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Farag A, Wakefield BJ, Jaske E, Paez M, Stewart G. Determinants of Patient Aligned Care Team (PACT) members' burnout and its relationship with patient-centered care. APPLIED ERGONOMICS 2024; 118:104272. [PMID: 38537519 DOI: 10.1016/j.apergo.2024.104272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/11/2024] [Accepted: 03/15/2024] [Indexed: 05/03/2024]
Abstract
Burnout is a prevalent issue among healthcare providers affecting up to 54% of physicians and 35% of nurses. Patient Aligned Care Teams (PACT) is a team-based primary care delivery model designed to assure the delivery of high-quality care while improving clinicians' well-being. Limited studies evaluated the relationship between work environment variables and PACT members' burnout and the relationship between PACT members' burnout and patient-centered care. This cross-sectional study is based on the 2018 Veterans Health Administration (VHA) national web-based PACT survey. Burnout was measured using a single-item question that was validated in previous studies. Descriptive statistics and logistic regression were used to analyze the data. Fifty-one percent of primary care providers and 40.12% of nurses reported high burnout. PACT members with a work environment characterized by high-quality team interaction, leadership support, and psychological safety experienced lower levels of burnout. PACT members' burnout explained 6% of the variance in PACT members' ability to deliver patient-centered care. Burnout among PACT members is attributed to multiple personal and occupational variables. This study identified modifiable work environment variables that can be used to inform burnout interventions.
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Affiliation(s)
- Amany Farag
- University of Iowa, College of Nursing, Iowa City, IA, USA.
| | | | - Erin Jaske
- VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Greg Stewart
- University of Iowa, Tippie College of Business, Iowa City, IA, USA
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Tomaszewska K, Kowalczuk K, Majchrowicz B, Kłos A, Kalita K. Areas of professional life and job satisfaction of nurses. Front Public Health 2024; 12:1370052. [PMID: 38638473 PMCID: PMC11024284 DOI: 10.3389/fpubh.2024.1370052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Job satisfaction among nurses is closely related to work environment as well as organizational and professional commitment. Satisfaction is a concept derived from Latin, where "satis" means "enough," as much as is needed to fully satisfy expectations, needs, aspirations, in such a way that there is no room for complaint. Job satisfaction, on the other hand, is formulated as a positive attitude of employees toward the duties of the job, the work environment and other employees. The aim of this paper was to demonstrate how the different areas of nurses' professional life, i.e., workload, control, rewards, community, sense of justice and values, correlate with their perceived job satisfaction. Materials and methods A cross-sectional study was conducted in a group of 509 nurses working in a public hospital in Poland. Data were collected using a survey questionnaire, which consisted of a section containing sociodemographic data and standardized instruments: The Minnesota Satisfaction Questionnaire (MSQ) and The Areas of Worklife Survey (AWS) developed by Maslach and Leiter. Correlations were made using Spearman's rho coefficient. The calculations also used stepwise linear regression analysis after checking certain assumptions, including checking the assumption of normality of residuals and the Durbin-Watson Test. Results The mean score for the 20 items of the MSQ questionnaire ranged from 3.05 to 3.43 on a 5-point Likert scale. Support from the interdisciplinary team, which concerned assessing the quality of the social environment in the workplace, cooperation and showing positive feelings received the highest rating among respondents (3.51 ± 0.76). The sense of fair treatment at work averaged 3.26 ± 0.58. The area of value conflict within the organization itself or between the employee's values and those of the organization, respondents rated an average of 3.26 ± 0.65. The mean score for all areas of professional work in the surveyed group was 3.09 ± 0.45. Conclusion As satisfaction in particular areas of work life increases, so does the level of satisfaction in such aspects of work as achievement and a sense of fairness. The higher the level of satisfaction in the area of control, the more the sense of satisfaction with independence increases. The higher the satisfaction of respondents in the areas of values, workload and control, the higher the level of satisfaction with working conditions occurs.
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Affiliation(s)
- Katarzyna Tomaszewska
- Department of Health Protection, Institute of Health Protection, The Bronislaw Markiewicz State Higher School of Technology and Economics, Jaroslaw, Poland
| | - Krystyna Kowalczuk
- Department of Integrated Medical Care, Medical University of Bialystok, Bialystok, Poland
| | - Bożena Majchrowicz
- Department of Nursing, Institute of Health Protection, State Academy of Applied Sciences, Przemysl, Poland
| | - Alicja Kłos
- Department of Health Protection, Institute of Health Protection, The Bronislaw Markiewicz State Higher School of Technology and Economics, Jaroslaw, Poland
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Abrams R, Jones B, Campbell J, de Lusignan S, Peckham S, Gage H. The effect of general practice team composition and climate on staff and patient experiences: a systematic review. BJGP Open 2024; 8:BJGPO.2023.0111. [PMID: 37827584 PMCID: PMC11169989 DOI: 10.3399/bjgpo.2023.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Recent policy initiatives seeking to address the workforce crisis in general practice have promoted greater multidisciplinarity. Evidence is lacking on how changes in staffing and the relational climate in practice teams affect the experiences of staff and patients. AIM To synthesise evidence on how the composition of the practice workforce and team climate affect staff job satisfaction and burnout, and the processes and quality of care for patients. DESIGN & SETTING A systematic literature review of international evidence. METHOD Four different searches were carried out using MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science. Evidence from English language articles from 2012-2022 was identified, with no restriction on study design. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and data were synthesised thematically. RESULTS In total, 11 studies in primary healthcare settings were included, 10 from US integrated healthcare systems, one from Canada. Findings indicated that when teams are understaffed and work environments are stressful, patient care and staff wellbeing suffer. However, a good relational climate can buffer against burnout and protect patient care quality in situations of high workload. Good team dynamics and stable team membership are important for patient care coordination and job satisfaction. Female physicians are at greater risk of burnout. CONCLUSION Evidence regarding team composition and team climate in relation to staff and patient outcomes in general practice remains limited. Challenges exist when drawing conclusions across different team compositions and definitions of team climate. Further research is needed to explore the conditions that generate a 'good' climate.
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Affiliation(s)
- Ruth Abrams
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Bridget Jones
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - John Campbell
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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Alharbi MF, Alkhamshi AM. Assessing the professional quality of life in the context of pediatric care. PeerJ 2024; 12:e17120. [PMID: 38500534 PMCID: PMC10946390 DOI: 10.7717/peerj.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024] Open
Abstract
Background This study examines the professional quality of life (ProQOL), including compassion satisfaction (CS) and compassion fatigue (CF), burnout (BO) and secondary traumatic stress (STS) among registered nurses in the context of pediatric care in Riyadh city in Saudi Arabia. Methods This study utilised a random multistage sampling method and a survey to collect data from 250 participants on personal characteristics, work-related aspects, lifestyle, and professional quality of life. Results The study participants were all female. Only 2.0% were under 25, with 27.2% aged between 25 and 30 years, 24.0% aged between 31 and 35, and 26.4% over 40 years old. The majority, 74%, were non-Saudis. The participants reported low compassion satisfaction (CS) and compassion fatigue (CF) levels. The CS, burnout (BO), and secondary traumatic stress (STS) scores were 3.23 ± 0.764, 2.75 ± 0.68, and 2.69 ± 0.54, respectively. The study found a significant difference in ProQOL level based on factors such as age, nationality, previous experience, department, shift length, overtime work, state of overtime (mandatory versus optional), and salary. Conclusions Working with vulnerable groups poses unique challenges for pediatric nurses. The nationality, salary, and state of overtime were found to be significantly different when compared to CS scores. Additionally, age, department, previous experience, shift length, and overtime work were very different compared to CF scores. However, lifestyle factors did not affect CS and CF scores significantly. Implications To improve their well-being and interest in activities, pediatric nurses should practice self-compassion and utilise available educational resources such as workshops. They should also strive to achieve a work-life balance and adopt healthy habits to reduce CF.
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Affiliation(s)
- Manal F. Alharbi
- Maternal & Child Health Nursing Department, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Aljawharah M. Alkhamshi
- Nursing Education Department, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia
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Chen HW. Managing a multi-panel clinic with heterogeneous patients. Health Care Manag Sci 2023; 26:673-691. [PMID: 37930502 DOI: 10.1007/s10729-023-09658-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 09/04/2023] [Indexed: 11/07/2023]
Abstract
Primary care providers (PCPs) are considered the first-line defenders in preventive care. Patients seeking service from the same PCP constitute that physician's panel, which determines the overall supply and demand of the physician. The process of allocating patients to physician panels is called panel design. This study quantifies patient overflow and builds a mathematical model to evaluate the effect of two implementable panel assignments. In specialized panel assignment, patients are assigned based on their medical needs or visit frequency. In equal panel assignment, patients are distributed uniformly to maintain a similar composition across panels. We utilize majorization theory and numerical examples to evaluate the performance of the two designs. The results show that specialized panel assignment outperforms when (1) patient demands and physician capacity are relatively balanced or (2) patients who require frequent visits incur a higher shortage penalty. In a simulation model with actual patient arrival patterns, we also illustrate the robustness of the results and demonstrate the effect of switching panel policy when the patient pool changes over time.
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Affiliation(s)
- Hao-Wei Chen
- Department of Information Systems and Supply Chain Management, John B. and Lillian E. Neff College of Business and Innovation, University of Toledo, Toledo, OH, USA.
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Apaydin EA, Rose DE, McClean MR, Mohr DC, Yano EM, Shekelle PG, Nelson KM, Guo R, Yoo CK, Stockdale SE. Burnout, employee engagement, and changing organizational contexts in VA primary care during the early COVID-19 pandemic. BMC Health Serv Res 2023; 23:1306. [PMID: 38012726 PMCID: PMC10683139 DOI: 10.1186/s12913-023-10270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic involved a rapid change to the working conditions of all healthcare workers (HCW), including those in primary care. Organizational responses to the pandemic, including a shift to virtual care, changes in staffing, and reassignments to testing-related work, may have shifted more burden to these HCWs, increasing their burnout and turnover intent, despite their engagement to their organization. Our objectives were (1) to examine changes in burnout and intent to leave rates in VA primary care from 2017-2020 (before and during the pandemic), and (2) to analyze how individual protective factors and organizational context affected burnout and turnover intent among VA primary care HCWs during the early months of the pandemic. METHODS We analyzed individual- and healthcare system-level data from 19,894 primary care HCWs in 139 healthcare systems in 2020. We modeled potential relationships between individual-level burnout and turnover intent as outcomes, and individual-level employee engagement, perceptions of workload, leadership, and workgroups. At healthcare system-level, we assessed prior-year levels of burnout and turnover intent, COVID-19 burden (number of tests and deaths), and the extent of virtual care use as potential determinants. We conducted multivariable analyses using logistic regression with standard errors clustered by healthcare system controlled for individual-level demographics and healthcare system complexity. RESULTS In 2020, 37% of primary care HCWs reported burnout, and 31% reported turnover intent. Highly engaged employees were less burned out (OR = 0.57; 95% CI 0.52-0.63) and had lower turnover intent (OR = 0.62; 95% CI 0.57-0.68). Pre-pandemic healthcare system-level burnout was a major predictor of individual-level pandemic burnout (p = 0.014). Perceptions of reasonable workload, trustworthy leadership, and strong workgroups were also related to lower burnout and turnover intent (p < 0.05 for all). COVID-19 burden, virtual care use, and prior year turnover were not associated with either outcome. CONCLUSIONS Employee engagement was associated with a lower likelihood of primary care HCW burnout and turnover intent during the pandemic, suggesting it may have a protective effect during stressful times. COVID-19 burden and virtual care use were not related to either outcome. Future research should focus on understanding the relationship between engagement and burnout and improving well-being in primary care.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Michael R McClean
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - David C Mohr
- National Center for Organization Development, Veterans Health Administration, Cincinnati, OH, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, Boston, MA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Karin M Nelson
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, University of Washington, Seattle, WA, USA
| | - Rong Guo
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
| | - Caroline K Yoo
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. (151), Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Hughes AM, Arredondo K, Lester HF, Oswald FL, Pham TND, Jiang C, Hysong SJ. What can we learn from COVID-19?: examining the resilience of primary care teams. Front Psychol 2023; 14:1265529. [PMID: 38078279 PMCID: PMC10703302 DOI: 10.3389/fpsyg.2023.1265529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/06/2023] [Indexed: 02/12/2024] Open
Abstract
Introduction The COVID-19 pandemic continues to place an unprecedented strain on the US healthcare system, and primary care is no exception. Primary care services have shifted toward a team-based approach for delivering care in the last decade. COVID-19 placed extraordinary stress on primary care teams at the forefront of the pandemic response efforts. The current work applies the science of effective teams to examine the impact of COVID-19-a crisis or adverse event-on primary care team resilience. Methods Little empirical research has been done testing the theory of team resilience during an extremely adverse crisis event in an applied team setting. Therefore, we conducted an archival study by using large-scale national data from the Veterans Health Administration to understand the characteristics and performance of 7,023 Patient Aligned Care Teams (PACTs) during COVID-19. Results Our study found that primary care teams maintained performance in the presence of adversity, indicating possible team resilience. Further, team coordination positively predicted team performance (B = 0.53) regardless of the level of adversity a team was experiencing. Discussion These findings in turn attest to the need to preserve team coordination in the presence of adversity. Results carry implications for creating opportunities for teams to learn and adjust to an adverse event to maintain performance and optimize team-member well-being. Teamwork can act as a protective factor against high levels of workload, burnout, and turnover, and should be studied further for its role in promoting team resilience.
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Affiliation(s)
- Ashley M. Hughes
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
- Center of VHA Innovation for Complex, Chronic Healthcare, Edward Hines JR VA Hospital, Hines, IL, United States
| | - Kelley Arredondo
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- Veterans’ Health Administration Office of Rural Health’s Veterans Center, White River Junction, VT, United States
- VA South Central Mental Illness Research, Education and Clinical Center (SC MIRECC), a Virtual Center, Houston, TX, United States
| | - Houston F. Lester
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Department of Management, University of Mississippi, Oxford, MS, United States
| | - Frederick L. Oswald
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Trang N. D. Pham
- Department of Biostatistics and Epidemiology, University of Illinois at Chicago, Chicago, IL, United States
| | - Cheng Jiang
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sylvia J. Hysong
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States
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Alshammari MH, Alboliteeh M. Moral courage, burnout, professional competence, and compassion fatigue among nurses. Nurs Ethics 2023; 30:1068-1082. [PMID: 37192753 DOI: 10.1177/09697330231176032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Moral courage is the ability to defend and practice ethical and moral action when faced with a challenge, even if it means rejecting pressure to act otherwise. However, moral courage remains an unexplored concept among middle eastern nurses. AIM This study investigated the mediating role of moral courage in the relationship between burnout, professional competence, and compassion fatigue among Saudi Arabian nurses. RESEARCH DESIGN Correlational, cross-sectional design following the STROBE guidelines. PARTICIPANTS AND RESEARCH CONTEXT Convenience sampling was used to recruit nurses (n = 684) for four government hospitals in Saudi Arabia. Four validated self-report questionnaires (Nurses' Moral Courage Scale, Nurse Professional Competence Scale-Short Form, Maslach Burnout Inventory, and Nurses Compassion Fatigue Inventory) were used to collect data between May to September 2022. Spearman rho and structural equation modeling analyses were employed to analyze the data. ETHICAL CONSIDERATIONS The ethics review committee of a government university in Ha'il region, Saudi Arabia, approval this study (Protocol no.: H-2021-012; Approved: 08/022,021). Participants were fully explained the study aims, and consent was voluntarily secured. RESULTS The emerging model showed that burnout had a direct and positive influence on compassion fatigue, while professional competence had a direct, negative effect on compassion fatigue. Moral courage had a small and direct but negative influence on compassion fatigue. Mediation analyses also indicated that moral courage significantly mediated the indirect effects of burnout and professional competence on compassion fatigue. CONCLUSION Moral courage can be a crucial aspect in preserving the psychological and mental health of nurses, particularly under stressful conditions. Therefore, it is advantageous from an organizational and leadership standpoint to implement measures such as programs and interventions to foster moral courage among nurses.
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Affiliation(s)
| | - Mohammad Alboliteeh
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il City, KSA
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O'Connor AW, Helfrich CD, Nelson KM, Sears JM, Jensen PK, Engstrom C, Wong ES. Full practice authority and burnout among primary care nurse practitioners. Nurs Outlook 2023; 71:102056. [PMID: 37856902 DOI: 10.1016/j.outlook.2023.102056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout. PURPOSE Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout. METHODS In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs. DISCUSSION Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant. CONCLUSION NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.
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Affiliation(s)
- Allyson W O'Connor
- Department of Health Systems and Population Health, University of Washington, Seattle, WA.
| | - Christian D Helfrich
- Department of Health Systems and Population Health, University of Washington, Seattle, WA; Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
| | - Karin M Nelson
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Department of Medicine, University of Washington, Seattle, WA
| | - Jeanne M Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA; Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Penny Kaye Jensen
- Office of Nursing Service, Department of Veterans Affairs, Washington, DC
| | - Christine Engstrom
- Office of Nursing Service, Department of Veterans Affairs, Washington, DC
| | - Edwin S Wong
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA
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Schaechter JD, Goldstein R, Zafonte RD, Silver JK. Workplace Belonging of Women Healthcare Professionals Relates to Likelihood of Leaving. J Healthc Leadersh 2023; 15:273-284. [PMID: 37908972 PMCID: PMC10615104 DOI: 10.2147/jhl.s431157] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Purpose There is a high rate of attrition of professionals from healthcare institutions, which threatens the economic viability of these institutions and the quality of care they provide to patients. Women professionals face particular challenges that may lower their sense of belonging in the healthcare workplace. We sought to test the hypothesis that workplace belonging of women healthcare professionals relates to the likelihood that they expect to leave their institution. Methods Participants of a continuing education course on women's leadership skills in health care completed a survey about their experiences of belonging in workplace and their likelihood of leaving that institution within the next 2 years. An association between workplace belonging (measured by the cumulative number of belonging factors experienced, scale 0-10) and likelihood of leaving (measured on a 5-point Likert scale) was evaluated using ordinal logistic regression. The relative importance of workplace belonging factors in predicting the likelihood of leaving was assessed using dominance analysis. Results Ninety-nine percent of survey participants were women, and 63% were clinicians. Sixty-one percent of participants reported at least a slight likelihood of leaving their healthcare institution within the next 2 years. Greater workplace belonging was found to be associated with a significant reduction in the reported likelihood of leaving their institution after accounting for the number of years having worked in their current institution, underrepresented minority status, and the interaction between the latter two covariates. The workplace belonging factor found to be most important in predicting the likelihood of leaving was the belief that there was an opportunity to thrive professionally in the institution. Belonging factors involving feeling able to freely share thoughts and opinions were also found to be of relatively high importance in predicting the likelihood of leaving. Conclusion Greater workplace belonging was found to relate significantly to a reduced likelihood of leaving their institution within the next 2 years. Our findings suggest that leaders of healthcare organizations might reduce attrition of women by fostering workplace belonging with particular attention to empowering professional thriving and creating a culture that values open communication.
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Affiliation(s)
- Judith D Schaechter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, MA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Brigham and Women’s Hospital, Boston, MA, USA
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Abstract
This essay discusses how the deep work of doctoring leveraged with technology can bring us close to the quadruple aim of better care, better health, lower cost, and fulfilling work.
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Affiliation(s)
- Elizabeth T Toll
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Ma KPK, Mollis BL, West II, Rolfes J, Clifton J, Kessler R, Baldwin LM, Chakravarti P, Dewane S, Gerrish W, Holmes J, Karlson K, Roberts V, Stephens KA. Integrated Behavioral Health in Primary Care Residency and Nonresidency Practices. Fam Med 2023; 55:530-538. [PMID: 37696022 PMCID: PMC10622053 DOI: 10.22454/fammed.2023.715036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Integrated behavioral health (BH) is becoming a preferred model of care for primary care because it improves patient outcomes and satisfaction. Little is known about whether residency practices are consistently modeling this preferred care model relative to real-world nonresidency practices. The study compared levels of BH integration, patient health outcomes, and satisfaction with care between residency practices and nonresidency practices with colocated BH providers. METHODS Baseline data were collected in 2018-2019 from 44 practices and their adult patients with chronic conditions participating in a cluster-randomized, pragmatic trial to improve BH integration. The sample included 18 (40.9%) residency and 26 (59.1%) nonresidency practices, with 1,817 (45.3%) patients from residency practices and 2,190 (54.7%) patients from nonresidency practices. Outcomes including BH integration levels (the Practice Integration Profile), patient health outcomes (the PROMIS-29), and patient satisfaction with care (the Consultation and Relational Empathy scale) were compared between residency and nonresidency practices using multivariate regression analyses. RESULTS No differences were found between BH integration levels, patient health outcomes, and patient satisfaction with care between residency and nonresidency practices. In a sample of primary care practices with colocated BH providers, residencies had BH integration and patient outcomes similar to real-world practices. CONCLUSIONS Primary care practices with residency programs reported comparable levels of BH integration, patient health outcomes, and patient satisfaction compared to practices without residency programs. Both types of practices require interventions and resources to help them overcome challenges associated with dissemination of high levels of BH integration.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Brenda L. Mollis
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Imara I. West
- Department of Psychiatry & Behavioral Sciences, University of Washington School of MedicineSeattle, WA
| | | | | | - Rodger Kessler
- Department of Family Medicine, University of Colorado Anschutz Medical CampusAurora, CO
| | - Laura-Mae Baldwin
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | | | | | - Winslow Gerrish
- Full Circle Health/Family Medicine Residency of IdahoBoise, ID
| | - John Holmes
- Department of Family Medicine, Idaho State UniversityPocatello, ID
| | | | - Verena Roberts
- Department of Family Medicine, Idaho State UniversityPocatello, ID
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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Mohr DC, Apaydin EA, Li BM, Molloy-Paolillo BK, Rinne ST. Changes in Burnout and Moral Distress Among Veterans Health Administration (VA) Physicians Before and During the COVID-19 Pandemic. J Occup Environ Med 2023; 65:605-609. [PMID: 37043388 PMCID: PMC10332509 DOI: 10.1097/jom.0000000000002861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND We investigated the impacts of workload, resources, organizational satisfaction, and psychological safety on changes in physician burnout and moral distress among physicians during the early pandemic. METHODS We obtained national administrative and survey data on burnout, moral distress, organizational satisfaction, psychological safety, COVID-19 burden, and state-level restrictions for 11,877-14,246 Veterans Health Administration (VA) physicians from 2019 and 2020. We regressed the changes in burnout and moral distress on the changes in reasonable workload, appropriate job resources, organizational satisfaction, and psychological safety, controlling for COVID-19 burden and restrictions, and individual and medical center characteristics. RESULTS Burnout and moral distress were not related to COVID-19 cases or restrictions but were reduced by improvements in workload, organizational satisfaction, and psychological safety. CONCLUSIONS Health systems should be conscious of factors that can harm or improve physician well-being, especially in the context of external stressors.
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Wilk JE, Clarke-Walper K, Nugent K, Hoge CW, Sampson M, Warner CH. Associations of health care staff burnout with negative health and organizational outcomes in the U.S. military health system. Soc Sci Med 2023; 330:116049. [PMID: 37418990 DOI: 10.1016/j.socscimed.2023.116049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/09/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023]
Abstract
RATIONALE Burnout is a personal and occupational phenomenon that has been associated with negative physical and psychological outcomes in medical staff. Additionally, there are implications for healthcare organizations, as those staff who are burned out are more likely to have lower productivity or leave the organization. As with the Covid-19 pandemic, future national emergencies and potentially large-scale conflicts will require similar and likely even larger scale responses from the U.S. Military Health System, thus it is important to understand burnout in this population so that the readiness of the staff and the military can remain at a high level. OBJECTIVE This assessment was designed to examine levels of burnout among United States Military Health System (MHS) staff working at Army installations and the factors that influence the development of burnout. METHODS Anonymous data was collected from 13,558 active-duty U.S. Soldiers and civilian MHS employees. Burnout was measured using the Copenhagen Burnout Inventory and the Mini-Z. RESULTS Results showed nearly half of staff who responded (48%) reported being burned out, an increase since last measured in 2019 (31%). Factors related to increased burnout included concerns about work/life balance and workload, low job satisfaction and feeling disconnected from others. Burnout was associated with increases in adverse physical and behavioral health (BH) outcomes. CONCLUSIONS Results indicate that burnout is a common problem across MHS Army staff and is related to significant adverse health consequences for the individual and reduced retention of staff for the organization. These findings highlight the need to address burnout through policies that standardize health care delivery policies and practices, providing support to leadership to promote a healthy workplace, and individual support to those who experience burnout.
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Affiliation(s)
- Joshua E Wilk
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Kristina Clarke-Walper
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Katie Nugent
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Charles W Hoge
- U.S. Army Office of the Surgeon General, 7700 Arlington Blvd, Falls Church, VA 22042, USA.
| | - Mary Sampson
- Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.
| | - Christopher H Warner
- U.S. Army Office of the Surgeon General, 7700 Arlington Blvd, Falls Church, VA 22042, USA; Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA.
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15
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O’Connor AW, Wong ES, Nelson KM, Sears JM, Helfrich CD. Patient Enrollment Growth and Burnout in Primary Care at the Veterans Health Administration. J Gen Intern Med 2023; 38:1689-1696. [PMID: 36697928 PMCID: PMC10212874 DOI: 10.1007/s11606-023-08034-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Patient enrollment levels at Veterans Health Administration (VHA) facilities change based on Veteran demand for care, potentially affecting demands on staff. Effects on burnout in the primary care workforce associated with increases or decreases in enrollment are unknown. OBJECTIVE Estimate associations between patient enrollment and burnout. DESIGN In this serial cross-sectional study, VHA patient enrollment and workforce data from 2014 to 2018 were linked to burnout estimates for 138 VHA facilities. The VHA's annual All Employee Survey provided burnout estimates. PARTICIPANTS A total of 82,421 responses to the 2014-2018 All Employee Surveys by primary care providers (PCPs), including physicians, nurse practitioners, and physician assistants; nurses; clinical associates; and administrative clerks were included. Respondents identified as patient-aligned care team members. MAIN MEASURES Independent variables were (1) the ratio of enrollment to PCPs at VHA facilities and (2) the year-over-year change in enrollment per PCP. Burnout was measured as the annual proportion of staff at VHA facilities who reported emotional exhaustion and/or depersonalization. Each primary care role was analyzed independently. KEY RESULTS Overall enrollment decreased from 1553 enrollees per PCP in 2014 to 1442 enrollees per PCP in 2018 across VHA facilities. Forty-three facilities experienced increased enrollment (mean of 1524 enrollees/PCP in 2014 to 1668 in 2018) and 95 facilities experienced decreased enrollment (mean of 1566 enrollees/PCP in 2014 to 1339 in 2018). Burnout decreased for all primary care roles. PCP burnout was highest, decreasing from a facility-level mean of 51.7% in 2014 to 43.8% in 2018. Enrollment was not significantly associated with burnout for any role except nurses, for whom a 1% year-over-year increase in enrollment was associated with a 0.2 percentage point increase in burnout (95% CI: 0.1 to 0.3). CONCLUSIONS Studies assessing changes in organizational-level predictors are rare in burnout research. Patient enrollment predicted burnout only among nurses in primary care.
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Affiliation(s)
- Allyson W. O’Connor
- Department of Health Systems and Population Health, University of Washington, Seattle, WA USA
| | - Edwin S. Wong
- Department of Health Systems and Population Health, University of Washington, Seattle, WA USA
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA USA
| | - Karin M. Nelson
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA USA
- Department of Medicine, University of Washington, Seattle, WA USA
| | - Jeanne M. Sears
- Department of Health Systems and Population Health, University of Washington, Seattle, WA USA
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA USA
- Harborview Injury Prevention and Research Center, Seattle, WA USA
- Institute for Work and Health, Toronto, Ontario Canada
| | - Christian D. Helfrich
- Department of Health Systems and Population Health, University of Washington, Seattle, WA USA
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA USA
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Beltràn Ponce S, Small CJ, Amini A, Johnstone C, Parikh JR, Rosenthal SA, Salerno KE, Schechter NR, Small W. Overcoming Burnout and Promoting Wellness in Radiation Oncology: A Report From the ACR Commission on Radiation Oncology. J Am Coll Radiol 2023; 20:487-493. [PMID: 36925094 PMCID: PMC10149602 DOI: 10.1016/j.jacr.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
Burnout, defined by the presence of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment, impacts a significant portion of radiation oncologists. This has been exacerbated by the COVID-19 pandemic, is notably worse for women, and has been identified as an international concern. Key contributors to burnout within radiation oncology include inadequate clinical and administrative support, imbalanced personal and professional lives including time with family and for self-care, decreased job satisfaction secondary to increased electronic medical record and decreased patient time, unsupportive organizational culture, lack of transparency from leadership and inclusion in administrative decisions, emotionally intensive patient interactions, challenges within the radiation oncology workforce, financial security related to productivity-based compensation and increasing medical training-related debt, limited education on wellness, and fear of seeking mental health services due to stigma and potential negative impacts on the trajectory of one's career. Limited data exist to quantify the impacts of these factors on the overall levels of burnout within radiation oncology specifically, and additional efforts are needed to understand and address root causes of burnout within the field. Strategies should focus on improving the systems in which physicians work and providing the necessary skills and resources to thrive in high-stress, high-stakes work environments.
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Affiliation(s)
- Sara Beltràn Ponce
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, Wisconsin and Chair, Society for Women in Radiation Oncology
| | - Christina J Small
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, Wisconsin, and Events and Outreach Chair, Society for Women in Radiation Oncology
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California
| | - Candice Johnstone
- Medical Director Radiation Oncology Froedtert West Bend Hospital, The Medical College of Wisconsin, Milwaukee, Wisconsin, Trustee of the American Registry of Radiologic Technologists, and President-elect, American Association of Women Radiologists
| | - Jay R Parikh
- Professor of Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seth A Rosenthal
- Department of Radiation Oncology, Sutter Medical Group, Sacramento, California
| | - Kilian E Salerno
- Associate Research Physician, Clinical Director, Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Naomi R Schechter
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, California, Chair, American College of Radiology Practice Parameters Committee Radiation Oncology, and Chair, American Society of Radiation Oncology Patient Safety Scientific Committee
| | - William Small
- Professor and Chairman, Department of Radiation Oncology, Stritch School of Medicine, and Director, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, Illinois, Chair, American College of Radiology Radiation Oncology Commission, and Executive Committee, American Joint Commission on Cancer.
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17
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Katta R, Strouphauer E, Ibraheim MK, Li-Wang J, Dao H. Practice Efficiency in Dermatology: Enhancing Quality of Care and Physician Well-Being. Cureus 2023; 15:e39195. [PMID: 37378213 PMCID: PMC10292050 DOI: 10.7759/cureus.39195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
A focus on improved efficiency can impact both patient care and physician well-being. Efficiency is one of the six domains of healthcare quality. It is also recognized as one of the three main pillars of professional fulfillment. Quality improvement measures in the area of efficiency are focused on reducing waste, specifically related to physicians' time, energy, and cognitive demands. Interventions and practices reported in the literature or communicated by dermatologists have documented efforts centered on patient care workflows, documentation, communication, and other areas. Team-based care models maximize the skill sets of other trained providers, while workflow changes encompassing process standardization, communication, and task automatization have improved patient safety and efficiency. Strategies to promote documentation efficiency have centered on eliminating extraneous documentation alongside the use of templates, text expander functionality, and dictation tools. The use of in-office or virtual scribes, when provided with adequate training and consistent feedback, has improved charting time, accuracy, and physician satisfaction. Although upfront investments in time and financial resources may be required, quality improvement in efficiency can benefit healthcare quality, patient safety, and physician satisfaction.
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Affiliation(s)
- Rajani Katta
- Internal Medicine, Baylor College of Medicine, Houston, USA
- Dermatology, University of Texas Health Science Center at Houston, Houston, USA
| | | | | | | | - Harry Dao
- Dermatology, Loma Linda University Health, Loma Linda, USA
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18
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Witmer HDD, Keçeli Ç, Morris-Levenson JA, Dhiman A, Kratochvil A, Matthews JB, Adelman D, Turaga KK. Operative Team Familiarity and Specialization at an Academic Medical Center. Ann Surg 2023; 277:e1006-e1017. [PMID: 35796435 DOI: 10.1097/sla.0000000000005463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To propose a framework for quantification of surgical team familiarity. BACKGROUND Operating room (OR) teamwork quality is associated with familiarity among team members and their individual specialization. We describe novel measures of OR team familiarity and specialty experience. METHODS Surgeon-scrub (SS) and surgeon-circulator (SC) teaming scores, defined as the pair's proportion of interactions relative to the surgeon's total cases in the preceding 6 months were calculated between 2017 and 2021 at an academic medical center. Nurse service-line (SL) experience scores were defined as the proportion of a nurse's cases performed within the given specialty. SS, SC, and nurse-SL scores were analyzed by specialty, case urgency, robotic approach, and surgeon academic rank. Two-sample Kolmogorov-Smirnov tests were used to determine heterogeneity between distributions. RESULTS A total of 37,364 operations involving 150 attending surgeons and 222 nurses were analyzed. Median SS and SC scores were 0.08 (interquartile range: 0.03-0.19) and 0.06 (interquartile range: 0.03-0.13), respectively. Higher margin SLs, senior faculty rank, elective, and robotic cases were associated with greater SS, SC, and nurse-SL scores ( P <0.001). CONCLUSIONS These novel measures of teaming and specialization illustrate the low levels of OR team familiarity and objectively highlight differences that necessitate a deliberate evaluation of current OR scheduling practices.
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Affiliation(s)
- Hunter D D Witmer
- Department of Surgery, University of Chicago Medicine, Chicago, IL
- Booth School of Business, University of Chicago, Chicago, IL
| | - Çağla Keçeli
- Booth School of Business, University of Chicago, Chicago, IL
| | | | - Ankit Dhiman
- Department of Surgery, University of Chicago Medicine, Chicago, IL
| | - Amber Kratochvil
- Perioperative Services, University of Chicago Medicine, Chicago, IL
| | | | - Dan Adelman
- Booth School of Business, University of Chicago, Chicago, IL
| | - Kiran K Turaga
- Department of Surgery, University of Chicago Medicine, Chicago, IL
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19
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Lam M, Sabharwal S. The Role of Scribes in Orthopaedics. JBJS Rev 2023; 11:01874474-202303000-00005. [PMID: 36947638 DOI: 10.2106/jbjs.rvw.22.00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
» The rapid increase in the use of electronic medical records (EMRs) has led to some unintended consequences that negatively affect physicians and their patients. » The use of medical scribes may serve as a possible solution to some of the EMR-related concerns. » Research has demonstrated an overall positive impact of having scribes on both physician and patient well-being, safety, and satisfaction. » Adaptation of advances in technology, including remote and asynchronous scribing, use of face-mounted devices, voice recognition software, and applications of artificial intelligence may address some of the barriers to more traditional in-person scribes.
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Affiliation(s)
- Michelle Lam
- Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, Oakland, California
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20
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Cauley AW, Green AR, Gardiner PM. Lessons Learned from Clinicians in a Federally Qualified Health Center: Steps Toward Eliminating Burnout. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:196-203. [PMID: 36508262 DOI: 10.1089/jicm.2021.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Burnout continues to impact health care workers and its effect takes a toll on their lives and wellbeing, especially in primary care. Relatively few studies have focused specifically on the perspective of clinicians in Federally Qualified Health Centers (FQHCs), which offer crucial, preventative health care services to vulnerable and underserved patient populations. Objective: To examine the perspectives of clinicians working at an FQHC in the Northeast United States after the implementation of a year-long wellness initiative. Design: A qualitative analysis of clinician's discussion during focus groups conducted after the wellness initiative. Subjects and Setting/Location: A total of 28 clinicians (primary care physicians and nurse practitioners) in an FQHC in the Northeast United States. Interventions: A one-year wellness initiative with programs and activities designed to bolster wellness. Outcome Measures: Analyzed NVIVO-coded transcripts of focus group discussion to generate codes and used modified grounded theory to extrapolate meaningful themes. Results: Five key themes emerged from the qualitative analysis: (1) clinicians often felt burdened by their workload and personally responsible when they were not able to provide optimal care to patients; (2) burnout was exacerbated by systemic problems at the FQHC; (3) medical assistants, medical scribes, schedulers, and other support staff played a crucial role in the wellness of the entire team; (4) perceived differences in priorities between administration and health care workers may have contributed to burnout; and (5) a communicative and stable team helped clinicians effectively care for their patients. Conclusions: Clinician burnout is a complex problem at FQHCs with many root causes. Addressing burnout and improving clinician wellness at FQHCs will require a multifaceted approach encompassing systemic, team, and individual components. The perspectives from the clinicians at our FQHC may inform wellness strategies for other safety net, clinical institutions in the primary care setting.
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Affiliation(s)
- Andrew W Cauley
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alexander R Green
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Paula M Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA
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21
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Sinsky CA, Morrow J. High cost of broken relationships. BMJ Qual Saf 2023:bmjqs-2023-015930. [PMID: 36806467 DOI: 10.1136/bmjqs-2023-015930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/19/2023]
Affiliation(s)
- Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, Illinois, USA
| | - James Morrow
- Granta Medical Group Shelford Medical Practice, Cambridge, UK
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Pan CX, Crupi R, August P, Sundaram V, Norful AA, Schwartz JE, Miele AS, Simons RR, Mikrut EE, Brondolo E. An Intensive Longitudinal Assessment Approach to Surveilling Trajectories of Burnout over the First Year of the COVID Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2930. [PMID: 36833628 PMCID: PMC9956892 DOI: 10.3390/ijerph20042930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 06/18/2023]
Abstract
Frontline clinicians responding to the COVID-19 pandemic are at increased risk of burnout, but less is known about the trajectory of clinician burnout as caseloads increase and decrease. Personal and professional resources, including self-efficacy and hospital support, can attenuate the risk of burnout. Yet, empirical data documenting how burnout and resources changed as the pandemic waxed and waned are limited. This intensive longitudinal prospective study employed ecological momentary assessment methods to examine trajectories of burnout and resources over the pandemic's first year in a New York City hospital. A 10-item survey was emailed every 5 days to frontline clinicians (physicians, nurses, and physician assistants). The primary outcome was a single-item validated measure of burnout; predictors included daily hospital COVID-19-related caseloads and personal and professional resources. Clinicians (n = 398) completed the initial survey and an average of 12 surveys over the year. Initially, 45.3% of staff reported burnout; over the year, 58.7% reported burnout. Following the initial COVID peak, caseloads declined, and burnout levels declined. During the second wave of COVID, as caseloads increased and remained elevated and personal and professional resource levels decreased, burnout increased. This novel application of intensive longitudinal assessment enabled ongoing surveillance of burnout and permitted us to evaluate how fluctuations in caseload intensity and personal and professional resources related to burnout over time. The surveillance data support the need for intensified resource allocation during prolonged pandemics.
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Affiliation(s)
- Cynthia X. Pan
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Robert Crupi
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Phyllis August
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10065, USA
| | - Varuna Sundaram
- NewYork-Presbyterian Queens Hospital, Flushing, NY 11355, USA
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, USA
| | | | - Joseph E. Schwartz
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Andrew S. Miele
- Department of Psychology, St. John’s University, New York, NY 11439, USA
| | - R. Rhiannon Simons
- Department of Psychology, St. John’s University, New York, NY 11439, USA
| | - Emilia E. Mikrut
- Department of Psychology, St. John’s University, New York, NY 11439, USA
| | - Elizabeth Brondolo
- Department of Psychology, St. John’s University, New York, NY 11439, USA
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Lu MA, O'Toole J, Shneyderman M, Brockman S, Cumpsty-Fowler C, Dang D, Herzke C, Rand CS, Sateia HF, Van Dyke E, Eakin MN, Daugherty Biddison EL. "Where You Feel Like a Family Instead of Co-workers": a Mixed Methods Study on Care Teams and Burnout. J Gen Intern Med 2023; 38:341-350. [PMID: 36038756 PMCID: PMC9422940 DOI: 10.1007/s11606-022-07756-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physicians and nurses face high levels of burnout. The role of care teams may be protective against burnout and provide a potential target for future interventions. OBJECTIVE To explore levels of burnout among physicians and nurses and differences in burnout between physicians and nurses, to understand physician and nurse perspectives of their healthcare teams, and to explore the association of the role of care teams and burnout. DESIGN A mixed methods study in two school of medicine affiliated teaching hospitals in an urban medical center in Baltimore, Maryland. PARTICIPANTS Participants included 724 physicians and 971 nurses providing direct clinical care to patients. MAIN MEASURES AND APPROACH Measures included survey participant characteristics, a single-item burnout measure, and survey questions on care teams and provision of clinical care. Thematic analysis was used to analyze qualitative survey responses from physicians and nurses. KEY RESULTS Forty-three percent of physicians and nurses screened positive for burnout. Physicians reported more isolation at work than nurses (p<0.001), and nurses reported their care teams worked efficiently together more than physicians did (p<0.001). Team efficiency was associated with decreased likelihood of burnout (p<0.01), and isolation at work was associated with increased likelihood of burnout (p<0.001). Free-text responses revealed themes related to care teams, including emphasis on team functioning, team membership, and care coordination and follow-up. Respondents provided recommendations about optimizing care teams including creating consistent care teams, expanding interdisciplinary team members, and increasing clinical support staffing. CONCLUSIONS More team efficiency and less isolation at work were associated with decreased likelihood of burnout. Free-text responses emphasized viewpoints on care teams, suggesting that better understanding care teams may provide insight into physician and nurse burnout.
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Affiliation(s)
- Monica A Lu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacqueline O'Toole
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Matthew Shneyderman
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | | | - Carolyn Cumpsty-Fowler
- Johns Hopkins Health System, Baltimore, MD, USA
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Carrie Herzke
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Cynthia S Rand
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - Heather F Sateia
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | | | - Michelle N Eakin
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA
| | - E Lee Daugherty Biddison
- Department of Medicine, Johns Hopkins School of Medicine, 600 N, Wolfe St, Osler 763, Baltimore, MD, 21287, USA.
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Norful AA, Brewer KC, Adler M, Dierkes A. Initial psychometric properties of the provider-co-management index-RN to scale registered nurse-physician co-management: Implications for burnout, job satisfaction, and intention to leave current position. J Interprof Care 2023:1-10. [PMID: 36688514 DOI: 10.1080/13561820.2022.2164563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Team-based care has become a cornerstone of care delivery to meet the demands of high-quality patient care. Yet, there is a lack of valid and reliable instruments to measure the effectiveness of co-management between clinician dyads, particularly physicians and registered nurses (RNs). The purpose of this study was to adapt an existing instrument, Provider Co-Management Index (PCMI), previously used among primary care providers into a new version to scale RN-physician co-management (called PCMI-RN). We also aimed to explore preliminary associations between RN-physician co-management and burnout, job satisfaction, and intention to leave current job. Face, cognitive, and content validity testing, using mixed methods approaches, were preceded by initial pilot testing (n = 122 physicians and nurses) in an acute care facility. The internal consistency reliability (α=.83) was high. One-quarter of participants reported burnout, 27% were dissatisfied with their job, and 20% reported intention to leave their job. There was a weak significant correlation between co-management and burnout (p = .010), and co-management and job satisfaction (p = .009), but not intention to leave current position. Construct validity testing is recommended. Future research using PCMI-RN may help to isolate factors that support or inhibit effective physician-nurse co-management.
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Affiliation(s)
- Allison A Norful
- School of Nursing, Columbia University School of Nursing, New York, NY, USA
| | | | - Margaret Adler
- Department of Nursing Quality, NewYork-Presbyterian Hudson Valley Hospital, Cortlandt, NY, USA
| | - Andrew Dierkes
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
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Oh A, Scott JY, Chow A, Jiang H, Dismuke-Greer CE, Gujral K, Yoon J. Rural and urban differences in the implementation of Virtual Integrated Patient-Aligned Care Teams. J Rural Health 2023; 39:272-278. [PMID: 35611882 DOI: 10.1111/jrh.12676] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Workforce shortages contribute to geographic disparities in accessing primary care services. An innovative, clinic-to-clinic videoconferencing telehealth program in the Veterans Health Administration (VHA) called the Virtual Integrated Patient-Aligned Care Teams (V-IMPACT) was designed to increase veterans' access to primary care and relieve workforce shortages in VA primary care clinics, including in many rural areas. This paper describes trends in clinic sites and veteran uptake of the V-IMPACT program, a model that delivered remote, team-based primary care services, from fiscal years (FY)2013-2018. METHODS This observational study used VHA administrative data to compare program uptake, measured by the program penetration rate (percent of patients using V-IMPACT services in each site) across sites; and characteristics for V-IMPACT users versus nonusers for 2,155,203 veteran-years in 69 sites across 7 regional networks for FY2013-2018. Regression models assessed the association between V-IMPACT use and veteran characteristics within sites. FINDINGS Across sites, V-IMPACT had higher penetration in rural sites (8%) and primary care community-based outpatient clinics (7%, P<.001). After adjusting for veteran characteristics, rural veterans (aOR = 1.05; P = .02) and veterans with higher comorbidity risk scores (aOR = 1.08; P<.001) were independently associated with V-IMPACT use. Highly rural veterans (OR = 0.60; P<.001) and veterans who lived ≥40 miles from the closest VHA primary care site (OR = 0.86; P<.001) were less likely to be a V-IMPACT user. CONCLUSIONS A clinic-to-clinic telehealth program, such as V-IMPACT, was able to reach many rural sites, rural veterans, and veterans in primary care health professional shortage areas. V-IMPACT has the potential to increase access to team-based primary care.
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Affiliation(s)
- Anna Oh
- San Francisco VA Health Care System, San Francisco, California, USA.,Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jennifer Y Scott
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Adam Chow
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Hao Jiang
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Clara E Dismuke-Greer
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Kritee Gujral
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California, USA.,Department of General Internal Medicine, University of California San Francisco, San Francisco, California, USA
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Kong M, Bodenheimer T. Primary Care Urgently Needs Support for Interprofessional Teams. Perm J 2022; 26:100-103. [PMID: 36411268 PMCID: PMC9761283 DOI: 10.7812/tpp/22.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Marianna Kong
- 1Department of Family and Community Medicine, University of California, San Francisco, CA, USA
| | - Thomas Bodenheimer
- 1Department of Family and Community Medicine, University of California, San Francisco, CA, USA,Thomas Bodenheimer, MD, MPH ;
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Lizcano‐Álvarez A, Esteban‐Hernández J, Alameda‐Cuesta A, Cid‐Expósito G, Palacios‐Ceña D. Chronic cardiovascular nursing care in Spanish primary care: A qualitative study. Int J Nurs Pract 2022:e13117. [DOI: 10.1111/ijn.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 07/25/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Angel Lizcano‐Álvarez
- Department of Nursing, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | - Jesús Esteban‐Hernández
- Department of Medical Specialties and Public Health, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | | | - Gema Cid‐Expósito
- Department of Nursing, Faculty of Health Sciences Universidad Rey Juan Carlos Madrid Spain
| | - Domingo Palacios‐Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS) Universidad Rey Juan Carlos Madrid Spain
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28
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Sinsky CA, Shanafelt TD, Ristow AM. Radical Reorientation of the US Health Care System Around Relationships: Rebalancing the Transactional Model. Mayo Clin Proc 2022; 97:2194-2205. [PMID: 36207152 DOI: 10.1016/j.mayocp.2022.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022]
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Schuttner L, Hockett Sherlock S, Simons CE, Johnson NL, Wirtz E, Ralston JD, Rosland AM, Nelson K, Sayre G. My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity. J Gen Intern Med 2022; 37:4189-4196. [PMID: 35606644 PMCID: PMC9126696 DOI: 10.1007/s11606-022-07533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. OBJECTIVE We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. DESIGN We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. PARTICIPANTS Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. KEY RESULTS Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. CONCLUSIONS Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.
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Affiliation(s)
- Linnaea Schuttner
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
| | - Stacey Hockett Sherlock
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA.,Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Carol E Simons
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Nicole L Johnson
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - Elizabeth Wirtz
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Ann-Marie Rosland
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Karin Nelson
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - George Sayre
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
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Medich M, Rose D, McClean M, Nelson K, Stewart G, Ganz DA, Yano EM, Stockdale SE. Predictors of VA Primary Care Clerical Staff Burnout Using the Job Demands-Resources Model. J Ambul Care Manage 2022; 45:321-331. [PMID: 35943358 PMCID: PMC9422767 DOI: 10.1097/jac.0000000000000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary care clerical staff may experience burnout if not adequately prepared and supported for patient-facing customer service tasks. Guided by the Job Demands-Resources (JD-R) model, we use national survey data from 707 primary care clerks at 349 VA clinics (2018; response rate: 12%) to evaluate associations between clerks' perceptions of tasks, work environment, training, and burnout. We found challenges with customer-facing tasks contribute to higher burnout, and supportive work environment was associated with lower burnout. Although perceptions of training were not associated with burnout, our results combined with the JD-R model suggest that customer service training may protect against burnout.
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Affiliation(s)
- Melissa Medich
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - Danielle Rose
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - Michael McClean
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - Karin Nelson
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - Gregory Stewart
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - David A. Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - Elizabeth M. Yano
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
| | - Susan E. Stockdale
- HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California (Drs Medich, Rose, Ganz, Yano, and Stockdale and Mr McClean); Primary Care Analytics Team, VA Puget Sound South Health Care System, Tacoma, Washington (Dr Nelson); Department of Medicine, School of Medicine (Dr Nelson), and Department of Health Services, School of Public Health (Dr Nelson), University of Washington, Seattle; Department of Management, University of Iowa, Iowa City (Dr Stewart); Department of Health Policy & Management, Fielding School of Public Health (Dr Yano), David Geffen School of Medicine (Drs Ganz and Yano), and Department of Psychiatry and Biobehavioral Sciences (Dr Stockdale), University of California Los Angeles; and RAND Corporation, Santa Monica, California (Dr Ganz)
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Bodenheimer T. Revitalizing Primary Care, Part 1: Root Causes of Primary Care's Problems. Ann Fam Med 2022; 20:464-468. [PMID: 36228065 PMCID: PMC9512560 DOI: 10.1370/afm.2858] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/16/2022] [Accepted: 05/27/2022] [Indexed: 11/09/2022] Open
Abstract
This 2-part essay offers a discussion of the health of primary care in the United States. Part 1 argues that the root causes of primary care's problems are (1) the low percent of national health expenditures dedicated to primary care (primary care spending) and (2) overly large patient panels that clinicians without a team are unable to manage, leading to widespread burnout and poor patient access.Information used in this essay comes from my personal clinical and policy experience bolstered by summaries of evidence. The analysis leans heavily on my visits to dozens of practices and interviews with hundreds of clinicians, practice leaders, and practice staff.In 2016, the United States spent approximately 5.4% of total health expenditures on primary care, compared with an average among 22 Organization for Economic Co-operation and Development (OECD) countries of 7.8%. With average US primary care panel size around 2,000, it would take a clinician without an effective team 17 hours per day to provide good care to that panel. Low primary care spending and excessive panel sizes are related because most medical students avoid careers featuring underfunded practices with unsustainable work-life balance.Over the past 20 years, many initiatives-explored in Part 2 of this essay-have attempted to address these problems. Part 2 argues that to revitalize primary care, 2 fundamental changes are needed: (1) increased spending dedicated to primary care and (2) creating powerful teams that add capacity to care for large panels.
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Affiliation(s)
- Thomas Bodenheimer
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Cooper Z, Reitmeier M, Bethel SR. Health professionals' attitudes on integrated care and social work practice. SOCIAL WORK IN HEALTH CARE 2022; 61:369-386. [PMID: 35899873 DOI: 10.1080/00981389.2022.2104984] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/15/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Research regarding the intersection of social work and integrated care has recently increased. Although research specific to the role and engagement of social workers in integrated care is promising, research regarding attitudes toward social workers on integrated behavioral health (IBH) teams remains scant. This study provides perspective regarding healthcare professionals' attitudes toward the role of social workers on IBH teams. A survey was constructed and distributed to health professionals (n = 104) from medicine, nursing, pharmacy, and social work. Mixed methods were used to evaluate survey findings. Results suggest attitudes toward social workers on IBH teams are generally favorable.
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Affiliation(s)
- Zachary Cooper
- University of Georgia School of Social Work, Athens, Georgia, USA
| | - Melissa Reitmeier
- University of South Carolina College of Social Work, Columbia, South Carolina, USA
| | - Samuel R Bethel
- University of South Carolina College of Social Work, Columbia, South Carolina, USA
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Health System Resiliency and the COVID-19 Pandemic: A Case Study of a New Nationwide Contingency Staffing Program. Healthcare (Basel) 2022; 10:healthcare10020244. [PMID: 35206859 PMCID: PMC8872234 DOI: 10.3390/healthcare10020244] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/15/2022] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
When COVID-19 emerged, the U.S. Veterans Health Administration (VA) was in the process of implementing a national contingency staffing program called Clinical Resource Hubs (CRHs). CRHs were intended to provide regional contingency staffing for primary and mental health clinics experiencing staffing shortages primarily through telehealth. Long-term plans (year 2) included emergency management support. Early in the implementation, we conducted semi-structured interviews with CRH directors and national program leaders (n = 26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. We found that the CRH program was flexible and nimble enough to allow VA to leverage providers at hubs to better respond to the demands of COVID-19. Actions taken at hubs to sustain patient access and staff resiliency during the pandemic included supporting call centers and training VA providers on virtual care delivery. Factors that facilitated CRH’s emergency response included hub staff expertise in telehealth and the increased acceptability of virtual care among key stakeholders. We conclude that hub providers serving as contingency staff, as well as specialization in delivering virtual outpatient and inpatient care, enabled VA health system resiliency and recovery during the COVID-19 pandemic.
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Sterling R, Rinne ST, Reddy A, Moldestad M, Kaboli P, Helfrich CD, Henrikson NB, Nelson KM, Kaminetzky C, Wong ES. Identifying and Prioritizing Workplace Climate Predictors of Burnout Among VHA Primary Care Physicians. J Gen Intern Med 2022; 37:87-94. [PMID: 34327656 PMCID: PMC8321506 DOI: 10.1007/s11606-021-07006-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/25/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Burnout, or job-related stress, affects more than half of all US physicians, with primary care physicians (PCPs) experiencing some of the highest rates in medicine. Our study analyzes national survey data to identify and prioritize workplace climate predictors of burnout among PCPs within a large integrated health system. DESIGN Observational study of annual survey data from the Veterans Health Administration (VHA) All Employee Survey (AES) for 2013-2017. AES response rate ranged from 56 to 60% during the study period. Independent and dependent variables were measured from separate random samples. In total, 8,456 individual-level responses among PCPs at 110 VHA practice sites were aggregated at the facility level by reporting year. We used the semi-automated LASSO procedure to identify workplace climate measures that were more influential in predicting burnout and assessed relative importance using the Shapely value decomposition. PARTICIPANTS VHA employees that self-identify as PCPs. MAIN MEASURES Dependent variables included two dichotomous measures of burnout: emotional exhaustion and depersonalization. Independent measures included 30 survey measures related to dimensions of workplace climate (e.g., workload, leadership, satisfaction). RESULTS We identified seven influential workplace climate predictors of emotional exhaustion and nine predictors of depersonalization. With few exceptions, higher agreement/satisfaction scores for predictors were associated with a lower likelihood of burnout. The majority of explained variation in emotional exhaustion was attributable to perceptions of workload (32.6%), organization satisfaction (28.2%), and organization support (19.4%). The majority of explained variation in depersonalization was attributable to workload (25.3%), organization satisfaction (22.9%), and connection to VHA mission (20.7%). CONCLUSION Identifying the relative importance of workplace climate is important for the allocation of health organization resources to mitigate and prevent burnout within the PCP workplace. In a context of limited resources, efforts to reduce perceived workload and improve organization satisfaction may represent the biggest leverage points for health organizations to address physician burnout.
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Affiliation(s)
- Ryan Sterling
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Seppo T Rinne
- VA Center for Healthcare Organization and Implementation Research, Bedford, MA, USA
| | - Ashok Reddy
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Megan Moldestad
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Peter Kaboli
- Iowa City VA Medical Center and University of Iowa, Iowa City, IA, USA
| | - Christian D Helfrich
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | | | - Karin M Nelson
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Catherine Kaminetzky
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Edwin S Wong
- Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
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Jing R, Mahmoudi E, Lai X, Zhang H, Fang H. The Association Between Panel Size and Health Outcomes of Patients with Hypertension in Urban China: a Population-Based Retrospective Cohort Study. J Gen Intern Med 2021; 36:3402-3409. [PMID: 33689117 PMCID: PMC8606355 DOI: 10.1007/s11606-021-06681-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of evidence regarding the association between family physicians' panel size and health outcomes of patients with hypertension in China. OBJECTIVE To examine the association between family physicians' panel size and health outcomes of patients with hypertension in urban China. DESIGN This retrospective cohort study during 1 contract year from July 1, 2018, to June 31, 2019, was set in four community health centers (CHCs) in Xiamen City, China. PARTICIPANTS A total of 18,119 adult patients (18+) diagnosed with hypertension and their 61 family physicians were included. MAIN MEASURES Family physicians' panel size was measured by the number of registered patients in the preceding 6 months. The outcome measures included blood pressure (BP) control rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) measured at each follow-up visit. KEY RESULTS Every additional 100 patients to the panel size were associated with an average of 17% increase in BP control rate (95% confidence interval [CI] = 1.15 to 1.19), and decrease in SBP (- 0.3 mmHg, 95% CI: - 0.38 to - 0.30), DBP (- 0.4 mmHg, 95% CI: - 0.39 to - 0.34), and MAP (- 0.4 mmHg, 95% CI: - 0.38 to - 0.33). After entering the quadratic term of panel size in the model, the panel size was negatively associated with BP control rate and positively associated with SBP, DBP, and MAP, while for the quadratic term, the odds ratio for BP control rate was positive and the coefficients for SBP, DBP, and MAP were negative. A U-shape association was found between panel size and health outcomes of patients with hypertension, and the turning point was about 600 patients. CONCLUSIONS The panel size of family physicians was curvilinearly associated with health outcomes of patients with hypertension in urban China.
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Affiliation(s)
- Rize Jing
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI USA
| | - Xiaozhen Lai
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haijun Zhang
- School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
- Peking University Health Science Center - Chinese Center for Disease Control and Prevention Joint Center for Vaccine Economics, Beijing, China
- Key Laboratory of Reproductive Health, National Health Commission of the People’s Republic of China, Beijing, China
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Crowley R, Atiq O, Hilden D, Cooney TG. Health Care for Our Nation's Veterans: A Policy Paper From the American College of Physicians. Ann Intern Med 2021; 174:1600-1602. [PMID: 34606323 DOI: 10.7326/m21-2392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Thomas G Cooney
- Oregon Health & Science University, Portland, Oregon (T.G.C.)
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Apaydin EA, Rose DE, McClean MR, Yano EM, Shekelle PG, Nelson KM, Stockdale SE. Association between care coordination tasks with non-VA community care and VA PCP burnout: an analysis of a national, cross-sectional survey. BMC Health Serv Res 2021; 21:809. [PMID: 34384398 PMCID: PMC8361617 DOI: 10.1186/s12913-021-06769-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The scope of care coordination in VA primary care increased with the launch of the Veterans Choice Act, which aimed to increase access through greater use of non-VA Community Care. These changes may have overburdened already busy providers with additional administrative tasks, contributing to provider burnout. Our objective was to understand the role of challenges with care coordination in burnout. We analyzed relationships between care coordination challenges with Community Care reported by VA primary care providers (PCPs) and VA PCP burnout. METHODS Our cross-sectional survey contained five questions about challenges with care coordination. We assessed whether care coordination challenges were associated with two measures of provider burnout, adjusted for provider and facility characteristics. Models were also adjusted for survey nonresponse and clustered by facility. Trainee and executive respondents were excluded. 1,543 PCPs in 129 VA facilities nationwide responded to our survey (13 % response rate). RESULTS 51 % of our sample reported some level of burnout overall, and 46 % reported feeling burned out at least once a week. PCPs were more likely to be burned out overall if they reported more than average challenges with care coordination (odds ratio [OR] 2.04, 95 % confidence interval [CI] 1.58 to 2.63). These challenges include managing patients with outside prescriptions or obtaining outside tests or records. CONCLUSIONS VA primary care providers who reported greater than average care coordination challenges were more likely to be burned out. Interventions to improve care coordination could help improve VA provider experience.
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Affiliation(s)
- Eric A Apaydin
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Danielle E Rose
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
| | - Michael R McClean
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Karin M Nelson
- Seattle-Denver Center of Innovation, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Susan E Stockdale
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., MC 152, Bldg. 206 Rm. 252, Los Angeles, CA, 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Astik GJ, Kulkarni N, Cyrus RM, Yeh C, O'Leary KJ. Implementation of a triage nurse role and the effect on hospitalist workload. Hosp Pract (1995) 2021; 49:336-340. [PMID: 34170803 DOI: 10.1080/21548331.2021.1949169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can be burdensome due to frequent interruptions and multitasking. We introduced a new role, the Triage nurse, to hold the triage pager and distribute patients. We sought to determine the effect of this Triage Nurse on the perceived workload of hospitalists and frequency of pages. METHODS We partnered with our patient throughput department to implement the Triage Nurse role who took the responsibility of tracking and distributing admissions among three admitting physicians along with coordinating report. We used the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) to measure perceived workload and accessed pager logs of admitters for 3 months before and after implementation. RESULTS Overall, 50 of an expected 67 NASA-TLX surveys (74.6%) were returned in the pre-intervention period and 64 of 92 (69.6%) were returned in the post-intervention period. We found a statistically significant reduction in the domains of physical demand, temporal demand, effort and frustration from pre- to post-intervention periods (p < 0.01). There was also a significant decrease in the performance domain (p = 0.01) with a lower number indicative of better perceived performance. There was a significant reduction in the mean number of pages received by admitting hospitalists over their 9-h shifts (81.3 + 17.3 vs 52.4 + 7.3; p < 0.01). CONCLUSION The implementation of the Triage Nurse role was associated with a significant decrease in the perceived workload of admitting hospitalists. Our findings are important because workload and interruptions can contribute to errors and burnout. Future studies should test interventions to improve hospitalist workload and evaluate their effect on patient outcomes and physician wellness.
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Affiliation(s)
- Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nita Kulkarni
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rachel M Cyrus
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Chen Yeh
- Biostatistics Collaboration Center, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Edwards ST, Marino M, Solberg LI, Damschroder L, Stange KC, Kottke TE, Balasubramanian BA, Springer R, Perry CK, Cohen DJ. Cultural And Structural Features Of Zero-Burnout Primary Care Practices. Health Aff (Millwood) 2021; 40:928-936. [PMID: 34097508 DOI: 10.1377/hlthaff.2020.02391] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although much attention has been focused on individual-level drivers of burnout in primary care settings, examining the structural and cultural factors of practice environments with no burnout could identify solutions. In this cross-sectional analysis of survey data from 715 small-to-medium-size primary care practices in the United States participating in the Agency for Healthcare Research and Quality's EvidenceNOW initiative, we found that zero-burnout practices had higher levels of psychological safety and adaptive reserve, a measure of practice capacity for learning and development. Compared with high-burnout practices, zero-burnout practices also reported using more quality improvement strategies, more commonly were solo and clinician owned, and less commonly had participated in accountable care organizations or other demonstration projects. Efforts to prevent burnout in primary care may benefit from focusing on enhancing organization and practice culture, including promoting leadership development and fostering practice agency.
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Affiliation(s)
- Samuel T Edwards
- Samuel T. Edwards is an assistant professor of medicine at Oregon Health and Science University and a staff physician in the Section of General Internal Medicine, Veterans Affairs Portland Health Care System, both in Portland, Oregon
| | - Miguel Marino
- Miguel Marino is an associate professor of biostatistics in the Department of Family Medicine, Oregon Health and Science University, and at the OHSU-Portland State University School of Public Health, in Portland, Oregon
| | - Leif I Solberg
- Leif I. Solberg is a senior research investigator at HealthPartners Institute, in Minneapolis, Minnesota
| | - Laura Damschroder
- Laura Damschroder is an implementation research consultant through Implementation Pathways, LLC, and a research investigator in the Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, in Ann Arbor, Michigan
| | - Kurt C Stange
- Kurt C. Stange is the Dorothy Jones Weatherhead Professor of Medicine; a professor of family medicine and community health, population and quantitative health sciences, oncology, and sociology; and the director of the Center for Community Health Integration, Case Western Reserve University, in Cleveland, Ohio
| | - Thomas E Kottke
- Thomas E. Kottke is a senior research investigator at HealthPartners Institute
| | - Bijal A Balasubramanian
- Bijal A. Balasubramanian is an associate professor in the Department of Epidemiology, Human Genetics, and Environmental Sciences and regional dean of UTHealth School of Public Health, in Dallas, Texas
| | - Rachel Springer
- Rachel Springer is a biostatistician in the Department of Family Medicine, Oregon Health and Science University
| | - Cynthia K Perry
- Cynthia K. Perry is a professor in the School of Nursing, Oregon Health and Science University
| | - Deborah J Cohen
- Deborah J. Cohen is a professor of family medicine and vice chair of research in the Department of Family Medicine, Oregon Health and Science University
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Nelson K, Reddy A, Stockdale SE, Rose D, Fihn S, Rosland AM, Stewart G, Denietolis A, Curtis I, Mori A, Rubenstein L. The Primary Care Analytics Team: Integrating research and clinical care within the Veterans Health Administration Office of Primary Care. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100491. [PMID: 34175100 DOI: 10.1016/j.hjdsi.2020.100491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 12/01/2022]
Abstract
By designing and evaluating health system improvements and providing evidence to clinical decision-makers, embedded researchers are a critical part of a Learning Health System (LHS). In this article, we describe the evolution and mission of the Primary Care Analytics Team (PCAT), an integrated research team within the Veterans Health Administration Office of Primary Care. We discuss challenges and strategies for success in working with clinical operations partners and provide recommendations for other Learning Health Systems units embedded in large integrated health care organizations.
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Affiliation(s)
- Karin Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA; HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA; Division of General Internal Medicine, University of Washington, Seattle, WA, USA.
| | - Ashok Reddy
- VA Puget Sound Health Care System, Seattle, WA, USA; HSR&D Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound, Seattle, WA, USA; Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Susan E Stockdale
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Danielle Rose
- HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA
| | - Stephan Fihn
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Ann-Marie Rosland
- Center for Health Equity Research and Promotion, VA Pittsburgh, USA; Department of Internal Medicine, University of Pittsburgh, USA
| | - Gregory Stewart
- Department of Management, University of Iowa, Iowa City, IA, USA
| | - Angela Denietolis
- Office of Primary Care, Veterans Health Administration, Washington, DC, USA
| | | | - Alaina Mori
- VA Puget Sound Health Care System, Seattle, WA, USA
| | - Lisa Rubenstein
- The RAND Corporation, Santa Monica, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Burnout among Primary Care Providers and Staff: Evaluating the Association with Practice Adaptive Reserve and Individual Behaviors. J Gen Intern Med 2021; 36:1222-1228. [PMID: 33420562 PMCID: PMC8131495 DOI: 10.1007/s11606-020-06367-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/25/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Workplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups. OBJECTIVE The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care. DESIGN This cross-sectional study used survey data from 154 primary care practices participating in the EvidenceNOW Heart of Virginia Healthcare initiative. PARTICIPANTS We analysed data from 1279 healthcare professionals in Virginia. Our sample included physicians, advanced practice clinicians, clinical support staff and administrative staff. MAIN MEASURES We used the PAR instrument to measure organizational capacity for change and the Change Diagnostic Index© (CDI) to measure individual behavioural response, which achieved a 76% response rate. Logistic regression analysis was used to estimate the effects of PAR and CDI on burnout. KEY RESULTS As organizational capacity for change increased, burnout in healthcare professionals decreased by 51% (OR: 0.49; 95% CI, 0.33, 0.73). As healthcare professionals showed improved response toward change, burnout decreased by 84% (OR: 0.16; 95% CI, 0.11, 0.23). Analysis by healthcare professional type revealed a significant association between high organizational capacity for change, positive response to change and low burnout among administrative staff (OR: 2.92; 95% CI, 1.37, 6.24). Increased hours of work per week was associated with higher odds of burnout (OR: 1.07; 95% CI, 1.05, 1.10) across healthcare professional groups. CONCLUSION As transformation efforts in primary care continue, it is critical to understand the influence of these initiatives on healthcare professionals' well-being. Efforts to reduce burnout among healthcare professionals are needed at both a system and organizational level. Building organizational capacity for change, supporting providers and staff during major change and consideration of individual workload may reduce levels of burnout.
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Schwartz R, Frayne SM, Friedman S, Romodan Y, Berg E, Haskell SG, Shaw JG. Retaining VA Women's Health Primary Care Providers: Work Setting Matters. J Gen Intern Med 2021; 36:614-621. [PMID: 33063204 PMCID: PMC7947068 DOI: 10.1007/s11606-020-06285-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND When an experienced provider opts to leave a healthcare workforce (attrition), there are significant costs, both direct and indirect. Turnover of healthcare providers is underreported and understudied, despite evidence that it negatively impacts care delivery and negatively impacts working conditions for remaining providers. In the Veterans Affairs (VA) healthcare system, attrition of women's health primary care providers (WH-PCPs) threatens a specially trained workforce; it is unknown what factors contribute to, or protect against, their attrition. OBJECTIVE Based on evidence that clinic environment, adequate support resources, and workload affect provider burnout and intent to leave, we explored if such clinic characteristics predict attrition of WH-PCPs in the VA, to identify protective factors. DESIGN This analysis drew on two waves of existing national VA survey data to examine predictors of WH-PCP attrition, via logistic regression. PARTICIPANTS All 2,259 providers from 140 facilities VA-wide who were WH-PCPs on September 30, 2016. MAIN MEASURES The dependent variable was WH-PCP attrition in the following year. Candidate predictors were clinic environment (working in: a comprehensive women's health center, a limited women's health clinic, a general primary care clinic, or multiple clinic environments), availability of co-located specialty support resources (mental health, social work, clinical pharmacy), provider characteristics (gender, professional degree), and clinic workload (clinic sessions per week). KEY RESULTS Working exclusively in a comprehensive women's health center uniquely predicted significantly lower risk of WH-PCP attrition (adjusted odds ratio 0.40; CI 0.19-0.86). CONCLUSIONS A comprehensive women's health center clinical context may promote retention of this specially trained primary care workforce. Exploring potential mechanisms-e.g., shared mission, appropriate support to meet patients' needs, or a cohesive team environment-may inform broader efforts to retain front-line providers.
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Affiliation(s)
- Rachel Schwartz
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA. .,WellMD Center, Stanford University School of Medicine, Stanford, CA, USA.
| | - Susan M Frayne
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sarah Friedman
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Yasmin Romodan
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Eric Berg
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Sally G Haskell
- Women's Health Services, VA Central Office, Washington, DC, USA.,VA Connecticut Health Care System, West Haven, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan G Shaw
- VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Epstein JA, Wu AW. Delivering Complex Care: Designing for Patients and Physicians. J Gen Intern Med 2021; 36:772-774. [PMID: 32935307 PMCID: PMC7947090 DOI: 10.1007/s11606-020-06212-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022]
Abstract
The management of high-utilizing patients is an area of active research with broad implications for the healthcare system. There are significant operational challenges to designing primary care models for these medically complex, high-needs patients. Although it is crucial to provide a high degree of continuity of care for this population, managing a cohort of these patients can lead to provider over-work and attrition. This may be magnified by the lack of training dedicated to addressing the unique care needs of these patients. While academic medical centers would seem well suited to care for individuals with multimorbidity needing intensive and specialized treatment, primary care providers in this setting need additional support to be clinically available for patients while pursuing scholarship and teaching. Formally recognizing intensive outpatient care as a specialty within internal medicine would help overcome some of these challenges. This would require a committed effort to high-level systems changes including a new focus on graduate medical education, the creation of division-level infrastructure within academic departments of medicine, and realistic levels of financial support to make this a viable career path.
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Affiliation(s)
- Jeremy A Epstein
- Department of Medicine, General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Albert W Wu
- Department of Medicine, General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Matulis JC, McCoy R. Patient-Centered Appointment Scheduling: a Call for Autonomy, Continuity, and Creativity. J Gen Intern Med 2021; 36:511-514. [PMID: 32885369 PMCID: PMC7471539 DOI: 10.1007/s11606-020-06058-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/13/2020] [Indexed: 10/25/2022]
Abstract
When making an appointment, patients are generally unaware of how much clinician time is available to address their concerns. Similarly, the primary care clinician is often unaware of what the patient expects to accomplish during the visit, leading to uncertainty about how much time they can allot to each sequentially appearing concern, and whether they can reasonably expect to address necessary preventive services and chronic disease management. Neither patient nor clinician expectations can be adequately managed through standardized scheduling templates, which assign a fixed appointment length based on a single stated reason for the visit. As such, standardized appointment scheduling may contribute to inefficient use of valuable face-to-face time, patient and clinician dissatisfaction, and low-value care. Herein, we suggest several potential mechanisms for improving the scheduling process, including (1) entrusting scheduling to the primary care team; (2) advance visit planning; (3) pro-active engagement of ancillary team members including behavioral health, nursing, social work, and pharmacy; and (4) application of innovative, technologically advanced solutions such as telehealth and artificial intelligence to the scheduling process. These changes have the potential to improve efficiency, patient and clinician satisfaction, and health outcomes, while decreasing low-value testing and return visits for unaddressed concerns.
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Affiliation(s)
- John C Matulis
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
| | - Rozalina McCoy
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
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Abraham CM, Zheng K, Norful AA, Ghaffari A, Liu J, Topaz M, Poghosyan L. Use of multifunctional electronic health records and burnout among primary care nurse practitioners. J Am Assoc Nurse Pract 2021; 33:1182-1189. [PMID: 33534286 DOI: 10.1097/jxx.0000000000000533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients. PURPOSE This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout. METHOD This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items-computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout. RESULTS Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13-0.71, p = .01). IMPLICATIONS FOR PRACTICE With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout.
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Scott Z, O'Curry S, Mastroyannopoulou K. Factors associated with secondary traumatic stress and burnout in neonatal care staff: A cross-sectional survey study. Infant Ment Health J 2021; 42:299-309. [PMID: 33449411 DOI: 10.1002/imhj.21907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION High rates of secondary traumatic stress and burnout have been found across nursing populations. However, few studies have focused on neonatal staff. OBJECTIVE The objectives of this article are to explore the prevalence and severity of secondary traumatic stress (STS) and burnout in neonatal staff, and identify risk factors and protective factors for STS and burnout within this population with the aim of informing future staff support. METHODS A quantitative, cross-sectional study using a survey design was conducted; 246 neonatal staff reported measures of STS, burnout, self-compassion and satisfaction with ward climate. RESULTS Neonatal staff reported high rates of moderate-severe STS and burnout. STS and burnout were negatively associated with self-compassion and satisfaction with ward climate, suggesting them to be protective factors against STS and burnout. STS was found to be a risk factor for burnout and vice versa. CONCLUSION Interventions that increase understanding of STS and burnout, nurture self-compassion, provide support and enhance stress management could help mitigate the impact of STS and burnout amongst neonatal staff.
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Affiliation(s)
- Zoe Scott
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sara O'Curry
- Addenbrookes Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Grembowski D. Burnout and Patient Referral Among Primary Care Providers in Veterans Affairs Patient Aligned Care Teams (VA PACTs). J Ambul Care Manage 2021; 44:126-137. [PMID: 33394816 DOI: 10.1097/jac.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Using the Veterans Health Administration's 2018 national provider and staff survey, this study describes the practice patterns of 1453 primary care providers for specialty care consults, program referrals, secure messaging, and telephone visits; and examines whether the practice patterns are associated with provider burnout in primary care teamlets. About 51% of providers experienced moderate to severe burnout and 22% had severe burnout. Providers who embraced all 4 practice approaches had lower odds of severe burnout than providers endorsing none of the approaches (odds ratio range, 0.35-0.39). Associations were weaker for providers with moderate to severe burnout.
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Affiliation(s)
- David Grembowski
- Department of Health Services, School of Public Health, University of Washington, Seattle; and VA Puget Sound Health Care System, Seattle-Denver Center of Innovation for Veteran-Centered & Value-Driven Care, US Department of Veterans Affairs, Seattle, Washington
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Privett N, Guerrier S. Estimation of the Time Needed to Deliver the 2020 USPSTF Preventive Care Recommendations in Primary Care. Am J Public Health 2021; 111:145-149. [PMID: 33211585 PMCID: PMC7750618 DOI: 10.2105/ajph.2020.305967] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives. To reexamine the time required to provide the US Preventive Services Task Force (USPSTF)-recommended preventive services to a nationally representative adult patient panel of 2500.Methods. We determined the required time for a single physician to deliver the USPSTF preventive services by multiplying the eligible population, annual frequency, and patient-contact time required for each recommendation, all calculated by using data from the recommendations themselves and literature. We modeled a representative panel of 2500 adults based on the 2010 US Census Bureau data.Results. To deliver the USPSTF recommended preventive services across a 2500 adult patient panel would require 8.6 hours per working day, accounting for 131% of available physician time. Compared with 2003, there are fewer recommendations in 2020, but they require 1.2 more physician patient-contact hours per working day.Conclusions. The time required to deliver recommended preventive care places unrealistic expectations on already overwhelmed providers and leaves patients at risk. This is a systems problem, not a time-management problem. The USPSTF provides a set of recommendations with strong evidence of positive impact. It is imperative that our health care system is designed to deliver.
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Affiliation(s)
- Natalie Privett
- At the time the study was conducted, both authors were with the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY. Natalie Privett was also with the Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai
| | - Shanice Guerrier
- At the time the study was conducted, both authors were with the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY. Natalie Privett was also with the Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai
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Norful AA, Rosenfeld A, Schroeder K, Travers JL, Aliyu S. Primary drivers and psychological manifestations of stress in frontline healthcare workforce during the initial COVID-19 outbreak in the United States. Gen Hosp Psychiatry 2021; 69:20-26. [PMID: 33485091 PMCID: PMC7836752 DOI: 10.1016/j.genhosppsych.2021.01.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The purpose of this study was to understand the physical and psychological impact of high stress clinical environments and contributory factors of burnout in multidisciplinary healthcare workforce during the initial outbreak of COVID-19. METHOD In-person qualitative interviews informed by an adaptation of Karasek's Job Demand-control model were conducted with a convenience sample of healthcare workforce from March to April 2020. RESULTS Themes emerging from interviews coalesced around three main areas: fear of uncertainty, physical and psychological manifestations of stress, and resilience building. Shifting information, a lack of PPE, and fear of infecting others prompted worry for those working with Covid-infected patients. Participants reported that stress manifested more psychologically than physically. Individualized stress mitigation efforts, social media and organizational transparency were reported by healthcare workers to be effective against rising stressors. CONCLUSION COVID-19 has presented healthcare workforce with unprecedented challenges in their work environment. With attention to understanding stressors and supporting clinicians during healthcare emergencies, more research is necessary in order to effectively promote healthcare workforce well-being.
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Affiliation(s)
- Allison A. Norful
- Columbia University School of Nursing, 630 W. 168th Street, Mail Code 6, New York, NY 10032, United States,Corresponding author
| | - Adam Rosenfeld
- Columbia University Mailman School of Public Health, 722 W 168th St, New York, NY 10032, United States.
| | - Krista Schroeder
- Temple University College of Public Health, Jones Hall 526, 3307 N. Broad Street, Philadelphia, PA 19140, United States.
| | - Jasmine L. Travers
- New York University Rory Meyers College of Nursing, 433 1st Ave., New York, NY 10010, United States
| | - Sainfer Aliyu
- MedStar Washington Hospital Center, 110 Irving St., NW, Washington, DC 20010, United States.
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Physician well-being in allergy and immunology: Creating a culture of wellness. Ann Allergy Asthma Immunol 2020; 126:219-227. [PMID: 33326844 DOI: 10.1016/j.anai.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE There are 3 domains of physician wellness: (1) the culture of wellness, (2) efficiency of practice, and (3) physician resilience. The culture of wellness encompasses an organization's values, environment, and behaviors that foster compassion and growth in its physicians. DATA SOURCES Studies have reported that burnout affects a physician's professionalism, altruism, and a sense of calling. Furthermore, burnout increases the risk of cardiovascular disease, alcohol abuse, divorce, depression, and even suicide among physicians. Physician burnout is associated with decreased efficiency at work, which can affect patient care, patient satisfaction, and even patient safety. As such, it is imperative that we develop a culture of wellness. STUDY SELECTIONS A culture of wellness reflects shared values and a sense of community within an organization. When a culture of wellness is present, leaders prioritize the personal and professional growth of its team members. RESULTS This article instructs readers on methods that can be used to develop a culture of wellness. CONCLUSION We need to address burnout at every level in health care, namely at health care organization and system levels, individual teams and offices, and at an individual level. In doing so, it becomes obvious that a lack of wellness (burnout) is a systems problem and not an individual's fault. We are all responsible for taking steps to change the culture to one of wellness. Working within our practices, organization, and allergy societies, we can change the culture to one of wellness.
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