Clinician Well-being Research Articles

Improving Clinician Well-being and Patient Safety Through Human-Centered Design

This Viewpoint discusses the need for clinicians to be involved in every stage of the development of patient safety interventions in order to not only improve patient care, but also maximize the interventions’ effectiveness and ensure clinician well-being and buy-in.

A narrative review of the impact of work hours and insufficient rest on job performance.

This review discusses the scientific evidence regarding effects of insufficient rest on clinical performance and house officer training programs, the associations of clinical duty scheduling with insufficient rest, and the implications for risk management. Narrative review. Several literature searches using broad terms such as "sleep deprivation," "veterinary," "physician," and "surgeon" were performed using PubMed and Google scholar. Sleep deprivation and insufficient rest have clear and deleterious effects on job performance, which in healthcare occupations impacts patient safety and practice function. The unique requirements of a career in veterinary surgery, which may include on-call shifts and overnight work, can lead to distinct sleep challenges and chronic insufficient rest with resultant serious but often poorly recognized impacts. These effects negatively impact practices, teams, surgeons, and patients. The self-assessment of fatigue and performance effect is demonstrably untrustworthy, reinforcing the need for institution-level protections. While the issues are complex and there is no one-size-fits-all approach, duty hour or workload restrictions may be an important first step in addressing these issues within veterinary surgery, as it has been in human medicine. Systematic re-examination of cultural expectations and practice logistics are needed if improvement in working hours, clinician well-being, productivity, and patient safety are to occur. A more comprehensive understanding of the magnitude and consequence of sleep-related impairment better enables surgeons and hospital management to address systemic challenges in veterinary practice and training programs.

Scoping review: Positive and negative impact of technology on clinicians

BackgroundUnnecessary electronic health record (EHRs) documentation burden and usability issues have negatively impacted clinician well-being (e.g., burnout and moral distress). PurposeThis scoping review was conducted by members from three expert panels of the American Academy of Nurses to generate consensus on the evidence of both positive and negative impact of EHRs on clinicians. MethodsThe scoping review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews guidelines. ResultsThe scoping review captured 1,886 publications screened against title and abstract 1,431 excluded, examined 448 in a full-text review, excluded 347 with 101 studies informing the final review. DiscussionFindings suggest few studies that have explored the positive impact of EHRs and more studies that have explored the clinician's satisfaction and work burden. Significant gaps were identified in associating distress to use of EHRs and minimal studies on EHRs’ impact on nurses. ConclusionExamined the evidence of HIT's positive and negative impacts on clinician's practice, clinicians work environment, and if psychological impact differed among clinicians.

Health care professionals' perceptions of unprofessional behaviour in the clinical workplace.

Unprofessional behaviour undermines organizational trust and negatively affects patient safety, the clinical learning environment, and clinician well-being. Improving professionalism in healthcare organizations requires insight into the frequency, types, sources, and targets of unprofessional behaviour in order to refine organizational programs and strategies to prevent and address unprofessional behaviours. To investigate the types and frequency of perceived unprofessional behaviours among health care professionals and to identify the sources and targets of these behaviours. Data was collected from 2017-2019 based on a convenience sample survey administered to all participants at the start of a mandatory professionalism course for health care professionals including attending physicians, residents and advanced practice providers (APPs) working at one academic hospital in the United States. Out of the 388 participants in this study, 63% experienced unprofessional behaviour at least once a month, including failing to respond to calls/pages/requests (44.3%), exclusion from decision-making (43.0%) and blaming behaviour (39.9%). Other monthly experienced subtypes ranged from 31.7% for dismissive behaviour to 4.6% for sexual harassment. Residents were more than twice as likely (OR 2.25, p<0.001)) the targets of unprofessional behaviour compared to attending physicians. Female respondents experienced more discriminating behaviours (OR 2.52, p<0.01). Nurses were identified as the most common source of unprofessional behaviours (28.1%), followed by residents from other departments (21%). Unprofessional behaviour was experienced frequently by all groups, mostly inflicted on these groups by those outside of the own discipline or department. Residents were most frequently identified to be the target and nurses the source of the behaviours. This study highlights that unprofessional behaviour is varied, both regarding types of behaviours as well as targets and sources of such behaviours. This data is instrumental in developing training and remediation initiatives attuned to specific professional roles and specific types of professionalism lapses.

A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action

BackgroundThe shortage of nursing care in US hospitals has become a national concern. PurposeThe purpose of this manuscript was to determine whether hospital nursing care shortages are primarily due to the pandemic and thus likely to subside or due to hospital nurse understaffing and poor working conditions that predated it. MethodsThis study used a repeated cross-sectional design before and during the pandemic of 151,335 registered nurses in New York and Illinois, and a subset of 40,674 staff nurses employed in 357 hospitals. FindingsNo evidence was found that large numbers of nurses left health care or hospital practice in the first 18 months of the pandemic. Nurses working in hospitals with better nurse staffing and more favorable work environments prior to the pandemic reported significantly better outcomes during the pandemic. DiscussionPolicies that prevent chronic hospital nurse understaffing have the greatest potential to stabilize the hospital nurse workforce at levels supporting good care and clinician wellbeing.

The impact of the Covid-19 pandemic on the quality of care in Israeli hospitals

The study goal was to assess the impact of the COVID-19 pandemic on strategies used by Israeli hospitals to improve quality of care, patient safety, patient experience and clinicians’ well-being. Leaders of public hospitals in Israel were asked to complete questionnaires regarding the impact of COVID-19 on quality. Fourteen of 29 public hospitals participated. Statistically significant differences were noted in the impact of COVID-19 on infection control and clinician well-being by hospital ownership, but no other differences were found, The COVID-19 pandemic had mixed impacts on most domains. Positive impacts were noted to some extent in patient safety and infection control, while waiting times for outpatients and clinicians’ well-being were more likely to be negatively influenced. The most common topics which were advanced during the COVID-19 pandemic were infection control, performance in national quality indicators, reporting of adverse events and near-miss events and care of diabetes, patient and family support in the COVID-19 unit, care in the emergency department, care of labor and delivery, supplying information for patients and the development of online services and telemedicine.

Inpatient clinician workload: a scoping review protocol to understand the definition, measurement and impact of non-procedural clinician workloads

IntroductionClinicians that care for hospitalised patients face unprecedented work conditions with exposure to highly infectious disease, exceedingly high patient numbers, and unpredictable work demands, all of which have resulted in...

Competencies for the Use of Artificial Intelligence in Primary Care.

The artificial intelligence (AI) revolution has arrived for the health care sector and is finally penetrating the far-reaching but perpetually underfinanced primary care platform. While AI has the potential to facilitate the achievement of the Quintuple Aim (better patient outcomes, population health, and health equity at lower costs while preserving clinician well-being), inattention to primary care training in the use of AI-based tools risks the opposite effects, imposing harm and exacerbating inequalities. The impact of AI-based tools on these aims will depend heavily on the decisions and skills of primary care clinicians; therefore, appropriate medical education and training will be crucial to maximize potential benefits and minimize harms. To facilitate this training, we propose 6 domains of competency for the effective deployment of AI-based tools in primary care: (1) foundational knowledge (what is this tool?), (2) critical appraisal (should I use this tool?), (3) medical decision making (when should I use this tool?), (4) technical use (how do I use this tool?), (5) patient communication (how should I communicate with patients regarding the use of this tool?), and (6) awareness of unintended consequences (what are the "side effects" of this tool?). Integrating these competencies will not be straightforward because of the breadth of knowledge already incorporated into family medicine training and the constantly changing technological landscape. Nonetheless, even incremental increases in AI-relevant training may be beneficial, and the sooner these challenges are tackled, the sooner the primary care workforce and those served by it will begin to reap the benefits.

Social support experiences of students and clinicians with disabilities in health professions.

Social support is vital in promoting the health, well-being, and performance of students and clinicians in health professions. Health settings' demanding and competitive nature imposes unique challenges on students and clinicians with disabilities. This paper aims to explore the trajectories and experiences of social support interactions amongst students and clinicians with disabilities in health professions. In a qualitative longitudinal study, 124 in-depth semi-structured interviews were conducted with 27 health students and 29 health clinicians with disabilities. Data analysis was informed by grounded theory as an adapted analytic approach involving constant comparisons. A few main characteristics of social support and trajectories in which social support is negotiated emerged from the data: (1) The need to be accepted and not questioned when asking for support, (2) Support interactions that do not heighten otherness, (3) Failure to acknowledge the challenges, (4) Interactions that support the process of disclosure (5) Interactions that allow mobilization of social support without strain or an extra effort. These findings have important implications for designing more supportive health professions, educational programs, and workplaces for people living with disabilities.

Balancing Clinician Workload Through Strategic Patient Panel Designs.

Clinician workload is a key contributor to burnout and well-being as well as overtime and staff shortages, particularly in the primary care setting. Appointment volume is primarily driven by the size of patient panels assigned to clinicians. Thus, finding the most appropriate panel size for each clinician is essential to optimization of patient care. One year of appointment and panel data from the Department of Family Medicine were used to model the optimal panel size. The data consisted of 82 881 patients and 105 clinicians. This optimization-based modeling approach determines the panel size that maximizes clinician capacity while distributing heterogeneous appointment types among clinician groups with respect to their panel management time (PMT), which is the percent of clinic work. The differences between consecutive PMT physician groups in total annual appointment volumes per clinician for the current practice range from 176 to 348. The optimization-based approach for the same PMT physician group results in having a range from 211 to 232 appointments, a relative reduction in variability of 88%. Similar workload balance gains are also observed for advanced practice clinicians and resident groups. These results show that the proposed approach significantly improves both patient and appointment workloads distributed among clinician groups. Appropriate panel size has valuable implications for clinician well-being, patients' timely access to care, clinic and health system productivity, and the quality of care delivered. Results demonstrate substantial improvements with respect to balancing appointment workload across clinician types through strategic use of an optimization-based approach.

Identifying sources of burnout among clinicians at a cancer center: A qualitative analysis.

429 Background: Clinician burnout leads to increased job turnover and workforce shortages, and reduced patient satisfaction and quality of care. Despite its importance, there has been limited study of burnout among the cancer care workforce including sources of burnout. This information can be used to inform intervention design for use in the cancer care setting specifically. To address this gap, we analyzed open-ended responses to a well-being survey administered to clinicians (physicians and advanced practice providers) at a Cancer Center. Methods: In February 2022, we electronically administered the American Medical Association’s clinician well-being survey to all practicing clinicians at a National Cancer Institute-designated Comprehensive Cancer Center in Florida. Of 700 clinicians, 405 (58%) responded. Of the respondents, 259 (64.0%) answered the free-text question “Tell us more about your stressors and what we can do to minimize them.” We used in-vivo coding to develop qualitative themes across responses. If a given response incorporated multiple themes, we coded the response under all pertinent themes. Results: A majority (76/259) of respondents commented on staffing issues, such as their clinics being understaffed or the quality of current staff. Another frequent theme (64/259) was the electronic health records (EHR) system, such as lack of integration between modules, inbox fatigue, alert fatigue, and inefficient documentation review processes. Respondents also reported scheduling issues as a pain point (56/259), such as having schedules that do not reflect actual clinical practice, being overbooked, and scheduling errors. Documentation burden was also highlighted as an issue across respondents (34/259). Documentation was considered tedious and some respondents reported a mismatch between available documentation tools in the EHR and actual documentation needs. Less common themes reported across respondents included design issues of facility space (e.g., no dedicated workspace to complete work without interruptions) and insufficient time to complete administrative, research, and documentation requirements. Conclusions: Our findings suggest that interventions that optimize staffing models, EHR processes (e.g., documentation), and scheduling practices may reduce burnout for a considerable number of cancer care clinicians.

Emergency medicine resident perspectives on well-being during COVID-19: a qualitative study

BackgroundEmergency medicine (EM) clinician well-being has been negatively impacted throughout the COVID-19 pandemic. Resident physicians are particularly vulnerable yet less is known about their perspectives.MethodsThe objective of this study was...

Educational interventions to improve emotional intelligence in nursing and medical students: A systematic review

Purpose: Emotional intelligence (EI) is a trainable skillset and has been shown to have a positive impact on clinician wellbeing, patient outcomes, and other personal and professional factors. This review aimed to evaluate and summarize current intervention strategies designed to improve EI in nursing and medical students.Results: Interventions varied by theme, content, learning activities, and duration. Nine different EI measurement instruments were utilized; learning outcomes were assessed by modified Kirkpatrick classifications. Nine out of 12 studies showed significant positive improvements in EI outcome measures post-intervention. Our review demonstrated moderate to high quality OCEBM level 1b and 2b evidence, moderate quality MERSQI/NOS-E risk of bias appraisal, and GRADE-defined desirable intervention effects with respect to positive modifications in Kirkpatrick identified learner perceptions and attitudes.Conclusions: Nearly all interventions resulted in positive change in EI. The greatest improvements resulted from intervention content relating to self-awareness, empathy, problem-solving, stress coping, and use/management of emotions, involved group-based learning activities, and were delivered in 10-15 hours spread over 8-12 weeks. No specific recommendations can be made about timing of interventions within nursing or medical professional curricula. Further research and development of objective behavioral EI skill assessments and patient outcomes is warranted.

Resident and nurse perspectives on the use of secure text messaging systems.

As hospitals shift away from pagers and towardssecure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. This was a qualitative study with focus groups. Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well-being. Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face-to-face communication and frontline decision-making. (3) STMS can promote patient safety through closed-loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well-being through satisfaction and relationship building. (6) STMS can negatively impact clinician well-being through increased stress related to communication volume. Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.

Storytelling Through Music to Facilitate Meaning Reconstruction and Address Psychosocial Stress in Oncology Nurses

Frontline healthcare workers are exposed to significant suffering and loss. Recent studies have shown increased rates of depression and suicide among nurses and physicians when compared to the general population. Few clinician well-being interventions focus on increasing the awareness and expression of clinician’s emotions to improve psychosocial well-being. In particular, nurses are at the forefront of cancer care, and studies indicate that they cope with work-related emotions in isolation. Storytelling Through Music is a 6-week intervention that combines storytelling, reflective writing, songwriting, and stress management skills. The parent study was a quasi-experimental design, with 43 oncology nurses in either the intervention group or a non-randomized comparison group. This study evaluates the post-intervention qualitative data from participants in the intervention group (n=22). Content analysis was used for analysis, which revealed the following themes: belonging, finding meaning, and emotional transformation. Participants reported learning they were not alone in the emotional experience, that they were reminded of why they work in oncology, and that hearing their story in song transformed their feelings from sadness to something beautiful. Further, they described that hearing their story reflected back to them in song was deeply moving and provided them with emotional insight.

A Guide for Implementing Surgeon Resilience Initiatives: An Example of Surgical Peer Support.

A Guide for Implementing Surgeon Resilience Initiatives: An Example of Surgical Peer Support.

Do No Harm: Health Systems’ Duty to Promote Clinician Well-Being

Do No Harm: Health Systems’ Duty to Promote Clinician Well-Being

The Critical Need for a Meaning-Centered Team-Level Intervention to Address Healthcare Provider Distress Now.

COVID-19 has unveiled and amplified the burnout, grief, and other forms of distress among healthcare providers (HCPs) that long preceded the pandemic. The suffering of the healthcare workforce cannot be simply and sufficiently addressed with a single psychotherapeutic intervention. Nevertheless, the National Academies of Sciences, Engineering, and Medicine Studies recommended prioritizing interventions that generate an increased sense of meaning in life and in work to reduce burnout and cultivate clinician wellbeing. Despite their guidance, there is a dearth of interventions for HCPs specifically targeting meaning and purpose as an avenue to reduce HCP distress. In a time when such an intervention has never been more essential, Meaning-Centered Pyschotherapy (MCP), a brief, evidence-based intervention designed for patients with advanced cancer may be key. This piece describes the principles underlying MCP and how it might be adapted and applied to ameliorate burnout among HCPs while providing a rationale to support future empirical studies in this area. Importantly, the systemic factors that contribute to the emotional and mental health burdens of HCPs are discussed, emphasizing the need for systems-level changes that are needed to leverage the potential outcomes of MCP for HCPs.

"Room to Reflect": A Pilot Workplace Resiliency Intervention for Nurses.

Rising workload demands for nurses necessitate the implementation of easily accessible and innovative clinician well-being resources on health care units. This pre/post pilot study sought to measure the impact of a mobile workplace intervention, “Room to Reflect” on staff nurse and nurse manager resilience. A mobile toolbox with a sound machine, Virtual Reality headset, and associated Quick Response code audio/video offerings, and a paper Pocket Guide of mindful restoration practices were provided to 7 health care units for a 3 month period. Pre/post questionnaires assessed perceived resilience using the Connor-Davidson Resilience scale, and intervention feasibility (ease of use), accessibility (spaces used), and effectiveness (restoration). Data analysis consisted of descriptive statistics, paired and independent samples t-tests, and Wilcoxon Signed Rank tests. From the pre (n = 97) to post (n = 57) intervention period, there was a significant difference in resilience for Clinician 3 staff nurses. A mean increase in resilience was noted among nurse managers following participation in the intervention, z = −2.03, p < 0.05. The Pocket Guide was the easiest offering to use, while VR offerings were accessed the most through Quick Response code. Space and time were the most common barriers to Room to Reflect use. Staff nurses felt supported by managers to use the program, and managers perceived that the program improved nurse job satisfaction.

Quality of Life Improvement: A Novel Framework and Approach to Well-Being.

Physician burnout is a complex problem that requires creative solutions. Despite increasing awareness of the importance of systems approaches to address physician well-being, few tools exist for organizations to bridge the gap between well-being theory and practice. As demonstrated during the COVID-19 pandemic, new threats to well-being can arise at any time, necessitating an iterative approach. Here we outline the quality of life improvement (QOLI) approach, a novel framework and approach that incorporates principles of human-centered design (HCD), quality improvement (QI), and implementation science (IS) to address clinician well-being. Additionally, we share our experience using this approach in a large academic anesthesiology department.