1
|
Grover A, Santen SA, Lockeman K, Burns D, Akuamoah-Boateng K, Siner C, Miller S, Sparkman BK, Ellis L, Nye C. Defining Types of Leadership Within an Academic Surgery Department to Promote Change for Decreasing Rates of Burnout. Am Surg 2024:31348241244643. [PMID: 38648008 DOI: 10.1177/00031348241244643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Successful leaders influence the group they represent. Effective surgical care is tied to its leadership climate. However, most surgical providers are not attuned to their individual strengths which if known they could leverage them within their teams. This study identifies leadership types within a department of surgery which may be used to better understand and cultivate their strengths. METHODS In 2022, 172 providers in an academic surgery department were offered the GallupTM CliftonStrengths assessment, a proprietary instrument that maps 34 strengths across 4 domains of leadership. The assessment provides a respondent with their top 5 strengths and the domain in which they naturally "lead". RESULTS Of 172 providers, 127 (74%) completed the assessment. While providers have strengths in multiple domains, they "lead with" a specific domain. Mapped from the providers' top 10 strengths, the most common "lead with" domain for surgical providers was Executing: the ability to implement ideas and produce results. Strategic Thinking: those who are analytical and push teams forward and Relationship Building: the ability to create strong and effective teams were followed by the least common domain. Influencing: the ability to communicate ideas and lead others. Formal leaders were significantly more likely to lead with Strategic Thinking. There were no significant differences between APPs and physicians. CONCLUSION A majority of surgical providers "lead with" the GallupTM Executing domain. Those who lead with executing skills work tirelessly to produce outcomes. Learning to leverage the strengths of our teams to create cohesion and efficiency may improve engagement and retention.
Collapse
Affiliation(s)
- Amelia Grover
- Department of Surgery VCU School of Medicine, Richmond, VA, USA
| | - Sally A Santen
- VCU School of Medicine University of Cincinnati College of Medicine, Richmond, VA, USA
| | - Kelly Lockeman
- VCU School of Medicine University of Cincinnati College of Medicine, Richmond, VA, USA
| | - Dana Burns
- School of Nursing, VCU, Richmond, VA, USA
| | | | | | - Sarah Miller
- VCU School of Medicine University of Cincinnati College of Medicine, Richmond, VA, USA
| | - Brian K Sparkman
- VCU School of Medicine University of Cincinnati College of Medicine, Richmond, VA, USA
| | - Lisa Ellis
- VCU School of Medicine University of Cincinnati College of Medicine, Richmond, VA, USA
| | - Carla Nye
- School of Nursing, VCU, Richmond, VA, USA
| |
Collapse
|
2
|
Parikh JR, Cavanaugh KJ. Formal wellness training of academic radiology leaders improves work-life conflict. Eur Radiol 2024:10.1007/s00330-024-10735-2. [PMID: 38639913 DOI: 10.1007/s00330-024-10735-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/11/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To investigate the effect of formal leadership training of academic radiology leaders within an academic center on their own burnout and professional fulfillment. METHODS The study cohort was academic radiology leaders within one of the largest academic organizations of academic radiologists within the United States. All academic radiology leaders within the organization were electronically mailed a weblink to a confidential IRB-approved survey in April 2021. The survey included validated questions from the Stanford Professional Fulfillment Index (PFI), values alignment, teamwork, overload, and work-family conflict. Academic leaders were invited in May 2021 to participate in instructor-led formal training on leading wellness focusing on 5 core leadership skills - emotional intelligence, self-care, resilience support, demonstrating care, and managing burnout. An identical follow-up survey was electronically mailed 6 months after initial training in November 2021. RESULTS The overall response rate of academic radiology leaders was 59% (19/32). For both measures, there was acceptable internal consistency (Cronbach's α = 0.63 for work exhaustion and α = 0.90 for fulfillment). There was a statistically significant improvement in work-family conflict (3.32 vs 2.86; p = 0.04). No statistically significant differences were identified for fulfillment, work exhaustion, alignment, work overload, and teamwork scores after training. CONCLUSION Formal instruction in leading wellness improved work-life conflict for academic radiology leaders. There was no significant change in burnout, fulfillment nor organizational alignment of the leaders. CLINICAL RELEVANCE STATEMENT Formal instruction in leading wellness raised awareness and improved work-life conflict in academic radiology leaders.
Collapse
Affiliation(s)
- Jay R Parikh
- Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1155 Pressler St., Unit 1350, CPB 5.3208, Houston, TX, 77030, USA.
| | - Katelyn J Cavanaugh
- Leadership Institute, The University of Texas MD Anderson Cancer Center, 7007 Bertner Avenue, Houston, TX, 77030, USA
| |
Collapse
|
3
|
Collins RT, Schadler A, Huang H, Day SB, Bauer JA. Impact of burnout and professional fulfillment on intent to leave among pediatric physicians: The findings of a quality improvement initiative. BMC Health Serv Res 2024; 24:434. [PMID: 38580940 PMCID: PMC10998309 DOI: 10.1186/s12913-024-10842-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/07/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Physician burnout is rampant, and physician retention is increasingly hard. It is unclear how burnout impacts intent to leave an organization. We sought to determine how physician burnout and professional fulfillment impact pediatric physicians' intent to leave (ITL) an organization. DESIGN AND METHODS We performed 120, 1:1 semi-structured interviews of our pediatric faculty and used the themes therefrom to develop a Likert-scale based, 22-question battery of their current work experience. We created a faculty climate survey by combining those questions with a standardized instrument that assesses burnout and professional fulfillment. We surveyed pediatric and pediatric-affiliated (e.g. pediatric surgery, pediatric psychiatry, etc.) physicians between November 2 and December 9, 2022. We used standard statistical methods to analyze the data. An alpha-level of 0.05 was used to determine significance. RESULTS A total of 142 respondents completed the survey, 129 (91%) were Department of Pediatrics faculty. Burnout was present in 41% (58/142) of respondents, whereas 30% (42/142) were professionally fulfilled. There was an inverse relationship between professional fulfillment and ITL, p < 0.001 for the trend. Among those who were not professionally fulfilled, the odds ratio of ITL in the next three years was 3.826 [95% CI 1.575-9.291], p = 0.003. There was a direct relationship between burnout and ITL, p < 0.001 for the trend. CONCLUSIONS Among pediatric physicians, professional fulfillment is strongly, inversely related with ITL in the next three years. Similarly, burnout is directly related with ITL. These data suggest a lack of professional fulfillment and high burnout are strong predictors of pediatric physician turnover.
Collapse
Affiliation(s)
- R Thomas Collins
- Division of Cardiology, Department of Pediatrics, University of Kentucky College of Medicine, 138 Leader Ave, 40508, Lexington, KY, USA.
| | - Aric Schadler
- Division of Neonatology, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Hong Huang
- Division of Neonatology, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Scottie B Day
- Division of Critical Care Medicine, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| | - John A Bauer
- Division of Neonatology, Department of Pediatrics, University of Kentucky College of Medicine, Lexington, KY, USA
| |
Collapse
|
4
|
Tawfik D, Bayati M, Liu J, Nguyen L, Sinha A, Kannampallil T, Shanafelt T, Profit J. Predicting Primary Care Physician Burnout From Electronic Health Record Use Measures. Mayo Clin Proc 2024:S0025-6196(24)00037-5. [PMID: 38573301 DOI: 10.1016/j.mayocp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/08/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To evaluate the ability of routinely collected electronic health record (EHR) use measures to predict clinical work units at increased risk of burnout and potentially most in need of targeted interventions. METHODS In this observational study of primary care physicians, we compiled clinical workload and EHR efficiency measures, then linked these measures to 2 years of well-being surveys (using the Stanford Professional Fulfillment Index) conducted from April 1, 2019, through October 16, 2020. Physicians were grouped into training and confirmation data sets to develop predictive models for burnout. We used gradient boosting classifier and other prediction modeling algorithms to quantify the predictive performance by the area under the receiver operating characteristics curve (AUC). RESULTS Of 278 invited physicians from across 60 clinics, 233 (84%) completed 396 surveys. Physicians were 67% women with a median age category of 45 to 49 years. Aggregate burnout score was in the high range (≥3.325/10) on 111 of 396 (28%) surveys. Gradient boosting classifier of EHR use measures to predict burnout achieved an AUC of 0.59 (95% CI, 0.48 to 0.77) and an area under the precision-recall curve of 0.29 (95% CI, 0.20 to 0.66). Other models' confirmation set AUCs ranged from 0.56 (random forest) to 0.66 (penalized linear regression followed by dichotomization). Among the most predictive features were physician age, team member contributions to notes, and orders placed with user-defined preferences. Clinic-level aggregate measures identified the top quartile of clinics with 56% sensitivity and 85% specificity. CONCLUSION In a sample of primary care physicians, routinely collected EHR use measures demonstrated limited ability to predict individual burnout and moderate ability to identify high-risk clinics.
Collapse
Affiliation(s)
- Daniel Tawfik
- Stanford University School of Medicine, Stanford, CA.
| | | | - Jessica Liu
- Stanford University School of Medicine, Stanford, CA
| | - Liem Nguyen
- Stanford University School of Engineering, Stanford, CA
| | | | | | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, CA; Stanford Medicine WellMD & WellPhD Center, Stanford, CA
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
5
|
O'Donnell WJ. Another Physician Bites the Dust: It's Time for Administrative Accountability. Am J Med 2024:S0002-9343(24)00138-4. [PMID: 38490309 DOI: 10.1016/j.amjmed.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
|
6
|
O'Donnell WJ. Administrative Harm and the EHR: Employing the Safety Report System to Remedy a System Failure. Am J Med 2024; 137:218-219. [PMID: 37984778 DOI: 10.1016/j.amjmed.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
|
7
|
Schwatka NV, Burden M, Dyrbye LN. An Organizational Leadership Development Approach to Support Health Worker Mental Health. Am J Public Health 2024; 114:142-147. [PMID: 38354347 PMCID: PMC10916722 DOI: 10.2105/ajph.2023.307407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 02/16/2024]
Affiliation(s)
- Natalie V Schwatka
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Marisha Burden
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Liselotte N Dyrbye
- Natalie V. Schwatka is with the Center for Health, Work & Environment, Department of Environmental & Occupational Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora. Marisha Burden is with the Division of Hospital Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora. Liselotte N. Dyrbye is the senior associate dean of faculty and chief well-being officer, professor of medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| |
Collapse
|
8
|
Kushner LE, Ristagno EH, Dong SW, Konold VJL, Fatemi Y, Stillwell TL, Wohrley JD, Sattler MM, Kalu IC, Boguniewicz J. Laying the Groundwork for a Fulfilling Career in Pediatric Infectious Diseases: The Transition From Fellowship to Faculty. J Pediatric Infect Dis Soc 2023; 12:627-633. [PMID: 37815429 DOI: 10.1093/jpids/piad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023]
Abstract
There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four essential pillars-(1) stepping into your role, (2) finding your niche, (3) building your network, and (4) self-care-all of which are supported by strong mentorship/sponsorship and continual realignment with one's personal mission statement. In addition to providing general principles and guidance, this review also outlines specific steps that a junior faculty member can take to expand their influence and build a successful, fulfilling career in pediatric infectious diseases.
Collapse
Affiliation(s)
- Lauren E Kushner
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth H Ristagno
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sara W Dong
- Department of Pediatrics, Division of Infectious Diseases, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Victoria J L Konold
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Yasaman Fatemi
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Terri L Stillwell
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Julie D Wohrley
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Rush University Children's Hospital, Chicago, IL, USA
| | - Matthew M Sattler
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ibukunoluwa C Kalu
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Juri Boguniewicz
- Department of Pediatrics, Section of Infectious Diseases and Epidemiology, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
9
|
Trockel MT, West CP, Dyrbye LN, Sinsky CA, Tutty M, Wang H, Carlasare LE, Menon NK, Shanafelt TD. Assessment of Adverse Childhood Experiences, Adverse Professional Experiences, Depression, and Burnout in US Physicians. Mayo Clin Proc 2023; 98:1785-1796. [PMID: 38043996 DOI: 10.1016/j.mayocp.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To assess associations of adverse childhood experiences (ACEs) and adverse occupational experiences (AOEs) with depression and burnout in US physicians. PARTICIPANTS AND METHODS We performed a secondary analysis of data from a representative sample survey of US physicians conducted between November 20, 2020, and March 23, 2021, and from a probability-based sample of other US workers. The ACEs, AOEs, burnout, and depression were assessed using previously published measures. RESULTS Analyses included data from 1125 of the 3671 physicians (30.6%) who received a mailed survey and 6235 of 90,000 physicians (6.9%) who received an electronic survey. The proportion of physicians age 29-65 who had lived with a family member with substance misuse during childhood (673 of 5039[13.4%]) was marginally lower (P <.001) than that of workers in other professions (448 of 2505 [17.9%]). The proportion of physicians age 29-65 who experienced childhood emotional abuse (823 of 5038 [16.3%]) was similar to that of workers in other professions (406 of 2508 [16.2%]). The average physician depression T-score was 49.60 (raw score ± SD, 6.48±3.15), similar to the normed US average. The AOEs were associated with mild to severe depression, including making a recent significant medical error (odds ratio [OR], 1.64; 95% CI, 1.33 to 2.02, P<.001), being named in a malpractice suit (OR, 1.30; 95% CI, 1.07 to 1.59, P=.008), and experiencing one or more coronavirus disease 2019-related AOEs (OR, 1.76; 95% CI, 1.56 to 1.99, P<.001). Having one or more ACEs was associated with mild to severe depression (OR, 1.58; 95% CI, 1.38 to 1.79, P<.001). The ACEs, coronavirus disease 2019-related AOEs, and medical errors were also associated with burnout. CONCLUSION Assessing ACEs and AOEs and implementing selective primary prevention interventions may improve population health efforts to mitigate depression and burnout in physicians.
Collapse
Affiliation(s)
- Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
| | - Colin P West
- Department of Medicine and Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Liselotte N Dyrbye
- Department of Medicine, University of Colorado School of Medicine, Aurora, IL
| | - Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL
| | - Michael Tutty
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, IL
| | - Hanhan Wang
- WellMD & WellPhD Center, Stanford University School of Medicine, Palo Alto, CA
| | - Lindsey E Carlasare
- Health Care Research and Policy Analysis, American Medical Association, Chicago, IL
| | - Nikitha K Menon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA
| | - Tait D Shanafelt
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
10
|
Ligibel JA, Goularte N, Berliner JI, Bird SB, Brazeau CMLR, Rowe SG, Stewart MT, Trockel MT. Well-Being Parameters and Intention to Leave Current Institution Among Academic Physicians. JAMA Netw Open 2023; 6:e2347894. [PMID: 38100103 PMCID: PMC10724765 DOI: 10.1001/jamanetworkopen.2023.47894] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Physician turnover interrupts care delivery and creates health care system financial burden. Objective To describe the prevalence of burnout, professional fulfillment, and intention to leave (ITL) among physicians at academic-affiliated health care systems and identify institutional and individual factors associated with ITL. Design, Setting, and Participants This cross-sectional study administered a survey to 37 511 attending-level medical specialists at 15 academic medical institutions participating in the Healthcare Professional Well-Being Academic Consortium. Data were collected from October 2019 to July 2021. Statistical analysis was performed from May 2022 to March 2023. Exposures Hypothesized institutional and individual determinants of occupational well-being. Main Outcomes and Measures The main outcome was ITL, defined as having at least a moderate intention (a score of 2 on a 0-4 scale) to leave one's institution within the next 2 years. Additional outcomes included burnout and professional fulfillment, defined using published Professional Fulfillment Index cut points. Results Of 18 719 academic physician survey respondents (8381 [44.8%] male; 2388 [12.8%] Asian, 10 599 [56.6%] White, 1039 [5.6%] other race, 4693 [25.1%] unknown race; 294 [1.6%] Hispanic or Latina/Latino/Latinx), 6903 of 18 217 (37.9%) met criteria for burnout and 7301 of 18 571 (39.3%) for professional fulfillment; 5177 of 15 890 (32.6%) reported moderate or greater ITL. Burnout, professional fulfillment, and ITL varied across specialties. After adjusting for demographics, each 1-point increase (range 0-10) in burnout was directly associated with ITL (odds ratio [OR], 1.52 [95% CI, 1.49-1.55])c, and each 1-point increase in professional fulfillment was inversely associated with ITL (OR, 0.64 [95% CI, 0.63-0.65]). After adjusting for demographics, burnout, and professional fulfillment, each 1-point increase (range 0-10) in supportive leadership behaviors (OR, 0.83 [95% CI, 0.82-0.84]), peer support (OR, 0.93 [95% CI, 0.91-0.95]), personal-organizational values alignment (OR, 0.81 [95% CI, 0.80-0.82]), perceived gratitude (OR, 0.95 [95% CI, 0.92-0.97]), COVID-19 organizational support (OR, 0.88 [95% CI, 0.85-0.91]), and electronic health record helpfulness (OR, 0.95 [95% CI, 0.93-0.97]) were inversely associated with ITL, whereas each 1-point increase (range 0-10) in depression (OR, 1.08 [95% CI, 1.05-1.10]) and negative impact of work on personal relationships (OR, 1.09 [1.07-1.11]) were directly associated with ITL. Conclusions and Relevance In this cross-sectional study of academic physicians, 32.6% indicated moderate or higher ITL within 2 years. Burnout, lack of professional fulfillment, and other well-being factors were associated with ITL, suggesting the need for a comprehensive approach to reduce physician turnover.
Collapse
Affiliation(s)
- Jennifer A. Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicolette Goularte
- WellMD & WellPhD, Stanford University School of Medicine, Stanford, California
| | - Jennifer I. Berliner
- Division of Cardiology and The Heart and Vascular Institute, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven B. Bird
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, Massachusetts
| | | | - Susannah G. Rowe
- Department of Ophthalmology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- Office of Equity, Vitality and Inclusion, Boston Medical Center, Boston University Medical Group, Boston, Massachusetts
| | - Miriam T. Stewart
- Division of General Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Mickey T. Trockel
- WellMD & WellPhD, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
11
|
Hoque F. Leadership & professional development: Emotional intelligence strengthens leadership presence. J Hosp Med 2023; 18:918-919. [PMID: 37394833 DOI: 10.1002/jhm.13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Farzana Hoque
- Division of Hospital Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
12
|
Azour L, McGuinness G. From Great Resignation to Great Retention: Orientation as a First Step in Engaging Faculty Well-being. Acad Radiol 2023; 30:2350-2357. [PMID: 37429779 DOI: 10.1016/j.acra.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
Onboarding lays a foundation spanning multipart missions and teaches faculty how to engage and excel in the departmental environment. At the enterprise level, onboarding is a process to connect and support diverse teams, with a range of symbiotic phenotypes, into thriving departmental ecosystems. At the more personal level, onboarding involves guiding individuals with unique backgrounds, experiences, and strengths into their new roles, growing both the individual and the system. This guide will share elements of an initial step in the departmental faculty onboarding process, faculty orientation.
Collapse
Affiliation(s)
- Lea Azour
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, New York, NY (L.A., G.M.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Box 957437, 757 Westwood Plaza, Los Angeles, CA 90095-7437 (L.A.).
| | - Georgeann McGuinness
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, New York, NY (L.A., G.M.)
| |
Collapse
|
13
|
Lam C, Kim Y, Costigan HJ, Stuckey H, Vidimos AT, Billingsley EM, Albertini JG, Miller JJ, Shanafelt TD. Well-Being and Professional Fulfillment in Mohs Surgeons: An Explanatory Sequential Mixed-Method Design Study. Dermatol Surg 2023; 49:645-648. [PMID: 37184466 DOI: 10.1097/dss.0000000000003801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND There are limited data evaluating specific themes of well-being and professional fulfillment in Mohs surgeons. OBJECTIVE To identify factors that drive occupational distress and those that promote well-being and professional fulfillment among Mohs surgeons. METHODS This is an explanatory sequential mixed-method study, using semistructured individual interviews. Common drivers of physician well-being and fulfillment were identified based on the independent assessment of the coding in the interview transcripts. RESULTS This study reports the following qualitative themes: (1) gratitude for the chosen profession and relationships, (2) unrealistic standards of perfection that may have contributed to past career success but are unattainable and create emotional burden, and (3) ability to practice in a manner aligned with personal values promotes professional fulfillment. CONCLUSION This study suggests that gratitude, self-compassion, and ability to practice in a manner aligned with personal values promote well-being and professional fulfillment in Mohs surgeons. Notably, we found that unrealistic standards of perfection and personal-organization practice incongruences contribute to burnout.
Collapse
Affiliation(s)
- Charlene Lam
- Department of Dermatology, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania
| | - Yesul Kim
- Division of Dermatologic Surgery, Cooper University Health Care, Camden, New Jersey
| | - Heather J Costigan
- Department of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Heather Stuckey
- Department of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | | | | | | | - Jeffrey J Miller
- Department of Dermatology, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania
| | - Tait D Shanafelt
- Department of Medicine, Stanford University, Palo Alto, California
| |
Collapse
|
14
|
Makowski MS, Trockel M, Paganoni S, Weinstein S, Verduzco-Gutierrez M, Kinney C, Kennedy DJ, Sliwa J, Wang H, Knowlton T, Stautzenbach T, Shanafelt TD. Occupational Characteristics Associated With Professional Fulfillment and Burnout Among US Physiatrists. Am J Phys Med Rehabil 2023; 102:379-388. [PMID: 37076955 DOI: 10.1097/phm.0000000000002216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
INTRODUCTION Multiple national studies suggest that among physicians, physiatrists are at increased risk for occupational burnout. OBJECTIVE The aim of the study is to identify characteristics of the work environment associated with professional fulfillment and burnout among US physiatrists. DESIGN Between May and December 2021, a mixed qualitative and quantitative approach was used to identify factors contributing to professional fulfillment and burnout in physiatrists. SETTING Online interviews, focus groups, and survey were conducted. PARTICIPANTS The participants are physiatrists in the American Academy of Physical Medicine and Rehabilitation Membership Masterfile. MAIN OUTCOME MEASURES Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. RESULTS Individual interviews with 21 physiatrists were conducted to identify domains that contributed to professional fulfillment followed by focus groups for further definition. Based on themes identified, scales were identified or developed to evaluate: control over schedule (6 items, Cronbach α = 0.86); integration of physiatry into patient care (3 items, Cronbach α = 0.71); personal-organizational values alignment (3 items, Cronbach α = 0.90); meaningfulness of physiatrist clinical work (6 items, Cronbach α = 0.90); teamwork and collaboration (3 items, Cronbach α = 0.89). Of 5760 physiatrists contacted in the subsequent national survey, 882 (15.4%) returned surveys (median age, 52 yrs; 46.1% women). Overall, 42.6% (336 of 788) experienced burnout and 30.6% (244 of 798) had high levels of professional fulfillment. In multivariable analysis, each one-point improvement in control over schedule (odds ratio = 1.96; 95% confidence interval = 1.45-2.69), integration of physiatry into patient care (odds ratio = 1.77; 95% confidence interval = 1.32-2.38), personal-organizational values alignment (odds ratio = 1.92; 95% confidence interval = 1.48-2.52), meaningfulness of physiatrist clinical work (odds ratio = 2.79; 95% confidence interval = 1.71-4.71), and teamwork and collaboration score (odds ratio = 2.11; 95% confidence interval = 1.48-3.03) was independently associated with higher likelihood of professional fulfillment. CONCLUSIONS Control over schedule, optimal integration of physiatry into clinical care, personal-organizational values alignment, teamwork, and meaningfulness of physiatrist clinical work are strong and independent drivers of occupational well-being in US physiatrists. Variation in these domains by practice setting and subspecialty suggests that tailored approaches are needed to promote professional fulfillment and reduce burnout among US physiatrists.
Collapse
Affiliation(s)
- Maryam S Makowski
- From the Stanford University, Stanford, California (MSM, MT, HW, TDS); Spaulding Rehabilitation Hospital, Boston, Massachusetts (SP); Association of Academic Physiatrists, Owing Mills, Maryland (SP, MV-G, TK); University of Washington, Seattle, Washington (SW); American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois (SW, DJK, TS); University of Texas Health Science Center at San Antonio, San Antonio, Texas (MV-G); Mayo Clinic, Minneapolis, Minnesota (CK); American Board of Physical Medicine and Rehabilitation, Rochester, Minnesota (CK, JS); Vanderbilt University, Nashville, Tennessee (DJK); and Northwestern University Feinberg School of Medicine: Shirley Ryan Ability Lab, Chicago, Illinois (JS)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Trockel M, Fischer A. Supporting a Culture of Wellness: Examining the Utility of the Residency Program Community Well-Being Instrument in the Medical Training and Work Environment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:552-554. [PMID: 36745876 DOI: 10.1097/acm.0000000000005163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Physicians are experiencing symptoms of burnout at unprecedented rates. It is essential to assess programmatic factors contributing to physician burnout as actionable items for work climate improvement. Creation of an evidence base of strategies and methods to cultivate a culture of wellness requires iterative assessment, program development and implementation, and evaluation. To serve their function optimally, assessment tools need to be reliable, valid, and sensitive to change. In this Invited Commentary, the authors discuss Vermette and colleagues' report on the Residency Community Well-Being (RCWB) instrument. The authors examine the utility of the RCWB, a novel, validated tool that quantifies the subjective community well-being of an individual residency program and has 3 subscales that measure key aspects of interpersonal interactions among residents, with emphasis on those within the program leadership sphere of influence. The commentary authors recommend further validation of the RCWB, but acknowledge the instrument is a useful contribution to currently available measures in the domains of community well-being, workplace climate, and culture of wellness. Workplace interventions focused on community well-being or culture of wellness are particularly salient ethical and educational priorities for medical training programs. Prioritizing community well-being will help nurture trainees as an investment in the future of medical care, rather than an exploitable resource valued primarily for short-term work demands.
Collapse
Affiliation(s)
- Mickey Trockel
- M. Trockel is clinical associate professor, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Avital Fischer
- A. Fischer is a second-year resident, Research Track, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
16
|
Lexa FJ, Parikh JR. Leadership: Causing and Curing Burnout in Radiology. J Am Coll Radiol 2023; 20:500-502. [PMID: 36914082 PMCID: PMC10149620 DOI: 10.1016/j.jacr.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/15/2023]
Abstract
Burnout in US radiology has reached crisis proportions. Leaders play critical roles in both causing and preventing burnout. This article will review the current state of the crisis and how leaders can work to stop causing burnout as well as developing proactive strategies for preventing and mitigating burnout.
Collapse
Affiliation(s)
- Frank J Lexa
- Professor and Vice Chair of Faculty Affairs, Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsyvania; and UPMC International Vice President, the American College of Radiology Chief Medical Officer, The Radiology Leadership Institute of the ACR.
| | - Jay R Parikh
- Professor and Division Wellness Lead, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
17
|
Parikh JR, Cavanaugh KJ. Formal Wellness Training of Academic Radiology Leaders and Improved Teamwork Scores of Their Faculty. J Am Coll Radiol 2023; 20:510-512. [PMID: 36948409 PMCID: PMC10149601 DOI: 10.1016/j.jacr.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Jay R Parikh
- Professor, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Katelyn J Cavanaugh
- Leadership Institute, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
18
|
Hurtado DA, Greenspan SA, Valenzuela S, McGinnis W, Everson T, Lenhart A. Promise and Perils of Leader-Employee Check-ins in Reducing Emotional Exhaustion in Primary Care Clinics: Quasi-Experimental and Qualitative Evidence. Mayo Clin Proc 2023:S0025-6196(22)00708-X. [PMID: 37024355 DOI: 10.1016/j.mayocp.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To analyze the role of short (<30 minutes) and frequent (quarterly) check-ins between clinic leaders and employees in reducing emotional exhaustion. METHODS Three interrelated studies were conducted: a 3-year repeated cross-sectional survey at 10 primary care clinics (n=505; we compared emotional exhaustion, perceived stress, and values alignment among employees of a clinic where check-ins were conducted vs 9 control clinics); interviews with leaders and employees (n=10) regarding the check-ins process and experiences; and interviews with leaders and employees (n=10) after replicating the check-ins at a new clinic. RESULTS Outcomes were similar at baseline. After a year, emotional exhaustion was lower at the check-ins compared with control clinics (standardized mean difference, d, -0.71 [P<.05]). After 2 years, emotional exhaustion remained lower at the check-ins clinic, but this difference was not significant. The check-ins were associated with an increment in values alignment (2018 vs 2017, d=0.59 [P<.05]; 2019 vs 2017, d=0.76 [P<.05]). There were no differences for perceived job stress. Interviews indicated that work-life challenges were discussed in the check-ins. However, employees need confidentiality and to feel safe to do so. The replication suggested that the check-ins are feasible to implement even amid turbulent times. CONCLUSION Periodic check-ins wherein leaders acknowledge and address work-life stressors might be a practical tactic to reduce emotional exhaustion in primary care clinics.
Collapse
Affiliation(s)
- David A Hurtado
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland; OHSU-PSU School of Public Health, Portland, OR.
| | - Samuel A Greenspan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland
| | - Steele Valenzuela
- Department of Family Medicine, Oregon Health & Science University, Portland
| | - Wendy McGinnis
- Department of Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| | - Teresa Everson
- Department of Family Medicine, Oregon Health & Science University, Portland; OHSU-PSU School of Public Health, Portland, OR; Multnomah County Health Department, Portland, OR
| | - Abigail Lenhart
- Department of Internal Medicine and Geriatrics, Oregon Health & Science University, Portland
| |
Collapse
|
19
|
Bondjers K, Lingaas I, Stensland S, Atar D, Zwart JA, Wøien H, Dyb G. "I've kept going" - a multisite repeated cross-sectional study of healthcare workers' pride in personal performance during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:322. [PMID: 37004056 PMCID: PMC10066023 DOI: 10.1186/s12913-023-09246-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/06/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND For healthcare workers, working through a pandemic may include both challenges, such as coping with increased demands and a lack of control, and rewards, such as experiencing a sense of achievement and meaningfulness. In this study, we explore the accomplishments healthcare workers themselves are proud of achieving at work, in order to elucidate the positive aspects of working through a pandemic. METHODS In June 2020 (T1), December 2020 (T2), and May 2021 (T3), healthcare workers (n = 1,996) at four Norwegian hospitals participated in a web-based survey assessing job strain, psychological health, and support during the pandemic. The survey included the open-ended question "During the past two weeks, what have you been feeling proud of achieving at work?". Responses (1,046) to this item were analyzed using conventional content analysis, which resulted in 13 subthemes under 6 themes. RESULTS For some, pride was found in their professional identity and dedication to their work. Others took pride in specific achievements, such as juggling their own needs (e.g., health, private life) with those of the workplace, contributing to cohesion and collaboration, their ability to learn and adjust, in being a useful resource at work, and in their efforts towards developing the organization and workplace. IMPLICATIONS The current findings shed light on what healthcare workers feel proud of achieving in their day-to-day work. Assessment of these factors provides insight on both positive and negative aspects of working clinically during a pandemic, and highlights specific targets for building sustainable and rewarding work environments for healthcare workers.
Collapse
Affiliation(s)
- Kristina Bondjers
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.
| | - Ingebjørg Lingaas
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Synne Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John-Anker Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Hilde Wøien
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
20
|
Park B, Tuepker A, Vasquez Guzman CE, Edwards S, Waller Uchison E, Taylor C, Eiff MP. An antidote to what's ailing healthcare workers: a new (old) way of relational leadership. Leadersh Health Serv (Bradf Engl) 2023; ahead-of-print. [PMID: 36971656 DOI: 10.1108/lhs-08-2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
PURPOSE The purpose of the study's mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants' abilities to apply relationship-oriented skills on their teams. DESIGN/METHODOLOGY/APPROACH The authors evaluated five program cohorts from 2018-2021, involving 127 interprofessional participants. The study's convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis. FINDINGS All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams. ORIGINALITY/VALUE Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.
Collapse
Affiliation(s)
- Brian Park
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| | - Anaïs Tuepker
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA and Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA
| | | | - Samuel Edwards
- Division of Medicine, Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA and Section of General Internal Medicine, Department of Veterans Affairs (VA), Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, Oregon, USA, and
| | - Elaine Waller Uchison
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| | - Cynthia Taylor
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| | - M Patrice Eiff
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA; School of Public Health, Oregon Health and Science University, Portland, Oregon, USA and Portland State University, Portland, Oregon, USA
| |
Collapse
|
21
|
Tawfik DS, Adair KC, Palassof S, Sexton JB, Levoy E, Frankel A, Leonard M, Proulx J, Profit J. Leadership Behavior Associations with Domains of Safety Culture, Engagement, and Health Care Worker Well-Being. Jt Comm J Qual Patient Saf 2023; 49:156-165. [PMID: 36658090 PMCID: PMC9974844 DOI: 10.1016/j.jcjq.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Leadership is a key driver of health care worker well-being and engagement, and feedback is an essential leadership behavior. Methods for evaluating interaction norms of local leaders are not well developed. Moreover, associations between local leadership and related domains are poorly understood. This study sought to evaluate health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey. METHODS The SCORE survey was administered to 31 Midwestern hospitals as part of a broad effort to measure care context, with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Mixed-effects hierarchical logistic regression was used to evaluate the relationships between local leadership scores and related domains, adjusted for role and work-setting characteristics. RESULTS Of the 23,853 distributed surveys, 16,797 (70.4%) were returned. Local leadership scores averaged 68.8 ± 29.1, with 7,338 (44.2%) reporting emotional exhaustion, 9,147 (55.9%) reporting concerning safety climate, 10,974 (68.4%) reporting concerning teamwork climate, 7,857 (47.5%) reporting high workload, and 3,436 (20.7%) reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 (95% confidence interval [CI] 0.71-0.73) for burnout, 0.48 (95% CI 0.47-0.49) for concerning safety climate, 0.64 (95% CI 0.63-0.66) for concerning teamwork climate, 0.90 (95% CI 0.89-0.92) for high workload, and 0.80 (95% CI 0.78-0.81) for intentions to leave, after adjustment for unit and provider characteristics. CONCLUSION Local leadership behaviors are readily measurable using a five-item scale and strongly associate with established domains of health care worker well-being, safety culture, and engagement.
Collapse
|
22
|
Shanafelt TD, Larson D, Bohman B, Roberts R, Trockel M, Weinlander E, Springer J, Wang H, Stolz S, Murphy D. Organization-Wide Approaches to Foster Effective Unit-Level Efforts to Improve Clinician Well-Being. Mayo Clin Proc 2023; 98:163-180. [PMID: 36603944 DOI: 10.1016/j.mayocp.2022.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 01/05/2023]
Abstract
Health care delivery organizations are positioned to have a tremendous impact on addressing the variables in the practice environment that contribute to occupational distress and that, when optimized, can promote clinician well-being. Many organizations are committed to this work and have clarity on how to address general, system-wide issues and provide resources for individual clinicians. While such top of the organization elements are essential for success, many of the specific improvement efforts that are necessary must address local challenges at the work unit level (department, division, hospital ward, clinic). Uncertainty of how to address variability and the unique needs of different work units is a barrier to effective action for many health care delivery systems. Overcoming this challenge requires organizations to recognize that unit-specific improvement efforts require a system-level approach. In this manuscript, we outline 7 steps for organizations to consider as they establish the infrastructure to improve professional well-being and provide a description of application and evidence of efficacy from a large academic medical center. Such unit-level efforts to address the unique needs of each specialty and occupation at the work unit level have the ability to address many of the day-to-day issues that drive clinician well-being. An enterprise approach is necessary to systematically advance such unit-level action.
Collapse
Affiliation(s)
- Tait D Shanafelt
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA.
| | - David Larson
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Bryan Bohman
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Rachel Roberts
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mickey Trockel
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Eva Weinlander
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Jill Springer
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Hanhan Wang
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Sherilyn Stolz
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| | - Daniel Murphy
- Stanford Medicine, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
23
|
Bogerd R, Debets MPM, Keuken DG, Hassink RJ, Henriques JPS, Lombarts KMJMH. The relationship between physicians' self-kindness and professional fulfillment and the mediating role of personal resilience and work-home interference: A cross-sectional study. PLoS One 2023; 18:e0284507. [PMID: 37093877 PMCID: PMC10124859 DOI: 10.1371/journal.pone.0284507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Professional fulfillment is crucial for physicians' well-being and optimal patient care. Highly demanding work environments, perfectionism and self-critical attitudes jeopardize physicians' professional fulfillment. OBJECTIVE To explore to what extent a kinder attitude towards the self, i.e. self-kindness, was associated with physicians' professional fulfillment and whether this relationship was mediated by personal resilience and work-home interference. METHODS In 2020, cardiologists (n = 374) in the Netherlands participated in a web-based survey. Self-kindness was measured by the self-kindness subscale of the Self-Compassion Scale, personal resilience by the Brief Resilience Scale, work-home interference by the negative Work-Home Interference subscale of the Survey Work-Home Interaction-Nijmegen, and professional fulfillment by the corresponding subscale of the Professional Fulfillment Index. Using Hayes' SPSS macro PROCESS v3.5, the authors tested the parallel mediation model. RESULTS Self-kindness was not directly associated with professional fulfillment (direct effect = .042, p = .36, 95% CI: -0.048, 0.132). Self-kindness was indirectly related to professional fulfillment through individual resilience (indirect effect = .049, 95% CI: .020, 0.086) and work-home interference (indirect effect = .057, 95% CI: .023, 096). CONCLUSIONS This study suggests that improving physicians' self-kindness may enhance professional fulfillment through personal resilience and work-home interference. Our findings may stimulate and remind physicians to be kind towards themselves as it may benefit them and their patients.
Collapse
Affiliation(s)
- Rosa Bogerd
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Maarten P M Debets
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Debby G Keuken
- The Netherlands Society of Cardiology, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - José P S Henriques
- The Netherlands Society of Cardiology, Utrecht, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Department of Medical Psychology, Professional Performance & Compassionate Care Research Group, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
24
|
Parikh JR, Cavanaugh KJ, Holladay CL. Misalignment of Values Associated With Radiology Staff Burnout. J Am Coll Radiol 2022; 19:1295-1297. [PMID: 35970473 PMCID: PMC10150659 DOI: 10.1016/j.jacr.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/13/2022] [Accepted: 06/29/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Jay R Parikh
- Professor, Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Katelyn J Cavanaugh
- Senior Analyst, Leadership Institute, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Courtney L Holladay
- Associate Vice President, Leadership Institute, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
25
|
Design and Implementation of a Program Development Practicum for Faculty Education and Advancement of Clinical Programs. Pediatr Rep 2022; 14:457-463. [PMID: 36412661 PMCID: PMC9680260 DOI: 10.3390/pediatric14040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/11/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Physicians are often tasked to develop and lead collaborative, program development efforts but many have limited formal training. We designed and evaluated a professional development workshop series to provide our faculty members with a framework and tools for the development of clinical programs: the Program Development Practicum (PDP). Faculty identified a clinical program of focus and for each clinical program identified, a program proposal, SBAR communication (situation, background, assessment, recommendation), executive summary, 1-min elevator pitch, and budget was developed. Five clinical programs were identified for improvement including: Inflammatory Bowel Disease, Celiac Disease, Transition of Care, Integrative Health Clinic, and Endoscopic Procedures. At the conclusion of the PDP, these programs were presented to key hospital leaders and resulted in an investment of resource support. Faculty also reported increased understanding of overall program development with the largest gains in knowledge in proposal writing and marketing. Overall, the PDP allowed for a revamp of key clinical services and faculty clarity on resource availability and expectations. We plan to continue with annual engagement of hospital leaders to share updates.
Collapse
|
26
|
Hu JS, Phillips J, Wee CP, Pangaro LN. Physician Burnout-Evidence That Leadership Behaviors Make a Difference: A Cross-Sectional Survey of an Academic Medical Center. Mil Med 2022; 188:usac312. [PMID: 36260483 DOI: 10.1093/milmed/usac312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION High rates of physician burnout are well documented in the USA. Identifying beneficial leadership behaviors as an organizational approach to mitigating burnout can lead to improved wellness in the physicians that they lead; however, few studies have examined which leadership behaviors are beneficial and which may be detrimental. MATERIALS AND METHODS This survey study of academic medical center physicians and their physician leaders assessed the correlation between burnout and leadership behaviors. Data were analyzed for the strength of correlation between scores for leadership behaviors and self-reported physician burnout with analysis of variance by sex, time from training, specialty, and age. RESULTS Of 1,145 physicians surveyed, 305 returned surveys. Among the respondents, 45% were female, 25% were 56 years or older, and 57% self-identified as practitioners of medicine or medicine subspecialties. Two transformational leadership categories of behaviors (idealized influence behaviors and individualized consideration) and one transactional leadership behavior category (contingent reward) correlated favorably with all domains of burnout (P < .0001). Conversely, two transactional leadership categories of burnout (management by exception passive and laissez-faire) correlated unfavorably with all burnout domains. CONCLUSIONS Organizational interventions are needed to improve burnout in physicians. Adopting favorable leadership behaviors while avoiding unfavorable leadership behaviors can improve burnout in those physicians being led. These findings could inform the conceptual basis of future physician leadership training programs as transactional leadership behaviors also have an impact on physician wellness.
Collapse
Affiliation(s)
- James S Hu
- Department of Medicine, University of Southern California/Norris Comprehensive Cancer Center, Los Angeels, CA 90033, USA
| | - Jennifer Phillips
- University of Southern California, Rossier School of Education, Los Angeles, CA 90089, USA
| | - Choo Phei Wee
- Department of Population and Public Health Sciences, Southern California Clinical and Translational Science Institute, University of Southern California/Keck School of Medicine, Los Angeles, CA 90089, USA
| | - Louis N Pangaro
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
27
|
Salenger R, Martin W. Physician Leadership in the Employed Universe. Hosp Top 2022; 100:151-158. [PMID: 34635036 DOI: 10.1080/00185868.2021.1938768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Physicians are increasingly becoming employed by hospitals and health systems. While associated with less professional autonomy, such employment offers physicians the opportunity to become leaders within a vertically integrated healthcare environment. Multidisciplinary care teams, led by physician champions, can impact care for a large swath of patients and establish clinical excellence. Successful teams can improve outcomes, increase professional satisfaction, and potentially set physicians on a path to becoming leaders within their health system.
Collapse
Affiliation(s)
- Rawn Salenger
- Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Division of Cardiac Surgery, University of Maryland Saint Joseph Medical Center, Towson, Maryland, USA
| | - William Martin
- Department of Management, Depaul University, Chicago, Illinois, USA
| |
Collapse
|
28
|
Burr KL, Hinkson CR, Smith BJ, Roberts KJ, Strickland SL, Hoerr CA, Rehder KJ, Miller AG. Factors Associated With a Positive View of Respiratory Care Leadership. Respir Care 2022; 67:1236-1245. [PMID: 35701175 PMCID: PMC9994323 DOI: 10.4187/respcare.10081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Burnout within health care is prevalent, and its effects are detrimental to patient outcomes, organizations, and individuals. Effects stemming from burnout include anxiety, depression, excessive alcohol and drug use, cardiovascular problems, time off work, and worse patient outcomes. Published data have suggested up to 50% of health care workers experience burnout and 79% of respiratory therapists (RTs) experience burnout. Leadership has been cited as a key driver of burnout among RTs. We aimed to identify factors associated with a positive or negative leadership perception. METHODS A post hoc analysis of an institutional review board-approved survey to evaluate RT burnout, administered via REDCap by convenience sample to 26 health care centers (3,124 potential respondents) from January 17-March 15, 2021, was performed to identify factors associated with a positive view of leadership. Survey questions included validated tools to measure leadership, burnout, staffing, COVID-19 exposure, and demographics. Data analysis was descriptive, and logistic regression was performed to evaluate factors associated with leadership perception. RESULTS Of 1,080 respondents, 710 (66%) had a positive view of leadership. Univariate analysis revealed those with a positive view of leadership were more likely to be working with adequate staffing, were rarely unable to complete all work, were less likely to be burned out, disagreed that people in this work environment were burned out, were less likely to miss work for any reason, more likely to be in a leadership position, worked fewer hours in intensive care, worked in a center affiliated with a medical school, worked day shift, were less likely to care for adult patients, and were more likely to be male. Logistic regression revealed providing care to patients with COVID-19 (odds ratio [OR] 5.8-10.5, P < .001-.006) was the only factor associated with a positive view of leadership, whereas working without adequate staffing (OR 0.27-0.28, P = .002-.006), staff RTs (OR 0.33, P < .001), work environment (OR 0.42, P = .003), missing work for any reason (OR 0.69, P = .003), and burnout score (OR 0.98, P < .001) were associated with a negative view of leadership. CONCLUSIONS Most RTs had a positive view of their leadership. A negative leadership score was associated with higher burnout and missing work. This relationship requires further investigation to evaluate if changes in leadership practices can improve employee well-being and reduce burnout.
Collapse
Affiliation(s)
- Katlyn L Burr
- Respiratory Care Services, Nemours Children's Health, Wilmington, Delaware.
| | - Carl R Hinkson
- Respiratory Care, Providence Regional Medical Center, Everett, Washington
| | - Brian J Smith
- Respiratory Care, University of California, Davis, Davis, California
| | - Karsten J Roberts
- Respiratory Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shawna L Strickland
- Health Sciences, Rush University, Chicago, Illinois; and American Epilepsy Society, Chicago, Illinois
| | | | - Kyle J Rehder
- Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina
| | - Andrew G Miller
- Division of Pediatric Critical Care Medicine and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
29
|
Shanafelt T, Trockel M, Wang H, Mayer T, Athey L. Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States. J Healthc Manag 2022; 67:317-338. [PMID: 35984407 PMCID: PMC9447437 DOI: 10.1097/jhm-d-22-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GOAL The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics. METHODS Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments. PRINCIPLE FINDINGS Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables. APPLICATIONS TO PRACTICE Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.
Collapse
Affiliation(s)
| | | | | | | | - Leslie Athey
- American College of Healthcare Executives, Chicago, Illinois
| |
Collapse
|
30
|
Wu W, Yu L. How does personal innovativeness in the domain of information technology promote knowledge workers’ innovative work behavior? INFORMATION & MANAGEMENT 2022. [DOI: 10.1016/j.im.2022.103688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
31
|
Mete M, Goldman C, Shanafelt T, Marchalik D. Impact of leadership behaviour on physician well-being, burnout, professional fulfilment and intent to leave: a multicentre cross-sectional survey study. BMJ Open 2022; 12:e057554. [PMID: 36691255 PMCID: PMC9171269 DOI: 10.1136/bmjopen-2021-057554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To examine how perceived leadership behaviours affect burnout, professional fulfilment and intent to leave the organisation among physicians. DESIGN Anonymous cross-sectional survey study from November 2016 to October 2018. SETTING 12 036 attending and resident physicians at 11 healthcare organisations participating in the Physician Wellness Academic Consortium (PWAC) were surveyed to assess burnout and professional fulfilment and their drivers. PARTICIPANTS A sample of 5416 attending physicians with complete data on gender, specialty, leadership, burnout and professional fulfilment. MAIN OUTCOMES AND MEASURES The leadership behaviour of each physician's supervisor was assessed using the Mayo Clinic Participatory Management Leadership Index and categorised in tertiles. Multivariable logistic regression analyses examined the effect of leadership behaviour rating of each physician's supervisor on burnout, professional fulfilment and intent to leave controlling for gender and specialty. RESULTS The response rate was 45% across 11 institutions. Half of the respondents were female. Professional fulfilment increased with increasing tertiles of leadership behaviour rating (19%, 34%, 47%, p<0.001). The odds of professional fulfilment were 5.8 times higher (OR=5.8, 95% CI: 5.1 to 6.59) for physicians in the top tertile compared with those in the lowest tertile. Physicians in the top tertile were also 48% less likely to be burned out (OR=0.52, 95% CI: 0.45 to 0.61) and reported 66% lower intent to leave (OR=0.34, 95% CI: 0.26 to 0.44). Individuals who rated their supervisor's leadership in upper tertiles relative to lower tertiles exhibited lower levels of burnout (18% vs 35% vs 47%, p<0.001), and intent to leave (16% vs 24% vs 50% p<0.001). CONCLUSION Perceived leadership behaviours have a strong relationship with burnout, professional fulfilment and intent to leave among physicians. Organisations should consider leadership development as a potential vehicle to improve physician wellness and prevent costly physician departures.
Collapse
Affiliation(s)
- Mihriye Mete
- Department of Behavioral Health Research, MedStar Health Research Institute, Hyattsville, Maryland, USA
- Department of Psychiatry, Georgetown University Medical Center, Washington, District of Columbia, USA
- MedStar Health Center for Wellbeing, Washington, District of Columbia, USA
| | - Charlotte Goldman
- Department of Urology, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Tait Shanafelt
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Daniel Marchalik
- MedStar Health Center for Wellbeing, Washington, District of Columbia, USA
- Department of Urology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| |
Collapse
|
32
|
Blanchard J, Li Y, Bentley SK, Lall MD, Messman AM, Liu YT, Diercks DB, Merritt‐Recchia R, Sorge R, Warchol JM, Greene C, Griffith J, Manfredi RA, McCarthy M. The perceived work environment and well-being: A survey of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:851-861. [PMID: 35531649 PMCID: PMC9347760 DOI: 10.1111/acem.14519] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 12/21/2022]
Abstract
Background During the COVID‐19 pandemic, health care provider well‐being was affected by various challenges in the work environment. The purpose of this study was to evaluate the relationship between the perceived work environment and mental well‐being of a sample of emergency physicians (EPs), emergency medicine (EM) nurses, and emergency medical services (EMS) providers during the pandemic. Methods We surveyed attending EPs, resident EPs, EM nurses, and EMS providers from 10 academic sites across the United States. We used latent class analysis (LCA) to estimate the effect of the perceived work environment on screening positive for depression/anxiety and burnout controlling for respondent characteristics. We tested possible predictors in the multivariate regression models and included the predictors that were significant in the final model. Results Our final sample included 701 emergency health care workers. Almost 23% of respondents screened positive for depression/anxiety and 39.7% for burnout. Nurses were significantly more likely to screen positive for depression/anxiety (adjusted odds ratio [aOR] 2.04, 95% confidence interval [CI] 1.11–3.86) and burnout (aOR 2.05, 95% CI 1.22–3.49) compared to attendings. The LCA analysis identified four subgroups of our respondents that differed in their responses to the work environment questions. These groups were identified as Work Environment Risk Group 1, an overall good work environment; Risk Group 2, inadequate resources; Risk Group 3, lack of perceived organizational support; and Risk Group 4, an overall poor work environment. Participants in the two groups who perceived their work conditions as most adverse were significantly more likely to screen positive for depression/anxiety (aOR 1.89, 95% CI 1.05–3.42; and aOR 2.04, 95% CI 1.14–3.66) compared to participants working in environments perceived as less adverse. Conclusions We found a strong association between a perceived adverse working environment and poor mental health, particularly when organizational support was deemed inadequate. Targeted strategies to promote better perceptions of the workplace are needed.
Collapse
Affiliation(s)
- Janice Blanchard
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Yixuan Li
- Department of Health Policy, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
| | - Suzanne K. Bentley
- Departments of Emergency Medicine & Medical Education Icahn School of Medicine at Mount Sinai, New York City Health+Hospitals/Elmhurst New York New York USA
| | - Michelle D. Lall
- Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
| | - Anne M. Messman
- Department of Emergency Medicine Wayne State University School of Medicine, University Health Center–6G Detroit Michigan USA
| | - Yiju Teresa Liu
- Department of Emergency Medicine David Geffen School of Medicine at UCLA, Harbor–UCLA Medical Center Torrance California USA
| | | | - Rory Merritt‐Recchia
- Department of Emergency Medicine Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Department of Emergency Medicine Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | - Jordan M. Warchol
- Department of Emergency Medicine University of Nebraska Medical Center Omaha Nebraska USA
| | - Christopher Greene
- Department of Emergency Medicine University of Alabama at Birmingham Birmingham Alabama USA
| | - James Griffith
- Department of Psychiatry George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- Department of Emergency Medicine George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- Departments of Health Policy and Emergency Medicine, Milken Institute School of Public Health George Washington University Washington District of Columbia USA
| |
Collapse
|
33
|
Velazquez AI, Gilligan TD, Kiel LL, Graff J, Duma N. Microaggressions, Bias, and Equity in the Workplace: Why Does It Matter, and What Can Oncologists Do? Am Soc Clin Oncol Educ Book 2022; 42:1-12. [PMID: 35649205 DOI: 10.1200/edbk_350691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite efforts to embrace diversity, women and members of racial, ethnic, and gender minority groups continue to experience bias, inequities, microaggressions, and unwelcoming atmospheres in the workplace. Specifically, women in oncology have lower promotion rates and less financial support and mentorship, and they are less likely to hold leadership positions. These experiences are exceedingly likely at the intersection of identities, leading to decreased satisfaction, increased burnout, and a higher probability of leaving the workforce. Microaggressions have also been associated with depression, suicidal thoughts, and other health and safety issues. Greater workplace diversity and equity are associated with improved financial performance; greater productivity, satisfaction, and retention; improved health care delivery; and higher-quality research. In this article, we provide tools and steps to promote equity in the oncology workplace and achieve cultural change. We propose the use of tailored approaches and tools, such as active listening, for individuals to become microaggression upstanders; we also propose the implementation of education, evaluation, and transparent policies to promote a culture of equity and diversity in the oncology workplace.
Collapse
Affiliation(s)
- Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
| | | | | | - Julie Graff
- Veterans Affairs Portland Health Care System, Portland, OR
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | |
Collapse
|
34
|
Blanchard J, Messman AM, Bentley SK, Lall MD, Liu YT, Merritt R, Sorge R, Warchol JM, Greene C, Diercks DB, Griffith J, Manfredi RA, McCarthy M, McCarthy M. In their own words: Experiences of emergency health care workers during the COVID-19 pandemic. Acad Emerg Med 2022; 29:974-986. [PMID: 35332615 PMCID: PMC9111302 DOI: 10.1111/acem.14490] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/03/2022] [Accepted: 03/19/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, a substantial number of emergency health care workers (HCWs) have screened positive for anxiety, depression, risk of posttraumatic stress disorder, and burnout. The purpose of this qualitative study was to describe the impact of COVID-19 on emergency care providers' health and well-being using personal perspectives. We conducted in-depth interviews with emergency physicians, emergency medicine nurses, and emergency medical services providers at 10 collaborating sites across the United States between September 21, 2020, and October 26, 2020. METHODS We developed a conceptual framework that described the relationship between the work environment and employee health. We used qualitative content analysis to evaluate our interview transcripts classified the domains, themes, and subthemes that emerged from the transcribed interviews. RESULTS We interviewed 32 emergency HCWs. They described difficult working conditions, such as constrained physical space, inadequate personnel protective equipment, and care protocols that kept changing. Organizational leadership was largely viewed as unprepared, distant, and unsupportive of employees. Providers expressed high moral distress caused by ethically challenging situations, such as the perception of not being able to provide the normal standard of care and emotional support to patients and their families at all times, being responsible for too many sick patients, relying on inexperienced staff to treat infected patients, and caring for patients that put their own health and the health of their families at risk. Moral distress was commonly experienced by emergency HCWs, exacerbated by an unsupportive organizational environment. CONCLUSIONS Future preparedness efforts should include mechanisms to support frontline HCWs when faced with ethical challenges in addition to an adverse working environment caused by a pandemic such as COVID-19.
Collapse
Affiliation(s)
- Janice Blanchard
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Anne M. Messman
- Wayne State University School of Medicine Detroit Michigan USA
| | - Suzanne K. Bentley
- Icahn SOM at Mount Sinai, New York City Health + Hospitals/Elmhurst New York New York USA
| | | | - Yiju Teresa Liu
- David Geffen School of Medicine at UCLA, Harbor‐UCLA Medical Center Torrance California USA
| | - Rory Merritt
- Alpert Medical School of Brown University Providence Rhode Island USA
| | - Randy Sorge
- Louisiana State University Spirit of Charity Emergency Medicine Residency Program New Orleans Louisiana USA
| | | | | | | | - James Griffith
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Rita A. Manfredi
- George Washington University School of Medicine and Health Sciences Washington District of Columbia USA
| | - Melissa McCarthy
- George Washington University, Milken Institute of Public Health Washington District of Columbia USA
| | - Melissa McCarthy
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,Department of Health Policy, George Washington University, Milken Institute of Public Health, 950 New Hampshire Ave, NW, Washington, DC, USA
| |
Collapse
|
35
|
Effects of Sleep, Exercise, and Leadership Support on Resilience in Frontline Healthcare Workers During the COVID-19 Pandemic. J Occup Environ Med 2021; 64:416-420. [PMID: 34935678 DOI: 10.1097/jom.0000000000002460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the direct and interacting effects of personal and systemic factors that contribute to psychological distress among frontline healthcare workers (FHCWs) during the COVID-19 pandemic. METHODS Data were collected using a hospital-wide, cross-sectional survey. A multivariable binary logistic regression and relative importance analysis was conducted to identify factors associated with screening positive for C19-distress. RESULTS A total of 1,005 (39.0%, 95%CI = 37.1-40.9%) out of 2,579 FHCWs met the pre-specified cutoff values for significant symptoms of C19-distress. Fewer sleep hours and lower perceptions of leadership support explained the majority of variance (19.4% relative variance explained [RVE]) in C19-distress, followed by team camaraderie (6.4% RVE), physical exercise (4.9% RVE), and engagement in hobbies (3.2% RVE). CONCLUSION These results underscore the importance of restorative behaviors as potential targets to help decrease distress and promote resilience in FHCWs.
Collapse
|
36
|
Shanafelt TD. Physician Well-being 2.0: Where Are We and Where Are We Going? Mayo Clin Proc 2021; 96:2682-2693. [PMID: 34607637 DOI: 10.1016/j.mayocp.2021.06.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/13/2022]
Abstract
Although awareness of the importance of physician well-being has increased in recent years, the research that defined this issue, identified the contributing factors, and provided evidence on effective individual and system-level solutions has been maturing for several decades. During this interval, the field has evolved through several phases, each influenced not only by an expanding research base but also by changes in the demographic characteristics of the physician workforce and the evolution of the health care delivery system. This perspective summarizes the historical phase of this journey (the "era of distress"), the current state (Well-being 1.0), and the early contours of the next phase based on recent research and the experience of vanguard institutions (Well-being 2.0). The key characteristics and mindset of each phase are summarized to provide context for the current state, to illustrate how the field has evolved, and to help organizations and leaders advance from Well-being 1.0 to Well-being 2.0 thinking. Now that many of the lessons of the Well-being 1.0 phase have been internalized, the profession, organizations, leaders, and individual physicians should act to accelerate the transition to Well-being 2.0.
Collapse
Affiliation(s)
- Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Palo Alto, CA.
| |
Collapse
|
37
|
Geerts JM, Kinnair D, Taheri P, Abraham A, Ahn J, Atun R, Barberia L, Best NJ, Dandona R, Dhahri AA, Emilsson L, Free JR, Gardam M, Geerts WH, Ihekweazu C, Johnson S, Kooijman A, Lafontaine AT, Leshem E, Lidstone-Jones C, Loh E, Lyons O, Neel KAF, Nyasulu PS, Razum O, Sabourin H, Schleifer Taylor J, Sharifi H, Stergiopoulos V, Sutton B, Wu Z, Bilodeau M. Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement. JAMA Netw Open 2021; 4:e2120295. [PMID: 34236416 DOI: 10.1001/jamanetworkopen.2021.20295] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. OBJECTIVE To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. EVIDENCE REVIEW A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. FINDINGS The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. CONCLUSIONS AND RELEVANCE Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.
Collapse
Affiliation(s)
- Jaason M Geerts
- Research and Leadership Development, Canadian College of Health Leaders, Ottawa, Ontario, Canada
- Bayes Business School, University of London, London, United Kingdom
| | - Donna Kinnair
- Royal College of Nursing, Marylebone, London, United Kingdom
| | - Paul Taheri
- Yale School of Medicine, New Haven, Connecticut
| | - Ajit Abraham
- Barts Health NHS Trust, Royal Hospital, London, United Kingdom
- Staff College: Leadership in Healthcare, London, United Kingdom
| | - Joonmo Ahn
- Department of Public Administration, Korea University, Seoul, Republic of Korea
| | - Rifat Atun
- Global Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Lorena Barberia
- Department of Political Science, University of São Paulo, São Paulo, Brazil
- Solidarity Research Network for Public Policies and Society, Observatorio COVID-19 Brazil
| | - Nigel J Best
- United Nations Mission in South Sudan, UN House, Juba, South Sudan
| | - Rakhi Dandona
- Public Health Foundation of India, Gurugram, India
- Department of Health Metrics Sciences, Institute for Health Metrics and Evaluation, University of Washington, Seattle
| | | | - Louise Emilsson
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Vårdcentralen Värmlands Nysäter and Centre for Clinical Research, County Council of Värmland, Värmland, Sweden
- Medicine and Health, Örebro University, Örebro, Sweden
| | - Julian R Free
- University of Lincoln, Brayford Pool, Lincoln, United Kingdom
| | - Michael Gardam
- Chief Executive Officer, Health PEI, Charlottetown, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - William H Geerts
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Shanthi Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Kooijman
- World Health Organization Patients for Patient Safety, Geneva, Switzerland
- Patients for Patient Safety Canada, Edmonton, Alberta, Canada
| | - Alika T Lafontaine
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
- Canadian Medical Association, First Nations Health Authority, Indigenous Physicians Association of Canada, West Vancouver, British Columbia, Canada
| | - Eyal Leshem
- Institute for Travel and Tropical Medicine, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel
- School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Erwin Loh
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
- St Vincent's Health Australia, East Melbourne, Australia
| | - Oscar Lyons
- Nuffield Department of Surgical Sciences, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | | | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Department of Global Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oliver Razum
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Hélène Sabourin
- Canadian Association of Occupational Therapists, Nepean, Ontario, Canada
- Organizations for Health Action, Ottawa, Ontario, Canada
| | - Jackie Schleifer Taylor
- London Health Sciences Centre, London, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brett Sutton
- Department of Health, Melbourne, Victoria, Australia
- Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Zunyou Wu
- China Center for Disease Control and Prevention, Beijing, China
- Division of HIV Prevention, National Center for AIDS/STD Control and Prevention, Beijing, China
- Department of Epidemiology, UCLA Fielding School of Public Health, University of California, Los Angeles
| | - Marc Bilodeau
- Surgeon General, Canadian Armed Forces, Ottawa, Ontario, Canada
| |
Collapse
|