Improving Physician Well-Being Through Organizational Change

 

Wellness Wednesdays and yoga breaks aren't sufficient. Here's how health care organizations can begin to address physician well-being.

Fam Pract Manag. 2020 Nov-Dec;27(6):23-28.

Author disclosure: no relevant financial affiliations disclosed.

The health, well-being, and success of an organization is directly linked to the health, well-being, and success of the individuals who belong to the organization. In many hospitals and health systems, leaders are beginning to understand that organizational goals that were traditionally aligned to patient outcomes must now include a broader set of metrics, including physician and staff well-being. Burnout, which more than 50% of physicians report experiencing, affects not only individual well-being but also hospital and health system revenue and patient care.15

Physician burnout has been attributed to a multitude of complex factors, many of which stem from challenges and stressors at the organizational level. In 2019, the National Academy of Medicine (NAM) issued a 333-page report titled Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.6 The report stated that numerous organizational, environmental, individual, regulatory, and sociocultural factors contribute to physician burnout, and called on health care leaders and organizations to target the following organizational factors:

  1. Excessive workload, administrative burden, and bureaucracy,

  2. Diminished professional relationships, trust, resources, autonomy and engagement, workplace safety and inclusion, and professional development,

  3. Ineffective compensation and reimbursement structures, performance policies and recognition processes, leadership and mentorship, team functionality, and EHR systems.

Health care organizations have many complex sets of metrics and goals, such as those related to productivity, which can unintentionally threaten physician well-being. Understanding even the inadvertent factors related to burnout is necessary to design effective solutions and produce high-functioning, high-value health care organizations. Health care systems have traditionally tried to achieve the Institute for Healthcare Improvement's “triple aim”: better care, better health, and lower costs. But many are now embracing the “quadruple aim” proposed by Drs. Thomas Bodenheimer and Christine Sinsky, who argued that “health care providers can't achieve the Triple Aim's core ideals without first prioritizing their own health needs.”7 The triple aim depends on a healthy workforce with a manageable workload. As organizations push for high-quality, low-cost patient care in the current delivery model, they often add to the workload, negatively affecting the well-being of health professionals and inadvertently delivering lower quality care at higher costs. Doing more with less is not working.

In addition, COVID-19 has added significant challenges and diminished revenues to health care systems, which could intensify factors that already limit well-being among health professionals. Systems facing new pressures must invest in the health of their employees now more than ever.

Organizations are not inherently evil, of course. They are simply entities run by people

ABOUT THE AUTHOR

Dr. Pipas is a family physician and Professor of Community and Family Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, and the Department of Medical Education at the Geisel School of Medicine at Dartmouth College in Hanover, N.H. She is the author of A Doctor's Dozen: 12 Strategies for Personal Health and a Culture of Wellness and has been recognized as a leader in wellness, education, research, and clinical care. Her recent awards include the 2019 Society of Teachers of Family Medicine Humanism Award and the 2019 Family Medicine Education Consortium This We Believe Award. Dr. Pipas serves as the chief wellness officer for CaseNetwork.

Author disclosure: no relevant financial affiliations disclosed.

References

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2. Dewa CS, Loong D, Bonato S, Thanh NX, Jacobs P. How does burnout affect physician productivity? A systematic literature review. BMC Health Serv Res. 2014;14:325.

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4. Fahrenkopf AM, Sectish TC, Barger LK, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336(7642):488–491.

5. Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011;305(19):2009–2010.

6. National Academy of Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. The National Academies Press; 2019. Accessed Oct. 1, 2020. https://www.nam.edu/ClinicianWellBeingStudy

7. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.

8. Kotter JP. Leading Change. Harvard Business Review Press; 1996.

9. Souba WW. Leadership and strategic alignment — getting people on board and engaged. J Surg Res. 2001;96(2):144–151.

10. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92(1):129–146.

11. Quinn JF, White BAA. Cultivating Leadership in Medicine. Kendall Hunt Publishing Company; 2020.

12. Southwick SM, Charney DS. Resilience: The Science of Mastering Life’s Greatest Challenge. Cambridge University Press; 2012.

13. Pipas CF. A Doctor’s Dozen: 12 Strategies for Personal Health and a Culture of Wellness. Dartmouth College Press; 2018.

14. CoreWellness Online. CaseNetwork. Accessed Oct. 1, 2020. http://casenetwork.com/markets/corewellness/

15. Shanafelt T, Trockel M, Ripp J, Murphy ML, Sandborg C, Bohman B. Building a program on well-being: key design considerations to meet the unique needs of each organization. Acad Med. 2019;94(2):156–161.

 
 

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