Wellbeing Committee Research Articles

Clinician Well-Being Assessment and Interventions in Joint Commission-Accredited Hospitals and Federally Qualified Health Centers.

Clinician burnout is a longstanding national problem threatening clinician health, patient outcomes, and the health care system. The aim of this study is to determine the proportion of hospitals and Federally Qualified Health Centers (FQHCs) that are measuring and taking system actions to promote clinician well-being. This cross-sectional study used an electronic questionnaire from April 21 to June 27, 2022, to assess the current state of organizational efforts to assess and address clinician well-being among a national sample of 1,982 Joint Commission-accredited hospitals and 256 accredited FQHCs. Outcomes of interest included the proportion of hospitals and FQHCs that assessed the prevalence of clinician burnout, established a chief wellness officer position, established a wellness committee, made clinician well-being an organizational performance metric, and implemented other activities/interventions that target clinician burnout. A total of 481 (21.5%) organizations responded to the survey (hospital n = 396 [20.0%], FQHC n = 85 [33.2%]). Response rates did not differ by organization size, type, teaching status or urban vs. rural location. Approximately one third (34.0%) of the organizations in the sample conducted an organizational well-being assessment among clinicians at least once in the past three years. Although nearly half of responding organizations reported implementing some kind of intervention to address clinician burnout, only 28.7% of organizations had adopted a comprehensive approach to address clinician well-being/burnout. Only 10.1% of hospitals and 5.4% of FQHCs reported having an established senior leadership position responsible for assessing and promoting clinician well-being at the organization level, and less than half (29.3% FQHCs, 37.6% hospitals) of organizations reported having an established wellness committee. Among 500+ bed hospitals, 61.2% had surveyed, 75.6% had established a well-being committee, 78.0% had implemented interventions to promote clinician well-being, and 26.8% had established a chief wellness officer. Although half of Joint Commission-accredited hospitals and FQHCs reported taking steps to improve clinician well-being, a minority are measuring clinician well-being, and few are taking a comprehensive approach or established a chief wellness officer position to advance clinician well-being as an organizational priority. Organizational clinician well-being improvement efforts are unlikely to be successful without measurement and leadership in place to drive change.

NHS Ayrshire and Arran Sustainability and Well-being Committee - Assessing and Improving Trainee Well-being

AimsTo promote the Royal College's core principles of sustainable psychiatry, Junior Doctors at Ayrshire Central Hospital formed the Sustainability and Well-being Committee. The principle aim through 2022, following the COVID-19 pandemic, was to maximise junior well-being - knowing a sustainable workforce is one that feels supported and fulfilled by work and working conditions.MethodsThrough meetings with junior doctors, qualitative information on factors impacting well-being in the work place was gathered, and three targets for improvement were identified.The following domains and interventions were implemented: 1.Improve working environment: The doctor's office was sized for 2 staff maximum - despite staffing levels consistently in excess of 20 junior doctors. Additionally, there was no natural light. We obtained a new significantly larger office space, with natural light.2.Comfort break area – Doctors identified that having an area with comfort seating to take breaks and socialise away from patients and visitors would be beneficial. We obtained a seating area and a coffee machine, maintained by the junior doctors.3.Access technology – Absence of desktops and IT issues with older laptops was impairing productivity and morale. We obtained 4 new desktop computers, and personal laptops for core trainees.A digital questionnaire was used to collect quantitative data retrospectively, from doctors currently working in the department, or who had done so in the last 6 months.Likert scales were used to assess pre and post-intervention levels of well-being, and ranking intervention impact on this. Doctors also identified future areas of intervention going forward into 2023.ResultsA total of 16 responses were obtained, and 100% of these agreed that feeling supported and good working conditions was important to maintaining wellness and productivity. Pre-intervention average wellness was rated 5.2 (with 1 being extremely poor, and 10 being extremely good), this increased to 8.1 post-intervention. Improved working environment had the most significant impact on well-being.Respondents identified environmental sustainability as target for improvement in 2023, potentially through improved recycling, reducing meat consumption and car sharing. Further well-being interventions e.g., walks, promotion of Balint group and social events were also suggested.ConclusionInterventions from the trainee-led Sustainability and Well-being Committee through 2022 improved working environment and subjective well-being. This demonstrates that junior staff can successfully initiate and lead projects to promote and improve sustainability in psychiatry. Results indicate that junior staff are willing to actively participate in interventions to improve well-being, and environmental sustainability in 2023.

Creating an infrastructure to address physician and advanced practice provider burnout at a complex community cancer care delivery system.

11015 Background: Oncology clinicians are at risk for developing burnout due to work-related factors such as high acuity patients, long work hours, limited autonomy, administrative and documentation demands (Copur, 2019; Eelen et al, 2014). The COVID-19 Pandemic has intensified burnout due to rapid and multiple changes in clinical practice, lack of fulfillment, and heightened moral distress and personal challenges (Hlubocky et al 2021). As a multi-center community cancer care system, an infrastructure was created and operationalized to address the work-related factors contributing to burnout. The purpose of the project was improved identification and prioritization of clinician (physician and APP) needs with subsequent targeted intervention. Methods: To measure success, a partnership with the American Medical Association (AMA) was formed to deploy the Mini-Z burnout survey. The survey was administered on July 2-August 20, 2021 to all Medical Oncology physicians and Advanced Practice Providers (APPs), n = 60. The survey was re-deployed from July 13-September 2nd, 2022. Data was collated by the AMA and presented back to executive leadership. Through this survey and follow up focus groups, it was identified that physicians tended to struggle more with the EHR and inability to disconnect from work compared to APPs. Our APPs identified several areas of opportunity including onboarding/orientation, mentorship/professional development, pay and scope of practice. An EHR Well-being Committee was established to evaluate EPIC signal reports to address both system and individual clinician needs. To address APP needs, key factors were addressed in the realm of professional development/orientation, compensation and scope of practice. This was approached with the goal of short-term gains and long-term sustainability. Results: The results indicated a 23.8% improvement in job satisfaction, 4.9% improvement in job stress, and 26.3% improvement in employment outlook. A decrease was also noted in EHR Time outside of work (4.5%) and burnout (16.1%). All areas of improvement met or exceeded national benchmarks. Analysis of these results indicate statistical significance for job satisfaction (p = 0.028, CI 2.8-40.4%) and employment outlook (p = 0.033, CI2.4-45.8%). Results that indicated improvement but were not statistically significant were job stress (p = 0.688, CI 17.6-27.4%), burnout (p = 0.191, CI 7.4-37.5%) and EHR time outside of work (p = 0.806). Conclusions: While the survey data does not account for clinician turnover between 2021 and 2022, initial review indicates a positive impact on job satisfaction and employment outlook which may be an early indication of improved colleague appreciation. Further study, post-pandemic is needed to evaluate effectiveness of care team efficiency and ongoing work to streamline EHR usage.

Impact of a resident-driven wellbeing committee on resident-perceived wellbeing, burnout, and resilience

BackgroundLimited data exists to guide strategies that reduce risks of burnout amongst pharmacy residents. ObjectiveThe primary objective of this analysis was to characterize wellbeing, burnout, and resiliency among pharmacy residents. The secondary objective was to assess the impact of a resident-run wellbeing committee on wellbeing, burnout, and resiliency. Practice DescriptionIn 2018, a wellbeing committee was developed at an academic medical center with the aim of promoting wellbeing and resilience amongst pharmacy residents. Practice InnovationThe wellbeing committee functions through 3 workgroups focused on resources, engagement, and advocacy. Collectively, these workgroups aim to facilitate wellbeing discussions, plan mindfulness events, and advocate for policies to enhance the wellbeing of residents. Evaluation MethodsPharmacy residents were invited to participate in an electronic survey aimed at characterizing resident wellbeing and assessing the impact of a resident-led wellbeing committee on wellbeing, burnout, and resiliency. The Resident & Fellow Wellbeing Index (RFWI) and Brief Resilience Scale (BRS) were utilized to assess burnout and resiliency, respectively. Continuous and categorical endpoints were assessed utilizing student t tests and chi-square tests, respectively. ResultsA total of 16 of 38 residents participated in this analysis. Scores for RFWI and BRS remained stable throughout the 16-week period. RFWI scores demonstrated that up to 50% of residents scored as “at risk” at any point during the study period, while over 80% of respondents maintained high levels of resilience. More than 50% of respondents reported a positive impact of the wellbeing committee on their wellbeing, burnout, and resilience. ConclusionA resident-led wellbeing committee demonstrated favorable impact on wellbeing, burnout, and resilience for majority of pharmacy residents. While this data suggests that such a committee may serve to protect residents from the negative impacts of burnout, future studies are necessary to further elucidate strategies to promote resident wellbeing.

A systemic look at professional burnout and well-being within an urban cancer center as a roadmap to recovery.

11017 Background: As the U.S. health care system’s vulnerabilities have been laid bare by an unremitting pandemic, it behooves us to build in resiliency as we look towards recovery. The “burnout epidemic” facing oncology clinicians has been well documented prior to the pandemic. From a systemic perspective, however, data across the cancer service line is scant. In an effort to identify the stress points and strengths of an oncology service line, we present cross-sectional data from 2018 examining burnout, physical and emotional well-being, and self-care needs across all primary cancer center roles within a major urban cancer center in NYC. Methods: An anonymous online survey was completed by 310 of 646 (48%) cancer service providers comprised of physicians, nurses, clinical support staff, managers, and clerical staff. The abbreviated Maslach Burnout Inventory (MBI-9), the Mental Health Inventory (MHI), and the brief COPE were included. Results: Respondents ranged from nurses (15%) to clinical support staff (29%), with 79% identifying as female. In a snapshot view, 25% of the sample endorsed feeling burned out from work. Rates of emotional exhaustion were highest among nurses (41%) and lowest among physicians (14%), p < 0.06. Depersonalization rates ranged from 1% for physicians to 11% for nurses and clerical staff (p < 0.003). A breakdown of those who would not choose the same career over again: clerical (36%), management (28%), nurses/clinical support staff (23%) and physicians (11%), p < 0.053). Clinical levels of distress ranged from 20% (clerical staff) to 30% (nurses). Self-reported health (1-5) was lower among clerical staff and nurses (3.1) compared to physicians (3.9), p < 0.001. The majority of staff utilized adaptive coping strategies including positive reframing and planning, with religion and humor often endorsed. Interest in counseling and communication skills training ranged from 56%/57% among physicians to 84%/88% among clerical staff, respectively. Conclusions: This panoramic view of one cancer service line just prior to the pandemic points to particular systemic stresses in areas of emotional exhaustion, career choice questioning, and psychological and physical health. While levels of burnout fall within and below rates reported in the literature, it also points to fault lines affecting key service line positions, particularly nurses and clerical staff. At the same time, it highlights an underlying resiliency in coping and receptivity to self-care and development. In response to this internal needs assessment, our cancer center is working towards building a stronger foundation in which staff will not only survive the expected and unexpected stresses of working in health care but find meaning and joy in work. While we cannot predict the future, we can learn from the past. In this vein, a Well-Being Committee that includes representatives across the cancer service line was launched in 2022.

Building a ‘Culture of Wellness’: Lessons for the Pandemic and Beyond

Building a ‘Culture of Wellness’: Lessons for the Pandemic and Beyond

Exploration of Individual and System-Level Well-being Initiatives at an Academic Surgical Residency Program

Physician well-being is a critical component of sustainable health care. There are few data on the effects of multilevel well-being programs nor a clear understanding of where and how to target resources. To inform the design of future well-being interventions by exploring individual and workplace factors associated with surgical trainees' well-being, differences by gender identity, and end-user perceptions of these initiatives. This mixed-methods study among surgical trainees within a single US academic surgical department included a questionnaire in January 2019 (98 participants, including general surgery residents and clinical fellows) and a focus group (9 participants, all clinical residents who recently completed their third postgraduate year [PGY 3]) in July 2019. Participants self-reported gender (man, woman, nonbinary). Individual and organizational-level initiatives, including mindfulness-based affective regulation training (via Enhanced Stress Resilience Training), advanced scheduling of time off, wellness half-days, and the creation of a resident-driven well-being committee. Well-being was explored using validated measures of psychosocial risk (emotional exhaustion, depersonalization, perceived stress, depressive symptoms, alcohol use, languishing, anxiety, high psychological demand) and resilience (mindfulness, social support, flourishing) factors. End-user perceptions were assessed through open-ended responses and a formal focus group. Of 98 participants surveyed, 64 responded (response rate, 65%), of whom 35 (55%) were women. Women vs men trainees were significantly more likely to report high depersonalization (odds ratio [OR], 5.50; 95% CI, 1.38-21.85) and less likely to report high mindfulness tendencies (OR, 0.17; 95% CI, 0.05-0.53). Open-ended responses highlighted time and priorities as the greatest barriers to using well-being resources. Focus group findings reflected Job Demand-Resource theory tenets, revealing the value of individual-level interventions to provide coping skills, the benefit of advance scheduling of time off for maintaining personal support resources, the importance of work quality rather than quantity, and the demoralizing effect of inefficient or nonresponsive systems. In this study, surgical trainees indicated that multilevel well-being programs would benefit them, but tailoring these initiatives to individual needs and specific workplace elements is critical to maximizing intervention effects.

2534. Development of an Infectious Diseases Fellowship Well-Being Program

BackgroundBurnout in graduate medical education is common and reported in ~70% of Internal Medicine (IM) residents. Most studies have described interventions focused on residency training, but fellowship training suffers from similar challenges and likely similar levels of burnout. After conducting a needs assessment amongst fellows within our Infectious Diseases (ID) fellowship program, we developed a wellness program to address these issues.MethodsIn Spring 2018, we reviewed the existing literature and consulted with local experts on trainee well-being. Based on our findings, we designed a multi-tiered approach to enhance wellness amongst fellows. An ID Fellowship Well-Being Committee (WBC) was created in September 2018 to lead the intervention. The WBC includes an even mix of fellows and faculty at multiple levels at all three main teaching hospitals associated with the program. Meetings occur every other month, and co-chairs (one faculty and one fellow) report back to the program director quarterly. Topic areas and interventions are described in Table 1. Fellows were sent a qualitative survey to evaluate the impact of the well-being interventions to date.ResultsFour of 5 first year fellows responded to the survey, and all felt the retreat should be repeated yearly. Themes identified from the survey included benefits of having protected time together, convening in a low pressure and informal setting to provide feedback, and spending quality time in a non-clinical setting with co-fellows. Fellows cited the wellness retreat as a strength at our annual fellowship external program review.ConclusionBurnout is likely high among IM sub-specialty fellows, and interventions are needed to support the well-being of those trainees. We describe a roadmap for the development of a well-being program at a relatively large, academic ID fellowship program led by a mixed fellow and faculty committee. We will continue to monitor data on fellow burnout and make programmatic changes based on feedback. We are hopeful that our work will empower other programs to engage in developing their own well-being programs. Disclosures All authors: No reported disclosures.

Improving Overall Resident and Faculty Wellbeing Through Program-Sponsored Innovations

This article was migrated. The article was marked as recommended. ProblemStudies suggest that burnout and wellbeing are inversely associated, thus early identification of risk factors for burnout and targeted interventions to improve resident wellbeing could help mitigate these outcomes. However, little is known about the impact of department-sponsored wellbeing programs on improving personal physician wellbeing.ApproachOur innovation attempted to create a culture of physician wellbeing within one year (October 2016-October 2017) after discovering high levels of burnout among our Internal Medicine residents and faculty. All residents and faculty were invited to participate in programming and an internally-developed "Wellness Needs Assessment" tracked the effectiveness of our efforts. Wellness endeavors were generally low-resource/high-yield interventions and included establishing a Physician Wellbeing Committee and budget, creating a robust social media presence, and providing over thirty event-based and continuous wellness interventions throughout the year. OutcomesOver one year, our wellbeing program demonstrated improvements across all ten sub-domains of wellness, although the distribution of responses when comparing their current overall level of wellness did not reach statistical significance. A large decrease in the rate of self-reported "thoughts of self-harm" was noted. Over 90% of participating physicians felt that the "culture of wellness" in the workplace had influenced their personal wellness.Next StepsNext steps include determining which wellbeing interventions are the most effective in promoting a culture of wellness and improving personal wellbeing. We plan to determine sustainability of the program over time, growing our arsenal of effective strategies to improve culture, and determine the effectiveness of this strategy across other specialties and locations.

Medical School Strategies to Address Student Well-Being: A National Survey.

To describe the breadth of strategies U.S. medical schools use to promote medical student well-being. In October 2016, 32 U.S. medical schools were surveyed about their student well-being initiatives, resources, and infrastructure; grading in preclinical courses; and learning communities. Twenty-seven schools (84%) responded. Sixteen (59%) had a student well-being curriculum, with content scheduled during regular curricular hours at most (13/16; 81%). These sessions were held at least monthly (12/16; 75%), and there was a combination of optional and mandatory attendance (9/16; 56%). Most responding schools offered a variety of emotional/spiritual, physical, financial, and social well-being activities. Nearly one-quarter had a specific well-being competency (6/27; 22%). Most schools relied on participation rates (26/27; 96%) and student satisfaction (22/27; 81%) to evaluate effectiveness. Sixteen (59%) assessed student well-being from survey data, and 7 (26%) offered students access to self-assessment tools. Other common elements included an individual dedicated to overseeing student well-being (22/27; 82%), a student well-being committee (22/27; 82%), pass/fail grading in preclinical courses (20/27; 74%), and the presence of learning communities (22/27; 81%). Schools have implemented a broad range of well-being curricula and activities intended to promote self-care, reduce stress, and build social support for medical students, with variable resources, infrastructure, and evaluation. Implementing dedicated well-being competencies and rigorously evaluating their impact would help ensure appropriate allocation of time and resources and determine if well-being strategies are making a difference. Strengthening evaluation is an important next step in alleviating learner distress and ultimately improving student well-being.

Impact of physician workload on burnout in the emergency department

ABSTRACTEmergency medicine is one of the medical fields with the highest rates of physician burnout. Research demonstrates hospitalists believe increasing workloads contribute to decreases in patient safety and satisfaction, and increases in morbidity and mortality. Our objective was to identify if emergency physicians who believe workload impacts patient care also experience worse rates of burnout symptoms.This two-phase study used an online survey with cross-sectional design distributed to emergency medicine physicians following the New Jersey American College of Emergency Physicians (NJ ACEP) Scientific Assembly in May 2016 and members of the ACEP Well-Being Committee and Wellness Section in December 2016.Respondents felt the greatest workload burdens by being ‘…unable to fully discuss treatment options or answer questions of a patient or family member’ or leading to ‘Delay in admitting or discharging patients.’ Excessive workload also contributed to respondents having to ‘Admit to hospital instead of discharge’ and resulted in ‘Worsened patient satisfaction.’ The ‘Emotional Exhaustion’ domain of the Maslach Burnout Inventory was the most highly affected by the perceived effects of workload on patient outcomes and ‘Personal Accomplishment’ was least affected. This research highlights the perception that workload contributing to patient harm may be associated with emergency medicine burnout.

Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study.

BackgroundThe Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a “train-the-champion approach”) with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2).ObjectiveThe objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance.MethodsAn implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering.ResultsChampions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ≈600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (−6.3%, 95% CI −10.1 to −2.5; n=85) equating to ≈30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance.ConclusionsThe beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation.

Professional Wellbeing Committee of WFSA: It is Time to Think and Take Action Regarding the Occupational Health of Anesthesiologists

Occupational wellbeing is a sign of work satisfaction and leads to the overall improvement of life quality. Finding a healthy solution to integrate the work into their lives and manage their balance and satisfaction well will result in better general wellbeing. Citation: Gastao F. Duval Neto. Professional Wellbeing Committee of WFSA: It is time to think and take action regarding the occupational health of anesthesiologists. J Anesth Perioper Med 2015; 2: 111-5. doi: 10.24015/JAPM.2015.0016This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Implementing NICE obesity guidance for staff: an NHS trust audit.

The UK National Institute of Health and Clinical Excellence (NICE) has produced guidelines (CG43) on preventing and managing overweight and obesity, which apply to the National Health Service (NHS) as an employer. To record in an NHS trust baseline assessment and management of obesity by its occupational health (OH) service staff, with reference to the standards in CG43, enabling deficiencies to be identified and improvements to be recommended as a benchmark for future measurement. Criteria relevant to OH in CG43 were identified and data were collected from trust policies, interviews with managers, questionnaires to OH staff, examination of OH resources and case notes of staff attending OH. Results were checked for compliance with CG43 standards. Although the trust met NICE standards as an employer, significant lack of compliance was found in its OH service. Only 53% of staff attending medical examinations had weight recorded, OH resources were inadequate and 75% of its staff had received no training. Problems identified included lack of written guidance, time and care pathways. The resulting action plan included a consultant-led working party liaising with the trust's health and well-being committee, training, enhanced OH resources, an obesity protocol, a database and weight management clinics. We found not only a lack of OH policy guidance but apparent inertia in dealing with obesity. The action plan demonstrated how OH clinical practice can draw upon CG43 to combat obesity in an NHS workforce.

Enhancing the psychological health of medical students: the student well-being committee

Medical schools' emphasis on technical excellence is sometimes at the expense of social and emotional development. This paper describes a programme, orchestrated by a vital Well-Being Committee, that involves students in a wide range of activities to enhance social and emotional well-being. The primary prevention of emotional impairment is the goal.