Healthcare workers are at increased risk of burnout and depression, as a confluence of factors have created a toxic brew of occupational stressors.

“The health professions are at a critical inflection point. The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care,” warned the authors of recent report1 by a national collaboration.

Formed last year by the National Academy of Medicine (NAM), the Action Collaborative on Clinician Well-Being and Resilience is meeting the problem through a comprehensive plan of attack.

“There is reason to be optimistic that the tide is turning,” the authors noted. “The strong commitment of more than 100 national organizations to the work of the collaborative has made clear that clinician well-being is a growing priority for healthcare leaders, policymakers, payers, and other decision-makers capable of bringing about system-level change.”

The ethical principles that guide clinical care, including the bedrock commitment to help patients, are under siege by growing demands on clinicians. “Burdensome tasks and increasing stress experienced by many clinicians, alarmingly high rates of burnout, depression, and suicide threaten their well-being,” the authors noted.

Thus, physicians, nurses, and other clinicians are at an increased risk if these factors are not mitigated and their resiliency bolstered.

“Clinicians are human, and it takes a personal toll on them when circumstances make it difficult to fulfill their ethical commitments and deliver the best possible care,” they noted. “Not only are clinicians’ lives at risk, so is patient safety. Some studies have revealed links between clinician burnout and increased rates of medical errors, malpractice suits, and healthcare-associated infections.”

In addition, clinician burnout undermines the fiscal health of the delivery system due to lost jobs and reduced productivity.

“The annual productivity loss in the United States that is attributable to burnout may be equivalent to eliminating the graduating classes of seven medical schools,” they emphasized. “These consequences are unacceptable by any standard. Therefore, we have an urgent, shared professional responsibility to respond and to develop solutions.”

Conceptual Module

The collaborative, as described in a recent NAM webinar, includes a somewhat intricate but potentially highly useful conceptual model.2 The group is trying to standardize an approach to the common problem of burnout by balancing various social and job pressures with personal skills of resilience.

“This is going to be a very dynamic model. It covers all points of careers, all different healthcare providers, and is very interactive,” said collaborative member Arthur Hengerer, MD, in a recent webinar. “We’re talking about developing stories and scenarios.”

This model includes external factors in work cultures like the level of bureaucracy, organizational mission and values, leadership and staff engagement, data collection requirements, diversity, and inclusion in support of the healthcare team. While this mix will understandably vary by institution — and a lot will depend on the individual worker’s defined role — each clinician brings his or her own individual factors to the job. Traits that will affect individual vulnerability and resilience include the following, cited by the collaborative:

Personal factors

• inclusion and connectivity;

• family dynamics;

• financial stressors/economic vitality;

• flexibility and ability to respond to change;

• level of engagement/connection to meaning and purpose in work.

Personality traits

• personal values, ethics, and morals;

• physical, mental, and spiritual well-being;

• relationships and social support;

• sense of meaning;

• work/life integration.

Skills and abilities

• clinical competency level/experience;

• communication skills;

• coping skills;

• delegation;

• empathy management;

• leadership;

• mastering new technologies or proficient use of technology;

• mentorship;

• optimizing workflow;

• organizational skills;

• resilience;

• teamwork skills.

REFERENCES

1. Dzau V, Kirch DG, Nasca TJ, et al. To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis. N Engl J Med 2018;378:312-314.

2. Brigham T, Barden C, Legreid Dopp A, et al. A Journey to Construct an All-Encompassing Conceptual Model of Factors Affecting Clinician Well-Being and Resilience. National Academy of Medicine, 2018. Available at: https://bit.ly/2J4t3yn.