Work on Clinician Well-Being at the National Academies Sharyl Nass, Ph.D. Director, Board on Health Care Services Health and Medicine Division National Academies of Sciences, Engineering, and Medicine
Action Collaborative on Clinician Well-Being and Resilience Overarching Goals: • Raise visibility of clinician burnout, depression, stress, and suicide • Improve baseline understanding of challenges to clinician well-being • Advance evidence-based, multidisciplinary solutions that will improve patient care by caring for the caregiver
Make up of the Collaborative ~65 participants representing: • Medicine, nursing, pharmacy, dentistry • Professional societies and membership organizations • Government agencies • Health IT vendors • Large health care centers • Payers • Researchers • Trainees and early career professionals • Patient and consumer perspectives
Steering Committee Victor J. Dzau, National Academy of Medicine Darrell G. Kirch, Association of American Medical Colleges Thomas J. Nasca, Accreditation Council for Graduate Medical Education Steven Bird, Society for Academic Emergency Medicine Neil Busis, American Academy of Neurology Pamela Cipriano, American Nurses Association Robert Harbaugh, Society of Neurological Surgeons Art Hengerer, Federation of State Medical Boards Sandeep Kishore, Icahn School of Medicine at Mount Sinai Clifton Knight, American Academy of Family Physicians Lois Margaret Nora, American Board of Medical Specialties Barry Rubin, University Health Network Daisy Smith, American College of Physicians
Working Groups 1. Research, Data, and Metrics 2. Conceptual Model 3. External Factors and Work Flow 4. Messaging and Communications 5. External Publications and Art Show
Research, Data, and Metrics Completed: • – Discussion Paper: “Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High- Quality Care” – Compilation of validated survey instruments to assess work-related dimensions of well-being – Discussion Paper: “A Pragmatic Approach for Organizations to Measure Health Care Professional Well-Being” Forthcoming: • – Financial cost of burnout among nurses – Gender differences in burnout and related factors
Factors Affecting Clinician Well-Being and Resilience
External Factors SOCIETY & CULTURE ORGANIZATIONAL FACTORS Alignment of societal expectation and clinician’s role Power dynamics • • Culture of safety and transparency Professional development opportunities • • Discrimination and overt and unconscious bias Scope of practice • • Media portrayal Workload, performance, compensation, and value • • attributed to work elements Patient behaviors and expectations • Political and economic climates • LEARNING/PRACTICE ENVIRONMENT Social determinants of health • Autonomy • Stigmatization of mental illness • Collaborative vs. competitive environment • RULES & REGULATIONS Curriculum • Health IT interoperability and usability/Electronic health Accreditation, high-stakes assessments, and publicized • • records quality ratings Learning and practice setting Documentation and reporting requirements • • Mentorship program HR policies and compensation issues • • Physical learning and practice conditions Initial licensure and certification • • Professional relationships Insurance company policies • • Student affairs policies Litigation risk • • Student-centered and patient-centered focus Maintenance of licensure and certification • • Team structures and functionality National and state policies and practices • • Workplace safety and violence Reimbursement structure • • Shifting systems of care and administrative requirements • HEALTH CARE RESPONSIBILITIES ORGANIZATIONAL FACTORS Administrative responsibilities • Bureaucracy Alignment of responsibility and authority • • Congruent organizational mission and values Clinical responsibilities • • Culture, leadership, and staff engagement • Learning/career stage • Data collection requirements • Patient population • Diversity and inclusion • Specialty related issues • Harassment and discrimination • Student/trainee responsibilities Level of support for all healthcare team members • • Teaching and research responsibilities •
External Factors and Work Flow Completed: • – Discussion paper: Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout” – Discussion paper: “A Vision for a Person-Centered Health Information System” – Discussion paper: “Implementing Optimal Team-Based Care to Reduce Clinician Burnout” Forthcoming: • – Streamlined suggestions to CMS re. E/M documentation guidelines
Healthy clinicians provide better patient care. Let’s build a better system that helps clinicians thrive. nam.edu/clinicianwellbeing
Knowledge Hub is organized around three main topics Causes: Organizational factors, learning environment, practice environment, • society and culture, personal factors, rules and regulations Effects: Safety and patient outcomes, clinician well-being, turnover and • reduction of work effort, health care costs Solutions: Organizational strategies, measuring burnout, individual strategies •
Case Studies in Spring 2019 • 5 case studies highlighting programs that are engaging in promising practices to reduce clinician burnout and improve well-being • Goal is to provide actionable guidance for organizations seeking to implement clinician well-being programs • Diverse array of programs • Criteria for inclusion • Community of shared learning; webinars
Expressions of Clinician Well-Being nam.edu/expressclinicianwellbeing • > 350 submissions including paintings, music, and written word • 10 art pieces available for traveling art show • 100 featured in a permanent digital gallery
Recent Workshops Graduate Medical Education Improving Care to Prevent Suicide Outcomes and Metrics See: www.nap.edu
Consensus study: Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being An ad hoc committee will examine: • causes of clinician burnout • consequences for both clinicians and patients • interventions to support clinician well-being and resilience • components of the clinical training and work environment • a variety of care settings • potential systems interventions to mitigate burnout. The committee will identify: promising tools and approaches to support clinician well-being • gaps in the evidence base • a research agenda to address areas of uncertainty. •
Study Sponsors • University of Massachusetts • • Josiah Macy Jr. Foundation Accreditation Council for Medical S chool Graduate Medical Education • Keck School of Medicine of USC • University of Michigan • American College of • Medical College of Wisconsin • Occupational and Environmental University of New Mexico • Montefiore Medicine Medicine Health S ciences Center • The Doctors Company Foundation • • American Hospital Association University of Utah Health • The Mont Fund • • The Arnold P . Gold Foundation University of Virginia Medical • The Ohio State University Center and University of • Association of American Medical • The State University of New York Virginia S chool of Medicine Colleges System • Vanderbilt University Medical • BJC HealthCare • Tulane University Center • Cedars-S inai Medical Center • University of Florida • Washington University S chool • Duke University Hospital • University of Illinois Hospital and of Medicine • Gordon and Betty Moore Health Sciences System • chool of Medicine and Y ale S Foundation Y ale New Haven Health S ystem • Johns Hopkins Health S ystem
Consensus Committee Members Christine Cassel, Co-Chair Pascale Carayon, Co-Chair Jose Pagan Elisabeth Belmont Neil Busis Sharon Pappas M. Lynn Crismon Cynda Rushton Liselotte Dyrbye Tait Shanafelt Pooja Kinkhabwala George Thibault Wanda Lipscomb Vindell Washington Saranya Loehrer Matthew Weinger M.A.J. Lex MacNeil
Consensus Study The committee will consider key components of the health care system: • factors that influence clinical workflow, workload, and human-systems interactions; the composition and function of care teams; • • outcomes-based payment and quality improvement programs; • current and potential use and impact of technologies and tools; and • regulations, guidance, policies, and accreditation standards. To support the well-being of all clinicians and trainees on the care team, prevent clinician burnout, and facilitate high-quality patient care, the committee will issue recommendations for system changes to: • streamline processes and reduce complexity • minimize the burden of documentation requirements • enhance workflow and teamwork
Input welcome throughout the study Submit written comments to: SupportingClinicianWellbeing@nas.edu www.nas.edu/supportingclincianwellbeing
Vision for the Future • A campaign for systems change • Evidence-based solutions • Leveraging networks of organizations committed to improving clinician well-being • Building a community of empowerment • Supporting healthy clinicians and high- quality patient care
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