Between one-third and one-half of U.S. clinicians experience burnout and addressing the epidemic requires systemic changes by health care organizations, educational institutions, and all levels of government, says a new report from the National Academy of Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being outlines six goals that these stakeholders should pursue to prevent and mitigate clinician burnout and foster professional well-being.
Burnout – characterized by emotional exhaustion, detachment, and a low sense of personal accomplishment – can jeopardize patient care and cause doctors, nurses, and other clinicians to leave the health care profession altogether. It is specifically job-related and not an individual mental health diagnosis, says the report. Mounting pressures in the health care system have contributed to burnout – including long hours, technologies and documentation requirements that detract from patient care, difficulties with work-home balance, and insufficient job resources, such as unsupportive organizational culture and ineffective team structures.
Personal stress management strategies are not sufficient to address the issue of clinician burnout, says the report. It is critical to address burnout not as an individual issue, but rather as a systems issue that emanates from workplace culture, health care policies and regulations, and societal expectations.
“The work system – including the physical environment, the technologies in use, and how care team members interact with each other – deeply influences clinicians’ professional well-being,” said committee co-chair Pascale Carayon, Leon and Elizabeth Janssen Professor and Director of the Wisconsin Institute for Healthcare Systems Engineering at the University of Wisconsin-Madison. “To provide the best patient care possible, health care organizations must create a work environment that fosters clinicians’ safety, health, and sense of fulfillment.”
“For many clinicians, developing real relationships with patients is what attracted us to health care in the first place, but administrative tasks often take us away from patient care,” said Christine Cassel, senior adviser on strategy and policy and professor of medicine at the University of California, San Francisco and co-chair of the committee that wrote the report. “With this report, we have a real opportunity to change the culture of health care delivery and help restore clinicians’ well-being and joy in medicine.”
The report outlines six goals the health care system should pursue:
- Create positive work environments. Health care executives should commit to, and be accountable for, creating a work environment that promotes high-quality care, job satisfaction, and social support, says the report. It recommends that health care organizations create and maintain an executive leadership role dedicated to clinician well-being. Health care organizations should also assess how business and management decisions — for example, whether to deploy new technologies — may affect clinicians’ job demands and levels of burnout, as well as patient care quality and safety. They should continuously monitor and evaluate the extent of burnout in their organization, using validated tools, and report on this at least annually to leaders, managers, and clinicians within the organization.
- Address burnout in training and at the early career stage. Clinicians often experience burnout early in professional The report recommends that schools of health professions (including medical schools, nursing schools, schools of pharmacy, and others) alleviate major sources of stress by monitoring workload (including preparation for licensure examinations and required training activities), implementing pass-fail grading, improving access to scholarships and affordable loans, and building new loan repayment systems.
- Reduce tasks that do not improve patient care. Federal agencies, state legislatures, and other standard-setting entities should identify and address the sources of clinician burnout related to laws, regulations, and policies, eliminating those that contribute little or no value to patient care. They should specifically evaluate regulations and standards related to payment, health information technology, quality measurement and reporting, and professional and legal requirements for licensure.
- Improve usability and relevance of health IT. Health information technology (IT), including electronic health records, should be as user-friendly and easy to operate as possible to reduce burnout, the report says. Health IT vendors and health care organizations should deploy technologies to reduce documentation demands and automate non-essential tasks. In addition, federal policymakers and private sector health IT companies should collaborate to develop the infrastructure and processes that enable shared decision-making between clinicians and patients.
- Reduce stigma and improve burnout recovery services. Many clinicians do not report burnout because they fear the potential consequences, including loss of licensure. In order to eliminate the stigma of getting help and to promote recovery and well-being, the report recommends that state legislative bodies facilitate access to employee assistance programs, peer support programs, and mental health providers without the information being admissible in malpractice litigation. Applications for medical licensure or renewal should focus only on current impairment due to any health condition, rather than past diagnoses for a mental health condition.
- Create a national research agenda on clinician well-being. By the end of 2020, federal agencies — including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, the Health Resources and Services Administration, and the U.S. Department of Veterans Affairs — should develop a coordinated research agenda on clinician burnout, says the report. Research priorities should include identifying the drivers of burnout across career and life stages for different types of clinicians; burnout’s implications for the workforce as well as patient safety outcomes; and potential systems-level interventions to improve clinician and learner well-being.
“Twenty years ago, the Institute of Medicine reports To Err Is Human and Crossing the Quality Chasm revealed a crisis in patient safety and led to a focus on quality that has revolutionized the U.S. health care system. Today, the same type of transformative change is needed to support clinician well-being, which is linked inextricably to the quality of care,” said National Academy of Medicine President Victor J. Dzau. “System-level solutions aimed at reducing or preventing burnout for clinicians of all types, across all workplaces and career stages, are essential to supporting a high-functioning health system and satisfactory patient experience. Health care leaders at all levels must take urgent action to uphold clinician well-being as a fundamental value that is essential to the fulfilment of their missions.”
The study — undertaken by the Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being — was sponsored by Accreditation Council for Graduate Medical Education, American College of Occupational and Environmental Medicine, American Hospital Association, Association of American Medical Colleges, BJC HealthCare, Cedars-Sinai Medical Center, the Doctors Company Foundation, Duke University Hospital, Arnold P. Gold Foundation, Gordon and Betty Moore Foundation, Johns Hopkins Health System, Josiah Macy Jr. Foundation, Keck School of Medicine of the University of Southern California, Medical College of Wisconsin, Montefiore Medicine, the Mont Fund, the Ohio State University, State University of New York System, Tulane University, University of Florida, University of Illinois Hospital and Health Sciences System, University of Massachusetts Medical School, University of Michigan, University of New Mexico Health Sciences Center, University of North Carolina at Chapel Hill, University of Utah Health, University of Virginia Medical Center, University of Virginia School of Medicine, Vanderbilt University Medical Center, Washington University School of Medicine, Yale School of Medicine, and Yale New Haven Health System.
The National Academy of Medicine, established in 1970 as the Institute of Medicine, is an independent organization of eminent professionals from diverse fields including health and medicine; the natural, social, and behavioral sciences; and beyond. It serves alongside the National Academy of Sciences and the National Academy of Engineering as an adviser to the nation and the international community. Through its domestic and global initiatives, the NAM works to address critical issues in health, medicine, and related policy and inspire positive action across sectors. The NAM collaborates closely with its peer academies and other divisions within the National Academies of Sciences, Engineering, and Medicine.