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1.
BMC Health Serv Res ; 24(1): 888, 2024 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-39097691

RESUMO

BACKGROUND: A concern before 2020, physician burnout worsened during the COVID-19 pandemic. Little empirical data are available on pandemic workplace support interventions or their influence on burnout. We surveyed a national sample of frontline physicians on burnout and workplace support during the pandemic. METHODS: We surveyed a stratified random sample of 12,833 US physicians most likely to care for adult COVID-19 patients from the comprehensive AMA Physician Professional Data ™ file. The sample included 6722 primary care physicians (3331 family physicians, 3391 internists), 880 hospitalists, 1783 critical care physicians (894 critical care physicians, 889 pulmonary intensivists), 2548 emergency medicine physicians, and 900 infectious disease physicians. The emailed survey elicited physicians' perceptions of organizational interventions to provide workplace support and/or to address burnout. Burnout was assessed with the Professional Fulfillment Index Burnout Composite scale (PFI-BC). Proportional specialty representation and response bias were addressed by survey weighting. Logistic regression assessed the association of physician characteristics and workplace interventions with burnout. RESULTS: After weighting, respondents were representative of the total sample. Overall physician burnout was 45.4%, significantly higher than in our previous survey. Open-ended responses mentioned that staffing shortages (physician, nursing, and other staff) combined with the increased volume, complexity, and acuity of patients during the pandemic increased job demands. The most frequent workplace support interventions were direct pandemic control measures (increased access to personal protective equipment, 70.0%); improved telehealth functionality (43.4%); and individual resiliency tools (yoga, meditation, 30.7%). Respondents placed highest priority on workplace interventions to increase financial support and increase nursing and clinician staffing. Factors significantly associated with lower odds of burnout were practicing critical care (compared with emergency medicine) OR 0.33 (95% CI 0.12 - 0.93), improved telehealth functionality OR 0.47 (95% CI 0.23 - 0.97) and being in practice for 11 years or longer OR 0.44 (95% CI 0.19-0.99). CONCLUSIONS: Burnout across frontline specialties increased during the pandemic. Physician respondents focused on inadequate staffing in the context of caring for more and sicker patients, combined with the lack of administrative efforts to mitigate problems. Burnout mitigation requires system-level interventions beyond individual-focused stress reduction programs to improve staffing, increase compensation, and build effective teams.


Assuntos
Esgotamento Profissional , COVID-19 , Médicos , SARS-CoV-2 , Local de Trabalho , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Esgotamento Profissional/prevenção & controle , Masculino , Feminino , Médicos/psicologia , Adulto , Local de Trabalho/psicologia , Pessoa de Meia-Idade , Pandemias , Estados Unidos/epidemiologia , Inquéritos e Questionários
2.
J Am Med Inform Assoc ; 31(10): 2246-2254, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39018492

RESUMO

OBJECTIVES: Physician burnout in the US has reached crisis levels, with one source identified as extensive after-hours documentation work in the electronic health record (EHR). Evidence has illustrated that physician preferences for after-hours work vary, such that after-hours work may not be universally burdensome. Our objectives were to analyze variation in preferences for after-hours documentation and assess if preferences mediate the relationship between after-hours documentation time and burnout. MATERIALS AND METHODS: We combined EHR active use data capturing physicians' hourly documentation work with survey data capturing documentation preferences and burnout. Our sample included 318 ambulatory physicians at MedStar Health. We conducted a mediation analysis to estimate if and how preferences mediated the relationship between after-hours documentation time and burnout. Our primary outcome was physician-reported burnout. We measured preferences for after-hours documentation work via a novel survey instrument (Burden Scenarios Assessment). We measured after-hours documentation time in the EHR as the total active time respondents spent documenting between 7 pm and 3 am. RESULTS: Physician preferences varied, with completing clinical documentation after clinic hours while at home the scenario rated most burdensome (52.8% of physicians), followed by dealing with prior authorization (49.5% of physicians). In mediation analyses, preferences partially mediated the relationship between after-hours documentation time and burnout. DISCUSSION: Physician preferences regarding EHR-based work play an important role in the relationship between after-hours documentation time and burnout. CONCLUSION: Studies of EHR work and burnout should incorporate preferences, and operational leaders should assess preferences to better target interventions aimed at EHR-based contributors to burnout.


Assuntos
Esgotamento Profissional , Documentação , Registros Eletrônicos de Saúde , Médicos , Humanos , Médicos/psicologia , Feminino , Masculino , Adulto , Fatores de Tempo , Pessoa de Meia-Idade , Plantão Médico , Atitude do Pessoal de Saúde , Inquéritos e Questionários , Assistência Ambulatorial
3.
Perm J ; 28(3): 58-68, 2024 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-38980769

RESUMO

BACKGROUND: The prevalence of physician burnout increased notably during the COVID-19 pandemic, but whether measures of burnout differed based on physician specialty is unknown. The authors sought to determine the prevalence of burnout, worklife conflict, and intention to quit among physicians from different specialties. METHODS: This is a cross-sectional online survey of physicians working at 2 urban hospitals in Vancouver, Canada, from August to October 2021. Responses were categorized by specialty (including surgical and nonsurgical), and data about whether physicians provided frontline patient care during COVID-19 were also included. Physician burnout was measured using the Maslach Burnout Inventory. RESULTS: The survey response rate was 42% (209/498). The overall prevalence of burnout was 69%. Burnout was not significantly different by specialty or between frontline COVID-19 specialties compared with other specialties. Physicians in surgical specialties were more likely to report work-life conflict than those in nonsurgical specialties (p = 0.012). Differences in intention to quit among specialties were not statistically significant. CONCLUSION: During the COVID-19 pandemic, physician burnout was high across physicians, without significant differences between specialties, highlighting the need to support all physicians.


Assuntos
Esgotamento Profissional , COVID-19 , Médicos , Humanos , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Estudos Transversais , COVID-19/psicologia , COVID-19/epidemiologia , Masculino , Feminino , Médicos/psicologia , Médicos/estatística & dados numéricos , Adulto , Inquéritos e Questionários , Pessoa de Meia-Idade , Prevalência , SARS-CoV-2 , Equilíbrio Trabalho-Vida , Colúmbia Britânica/epidemiologia
4.
Clin Infect Dis ; 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38843037
5.
BMC Health Serv Res ; 24(1): 748, 2024 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-38890733

RESUMO

BACKGROUND: Given the increasing prevalence of the physician burnout, this study provides new insights into the antecedents driving burnout and turnover intent. By introducing the concept of physician fortitude, we develop a valid and statistically-reliable measure that increases our understanding of these issues. METHODS: A two-sample design was employed. Using a sample of 909 physicians, Advanced Practice Providers (APPs) and healthcare leaders, exploratory factor analysis was employed to create a 12-item fortitude scale. In the second study, using a sample of 212 of practicing physicians, APPs and healthcare leaders, bivariate and tetrachoric correlations, and ordinary least square regression modeling were able to establish reliability and validity. RESULTS: The fortitude scale shows sufficient reliability. Moreover, we found significant support for convergent and criterion-related validity. Fortitude was significantly related to all three subdimensions of burnout, including emotional exhaustion (r = -.62, p < .01), depersonalization (r = -.70, p < .01) and personal accomplishment (r = .65, p < .01), and turnover intent (r = -.55, p < .01). Moreover, the fortitude measure explained more variance in all three subdimensions of burnout and turnover intent compared to common measures, including grit, hardiness, mental toughness and resilience (p < .01). CONCLUSIONS: Results from this study empirically demonstrate that fortitude is significantly related to burnout, and turnover intent. This new fortitude measure adds a new perspective to assist in the development of more effective interventions. Opportunities for future research are discussed.


Assuntos
Esgotamento Profissional , Reorganização de Recursos Humanos , Médicos , Humanos , Esgotamento Profissional/psicologia , Reorganização de Recursos Humanos/estatística & dados numéricos , Médicos/psicologia , Feminino , Masculino , Adulto , Reprodutibilidade dos Testes , Inquéritos e Questionários , Pessoa de Meia-Idade , Satisfação no Emprego , Análise Fatorial , Psicometria , Intenção
6.
J Pediatr Gastroenterol Nutr ; 79(1): 10-17, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38693783

RESUMO

OBJECTIVES: The pediatric gastroenterology workforce has grown in the last few decades. The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) formed a task force to understand current pediatric gastroenterology organizations' practice structures. METHODS: 19-item electronic survey was distributed to NASPGHAN members who were clinical or academic division directors. RESULTS: 30% responded to the survey, all directors of academic practices. The median number of clinical sessions per week was seven sessions, and the median individual work relative value unit (wRVU) target for practices was 4000-4500. Healthcare team ratios compared to provider clinical full-time equivalent were reported as the following: Nursing 0.80, medical assistant (MA) 0.29, dietitian 0.29, social worker 0.14, and psychologist 0.13. Regarding compensation, 68.0% were salaried with bonus based on billing or director decision, 28.0% were salaried with no incentive pay, and 4.0% were salaried with a portion at risk if the target was not met, and a bonus was given if the target was met. Most practices participated in a wellness activity with the most common strategies being didactic lectures about physician burnout (80%), annual burnout check-ins (68%), and/or after-hours social activities (60%). CONCLUSIONS: Pediatric gastroenterology practices vary regarding clinical sessions per week and annual wRVU targets with the median at seven sessions per week and an annual goal of 4000-4500 wRVUs, similar to reported national benchmark goals at the 50th percentile. Healthcare teams, including nursing, MAs, dietitians, social workers, and psychologists, had similar ratios of staff to providers for all sizes and types of practices. Most practices are engaging in wellness initiatives.


Assuntos
Gastroenterologia , Pediatria , Carga de Trabalho , Humanos , Gastroenterologia/organização & administração , Pediatria/organização & administração , Inquéritos e Questionários , Salários e Benefícios , Gerenciamento da Prática Profissional/organização & administração , Estados Unidos , Médicos/psicologia , Masculino
7.
Pediatr Clin North Am ; 71(3): 413-429, 2024 06.
Artigo em Inglês | MEDLINE | ID: mdl-38754933

RESUMO

Physician burnout is pervasive and takes a heavy toll on individuals and the healthcare system. Post-coronavirus disease 2019 the negative impact of organizational culture on physician burnout has been highlighted. Substantial research has accrued identifying steps organizations can take to pivot and develop leaders committed to physician well-being. Physicians can also proactively explore research in sleep, nutrition, physical activity, stress management, and social connections. Positive mindset has a powerful protective effect in medicine, especially in the emerging areas of self-valuation, self-compassion, and positive psychology. Physician coaching can accelerate positive behavior change. Committed physician leaders are needed for sustained culture change to occur.


Assuntos
Esgotamento Profissional , COVID-19 , Autocuidado , Humanos , Esgotamento Profissional/prevenção & controle , COVID-19/epidemiologia , COVID-19/psicologia , Médicos/psicologia , Pandemias , Cultura Organizacional , SARS-CoV-2
8.
BMC Health Serv Res ; 24(1): 434, 2024 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-38580940

RESUMO

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.


Assuntos
Esgotamento Profissional , Médicos , Humanos , Criança , Melhoria de Qualidade , Esgotamento Profissional/epidemiologia , Intenção , Inquéritos e Questionários
9.
Am J Surg ; 235: 115698, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38538484

RESUMO

BACKGROUND: Emotional intelligence (EI) can decrease physician burnout. EI and burnout were assessed in surgical residents through participation in Patient-Centric Resident Conferences (PCRCs), which incorporated patients in resident education. We hypothesized PCRCs would improve EI and reduce burnout. METHODS: This was a single institution study of General Surgery residents from 2018 to 2019. Residents participated in standard didactic conferences and PCRCs. The Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF) survey and an ACGME burnout survey were administered at three time points. RESULTS: Higher EI scores correlated with lower burnout scores over three survey distributions (R2 0.35, 0.39, and 0.68, respectively). EI and burnout scores did not change significantly over time. EI and burnout were not associated with conference attendance, meaning in work, or satisfaction with teaching. CONCLUSIONS: General Surgery resident EI and burnout scores were inversely correlated. Previously, PCRCs were shown to be associated with increased resident meaning in work. The current study demonstrates PCRCs did not have a significant impact on measures of resident EI or burnout. Further research is needed for EI and burnout in surgery.


Assuntos
Esgotamento Profissional , Inteligência Emocional , Cirurgia Geral , Internato e Residência , Humanos , Cirurgia Geral/educação , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Masculino , Feminino , Adulto , Inquéritos e Questionários , Assistência Centrada no Paciente
10.
Adv Med Educ Pract ; 15: 181-187, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38495574

RESUMO

Background: The contemporary challenges of improving patient engagement in chronic disease management and addressing the growing problem of physician burnout are commonly viewed as separate issues. However, there is extensive evidence that person-centered approaches to patient engagement, such as motivational interviewing (MI), are associated both with better outcomes for patients and improved well-being for clinicians. Methods: We conducted an exploratory survey study to ascertain whether resident physicians who perceive that they embrace and utilize the MI approach also report less burnout. A total of 318 residents in several specialties were invited via email to complete a 10-question survey about patient engagement and the experience of burnout. Frequencies and percentages were calculated for all categorical/ordinal variables to describe survey participants and question responses. Correlation coefficients were obtained to assess relationships between all burnout and engagement questions. Results: A total of 79 residents completed the survey (response rate of 24.8%). There was broad agreement about the importance of patient engagement and the use of the MI approach, and approximately 60% of residents indicated that burnout was a problem. Two items related to residents' perceived use of MI were correlated with feeling a sense of personal accomplishment, one of the protective factors against burnout. Conclusion: Consistent with other studies indicating that person-centered approaches are associated both with better patient outcomes and provider wellbeing, our data suggest that residents' self-reported use of the MI approach in patient care may be related to less burnout. It appears that training in the MI approach in graduate medical education may be simultaneously good for patient outcomes and good for resident well-being.


Teaching resident physicians how to take care of their own health, and how to help patients take more responsibility for their health, are typically viewed as two separate challenges. However, studies have shown that patient-centered approaches have benefits both for patient health and clinician health. In our survey of resident physicians, we found that those who say they use motivational interviewing, a patient-centered approach, also report less burnout. This means that teaching resident physicians an effective way to interact with patients is also good for the trainees' health.

11.
BMC Public Health ; 24(1): 862, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509564

RESUMO

BACKGROUND: Rates of physician burnout increased during the COVID-19 pandemic and are expected to continue to rise. Mid-career physicians, female physicians, and military physicians have all been identified as potentially vulnerable populations to experience burnout. We examine factors associated with physician burnout among this intersectional group through a qualitative key informant interview study. METHODS: We developed a semi-structured interview guide using the Institute for Healthcare Improvement's Improving Joy in Work Framework and recruited military, mid-career female physicians who worked in the Military Health System(MHS) during the COVID-19 pandemic, (March 2020 -December 2021). Notes were collated and deductive thematic analysis was conducted. RESULTS: We interviewed a total of 22 mid-career female physician participants. Participants were between 30 and 44 years of age and 7 were mothers during the pandemic. Most were White and served in the Army. All participants discussed the importance of building rapport and having a good relationship with coworkers. All participants also described their discontentment with the new MHS GENESIS electronic health record system. An emerging theme was military pride as most participants were proud to serve in and support the military population. Additionally, participants discussed the negative impact from not feeling supported and not feeling heard by leadership. CONCLUSIONS: Much like providers in other health systems during the pandemic, MHS physicians experienced burnout. This study allowed us to gather key insights to improve policies for active duty service mid-career female military physicians. Provider inclusion, autonomy, and work culture play critical roles in future systems improvement and workforce retention.


Assuntos
Esgotamento Profissional , COVID-19 , Serviços de Saúde Militar , Médicos , Humanos , Feminino , Criança , COVID-19/epidemiologia , Pandemias , Esgotamento Profissional/epidemiologia
12.
J Invasive Cardiol ; 36(5)2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38422526

RESUMO

The frequency of burnout is rising among cardiologists, affecting not only their well-being but also the quality of patient care. Computerization of practice, bureaucracy, excessive workload, lack of control/autonomy, hostile and hectic work environments, insufficient income, and work life imbalance are the main categories listed as contributing factors to cardiologists' burnout. Organization- and physician-directed interventions can be impactful; however, the effectiveness and feasibility of these interventions have rarely been assessed in cardiology. This review summarizes recent publications on burnout in cardiology, discusses the contributing factors and implications of burnout on physicians' health and patient safety, and explores possible interventions.


Assuntos
Esgotamento Profissional , Cardiologia , Humanos , Esgotamento Profissional/psicologia , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/etiologia , Cardiologistas/psicologia , Carga de Trabalho/psicologia
13.
J Invasive Cardiol ; 36(2)2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38335507

RESUMO

Several studies suggest differences in burnout and coping mechanisms between female and male physicians. We conducted an international, online survey exploring sex-based differences in the well-being of interventional cardiologists. Of 1251 participants, 121 (9.7%) were women. Compared with men, women were more likely to be single and under 50 years old, and they asked more often for development opportunities and better communication with administration. Overall burnout was similar between women and men, but women interventional cardiology attendings were more likely to think that they were achieving less than they should. Improved communication with administration and access to career development opportunities may help prevent or mitigate burnout in women interventional cardiologists.


Assuntos
Esgotamento Profissional , Cardiologistas , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Caracteres Sexuais , Inquéritos e Questionários , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle
14.
Intern Med J ; 54(2): 348-351, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38350660

RESUMO

In 2016, as a trainee doctor, I wrote a paper on changing the culture of medicine. I felt the medical system was broken back then, and it seems even less functional now, with higher rates of burnout, dropout and staff shortages nationally. As a result of a lack of resources, it feels impossible to provide the care to our communities expected of us, making our work challenging and disheartening. Until all stakeholders acknowledge the systemic issues faced by our workforce, service outcomes and physician well-being may not improve. We need to collaborate and innovate to reform the healthcare system taking a multifaceted, evidence-based approach, implementing an appropriate balance of systemic change and interventions to support individual well-being. As we collectively work towards these changes, tragic optimism may spur physicians to develop meaning and purpose despite the inevitable challenges. This may serve as the motivation and fuel required to survive and sustain our practice but also thrive working in careers of value.


Assuntos
Esgotamento Profissional , Médicos , Humanos , Atenção à Saúde , Esgotamento Profissional/epidemiologia , Recursos Humanos
15.
Work ; 78(2): 245-256, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38189719

RESUMO

BACKGROUND: The COVID-19 pandemic has put health care systems of many countries under major stress. Due to its high transmission capacity, it has spread across the globe at a rampant pace. India is one of the countries which has been severely affected by COVID-19. It has posed onerous tasks in front of doctors. Along with it, it has left physical, social and mental implications on well-being of doctors. OBJECTIVES: The purpose of this study is to get an in-depth understanding about the implications of COVID-19 on physical, social and mental aspects of resident doctors in tertiary care hospital. METHOD: We performed a qualitative study which involved in-depth interviews of resident doctors who have worked during the COVID-19 pandemic from general medicine department of tertiary care hospital. Interviews were then manually transcribed and analyzed. RESULT: Data analysis by preparing transcript unveiled that doctors were constantly facing burnout and mental distress along with less social support. Our study also found that there was a shortage of resources and demonstrated poor doctor patient ratio which led to a decrease in efficiency of doctors. Our findings are not only confined to doctors facing burden but has also explored sanguine perceptions of resident doctors. CONCLUSION: While treating COVID-19 patients, resident doctors suffered a great setback. Providing them with mental aid, social support, ample resources and decreasing their work burden is recommended to effectively manage future pandemic.


Assuntos
Esgotamento Profissional , COVID-19 , Internato e Residência , Pesquisa Qualitativa , SARS-CoV-2 , Centros de Atenção Terciária , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Masculino , Índia/epidemiologia , Feminino , Esgotamento Profissional/psicologia , Médicos/psicologia , Adulto , Pandemias , Apoio Social , Entrevistas como Assunto
16.
Fam Pract ; 2024 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-38285806

RESUMO

INTRODUCTION: The lingering burden of the COVID-19 pandemic on primary care clinicians and practices poses a public health emergency for the United States. This study uses clinician-reported data to examine changes in primary care demand and capacity. METHODS: From March 2020 to March 2022, 36 electronic surveys were fielded among primary care clinicians responding to survey invitations as posted on listservs and identified through social media and crowd sourcing. Quantitative and qualitative analyses were performed on both closed- and open-ended survey questions. RESULTS: An average of 937 respondents per survey represented family medicine, pediatrics, internal medicine, geriatrics, and other specialties. Responses reported increases in patient health burden, including worsening chronic care management and increasing volume and complexity. A higher frequency of dental- and eyesight-related issues was noted by respondents, as was a substantial increase in mental or emotional health needs. Respondents also noted increased demand, "record high" wait times, and struggles to keep up with patient needs and the higher volume of patient questions. Frequent qualitative statements highlighted the mismatch of patient needs with practice capacity. Staffing shortages and the inability to fill open clinical positions impaired clinicians' ability to meet patient needs and a substantial proportion of respondents indicated an intention to leave the profession or knew someone who had. CONCLUSION: These data signal an urgent need to take action to support the ability of primary care to meet ongoing patient and population health care needs.

17.
Int J Health Plann Manage ; 39(1): 141-151, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37823601

RESUMO

GOALS: The American healthcare system is amid a burnout epidemic, worsened by COVID, that must be addressed expeditiously and with high priority. The burden Emergency Physicians encountered before and during the pandemic is well known, with countless healthcare workers exiting the work force. A Chief Wellness Officer (CWO) is a senior leader who works primarily to cultivate organisational wellness and to foster and promote a culture of well-being throughout an institution. Specifically, the CWO assists the health system leadership promote clinician engagement and address clinician burnout. This paper explores the status of existing CWOs, and cites the benefits, impacts, and barriers to implementation of a CWO, with focus on the field of Emergency Medicine (EM). METHODS: A steering committee of wellness experts was formed from a national EM organisation. A purposive search and literature review using search terms relating to CWOs was completed. Publications were examined for relevance and recency. The committee created an online questionnaire surveying current US CWOs, conducted personal interviews, and met through regular focused meetings. A framework delineating the role of a CWO as an organisation evolves from instituting novice wellness interventions to expert organisational innovations was created. PRINCIPLE FINDINGS: Despite their title, CWOs are not regularly included in c-suite decisions. Barriers to instituting a CWO include perceived financial cost, the medical system itself, and physician resistance. Defining and measuring objective return on investment may be a solution to overcoming barriers. CWOs who create comprehensive institutional wellness innovations bring organisations to the highest proficient and expert levels of wellness practices, positively affecting physician engagement and deflecting burnout. CWOs instituting novice and beginner levels of wellness interventions, especially in EM, only modestly impact individual wellness practices. PRACTICAL APPLICATIONS: A CWO and team with an organisational voice and a C-suite stakeholder's seat are essential to centralising and leading effective wellness efforts and innovations in EM and other specialities. This team will improve the work environment and culture and begin to fix our broken healthcare system and providers.


Assuntos
Esgotamento Profissional , Medicina de Emergência , Médicos , Humanos , Pessoal de Saúde , Esgotamento Profissional/prevenção & controle , Pandemias/prevenção & controle
18.
Health Serv Res ; 59(1): e14203, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37438938

RESUMO

OBJECTIVE: The aim of the study was to (1) characterize organizational differences in primary care physicians' electronic health record (EHR) behavior; (2) assess within-organization consistency in EHR behaviors; and (3) identify whether organizational consistency is associated with physician-level efficiency. DATA SOURCES: EHR metadata capturing averaged weekly measures of EHR time and documentation composition from 75,124 US primary care physicians across 299 organizations between September 2020 and May 2021 were taken. EHR time measures include active time in orders, chart review, notes, messaging, time spent outside of scheduled hours, and total EHR time. Documentation composition measures include note length and percentage use of templated text or copy/paste. Efficiency is measured as the percent of visits with same-day note completion. STUDY DESIGN: All analyses are cross-sectional. Across-organization differences in EHR use and documentation composition are presented via 90th-to-10th percentile ratios of means and SDs. Multilevel modeling with post-estimation variance partitioning assesses the extent of an organizational signature-the proportion of variation in our measures attributable to organizations (versus specialty and individual behaviors). We measured organizational internal consistency for each measure via organization-level SD, which we grouped into quartiles for regression. Association between internally consistent (i.e., low SD) organizational EHR use and physician-level efficiency was assessed with multi-variable OLS models. DATA COLLECTION: Extraction from Epic's Signal platform used for measuring provider EHR efficiency. PRINCIPAL FINDINGS: EHR time per visit for physicians at a 90th percentile organization is 1.94 times the average EHR time at a 10th percentile organization. There is little evidence, on average, of an organizational signature. However, physicians in organizations with high internal consistency in EHR use demonstrate increased efficiency. Physicians in organizations with the highest internal consistency (top quartile) have a 3.77 percentage point higher same-day visit closure rates compared with peers in bottom quartile organizations (95% confidence interval: 0.0142-0.0612). CONCLUSIONS: Results suggest unrealized opportunities for organizations and policymakers to support consistency in how physicians engage in EHR-supported work.


Assuntos
Medicina , Médicos , Humanos , Registros Eletrônicos de Saúde , Estudos Transversais , Documentação
19.
J Healthc Leadersh ; 15: 375-383, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38046535

RESUMO

Purpose: Healthcare organizations strive to increase physician engagement and decrease attrition. However, little is known about which specific worklife areas may be targeted to improve physician engagement or retention, especially after stressful events such as a COVID19 surge. Our objective was to identify demographic characteristics and worklife areas most associated with increased physician engagement and decreased intent to leave in pediatric faculty. Patients and Methods: In September 2020, we conducted a cross-sectional survey of faculty at an academic, tertiary-care children's hospital. A convenience and voluntary sampling approach was used. The survey included demographics, Maslach Burnout Index-Human Services Survey (MBI-HSS) and the Areas of Worklife Survey (AWS). The MBI-HSS was used to measure faculty engagement. The AWS measures satisfaction with six worklife areas (workload, control, reward, fairness, community, values). We used bivariate analyses to examine relationships between worklife areas and engagement and between worklife areas and intent to leave. We included multivariate logistic regression models to examine worklife areas most associated with increased work engagement and decreased intent to leave. Results: Our response rate was 41% (113/274 participants). In bivariate analysis, engaged faculty reported higher satisfaction in all worklife areas. In multivariate analyses, positive perceptions of workload (odds ratio (OR) 2.83; 95% confidence interval (CI), 1.2-6.9), control (OR, 3.24; 95% CI 1.4-7.3), and community (OR, 6.07; 95% CI 1.9-18.7) were associated with engagement. Positive perceptions of values (OR, 0.07; 95% CI 0.02-0.32) and community (OR, 0.19; 95% CI 0.05-0.78) were negatively associated with intent to leave. Conclusion: We found that positive perceptions of workload, control, and community were most associated with engagement. Alignment of values and increased sense of community were associated with decreased intent to leave. Our findings suggest specific worklife areas may be targeted to increase faculty engagement and retention.

20.
Surg Neurol Int ; 14: 326, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37810292

RESUMO

Background: This study underscores the high burnout rates among physicians, particularly surgical residents, attributing it to the demanding health-care ecosystem. It highlights the negative impacts of burnout, such as medical errors and increased health-care costs, while exploring the potential mitigating role of emotional intelligence (EI) and mindfulness. The research aimed to analyze the existing literature on EI in neurosurgery, focusing on its relationship with physician burnout and its potential role in healthcare leadership and residency training programs. Methods: A comprehensive literature review was conducted using multiple databases, including PubMed, OVID Embase, and OVID Medline, using the keywords "Emotional Intelligence" and "neurosurgery." The search duration spanned from each database's inception to June 2023. Results: The review highlighted various studies emphasizing the importance of integrating EI and mindfulness training into medical education and leadership, suggesting that a balance between technical competencies and interpersonal skills are critical. It identified personal integrity, effective communication, professional ethics, pursuit of excellence, relationship building, and critical thinking as key competencies for health-care leadership. Conclusion: EI and a growth mindset play a critical role in managing burnout, enhancing job satisfaction and performance, and promoting effective healthcare leadership. The review, however, acknowledges certain limitations such as small sample sizes, single-institution experiences, potential biases, and inconsistencies in burnout parameters and EI measurement tools. Despite these, it points toward potential areas for future investigation and highlights the importance of standardized EI measurement tools and robust quantitative assessment methods.

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