National Plan for Health Workforce Well-Being (2022)

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

2 Priority Area: Invest in Measurement, Assessment, Strategies, and Research Expand the uptake of existing tools at the health system level and advance national research on decreasing health worker burnout and improving well-being. “So far, most of the response of my organization has been psycho- social support for health care workers, but I'd like to see us measure burnout organizationally, track it and design improvement efforts around it.” - Frontline Health Worker1 Burnout negatively affects patient outcomes, health workers, and health system finances; high rates of burnout reported by U.S. health workers are a signal that the overall health system is fail- ing to achieve system-wide improvement (NASEM, 2019). The longitudinal use of validated tools is required to accurately mea- sure the prevalence of burnout and distress in health care settings of all sizes and in all locations, as well as the impact of strategies to decrease workplace burnout. Measuring and understanding the drivers of workplace distress and burnout among individuals, and particularly health care teams, are essential to forming the base- line for organizations to establish their well-being guidelines and to evaluating the effectiveness of strategies to decrease workplace distress and improve health worker well-being. However, employ- ing measures that are unable to capture burnout holistically can be inappropriate and do more harm than good (NASEM, 2019). 1 For background on this quote and those in other chapters, visit the NAM’s Clinician Burnout Crisis in the Era of COVID-19: Insights from the Frontlines of Care webpage at: https://nam.edu/initiatives/ clinician-resilience-and-well-being/clinician-burnout-crisis-in-the-era-of-covid-19/. 19 

20 | National Plan for Health Workforce Well-Being Metrics to assess the prevalence of burnout need to be harmo- nized with organizational efforts around employee engagement and satisfaction. These metrics also need to be appropriate for the setting, using valid and reliable survey instruments to measure burnout, well-being, and other “clinically relevant dimensions of distress that include meaning in work, severe fatigue, work-life integration, quality of life, and suicidal ideation” (Dyrbye et al., 2016). More validation and efforts to assess burnout among health professional students are needed, though burnout surveys for medical students have emerged. Cross-walks between workplace measures of burnout and distress have also been developed (Brady et al., 2022). For health systems, the choice of which survey to im- plement matters less than the decision to choose a validated survey tool and the commitment to measure and report the prevalence of health worker burnout and distress over time. Accurate assessment of total workload and the quality of care provides complementary data to surveys of burnout and distress, and should also be reg- ularly included (Sinsky et al., 2020a). At the national level, addi- tional research is needed to not only better understand the extent of health worker burnout as a baseline but also to identify links to clinical outcomes, and ultimately build on the success of various interventions for decreasing burnout and improving well-being across the field. Importantly, data that identify the prevalence of health work- force burnout should not be used for public rankings due to the highly subjective nature of the questions and undue incentives to receive high scores, rather than to collect honest feedback for in- ternal use to drive change (Mayer et al., 2021; NASEM, 2019). As mentioned in Chapter 1, it is in an organization’s financial inter- ests and part of their care responsibility to take action to decrease burnout among health workers, but other actor groups can take shared responsibility and provide additional incentives as part of a systems approach. PREPUBLICATION COPY - Uncorrected Proofs 

Invest in Measurement, Assessment, Strategies, and Research | 21 Priority Area: Invest in measurement, assessment, strategies, and research. Burnout and well-being of health workers and Goal 1 learners, and the drivers of workplace stress, are routinely measured. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Health Systems Actors Health Workers Insurers and Payers 1A. Measure and assess core leadership behaviors that pro- mote workforce well-being (e.g., the Mayo Clinic Leader Index uses the Include, Inform, Inquire, Develop, Recognize framework; see Related Resources). 1B. Identify internal and external funding streams for mea- surement and assessment of learner and health workforce burnout and well-being. 1C. Measure the prevalence and drivers of health worker and learner burnout and distress, using one of the existing validated survey tools for which established benchmarks are Actions available. 1D. Recognize and evaluate the links between well-being outcomes and key performance indicators that are most relevant to the organization and learning environments (e.g., quality of care, patient-reported outcomes and experience, staff turnover). 1E. Disaggregate and de-identify data, share it across the organization and to relevant groups for the purpose of continuous learning, and use it to develop intervention strategies that will drive positive local changes in the workplace and learning environments. PREPUBLICATION COPY - Uncorrected Proofs 

22 | National Plan for Health Workforce Well-Being A national commitment is made to invest in research, Goal 2 strategies, and partnerships to improve health worker and learner well-being. Academic Institutions, Clinical Training Programs, and Accreditation Bodies Federal, State, and Local Governments Health Information Technology (IT) Companies Health Systems Actors Health Workers Insurers and Payers Private and Non-Profit Organizations Professional and Specialty Societies 2A. Coordinate a research agenda to examine: • organizational, learning environment, and health sys- tem factors (e.g., payment models, health IT, regulatory practices, workload and staffing models, local culture) that contribute to burnout, moral injury, occupational distress, intention to leave health care as a profession, and death by suicide among health workers; • the impact of bias, discrimination, sexism, ableism, Actions anti-LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, and ally/asexual) efforts and/or racism on the professional and personal well- being of health workers and learners; • the immediate and long-term effects of COVID-19 on the well-being of the health workforce; and • strategies to improve health worker and learner well- being in the local environment. PREPUBLICATION COPY - Uncorrected Proofs 

Invest in Measurement, Assessment, Strategies, and Research | 23 2B. Fund a coordinated research agenda that focuses primar- ily on the issues outlined in Action 2A. 2C. Create and manage a national registry of evidence-based interventions to coordinate and facilitate research and in- novation aimed at eliminating health worker and learner burnout and improving professional worker and learner well-being. 2D. Establish and support a national epidemiologic tracking Actions program to measure health worker and learner well-being, distress, and burnout with mandated funding. 2E. Enhance wide-scale uptake of implementation best practices and approaches to improve well-being and decrease burnout across various stakeholder groups. 2F. Convene conferences and symposia to share strategies for improving well-being and preventing and reducing burnout and distress. NOTE: The list of actors in this table is not exhaustive. Many of the actors named in this table will need to plan and coordinate their actions with each other as part of a systems approach to health workforce well-being. RELATED RESOURCES2 1 Conduct Workplace Assessment • Overview of Established Tools: Valid and Reliable Survey In- struments to Measure Burnout, Well-Being, and Other Work- Related Dimensions (National Academy of Medicine) • Tool: Healthy Work Environment Assessment Tool (American Association of Critical-Care Nurses) • Tool: NIOSH Worker Well-Being Questionnaire (WELLBQ) (National Institute for Occupational Safety and Health) • Tool: Wellness Culture and Environment Support Scale (Mel- nyk et al., 2017) • Calculator: Organizational Cost of Physician Burnout (Ameri- can Medical Association) • Discussion Paper: A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being (Dyrbye et al., 2018) 2 For additional resources, visit the NAM’s Resource Compendium for Health Care Worker Well-Being webpage at: https://nam.edu/compendium-of-key-resources-for-improving-clinician-well-being/. PREPUBLICATION COPY - Uncorrected Proofs 

24 | National Plan for Health Workforce Well-Being • Discussion Paper: Establishing Crosswalks Between Common Measures of Burnout in US Physicians (Brady et al., 2022) • Survey Findings: Pulse on the Nation’s Nurses Survey Series: COVID-19 Two-Year Impact Assessment Survey (American Nurses Foundation, 2022) Strengthen Leadership Behaviors • Guide: Cultivating Leadership: Measure and Assess Leader Behaviors to Improve Professional Well-Being (American Medical Association) • Perspective: Preventing a Parallel Pandemic—A National Strategy to Protect Clinicians’ Well-Being (Dzau et al., 2020) PREPUBLICATION COPY - Uncorrected Proofs