The National Academy of Medicine’s NAM Perspectives platform extends the National Academies’ convening and advising functions by providing a venue for leading health, medical, science, and policy experts to reflect on issues and opportunities important to the advancement of health, health care, and biomedical science. NAM Perspectives are individually-authored papers that do not reflect consensus positions of the NAM, the National Academies, or the authors’ organizations. They are not reports of the National Academies.
Below, we are pleased to present the top 10 most read NAM Perspectives papers of 2020. These manuscripts cover a wide array of issues, from clinician burnout and well-being to the social determinants of health. Please enjoy revisiting these NAM Perspectives, and sign up to receive more Perspectives in 2021!
#10. Organizational Evidence-Based and Promising Practices for Improving Clinician Well-Being
C. A. Sinsky, L. Daugherty Biddison, A. Mallick, A. Legreid Dopp, J. Perlo, L, Lynn, and C. D. Smith.
Clinician burnout is an occupational syndrome driven by the work environment. An organization seeking to reduce burnout and improve well-being among its clinicians can create a better work environment by aligning its commitments, leadership structures, policies, and actions with evidence-based and promising best practices. In Organizational Evidence-Based and Promising Practices for Improving Clinician Well-Being, the authors outline organizational approaches that focus on fixing the workplace, rather than “fixing the worker,” and by doing so, advance clinician well-being and the resiliency of the organization. A resilient organization, or one that has matched job demands with job resources for its workers and that has created a culture of connection, transparency, and improvement, is better positioned to achieve organizational objectives during ordinary times and also to weather challenges during times of crisis. Read the Perspective.
Tweet this! “Today’s growing clinician well-being movement will be most successful not by admonishing individual clinicians to be more resilient, but by creating more resilient organizations.” More in our #10 most read #NAMPerspectives: https://doi.org/10.31478/202011a #ClinicianWellBeing #NAMTop10
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#9. Implementing Optimal Team-Based Care to Reduce Clinician Burnout
C. D. Smith, C. Balatbat, S. Corbridge, A. L. Dopp, J. Fried, R. Harter, S. Landefeld, C. Martin, F. Opelka, L. Sandy, L. Sato, and C. Sinsky
Team-based health care has been linked to improved patient outcomes and may also be a means to improve clinician well-being. The increasingly fragmented and complex health care landscape adds urgency to the need to foster effective team-based care to improve both the patient and team’s experience of care delivery. Implementing Optimal Team-Based Care to Reduce Clinician Burnout describes key features of successful health care teams, reviews existing evidence that links high-functioning teams to increased clinician well-being, and recommends strategies to overcome key environmental and organizational barriers to optimal team-based care in order to promote clinician and patient well-being. Read the Perspective.
Tweet this! Teamwork has been found to partially mitigate the relationship between work demands and burnout. The #9 most read #NAMPerspectives paper of 2020 details why: https://doi.org/10.31478/201809c #NAMTop10 #ClinicianWellBeing
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#8. Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature
A. C. Essary, K. S. Bernard, B. Coplan, R. Dehn, J. G. Forister, N. E. Smith, and V. L. Valentin
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 Burnout and Job and Career Satisfaction in the Physician Assistant Profession: A Review of the Literature is the first paper to explore the literature that relates specifically to PA burnout and career and job satisfaction. Read the Perspective.
Tweet this! Physician assistants are an important part of health care teams, but little research has been done to understand how to best support their well-being & career satisfaction. Read more in our #8 most read #NAMPerspectives of 2020: https://doi.org/10.31478/201812b #NAMTop10 #ClinicianWellBeing
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#7. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System
B. K. Madras, N. J. Ahmad, J. Wen, J. Sharfstein, and the Prevention, Treatment, and Recovery Working Group of the Action Collaborative on Countering the U.S. Opioid Epidemic
Even though evidence-based treatment for opioid use disorders (OUD) is effective, almost four in five Americans with OUD do not receive any form of treatment. The gap in access to evidence-based care, including treatment with medications for OUD, stems in part from barriers to change within the health care system. Improving Access to Evidence-Based Medical Treatment for Opioid Use Disorder: Strategies to Address Key Barriers Within the Treatment System includes nine key barriers that prevent access to evidence-based care, including stigma; inadequate clinical training; a dearth of addiction specialists; lack of integration of MOUD provision in practice; regulatory, statutory, and data sharing restrictions; and financial barriers. Action from a number of actors is urgently needed to address this crisis. Read the Perspective.
Tweet this! Key barriers to accessing the treatment system for OUD include stigma, a lack of addiction medicine specialists, regulatory and cost hurdles, and more. The #7 most read #NAMPerspectives of 2020 includes strategies to overcome these barriers: https://doi.org/10.31478/202004b #NAMTop10
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#6. People in Hong Kong Have the Longest Life Expectancy in the World: Some Possible Explanations
R. Y. Chung, and Sir M. Marmot
Since 1985, Japan has led the world in life expectancy, but Hong Kong, the once British colony and now a special administrative region of China, has taken over the lead position since 2010. With its extremely rapid post–World War II (WWII) economic development and its associated epidemiological transition from communicable to noncommunicable diseases as the leading causes of death, Hong Kong’s life expectancy has seen a steady increase over the past half-century with 81.9 years for men and 87.6 years for women in 2017. People in Hong Kong Have the Longest Life Expectancy in the World: Some Possible Explanations asks the question is why this number has risen so steadily, and whether there is anything that can be learned from the Hong Kong experience for the world at large. Read the Perspective.
Tweet this! Examining the life expectancy and contributing factors of those who live in Hong Kong could inform approaches to healthy longevity worldwide. The #6 most read #NAMPerspectives of 2020 breaks down these many factors: https://doi.org/10.31478/202001d #NAMTop10
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#5. COVID-19: AN Urgent Call for Coordinated, Trusted Sources to Tell Everyone What They Need to Know and Do
S. Ratzan, L. Gostin, N. Meshkati, K. Rabin, and R. Parker
The rapid escalation of COVID-19 has been associated with confusing and sometimes contradictory communication about its spread and what individuals need to know and do about COVID-19. As information becomes available at unpredictable times and in unpredictable ways, it has been challenging to report on the status of the outbreak in a manner that is always consistent with the reporting that has come before. These sometimes contradictory messages are confusing to the general public and may undermine both the public health response and public trust in official information sources. Increasingly, people may wonder how transparent, honest, and up to date the information they are receiving is—and whether they should believe it. The authors of COVID-19: AN Urgent Call for Coordinated, Trusted Sources to Tell Everyone What They Need to Know and Do agree that a responsible public health and health communication response to this pandemic is critical, but wonder if it can be achieved if the public does not believe what they are being told. Read the Perspective.
Tweet this! The #5 most read #NAMPerspectives of 2020, on communication during a pandemic, notes that basic information like wash your hands and avoid exposure to people with flu-like symptoms can and should be reiterated: https://bit.ly/2TFOyLE #COVID19 #NAMTop10
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#4. Burnout Among Health Care Professionals: A Call to Explore and Address this Underrecognized Threat to Safe, High-Quality Care
L.N. Dyrbye, T.D. Shanafelt, C.A. Sinsky, P.F. Cipriano, J. Bhatt, A. Ommaya, C.P. West, and D. Meyers
Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care discusses how the United States 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. Read the Perspective.
Tweet this! Clinician burnout affects patient safety, productivity, patient satisfaction and health care costs. The #4 most read #NAMPerspectives paper of 2020 examines how further research can help: http://ow.ly/RbnJ30hs1DI #NAMTop10 #ClinicianWellBeing
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#3. Alternatives to Antibiotics: Why and How
H. K. Allen
Alternatives to Antibiotics: Why and How discusses how the antibiotic resistance problem is caused by the evolution and transfer of genes that confer resistance to medically important antibiotics into human pathogens. The acquisition of such resistance genes by pathogens complicates disease treatment, increases health care costs, and increases morbidity and mortality in humans and animals. As antibiotic resistance continues to evolve, antibiotics of so-called last resort become even more precious. Reducing or preventing the dissemination of antibiotic resistance genes into human pathogens is currently of high international importance. Read the Perspective.
Tweet this! As antibiotic resistance continues to evolve, solutions are more important than ever. @theNAMedicine’s #4 most-read #NAMPerspectives paper of 2019 offers a look at alternatives: http://bit.ly/2uAHzZ7 #NAMTop10
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#2. Social Determinants of Health 101 for Health Care: Five Plus Five
S. Magnan
As defined by the World Health Organization (WHO), the social determinants of health (SDoH) are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. The social determinants of health also determine access and quality of medical care—sometimes referred to as medical social determinants of health. Future opportunities may exist in genetics and biological determinants; however, whether modifying these will be as feasible as modifying the social determinants of health is unknown. Social Determinants of Health 101 for Health Care: Five Plus Five considers what we know and what we need to learn about SDoH to achieve the national quality strategy of better care, healthy people/healthy communities, and affordable care. Read the Perspective.
Tweet this! The #2 most read #NAMPerspectives paper of 2020 highlights that exploring opportunities to address social determinants of health in health care is imperative for improved patient care. http://ow.ly/aysf30hs11j #NAMTop10
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#1. Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2
J. L. Hick, D. Hanfling, M. K. Wynia, and A. T. Pavia
The novel coronavirus SARS-CoV-2 and resulting disease state COVID-19 pose a direct threat to an over-burdened U.S. medical care system and supporting supply chains for medications and materials. The principles of crisis standards of care (CSC) initially framed by the Institute of Medicine in 2009 ensure fair processes are in place to make clinically informed decisions about scarce resource allocation during an epidemic. This may include strategies such as preparing, conserving, substituting, adapting, re-using, and re-allocating resources. In Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2 for health care planners and clinicians, the authors discuss the application of CSC principles to clinical care, including personal protective equipment, critical care, and outpatient and emergency department capacity challenges posed by a coronavirus or other major epidemic or pandemic event. Health care facilities should be developing tiered, proactive strategies using the best available clinical information and building on their existing surge capacity plans to optimize resource use in the event the current outbreak spreads and creates severe resource demands. Health care systems and providers must be prepared to obtain the most benefit from limited resources while mitigating harms to individuals, the health care system, and society. Read the Perspective.
Tweet this! The #1 most read #NAMPerspectives of 2020 provides a potential outline for how health systems can best allocate resources and staffing to respond to the spread of an infectious disease outbreak like #COVID19: https://doi.org/10.31478/202003b #NAMTop10
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