Take Action Against Clinician Burnout

Action Steps and Resources for Health Care Leaders

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When we invest in clinician well-being, everyone wins.

Taking Action Against Clinician Burnout: A Systems Approach to Improving Professional Well-Being

INTRODUCTION

Even before the COVID-19 pandemic, U.S. health care workers were feeling overwhelmed, frustrated, and stretched thin by a health system that often serves as a barrier to the vital clinician-patient relationship. A 2019 report from the National Academy of Medicine (NAM) found that the consequences extend beyond individual health care workers’ experiences of stress, burnout, anxiety, depression, and suicide. Clinician burnout is an occupational syndrome caused by mounting pressures in the U.S. health care system, which can adversely influence the quality and safety of patient care.

The report, Taking Action Against Clinician Burnout: A Systems Approach to Improving Professional Well-Being, emphasizes it is critical to address burnout not as an individual issue, but rather as a systems issue that stems from workplace culture, health care policies and regulations, and societal expectations. Building more supportive work environments will help address the serious public health concern of clinician burnout.

Making a commitment to invest in caregivers can lead to real improvements in their experiences, and is worth the time it takes. Janice Nevin, president and CEO of ChristianaCare, said, “We know that if we do not care for our caregivers first, it’s going to be very difficult for us to do what we need for our patients, for the communities we serve.”

The COVID-19 pandemic has made clear that health workers need more support from their health care organizations, health education institutions, and in the professional culture of medicine. We must build on lessons learned during the pandemic to better prepare our health workforce—the backbone of our health system—for the future. Supporting clinician well-being requires sustained attention and action at organizational, state, and national levels, as well as investment in research and information-sharing to advance evidence-based solutions. Below are a collection of resources and tools for health care leaders to help reduce clinician burnout.

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“Making a commitment to invest in caregivers can lead to real improvements in their experiences, and is worth the time it takes. Janice Nevin, president and CEO of ChristianaCare, said, “We know that if we do not care for our caregivers first, it’s going to be very difficult for us to do what we need for our patients, for the communities we serve.”

AT A GLANCE
Burnout is a Systems Issue that Requires System-Level Solutions

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Many clinicians face burnout, as well as stress, anxiety, depression, substance abuse, and suicidality. Physicians are at increased risk for burnout compared to other U.S. workers. Burnout leads to reduced job productivity and higher rates of turnover with an estimated $4.6 billion in societal costs attributable to burnout each year in the U.S. Burnout’s effects on clinicians can also have an impact on patients and affect patient care.
Clinician burnout is largely the result of external factors outside the control of an individual clinician – including regulations, payment incentives, organizational policy and culture, social pressures and stigma, and more.
Clinician burnout is a system issue. Therefore, system-level solutions are needed to address burnout and promote well-being. Such solutions require significant buy-in from leaders across the health system, including governing boards, executive officers, senior leaders, department chairs, and administrative and operational leaders.
Priority areas graphic

“We need to pay attention to the efforts that show we care about physicians,” said Kirk Calhoun, president of the University of Texas Health Science Center at Tyler and chair-elect of the Association of American Medical Colleges. “That means providing a comfortable workspace and having electronic systems that don’t take away from care. It means open communications and minimizing conflict in how people go about doing their jobs.”

CHECKLIST
Take the Lead to Reduce Burnout

Key actions to mitigate clinician burnout

Taking Action Against Clinician Burnout: A Systems Approach to Supporting Professional Well-Being calls upon leaders in health care organizations and health professions educational institutions to prioritize major improvements in clinical work and learning environments in all settings and across all disciplines. Individual-focused strategies can be an effective part of larger organizational efforts but do not sufficiently address clinician burnout on their own.

  • Engage governing boards, executive officers, senior leaders, department chairs, and administrative leaders in a shared commitment to create and maintain a positive and healthy work environment
  • Create and maintain an executive-level leadership role and function, often referred to as chief wellness officer, responsible for improving and sustaining professional well-being across the organization
  • Identify and address those aspects of the work and learning environments, institutional culture, infrastructure and resources, and policies that erode professional well-being and contribute to burnout
  • Eliminate barriers that prevent or discourage access to professional and personal support programs for individual clinicians and learners
  • Allocate resources in ways that address clinical burnout
  • Create conditions in work and learning environments that equip clinicians and non-clinician staff with dedicated time, resources, and skills to advance clinician well-being
  • Bring together parts of the organization that don’t yet communicate to jointly consider requirements, constraints, and unanticipated consequences of having been siloed, such as overlapping regulations
  • Align organizational goals and resources
  • Commit to a culture of teamwork, collaboration, and adaptability in support of continuous learning
  • Monitor clinician well-being using validated instruments to measure burnout, at a minimum annually
  • Evaluate how business and management decisions may affect clinicians’ job demands and job resources, patient care quality and safety, and levels of burnout within the organization – adjust decisions and their implementation accordingly
  • Assess total workload and the complexity of the work expected of clinicians (including continuing professional education, maintenance of certification, required institutional learning modules, and work performed outside of scheduled hours)
  • Target reports internally, including to leadership, managers, and clinicians, to share transparently within the organization
  • Avoid any perception of blaming frontline staff for results or exerting pressure for them to remediate results
  • Advocate for needed regulatory reforms
  • Create incentives for, and lower barriers to, the development and implementation of new ideas, approaches, and technologies that have the promise of enhancing professional well-being as well as improving quality of care
  • Co-create solutions with clinicians, rather than imposing them, to increase the likelihood of meaningful and sustainable progress
  • Share successes within the organization as well as the field at large to accelerate improvement

“Improving clinician well-being should also be embedded in the organization’s annual goal-setting process, said Thomas Priselac, president and CEO of Cedars-Sinai Health System in Los Angeles. The health system revisits these goals at least quarterly. “It not only signals to the organization what our strategic priorities are, but it also creates an organizational accountability loop,” he said.

CASE STUDIES

The following case studies were authored by members of the NAM Action Collaborative on Clinician Well-Being and Resilience (Clinician Well-Being Collaborative) and NAM staff on the basis of extensive interviews, document review, and site visits.

culture thumbnail CULTURE

Virginia Mason Kirkland Medical Center is an outpatient clinic in the Virginia Mason Health System. Kirkland Medical Center cultivates a culture of collegiality and respect from the interview process to everyday practice, throughout which leadership expectations are clearly set and reaffirmed.

Ohio State University thumbnail CHIEF WELLNESS OFFICER

Central to the coordination and alignment of initiatives that span across The Ohio State University are the Office of the Chief Wellness Officer and the One University Health and Wellness Council.

Ohio State College of Nursing thumbnail STRATEGIC PLANNING

The Ohio State University College of Nursing offers a variety of curriculum and non-curriculum-based programs to optimize student well-being. Wellness is built into the college’s five-year strategic plan, and outcomes are monitored annually.

Ohio State Wexner Medical Center thumbnailSUPPORT PROGRAMS

At Ohio State, efforts to promote and support clinician well-being include facilitated traumatic event debriefings, monthly Schwartz Rounds®, and a preventive health initiative that offers staff retreats, free mindfulness courses, and culinary medicine classes.

Virginia Mason Kirkland Medical Center thumbnail TEAM-BASED CARE

Virginia Mason Kirkland Medical Center fosters intentional programs and policies that encourage all clinicians and staff to employ strategies that optimize workflow and team-based care.

RESOURCES

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Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being

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National Plan for Health Workforce Well-Being

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