Relieving physician burnout: testing a plan in real health care settings

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Creating a plan to alleviate burnout in doctors and other clinicians is a great idea. But will the plan work in real-world conditions?

This year, the National Institute for Occupational Safety and Health (NIOSH) published the Impact Wellbeing Guide. It is a free online resource with six steps for hospital and health care system leaders to create long-term plans and promote workplace practices that contribute to worker wellness.

It was tested by leaders in six hospitals within the CommonSpirit Health system across the United States, with additional input from nearly two dozen organizations, including professional groups, academic institutions, unions, and federal agencies.

Working under the U.S. Centers for Disease Control & Prevention, NIOSH is a research agency that focuses on worker safety. John Howard, MD, MPH, JD, LLM, MBA, is in his third term as director of NIOSH. He and Christy Spring, MA, associate director of the NIOSH Office of Communication and Research to Practice, discussed the testing process and how the plan relates to hospitals, health systems, and physician practices.

This transcript has been edited for length and clarity.

Medical Economics: The Impact Wellbeing Guide was tested in a health system. Can you describe that testing process and why that research is so important?

John Howard, MD, MPH, JD, LLM, MBA
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John Howard, MD, MPH, JD, LLM, MBA: I will say that it was tested in a number of hospitals and the importance of that real world testing can't be overemphasized. Because being the experts in a particular area, we take our research and we try to come up with implementation tools, we write something down, but it doesn't mean that it's compelling, it has traction with folks who are out there in the world that you're trying to affect unless they use it, take it out for a spin, kick the tires, see whether it works or not. And I think that's the value of this guide because it's already had that sort of first look at folks who are out there on the front lines.

Christy Spring, MA
_{© National Institute for Occupational Safety and Health}

Christy Spring, MA: We work to identify a hospital system partner that would help us real world test this and give us that actual feedback from the front lines of this is good, this is hard for us to do, think about rearranging this, so that it could really work amongst a variety of hospital settings. We found a hospital partner that was able to work with us over a six-month period, and they were able to give us a range of hospital sizes and locations, knowing that hospitals depending on their size, their resources available, and where they are located may have different challenges in terms of addressing some of these organizational factors. So by having a partner like CommonSpirit, who is able to give us that variety and actively worked with us on giving us feedback throughout the process, we were able to develop through the partnership, a guide that we feel is going to be useful whether you are a small hospital, a rural hospital, an urban hospital, a really large well-resourced hospital, and that was really critical to us to make sure that this guide was going to work for all of those situations.

John Howard, MD, MPH, JD, LLM, MBA: Even though it's one guide, there's enough flexibility within the six steps because the first step says, you know, review where your current operations are, at second step, you know, build a well-being team, those are initial steps that some hospitals may have already done and then other hospitals haven't done at all. They say, well, one-size-fits-all doesn't work. That's certainly true. But we wanted to add flexibility even within the steps where you're looking at that because the third step is kind of interesting in that we asked the hospital to review their credentialing system, because we found in a lot of hospitals, that the credentialing system acts as sort of an obstacle to building trust and allowing healthcare workers to seek help when they need it because there's a stigma associated with a health care worker that reaches out for psychological help, et cetera, that way of building trust and two-way communications. Even within the guide, there's enough flexibility where some institutions, even if you're in a primary care medical clinic, you're not in a hospital at all, you're in a different setting, maybe you're in a nursing home, and you're looking at the staff there. Wherever you are in the health care setting, we hope that the steps are applicable to you. Use what you can, use what is important to you, use where the gaps are, in your particular health care setting.

Medical Economics: We discussed the Impact Wellbeing Guide in a hospital or health system context. Can you talk about those principles and how they might apply to a physician's practice?

John Howard, MD, MPH, JD, LLM, MBA: There's a couple things that are pivotal, foundational, strategic, that are really critical to remember about the approach, no matter what kind of an institution, no matter what kind of a setting you're in, in terms of health care. One is, we want you to look at your organizational system. How is work organized? As opposed to a sole reliance on individual resilience. In other words, you need to be resilient. You need to buck up, you need to be strong to be a health care worker – that's an avenue that has not worked. We think when it's applied, and people are encouraged to develop individual resilience, which is not a bad thing, but then the employer ignores the organizational factors that lead to burnout. You're not getting any progress there. So that's an important issue. The other strategic issue is two-way communication. Meaning, whether in a primary clinic with one nurse and one assistant and one doctor, if you're not meeting the decision-making requirements of that organization, in other words, you're not having two-way communication. Here's how I think you should be organized and you don't get the feedback from your organization, or if you've got a couple thousand health care workers in a large academic medical center, it's a little harder structurally to get that that decision-making sharing but it has to happen, because otherwise that third issue, which is trust, between the employer, between the person in charge and the actual worker who's doing the work, you won't have that trust at all. So those are some of the foundational issues that are really important, that are within all of these steps. There's so foundational that the guide is built on those foundations.

This spring, NIOSH announced the Institute and the Dr. Lorna Breen Heroes’ Foundation hosted a three-part virtual workshop series to dive deeper into the Impact Wellbeing Guide, which helped hospital leaders better understand how the Guide can be used to accelerate professional well-being efforts. The workshop series, which will be available to view on the Impact Wellbeing website, walked participants through each of the Guides’ six actions and featured leaders from organizations nationwide who shared their real-world experiences implementing wellbeing work that aligned to the Guide.

The campaign offers resources for health care workers including, tips for discussing mental health and burnout with peers, and ways to advocate for the use of the Impact Wellbeing Guide within their hospital.