Twenty years ago, it issued a landmark report on medical errors that fueled a nationwide patient safety movement. Yesterday, the National Academy of Medicine said the healthcare system must make the same kind of transformative changes to address clinician burnout.
With between one-third and one-half of U.S. clinicians experiencing burnout, the National Academy of Medicine called the problem an epidemic that requires systemic changes by healthcare organizations, educational institutions and all levels of government. In a new report, the academy outlined six goals—from creating positive work environments to improving the usability of information technology—stakeholders should aim at to prevent and mitigate burnout among physicians, nurses, medical students and other health professionals.
The academy, known then as the Institute of Medicine, authored the report "To Err is Human" and shocked the country with the revelation that nearly 100,000 people a year lost their lives to preventable medical errors, which fostered the drive to improve quality in the healthcare industry. Academy President Victor Dzau said the organization hopes it latest report will have a similar effect as burnout has been linked to increased medical errors, reduced quality of care and high turnover rates.
“Twenty years ago, the Institute of Medicine reports 'To Err Is Human' and 'Crossing the Quality Chasm' revealed a crisis in patient safety and led to a focus on quality that has revolutionized the U.S. healthcare system. Today, the same type of transformative change is needed to support clinician well-being, which is linked inextricably to the quality of care,” he said, in a statement.
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Personal stress management strategies are not sufficient to address the issue of clinician burnout, the report said. Instead, it is critical to address burnout not as an individual issue but rather as a systems issue that emanates from workplace culture, healthcare policies and regulations and societal expectations, the report said.
“The work system—including the physical environment, the technologies in use, and how care team members interact with each other—deeply influences clinicians’ professional well-being,” said Pascale Carayon, co-chair of the committee that authored the report and director of the Wisconsin Institute for Healthcare Systems Engineering at the University of Wisconsin-Madison.
Many clinicians were attracted to healthcare to develop relationships with patients but find administrative tasks take them away from patient care, said Christine Cassel, senior adviser on strategy and policy and professor of medicine at the University of California, San Francisco and the other committee co-chair. “With this report, we have a real opportunity to change the culture of healthcare delivery and help restore clinicians’ well-being and joy in medicine,” she said.
The report outlined the following six goals the healthcare system should pursue to reduce burnout:
- Create positive work environments. The report called on healthcare executives to create a work environment that promotes high-quality care, job satisfaction and social support. It recommends that healthcare organizations create and maintain an executive leadership role dedicated to clinician well-being. Healthcare organizations should also assess how business and management decisions—such as whether to deploy new technologies—may affect clinicians’ job demands and levels of burnout, as well as patient care quality and safety. Organizations should continuously monitor and evaluate the extent of burnout in their organization using validated tools and report on findings at least annually to leaders, managers and clinicians within the organization.
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- Address burnout in training and at the early career stage. Clinicians often experience burnout early in their professional career. For instance, with many physicians it starts in medical school. The report recommends that schools that educate health professionals (including medical schools, nursing schools, schools of pharmacy and others) alleviate major sources of stress by monitoring workload (including preparation for licensure examinations and required training activities), implement pass-fail grading, improve access to scholarships and affordable loans and build new loan repayment systems.
- Reduce tasks that do not improve patient care. Federal agencies, state legislatures and other standard-setting entities should identify and address the sources of clinician burnout related to laws, regulations and policies, and eliminate those that contribute little or no value to patient care, the report said. They should specifically evaluate regulations and standards related to payment, health information technology, quality measurement and reporting and professional and legal requirements for licensure.
- Improve usability and relevance of health IT. Health information technology, including electronic health records, should be as user-friendly and easy to operate as possible to reduce burnout, the report says. Health IT vendors and healthcare organizations should deploy technologies to reduce documentation demands and automate nonessential tasks. In addition, federal policymakers and private sector health IT companies should collaborate to develop the infrastructure and processes that enable shared decision-making between clinicians and patients.
- Reduce stigma and improve burnout recovery services. Many clinicians do not report burnout because they fear the potential consequences, including loss of licensure. The report recommends that state legislative bodies facilitate access to employee assistance programs, peer support programs and mental health providers without the information being admissible in malpractice litigation. Applications for medical licensure or renewal should focus only on current impairment due to any health condition, rather than past diagnoses for a mental health condition.
- Create a national research agenda on clinician well-being. By the end of 2020, federal agencies—including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, the Health Resources and Services Administration and the U.S. Department of Veterans Affairs—should develop a coordinated research agenda on clinician burnout, says the report. Research priorities should include identifying the drivers of burnout across career and life stages for different types of clinicians and burnout’s implications for the workforce as well as patient safety outcomes.
The study, undertaken by a committee, was sponsored by leading organizations including the Accreditation Council for Graduate Medical Education, the American Hospital Association and the Association of American Medical College, as well as hospitals and medical schools around the country.
Lotte Dyrbye, M.D., co-director of the Mayo Clinic’s program on physician well-being and a committee member, said the group hopes the report will lead to meaningful system-level change to turn the tide on burnout.
"To reach our common goal of improved patient outcomes at a reduced cost, we need a healthcare professional workforce that is thriving. Getting there will require system solutions that address workload, work complexity, administrative tasks, practice efficiency and other factors. Healthcare professionals expect and want to work hard, but need to do so in environments that are sustainable,” she said in a statement. "Burnout is the result of chronic workplace stress. Solutions lie within the work environment."