APPENDIX B

Background from the National Academies Consensus Study Report and Other Reference Materials for the National Plan’s Priority Areas

The foundation for the National Plan’s priority areas was the goals and recommendations from the consensus study report Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being¹, and the activities and products of the Collaborative’s Working Groups, including:

1. Working Group on Implementing Tools to Improve Clinician Well-Being,
2. Working Group on Mobilizing National Stakeholders for Clinician Well-Being, and
3. Working Group on Navigating the Impacts of COVID-19 on Clinician Well-Being.

CONSENSUS STUDY REPORT GOALS FOR REDUCING CLINICIAN BURNOUT AND ENHANCING PROFESSIONAL WELL-BEING²

1. “Create Positive Work Environments: Transform health care work systems by creating positive work environments that

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¹https://doi.org/10.17226/25521.

² For more information, see: National Academies of Sciences, Engineering, and Medicine. 2019. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being. Washington, DC: The National Academies Press. https://doi.org/10.17226/25521.

1. prevent and reduce burnout, foster professional well-being, and support quality care.
2. Create Positive Learning Environments: Transform health professions education and training to optimize learning environments that prevent and reduce burnout and foster professional well-being.
3. Reduce Administrative Burden: Prevent and reduce the negative consequences on clinicians’ professional well-being that result from laws, regulations, policies, and standards promulgated by health care policy, regulatory, and standards-setting entities, including government agencies (federal, state, and local), professional organizations, and accreditors.
4. Enable Technology Solutions: Optimize the use of health information technologies to support clinicians in providing high-quality patient care.
5. Provide Support to Clinicians and Learners: Reduce the stigma and eliminate the barriers associated with obtaining the support and services needed to prevent and alleviate burnout symptoms, facilitate recovery from burnout, and foster professional well-being among learners and practicing clinicians.
6. Invest in Research: Provide dedicated funding for research on clinician professional well-being.”

WORKING GROUP ON IMPLEMENTING TOOLS TO IMPROVE CLINICIAN WELL-BEING

To help health systems take action, the NAM Resource Compendium for Health Care Worker Well-Being³ organizes available strategies and tools into six essential elements for health worker well-being:

1. Advance Organizational Commitment: Organizational commitment involves visible actions and investments to show that a systematic approach to decreasing health care worker burnout and improving well-being is being undertaken.
2. Strengthen Leadership Behaviors: Leadership must believe in the importance of health care worker well-being, commit

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³https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/.

2. to making well-being a strategic priority, and support a culture of well-being. Leadership at all levels is important, as are tools for accountability.
3. Conduct Workplace Assessment: Measurement is essential to understanding the extent and severity of burnout and the well-being of the members of any workforce, and to determining the effectiveness of intervention strategies.
4. Examine Policies and Practices: Health care workers experience moral distress and injury when the policies and practices of their organization conflict with their professional commitment to patient care and their ability to do their work. A resilient organization will periodically reassess its policies and practices and eliminate those that are no longer relevant or no longer required.
5. Enhance Workplace Efficiency: Workplace efficiency embodies practices that are geared toward facilitating and streamlining staff duties while maintaining clinical excellence.
6. Cultivate a Culture of Connection and Support: An organization can best support its health care workforce by giving people the ability to do their jobs and then allowing them to return safely home with time and emotional energy to engage in their personal lives with their family, friends, and community.

WORKING GROUP ON MOBILIZING NATIONAL STAKEHOLDERS FOR CLINICIAN WELL-BEING

Convening on Reducing Documentation and Administrative Burden (January 31, 2022)

More information is available at: https://nam.edu/event/reducing-documentation-administrative-burden-for-clinician-well-being/.

Meeting Objectives:

The Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) collaborated on revisions to the Evaluation and Management (E/M) office visit Current Procedural Terminology (CPT) codes that became effective in January 2021. These changes were intended to address documentation standards

that cause administrative burden among health care workers in nearly every specialty.

The overarching objective of this meeting was to take the principles of implementing the E/M CPT code changes and documentation-related administrative burden and apply them to the broader concept of putting policy change into action. The NAM Clinician Well-Being Collaborative intended to assemble policy and health care stakeholders to:

1. Discuss successes and challenges in operationalizing documentation policy change,
2. Examine the impact of these specific coding revisions on administrative burden, and
3. Identify opportunities to inform the process of policy change on a broader scale.

Meeting participants generated lessons learned from the E/M CPT code changes to guide the formulation, implementation, and assessment of future administrative relief policies that will have positive, interprofessional effects on clinician well-being.

Convening on Health Technology for Reducing Burden (April 8, 2022)

More information is available at: https://nam.edu/event/health-technology-to-reduce-burnout/.

Meeting Objectives:

Technology can be both a source of and solution to the challenges of prior authorization, in-basket management, credentialing, documentation burden, and other major drivers of clinician burnout. The NAM Clinician Well-Being Collaborative assembled industry leaders, policy makers, and clinician stakeholders to spotlight promising technologies that alleviate provider burden and enhance patient-centered care, then explored key opportunities for deploying technologies at the health care organization level on a national scale.

The virtual public convening:

1. Highlighted innovations with promise for rapid implementation and broad scale that are available now, noted the persistent barriers to penetrating real-world small and large practice settings to be resolved, and identified forward-looking technologies to reduce provider burden.
2. Examined data that illustrate technology-related pain points for frontline care providers and that serve as opportunities for innovation.
3. Learned from implementers who have successfully deployed technologies at their institutions to reduce provider burden and can spotlight technologies in development in a variety of practice settings.
4. Discussed the role of federal barriers and incentives in catalyzing implementation of technology innovations to reduce provider burden on a national scale.

Convening on Leveraging the Role of Payers and Regulators in the Health Worker Well-Being Movement (October 3, 2022)

More information is available at: https://nam.edu/event/leveraging-the-role-of-payers-and-regulators-in-the-health-worker-well-being-movement/.

Meeting Objectives:

The NAM Clinician Well-Being Collaborative assembled Collaborative members who are industry leaders and clinician stakeholders, as well as regulators and payers in the private and public sector, for a closed discussion on the structural impacts of the current payment system on burnout and moral injury in order to envision a future care delivery system that can enhance health worker wellbeing.

The convening:

1. Examined elements of the current payment system that create barriers to health worker well-being.
2. Highlighted the role of payers and regulators in alleviating health worker burnout and distress.

3. Discussed pathways forward for payers and regulators to promote health worker well-being.

WORKING GROUP ON NAVIGATING THE IMPACTS OF COVID-19 ON CLINICIAN WELL-BEING

Convening on Clinician Retention in the Era of COVID: Uniting the Health Workforce to Optimize Well-Being (March 15, 2022)

More information is available at: https://nam.edu/event/clinician-retention-in-the-era-of-covid-uniting-the-health-workforce-to-opti-mize-well-being/.

Meeting Objectives:

The COVID-19 pandemic has brought clinician well-being to the forefront of national attention. Staffing shortages have exacerbated an already thinly stretched health care workforce that is also experiencing violence and harassment in the workplace and significant moral injury. In addition to addressing the acute challenges of COVID-19, embedding well-being as a value is foundational for health care organizations to address the systemic barriers to clinician well-being and create environments that support clinician retention and expertise in patient care. Therefore, we need to unite in our journey to strengthen well-being with and for the health care workforce.

The NAM’s Action Collaborative on Clinician Well-Being and Resilience assembled industry leaders, C-Suite members, and frontline health care workers to share perspectives on challenges and barriers, pinpoint solutions, and discuss actionable strategies to mitigate burnout and strengthen the health care workforce. The public meeting highlighted:

• Individual-level stressors in the context of COVID-19,
• Institutional-level challenges and opportunities to support workforce well-being, and
• National-level levers for improving workforce well-being, the pipeline of health workers, and stemming the shortage.

The meeting featured lessons from three institutions about their journeys in creating wellness action plans for and with their frontline staff with the intention to encourage other health-serving institutions to begin or continue their journeys.

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