While physician burnout and other forms of occupational distress are long-standing problems, they were exacerbated by the COVID-19 pandemic. And despite calls from the AMA, National Academy of Medicine and the U.S. surgeon general for organizational action to address burnout, most hospitals and federally qualified health centers (FQHCs) have not made this a strategic priority, according to a study published in The Joint Commission Journal on Quality and Patient Safety.
“Clinician burnout is a serious issue. And in recognizing the gravity of burnout and its potential consequences on clinicians, patients and organizational performance, we wanted to know what our accredited hospitals and federally qualified health centers were doing to assess and address clinician well-being,” said Beth Ann Longo, DrPH, MSN, RN, corresponding author of the study and associate director for the department of research for The Joint Commission.
Between April 21 and June 27, 2022, online surveys were sent to a random national sample of 1,982 Joint Commission-accredited hospitals and 256 accredited federally qualified health centers (FQHCs). The AMA’s road map for joy in medicine (PDF) was used as the framework for the survey. This road map is part of the AMA Joy in Medicine™ Health System Recognition Program.
The survey measured the proportion of hospitals and FQHCs that assessed the prevalence of burnout, established a chief wellness officer position and a wellness committee, made well-being an organizational performance metric and implemented other organization-level interventions to reduce burnout.
“What we learned from the study is that most health care organizations are in the early stages of addressing well-being,” Longo said, noting “we found that only about one-third of the health care organizations conducted a well-being assessment among their clinicians at least once in the previous three years.”
And while nearly half of responding health care organizations reported implementing some kind of intervention to address burnout, fewer than 30% had adopted a comprehensive approach to address well-being. On top of that, only 10% of hospitals and 5% of FQHCs reported having an established senior leadership position responsible for assessing and promoting well-being at the organizational level. Meanwhile, about 29% of FQHCs and 38% of hospitals reported having established a well-being committee.
This signaled that a sizable number of health care organizations “need our support given that many were early in their journey to address clinician well-being,” Longo said.
But for large hospitals with more than 500 beds, about 61% reported that they had surveyed for burnout while 76% had established a well-being committee. Additionally, 78% had implemented interventions to promote clinician well-being and nearly 27% had established a chief wellness officer.
Christine Sinsky, MD, vice president of professional satisfaction at the AMA, is also a co-author of this study.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
“I’ve been part of the National Academy of Medicine Collaborative now for about four years, and there are a significant amount of resources out there. But we just didn’t know where health care organizations are in their journeys,” said David W. Baker, MD, executive vice president of health care quality evaluation and improvement at The Joint Commission.
“Even though there are resources available we’ve heard from many health care organizations that they just don’t know where to begin,” added Dr. Baker, who is editor-in-chief of The Joint Commission Journal on Quality and Patient Safety.
With the road map for joy in medicine from the AMA, “health care organizations have a framework to guide their efforts to address burnout, which is why it was important for us to incorporate components of the road map in the survey design,” Longo said.
“If health care organizations can begin their journey using that framework, we think that they’ll be better positioned to drive action within their facilities,” she added.
“We were surprised at how many health care organizations said they needed resources, especially because the Clinician Well-being Collaborative under the National Academy of Medicine is a large, active group,” Dr. Baker said. “However, it’s very heavily composed of leaders from academic medical centers and better resourced organizations” who are already doing more for well-being.
“That’s one of the things as well that we found in the survey is that smaller hospitals, rural hospitals, are doing even less because they are not aware of those resources,” he said. “So, it’s really important that we understand the significant variation across the country.”
“We also need to remember that hospitals have been really overwhelmed over the last few years. So, part of me is surprised at the results of the survey, but it shouldn’t be surprising because so many organizations have just been trying to stay afloat,” Dr. Baker said. “They need to have a road map. They need resources, but they need to have somebody or some organization that can really help them along. If you’re just coming into this and you don’t understand the literature, it’s quite complex.”
This is where the AMA Physician Well-Being Program can help. The program will help raise awareness, advance knowledge and catalyze change to reduce burnout and promote joy, meaning and purpose for doctors in physician practices and health systems.
“It’s extremely important that organizations know about the well-being of their clinicians,” Longo said. “By measuring well-being, they can identify factors that are contributing to distress among their clinician workforce. With that knowledge, they can look for resources with strategies that target the areas of greatest need or greatest priority.”
“Measurement is also an opportunity to obtain feedback from clinicians on what are the biggest pain points for them specific to their organization,” she said, noting that measuring burnout is “really the first step in engagement and trying to identify priorities.”
Through the AMA Organizational Biopsy®, the AMA offers a set of services for health systems and health care organizations. This includes a well-being assessment tool developed to support holistically measuring and taking action to improve well-being within an organization.
Because burnout is a complex issue, this requires multifaceted approaches, Dr. Baker said. “Ideally, if a health care organization is working on a number of elements—that can be the electronic health record, it can provide a better support for clinicians who are experiencing distress, and offer better teamwork, a whole variety of support—if they understand the problems and they can develop multifaceted interventions, they can really make major improvements.”
AMA STEPS Forward® offers open-access toolkits that provide innovative strategies that allow physicians and their staff to thrive. For example, STEPS Forward offers playbooks filled with actionable resources to help:
Additionally, the AMA STEPS Forward® Innovation Academy offers other opportunities for learning from practice-innovation experts and peers through webinars, mentoring, panel discussions, boot camps and immersion programs. The AMA STEPS Forward Innovation Academy is hosting its first in-person two-day boot camp for FQHCs and other outpatient health centers Sept. 11–12 in Chicago. The boot camp is free.
“The first step in moving forward is identifying somebody who is responsible and that person has to have significant resources and be empowered to do it,” Dr. Baker said. “In the last three years, everybody’s just been struggling to deal with COVID and that has worsened the burnout problem.”
“This is the opportunity for them to think about how we can move forward on the wellness issue. Not just by focusing on recovery from COVID because there were problems before COVID,” he said. “So, to have a leader or leaders engage and get the feelings of the clinicians’ pain points, and then establish a group to try to prioritize and move forward.
“And you have to have that measurement otherwise you don’t know what’s working,” Dr. Baker added, noting the AMA’s “joy in medicine road map is a nice place to move forward, but health care organizations must start with a leader who can measure where the health care organization currently is on its journey to wellness.”