) focus on supporting billing and legal documentation, and do not assist with ongoing patient care. EHRs require data in ways that disrupt clinician workflow, and consume more than half of their workday. This discussion paper analyzes how the medical community can re-engage with EHRs so that they may become flexible and comprehensive enough to serve clinicians, patients, and insurance providers alike.
Implementing Optimal Team-Based Care to Reduce Clinician Burnout
Teamwork is critical for clinician well-being and better patient care. But how can we better foster team-based care so that patients and clinicians can thrive? A new discussion paper from the National Academy of Medicine explores optimal team-based care and its role in reducing clinician burnout and achieving better patient outcomes. Authors describe key features of successful health care teams, review existing evidence that links high-functioning teams to increased well-being, and recommend strategies to overcome barriers to optimal team-based care.
Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature
While much is known about the prevalence of burnout among physicians and nurses, little is known about burnout in the physician assistant (PA) profession. Approximately 50 percent of physicians and 35 percent of nurses report symptoms of burnout. Burnout is linked to increased health care costs, medical errors, and poor patient outcomes. The PA profession emerged in the 1960s in response to workforce shortages in rural and underserved communities. The profession has evolved from one designed for primary care to one that is adaptable to broad workforce demands. PAs are now employed in almost all medical specialties, including those with physicians reporting high rates of burnout. The authors believe that this is the first paper to explore the literature that relates specifically to PA burnout and career and job satisfaction.
A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being
Clinician well-being is crucial in ensuring a healthier future for all. But we cannot effectively combat clinician burnout without measuring its pervasiveness. The following discussion paper investigates several measurement tools that organizations can use to assess clinician burnout and well-being. Tools vary widely and should be chosen carefully by researchers and organizational leadership. Authors provide a list of considerations and a brief overview of the tools that may be available to you.
A Vision for a Person-Centered Health Information System
We have a health care system with robust but highly fragmented capabilities. How can we leverage technology to enhance harmonized, patient-centered care? Realizing the full potential of patient-centered health care technology that also reduces clinician burden will require collaboration across multiple sectors, a willingness to share data, and the development of universal standards. This discussion paper describes a vision for the future, identifies existing gaps and barriers, and describes a potential roadmap to achieving a person-centered health information system.
Additional Related Resources
- Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being (New England Journal of Medicine)
- Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being
- Related Perspectives from the National Academies
- National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience podcast (American Society of Health-System Pharmacists)
- Do you know what’s in the landmark report on Clinician Burnout from the National Academy of Medicine? podcast (MissingLogic, LLC)
- Making the Case for the Chief Wellness Officer in America’s Health Systems (Health Affairs)
- To Care is Human: Collectively Confronting the Clinician Burnout Crisis (New England Journal of Medicine)
We currently do not require additional formal sponsors of the collaborative, but we very much want all interested organizations to stay connected as supportive partners. You can join our efforts by becoming a Network Organization of the Action Collaborative.
Thank you for your commitment to clinician well-being.
If you are suicidal and need emergency help, call 911 immediately or 1-800-273-8255 if in the United States. If you are in another country, find a 24/7 hotline at www.iasp.info/resources/Crises_Centres.