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Pages 1-20

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From page 1...
... health care system to achieve the goals of better population health, enhanced patient care experiences, and lower health care costs depends in large part on clinicians, the health care professionals who provide direct patient care.1 Delivering safe, patient-centered, high-quality, and high-value health care requires a clinical workforce that is functioning at the highest level. However, there is growing recognition among health care system experts that clinician well-being, so essential to the therapeutic alliance among clinicians, patients, and families, is eroding because of occupational stress.
From page 2...
... A chronic imbalance of high job demands and inadequate job resources can lead to burnout. The job demand– resources imbalance in health care is exacerbated by the increasing push for system performance improvement, which leads to greater administrative burden, production pressures, and shifts in financial incentives and payment structures; by technology implementation that hinders rather than supports patient care; by changing professional expectations; as well as by standards and regulatory policies that are insufficiently aligned with the delivery of high-quality patient care or professional values.
From page 3...
... Over the course of the 18-month study, the committee gathered evidence, reviewed and deliberated on that evidence, and developed recommendations on designing systems to reduce clinician burnout and foster professional well-being. CONCEPTUAL FRAMEWORK To achieve the dual objective of addressing burnout and well-being and improving patient care, the committee concluded that it will be necessary to consider clinician burnout and professional well-being in the context of a broader system.4 The committee's framework for a systems approach to clinician burnout and professional well-being reflects theories and principles from the fields of human factors and systems engineering, job and organizational design, and occupational safety and health.
From page 4...
... er | P ead | h es L ys al s iti ic En ti v v i ro Ac n m ent | | Frontline Care Delivery | Health Care Organization | External Environment * Note: Care team members include clinicians, staff, learners, patients, and families.
From page 5...
... To reduce clinician burnout and foster professional well-being, learning and continuous improvement processes are necessary for identifying, evaluating, and implementing effective improvements at all levels of the system. Frontline care delivery is the "work system" where interactions among the care team, including clinicians, learners (i.e., trainees and students)
From page 6...
... . Despite the many positive benefits, the negative impact of health information technology, including electronic health records, on care delivery, workflow, workload, and burnout is well documented.
From page 7...
... . • Use a systems approach to proactively improve professional well-being while supporting patient care.
From page 8...
... Goal 1. Create Positive Work Environments: Transform health care work systems by creating positive work environments that prevent and reduce burnout, foster professional well-being, and support quality care.
From page 9...
... The active engagement of clinicians and patients is essential to the efforts of health care organizations to create positive work environments, including efforts to prioritize actions, procedures, and policies that will deliver the greatest value to direct patient care. Recommendation 1A Health care organizations should develop, pilot, implement, and evaluate organization-wide initiatives to reduce the risk of burnout, foster professional well-being, and enhance patient care by improving the work environment.
From page 10...
... Recommendation 1B To guide new systems that have been designed to promote professional well-being and patient care quality, health care organizations should adopt and apply the following principles that improve the work environment and balance job demands and job resources. • Enhance meaning and purpose in work, and optimize workload and task distribution.
From page 11...
... Health professions educational institutions, affiliated clinical training sites, accreditors, and related external organizations have a responsibility to create and maintain positive learning environments that support the professional development and well-being of students and trainees (learners)
From page 12...
... Recommendation 2B Health professions educational institutions and affiliated clinical training sites should routinely assess the learning environment and factors that erode professional well-being and contribute to learner burnout. The data should guide systems-oriented efforts to optimize the learning environment, prevent and reduce learner burnout, and improve professional well-being.
From page 13...
... It is essential for health pro fessions educational institutions to protect learners' privacy and address any stigma or pressure that learners may perceive related to assessment or reporting. • Use the data to guide systems-oriented efforts to prevent and re duce learner burnout and improve professional well-being as part of a continuous learning and improvement process where data are shared transparently across learners' health professions educational institutions and affiliated clinical training sites.
From page 14...
... Department of Health and Human Services' Centers for Medicare & Medicaid Services and The Office of the National Coordinator for Health Information Technology, the National Quality Forum, state legislatures, professional boards, and departments of health, should systematically assess laws, regulations, policies, and standards to determine their effects on clinician job demands and resources as well as the effects on patient care quality, safety, and cost. To accomplish this, these entities should: • Allocate the necessary resources to support assessment of the ef fects of regulations, policies, and standards on clinicians in various care settings.
From page 15...
... Goal 4. Enable Technology Solutions: Through collaboration and engagement of vendors, clinicians, and expert health information technology system developers, optimize the use of health information technologies to support clinicians in providing high-quality patient care.
From page 16...
... For example: • Regulators should use rigorous human factors usability and safety criteria to evaluate and certify health IT. • Health IT vendors and health care organizations should design and configure systems to improve the clinical work environment, including attention to cognitive load and workflows that reduce the demand of clinical documentation and automate non-essential tasks.
From page 17...
... Recommendation 5B State legislative bodies should create legal protections that allow clinicians to seek and receive help for mental health conditions as well as to deal with the unique emotional and professional demands of their work through employee assistance programs, peer support programs, and mental health providers without the information being admissible in malpractice litigation. Recommendation 5C Health professions educational institutions, health care organizations, and affiliated training sites should identify and address those aspects of the learning environment, institutional culture,
From page 18...
... The compelling evidence of the alarmingly high rates of burnout and its negative effects on the health care system and patient care requires the expansion and support of research and innovation in this area. Such support can be achieved through the collaborative efforts of government bodies and organizations charged with improving care quality and patient safety, improving the patient experience, reducing health care costs, and supporting the professional development of learners and clinicians in the health professions.
From page 19...
... A public–private partnership should support the creation and ongoing management of a national registry of evidence-based interventions to facilitate research and innovation beneficial to every stakeholder with responsibility for eliminating clinician and learner burnout and improving professional well-being.


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