National Academies Press: OpenBook

National Plan for Health Workforce Well-Being (2024)

Chapter: Front Matter

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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National Plan for
Health Workforce
Well-Being

National Academy of Medicine

Action Collaborative on
Clinician Well-Being and Resilience

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Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention but does not constitute endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine.

International Standard Book Number-13: 978-0-309-69467-4
International Standard Book Number-10: 0-309-69467-1
Digital Object Identifier: https://doi.org/10.17226/26744
Library of Congress Catalog Number: 2022918777

Copyright 2024 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved.

Printed in the United States of America.

Suggested citation: National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. V. J. Dzau, D. Kirch, V. Murthy, and T. Nasca, editors. NAM Special Publication. Washington, DC: The National Academies Press. https://doi.org/10.17226/26744.

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
-GOETHE

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Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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ABOUT THE NATIONAL ACADEMY OF MEDICINE

The National Academy of Medicine is one of three Academies constituting the National Academies of Sciences, Engineering, and Medicine (the National Academies). The National Academies provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

Learn more about the National Academy of Medicine at NAM.edu.

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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ACTION COLLABORATIVE ON CLINICIAN WELL-BEING AND RESILIENCE

Steering Committee (2022)

VICTOR J. DZAU (Collaborative Co-Chair), National Academy of Medicine

DARRELL G. KIRCH (Collaborative Co-Chair), Association of American Medical Colleges and Stanford University

VIVEK H. MURTHY (Collaborative Co-Chair), U.S. Department of Health and Human Services

THOMAS J. NASCA (Collaborative Co-Chair), Accreditation Council for Graduate Medical Education

ROBYN BEGLEY, American Hospital Association

DON BERWICK, Institute for Healthcare Improvement

KATIE BOSTON-LEARY, American Nurses Association

ROBERT CAIN, American Association of Colleges of Osteopathic Medicine

PAMELA CIPRIANO, University of Virginia School of Nursing and American Nurses Association

CAROLYN CLANCY, Veterans Health Administration

ERNEST J. GRANT, American Nurses Association

BRETT KESSLER, American Dental Association

LUCINDA L. MAINE, American Association of Colleges of Pharmacy

RICK POLLACK, American Hospital Association

BARRY RUBIN, Peter Munk Cardiac Centre, Toronto General Hospital

LEWIS G. SANDY, UnitedHealth Group

TAIT SHANAFELT, Stanford Medicine

RACHEL VILLANUEVA, National Medical Association

MICHELLE A. WILLIAMS, Harvard T.H. Chan School of Public Health

Action Collaborative Members

NANCY H. AGEE, Carilion Clinic

MEGAN AMAYA, The Ohio State University College of Nursing

ELISA ARESPACOCHAGA, American Hospital Association

DAVID BAKER, The Joint Commission

ALAN BALCH, Patient Advocate Foundation

CONNIE BARDEN, American Association of Critical-Care Nurses

KARI SUE BERNARD, American Academy of PAs Task Force on PA Burnout

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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CAROL A. BERNSTEIN, Albert Einstein College of Medicine/Montefiore Medical Center

JENNIFER BICKEL, Moffitt Cancer Center

ANDREA BORONDY KITTS, Rescue Lung Society

LEE DAUGHERTY BIDDISON, Johns Hopkins Medicine

STEVE BIRD, UMass Chan Medical School

TIMOTHY BRIGHAM, Accreditation Council for Graduate Medical Education

KIRK J. BROWER, University of Michigan

HELEN BURSTIN, Council of Medical Specialty Societies

NEIL BUSIS, Department of Neurology, NYU Langone Health

PASCALE CARAYON, University of Wisconsin–Madison

MARCELA DEL CARMEN, Massachusetts General Hospital

CHRISTINE CASSEL, University of California, San Francisco

CHIA-CHIA CHANG, CDC National Institute for Occupational Safety and Health

ROBERT A. CHERRY, UCLA Health System

LINDA HAWES CLEVER, RENEW

KEVIN COCKROFT, Penn State Health

MICHAEL F. COLLINS, UMass Chan Medical School

ELISHA DANMEIER, RENEW

SARAH DELGADO, American Association of Critical-Care Nurses

VANESSA DOWNING, ChristianaCare

LOTTE DYRBYE, University of Colorado School of Medicine

HEATHER FARLEY, ChristianaCare

JORDYN FEINGOLD, Icahn School of Medicine at Mount Sinai

SUSAN FORNERIS, National League for Nursing

JESSICA FRIED, University of Michigan

JEANE GARCIA-DAVIS, Office of the Surgeon General

SANDY GOEL, University of Michigan

JEFFERY P. GOLD, University of Nebraska Medical Center

THOMAS GRANATIR, American Board of Medical Specialties

HEATHER GUNNELL, Dartmouth-Hitchcock Medical Center

ROBERT E. HARBAUGH, Penn State Health

RICHARD HAWKINS, American Board of Medical Specialties ART

HENGERER, Federation of State Medical Boards

AMY HILDRETH, Atrium Health Wake Forest Baptist Health

SUSAN HINGLE, SIU School of Medicine and American College of Physicians

EVE HOOVER, American Academy of PAs

KEITH HORVATH, Association of American Medical Colleges

DAVID B. HOYT, American College of Surgeons

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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LISA ISHII, Johns Hopkins Health System

JAY (JULIUS A.) KAPLAN, LCMC Health and American College of Emergency Physicians

JOE KERSCHNER, Medical College of Wisconsin

ANDREA BORONDY KITTS, Rescue Lung Society

BAYLI LARSON, American Society of Health-System Pharmacists

ANNA LEGREID DOPP, American Society of Health-System Pharmacists

COLLEEN LENERS, American Association of Colleges of Nursing

SAUL LEVIN, American Psychiatric Association

LORNA LYNN, American Board of Internal Medicine

MICHAEL MAGUIRE, ChristianaCare and Alfred I. duPont Hospital for Children

ADITI MALLICK, The George Washington University Hospital

BEVERLY MALONE, National League for Nursing

BARRY MARX, Centers for Medicare and Medicaid Services

BERNADETTE MELNYK, The Ohio State University

DAVID MEYERS, Agency for Healthcare Research and Quality

EDITH MITCHELL, National Medical Association

AMY NGUYEN HOWELL, Optum

LOIS MARGARET NORA, Northeast Ohio Medical University

LAVONNE ORTEGA, Centers for Disease Control and Prevention

NISHA PATEL, UAB Medicine

STACEY PAUL, The Joint Commission

HAL PAZ, Stony Brook University

LAUREN PECCORALO, Icahn School of Medicine at Mount Sinai

JESSICA PERLO, Institute for Healthcare Improvement

THOMAS M. PRISELAC, Cedars-Sinai Health System

DAVID S. RAIFORD, Vanderbilt University Medical Center

NIKHIL RAJAPURAM, Icahn School of Medicine at Mount Sinai

JOHN R. RAYMOND, SR., The Medical College of Wisconsin

RICHARD RIGGS, Cedars-Sinai Health System

JON RIPP, Icahn School of Medicine at Mount Sinai and CHARM

DAVID A. ROGERS, UAB Medicine

JOE ROTELLA, American Academy of Hospice and Palliative Medicine

LUKE SATO, CRICO

MARGARET (GRETCHEN) SCHWARZE, University of Wisconsin–Madison

JULIE SEES, American Osteopathic Association

SRIJAN SEN, University of Michigan

TINA SHAH, TNT Health Enterprises, LLC

ROBERT SIMARI, University of Kansas Medical Center

Page viii Cite
Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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STEVE SINGER, Accreditation Council for Continuing Medical Education

CHRISTINE SINSKY, American Medical Association

CYNTHIA (DAISY) SMITH, American College of Physicians

SONYA G. SMITH, American Dental Education Association

KEVIN SOWERS, Johns Hopkins Health System and Johns Hopkins Medicine

MARLO STEIRER, American Board of Medical Specialties

JAVEED SUKHERA, Institute of Living and Hartford Hospital

V. FAN TAIT, American Academy of Pediatrics

CHRISTINE TODD, SIU School of Medicine

TERRY TSUE, University of Kansas Health System

MARK UPTON, Veterans Health Administration

AMY VINSON, American Society of Anesthesiologists and Harvard Medical School

DAVID WEISSMAN, CDC National Institute for Occupational Safety and Health

ERIC WEISSMAN, Association of American Medical Colleges

AMY WINDOVER, Center for Excellence in Healthcare Communication, Cleveland Clinic

Development of this publication was facilitated by the contributions of the following people:

NAM Staff

KIMBER BOGARD, Deputy Executive Officer, Programs

T. ANH TRAN, Program Officer and Director

FARIDA AHMED, Associate Program Officer (from June 2022)

CATHERINE COLGAN, Research Assistant

SAMANTHA PHILLIPS, Communications Officer

JENNA L. OGILVIE, Deputy Director, Communications

Consultant

CHARLEE ALEXANDER, Independent Consultant

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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REVIEWERS

The products that compose this volume were reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine (NAM).

We wish to thank the following individuals for their contributions:

The reviewers listed above provided many constructive comments and suggestions, but they were not asked to endorse the content of the publication and did not see the final draft before it was published. Review of this publication was overseen by KIMBER BOGARD, Deputy Executive Officer, Programs; T. ANH TRAN, Program Officer and Director; FARIDA AHMED, Associate Program Officer; and CATHERINE COLGAN, Research Assistant. Responsibility for the final content of this publication rests entirely with the editors and the NAM.

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DEFINITIONS

Burnout is a workplace “syndrome characterized by high emotional exhaustion, high depersonalization (e.g., cynicism), and a low sense of personal accomplishment” (NASEM, 2019).

Culture is the “combination of a body of knowledge, a body of belief, and a body of behavior…. This includes personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions” (NIH, 2021).

Health equity is the “state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or other socially defined circumstance” (NASEM, 2017).

Health systems encompass organizations and people who work to “improve, maintain, or restore the health of individuals and their communities.” Health system settings include hospitals, medical practices, urgent care centers, and other places where health workers deliver care and engage in the “prevention and control of communicable disease and health promotion” (WHO, 2007).

Health workforce comprises a range of occupations, including health workers “such as registered nurses, physicians,” and allied health professionals, “as well as individuals in health care support roles, such as community health workers,” public health workers, “direct support professionals, and caregivers” (HRSA, 2021). “Health workers” is used to encompass the full range of health professionals, and more specific language is used when necessary.

Mental health is a “state of well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (WHO, 2022).

Moral distress occurs when an individual faces a dilemma of knowing their ethical responsibility (e.g., the appropriate care for their patients) but is unable to act upon it due to circumstances beyond

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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their control (Morley et al., 2017). Moral injury is related and occurs when individuals are repeatedly engaging with, failing to prevent, or witnessing such dilemmas (Litz et al., 2009).

Positive work and learning environments are safe and healthy, support the well-being of health workers and learners, and foster ethical and meaningful training and practice (NASEM, 2019).

Professional well-being is a “function of being satisfied with one’s job, finding meaning in work, feeling engaged at work, having a high-quality working life, and finding professional fulfillment in work” (Danna and Griffin, 1999; Doble and Santha, 2008).

Psychological safety is a climate of trust and respect in which people are comfortable expressing and being themselves, and share the belief that teammates will not embarrass, reject, or punish a colleague for speaking up (AMA, 2020; Center for Creative Leadership, 2022; Edmonson, 2018).

Resilience is the ability of an individual, organization, “community, or system to withstand, adapt, recover, rebound, or grow from adversity, stress, or trauma” (NASEM, 2019).

Social determinants of health are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These non-medical factors create socially-defined circumstances that can influence health outcomes (WHO, 2008).

Stigma is a “negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency. A stigma implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual” (APA, 2022).

Workplace stress is the “harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Workplace stress can lead to poor health or even injury” (NIOSH, 2016).

Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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Suggested Citation:"Front Matter." National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. Washington, DC: The National Academies Press. doi: 10.17226/26744.
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ACRONYMS AND ABBREVIATIONS

AMA American Medical Association
CDC Centers for Disease Control and Prevention
CMS Centers for Medicare & Medicaid Services
COVID-19 coronavirus disease 2019
CPT Current Procedural Terminology
EHR electronic health record
FSMB Federation of State Medical Boards
HHS U.S. Department of Health and Human Services
HRSA Health Resources and Services Administration
IT information technology
LGBTQIA+ lesbian, gay, bisexual, transgender, queer/questioning, intersex, and ally/asexual
NAM National Academy of Medicine
NIH National Institutes of Health
NIOSH National Institute for Occupational Safety and Health
PPE personal protective equipment
PTSD posttraumatic stress disorder
SDOH social determinants of health
WHO World Health Organization
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In the United States, 54% of nurses and physicians, 60% of medical students and residents, and 61% of pharmacists have symptoms of burnout. Burnout is a long-standing issue and a fundamental barrier to professional well-being. It was further exacerbated by the COVID-19 pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care. Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care.

The National Plan for Health Workforce Well-Being is intended to inspire collective action that focuses on changes needed across the health system and at the organizational level to improve the well-being of the health workforce. As a nation, we must redesign how health is delivered so that human connection is strengthened, health equity is achieved, and trust is restored. The National Plan’s vision is that patients are cared for by a health workforce that is thriving in an environment that fosters their well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity; therefore, achieving the “quintuple aim.”

Together, we can create a health system in which care is delivered joyfully and with meaning, by a committed team of all who work to advance health, in partnership with engaged patients and communities.

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