NAM Perspectives on Clinician Well-Being & Resilience
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Culture of Silence Series
An interprofessional group of members of the Global Forum on Innovation in Health Professional Education are working together to illuminate issues concerning stress and burnout of health professionals and the role of health professional education to mitigate the negative effects of prolonged stress. Learn more about the Global Forum >>
Sandeep Kishore and several other members of the Global Forum on Innovation in Health Professional Education wanted to draw attention to the problem of medical student and physician suicide. Kishore and three others wrote a discussion paper, Breaking the Culture of Silence on Physician Suicide,which was published by the National Academy of Medicine (NAM). This paper draws attention to the tragedy of stress and suicide in health professional students and practitioners, specifically focusing on doctors and surgeons. The authors of this NAM discussion paper called for others to bring their voice to the conversation around depression and suicide in doctors and doctors in training as part of the Culture of Silence series.
Stress and Wellness in Health Professions Education Series
Students, trainees, faculty, and health professionals all affirm that stress in the health professions has a direct human toll on productivity, efficiency, quality, and the human capital of the workforce. A strategic move is necessary to shift the paradigm and create a new normal—one that is life affirming, health oriented, and drives durable changes for the next generation. To develop a foundation for dialogue among the professions, individual members of the Global Forum on Innovation in Health Professional Education from various health professions volunteered to write perspectives that summarize the types of stresses affecting their profession. These authors examine systems-level stressors from each of their individual perspectives, and explore how their profession responds to stress within education and practice.
- Utilizing a Systems and Design Thinking Approach for Improving Well-Being within Health Professions’ Education and Health Care
Perspectives from the Action Collaborative on Clinician Well-Being & Resilience
Stigma Compounds the Consequences of Clinician Burnout During COVID-19: A Call to Action to Break the Culture of Silence
Dr. Lorna Breen was the head of the Emergency Department at New York-Presbyterian Allen Hospital in New York City. She dedicated her career to helping others and tirelessly treated patients with COVID-19 at the height of the outbreak, eventually contracting COVID-19 herself. Dr. Breen died by suicide after telling her family that she was reluctant to seek help or ask for assistance for overwhelming work-related stress because she feared that she would lose her medical license or be ostracized by her colleagues. Dr. Breen’s sister and brother-in-law reflect on the final weeks of their sister’s life and work and make an impassioned call to break the culture of silence that surrounds mental health support and assistance for clinicians.
Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action
While meant to improve care quality and efficiency, the electronic health record (EHR) has inadvertently burdened clinicians. U.S. health care professionals spend up to two-thirds of their workday on EHR and desk work instead of direct patient care, and current EHR design emphasizes billing and administrative functions over care delivery and clinical decision-making. Fortunately, interventions are available now that can help address clinician burnout associated with EHR use. If implemented carefully and with the input of clinicians, the EHR can be shifted from contributing to clinician burnout to contributing to clinician well-being.
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.
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.
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 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.
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.
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?
This discussion paper 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.
Care-Centered Clinician 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.
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.
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.
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.