National report focuses renewed attention on clinician ‘burnout’
Last month, the National Academy of Medicine (NAM) released a 300-page report that applies the same systems thinking that has become a mainstay of patient safety work to the challenge of clinician burnout.
The report, Taking ActionAgainst Clinician Burnout: A Systems Approach to Professional Well Being, organizes NAM’s recommendations under six goals:
Create positive work environments.
Create positive learning environments.
Reduce administrative burden.
Enable technology solutions.
Provide support to clinicians and learners.
Invest in research.
Beginning with professional education, through practice on the frontlines of care delivery, business and regulatory concerns, and new research agendas, the framework amounts to a transformative blueprint for a health care system of the future.
Burnout — emotional exhaustion, cynicism, and a diminished sense of professional accomplishment — is now recognized as a problem affecting workers throughout health care, with harmful ramifications for their personal well-being, as well as their patients and organizations. Among health care professions that have been surveyed — primarily nurses, physicians, residents and medical students — the number of individuals who report symptoms of burnout range from 35% to 60%. The incidence of burnout among other groups, such as pharmacists and dentists, has not been adequately measured, but is assumed to be significant.
Pascale Carayon, Ph.D., who co-chaired the interdisciplinary committee with Christine Cassel, M.D., acknowledged in an interview
with JAMA’s Editor, Howard Bauchner, M.D., that there is no easy fix for the problem:
We cannot say, “You should do 1, 2, 3.” So we defined guidelines for well-being systems primarily targeted on healthcare organizations, to give a roadmap for where they can start engaging.
According to the report, wellness training and support for clinicians are helpful and should be part of organizational strategies but do not alone sufficiently address the root causes of burnout.
We’re planting seeds on a dozen fronts, and they’re all sprouting. Although it may still be awhile before the effects are felt on the frontline, I’ve really been heartened. People understand why this is important, and they’re doing something about it.
Massachusetts organizations have begun to make changes
In Massachusetts, academic institutions, professional societies and health systems have been working on these issues and are optimistic that the effect of early improvement efforts will grow as they gain traction and scale. Steven Defossez, M.D., practicing radiologist and Vice President of Clinical Integration at the Massachusetts Health & Hospital Association, says, "We’re planting seeds on a dozen fronts, and they’re all sprouting. Although it may still be awhile before the effects are felt on the frontline, I’ve really been heartened. People understand why this is important, and they’re doing something about it."
Dr. Defossez co-chairs the Joint Task Force of MHA and the Massachusetts Medical Society that, together with the Harvard T.H. Chan School of Public Health and the Harvard Global Health Institute, published A Crisis in Health Care: A Call to Action on Physician Burnout in January 2019. Like the NAM report, it issues ambitious recommendations, including expansion of health services for clinicians, improved usability of electronic health records, and appointment of executive-level leadership for clinician wellness at all provider organizations. In addition, MHA’s Promoting Employee Well-being Committee, which has been meeting since March 2018, has posted numerous resources on PatientCareLink, MHA’s publicly available quality and safety website.
The Massachusetts Board of Registration in Medicine (BORIM) is also supportive. Working with the Joint Task Force, BORIM committed to all applicable recommendations made by the Workgroup on Physician Wellness and Burnout of the Federation of State Medical Boards, which includes removing barriers to physicians’ access to behavioral health services. BOROIM has also agreed to allow 7 of the 10 risk management credits physicians need for continuing education to be about wellness and burnout.
Maryanne Bombaugh, M.D., M.Sc., MBA, President of MMS, also appreciates BORIM’s leadership on this issue. She emphasizes the importance of leadership to address burnout at all levels, from the regulatory and health care corporate boards through health systems, physician practices and all clinical environments. Dr. Bombaugh believes, “Unless leaders embrace this as fundamentally important, it may it may not get action. The leaders of every practice — large or small — set the tone for a positive, learning work environment that supports its physicians and employees. Patients are incredibly important and so are those who care for them.”
MHA’s Caring for the Caregiver
Evidence-based practices and resources for employee recognition, workplace safety and worker well-being. A joint venture of the Massachusetts Health & Hospital Association, Organization of Nurse Leaders of MA, RI, NH, CT, VT, and Hospital Association of Rhode Island.
Medical Professionals Empowerment Program
A 20-episode podcast featuring physicians discussing practical methods for “empowering themselves, their teams, employers, and the broken system.” Created by Physician Health Services, a corporation of the Massachusetts Medical Society.
Turning the EHR from a liability into an asset
Reliant Medical Group ranked in the 97th percentile for EHR usability in a recent national study. In this white paper, Reliant details its strategy to optimize the EHR and help physicians avoid burnout.
NAM Action Collaborative on Clinician Well-Being and Resilience
A webinar series from the National Academy of Medicine highlighting programs that have reduced burnout and improved well-being for clinicians.
