Checklist for Health Care Leadership to Take Action Against Clinician Burnout

Taking Action Against Clinician Burnout: A Systems Approach to Supporting Professional Well-Being, a 2019 report from the National Academy of Medicine, identifies clinician burnout as a threat to the quality of patient care. Mounting system pressures within the U.S. health care system have contributed to an imbalance in which the demands of the clinician’s job are greater than the resources and supports available to them.

A chronic imbalance of excessive job demands and inadequate job resources can lead to burnout – a workplace syndrome characterized by high emotional exhaustion, high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work.

In large part, the balance of job demands and job resources affecting clinicians and learners is under the direct influence of the health care organizations (HCOs) in which clinicians work and train. Organizational leadership’s decisions on resources, constraints, incentives, and demands shape the work and the behavior of people in the organization.

The report calls on leaders in HCOs and health professions educational institutions to prioritize the creation of positive, healthy clinical work and learning environments in all settings, and thereby mitigate clinician burnout and foster professional well-being across all disciplines.

Key actions for health care leadership to take to mitigate clinician burnout:

 Involve leaders across the organization in clinician well-being efforts 

Engage governing boards, executive officers, senior leaders, department chairs, and administrative leaders in a shared commitment to create and maintain a positive and healthy work environment

Create and maintain, at the executive level, a leadership role and function responsible for improving and sustaining professional well-being across the organization

Build organizational will to make clinician well-being a priority

Identify and address those aspects of the work and learning environments, institutional culture, infrastructure and resources, and policies that erode professional well-being and contribute to burnout

Advocate for needed regulatory reforms

Eliminate barriers that prevent or discourage access to professional and personal support programs for individual clinicians and learners

Allocate resources in ways that address clinician burnout

Create conditions in work and learning environments that equip clinicians and non-clinician staff with dedicated time, resources, and skills to advance clinician well-being 

Develop, communicate, and coordinate a shared focus on improving patient care across the organization

Mutually consider requirements, constraints, and unanticipated consequences of organizationally separate entities

Align organizational goals and resources

Commit to a culture of teamwork, collaboration, and adaptability in support of continuous learning

Use data to continuously improve the clinical work and learning environments 

Monitor clinician well-being using validated instruments to measure burnout at a minimum annually

Evaluate how business and management decisions may affect clinicians’ job demands and job resources, patient care quality and safety, and levels of burnout within the organization – adjust decisions and their implementation accordingly

Assess total workload and the complexity of the work expected of clinicians (including continuing professional education, maintenance of certification, required institutional learning modules, and work performed outside of scheduled hours)

Target reports internally, including to leadership, managers, and clinicians, to share transparently within the organization

Avoid any perception of blaming frontline staff for results or exerting pressure for them to remediate results

Create sustainable solutions addressing factors driving burnout 

Create incentives for, and lower barriers to, the development and implementation of new ideas, approaches, and technologies that have the promise of enhancing professional well-being as well as improving quality of care

Co-create solutions with clinicians, rather than imposing them, to increase the likelihood of meaningful and sustainable progress

Share successes within the HCO as well as the field at large to accelerate improvement

Addressing the factors contributing to clinician burnout and the barriers to professional well-being using a systems approach will ultimately help health systems improve patients’, families’, and clinicians’ experiences and outcomes.