By Christopher Cheney
The Ohio State University College of Nursing and the Health Policy Institute of Ohio have released a comprehensive plan to improve clinician wellbeing.
Burnout is one of the top challenges facing clinicians and other healthcare workers nationwide. In a report published last week by The Physicians Foundation, 30% of more than 2,300 physicians surveyed cited feelings of hopelessness or having no purpose due to changes in their practices related to the coronavirus pandemic. Research published in September 2018 indicates that nearly half of physicians across the country are experiencing burnout symptoms.
The new comprehensive plan to improve clinician wellbeing has four primary components.
1. Wellness culture
The plan calls on health systems and hospitals to advance an organizational culture that supports wellness such as appointing a chief wellness officer.
“You must take a systematic, multi-component approach to culture. That means you have got to work this from the grassroots to managers, supervisors, and top leaders. You have got to hit all of those areas if you really expect to change culture,” says Bernadette Melnyk, PhD, RN, APRN-CNP, dean of the College of Nursing and chief wellness officer at The Ohio State University in Columbus, Ohio.
She gave several examples of a multi-faceted strategy to establish a wellness culture.
“You have got to have policies that are directed to people’s wellbeing. You have got to have a system-wide team under the chief wellness officer that can work with point-of-care clinicians. But first, anybody who is serious about creating a culture of wellness must assess the extent of the issue—that is super important. To do a survey for the sake of doing a survey is not worth doing. You need to assess the problem first, then use that data for targeted interventions.”
Flex work is a good example of a policy that supports clinician wellness, Melnyk says. “Clinicians need leaders to give them permission to have some flexibility in their work.”
2. Targeted programs
To foster clinician wellness, health systems and hospitals should promote programs that reduce burnout and strengthen resiliency among healthcare students and clinicians such as cognitive behavioral therapy and trauma support.
Promoting resiliency is a preventive measure to address burnout, Melnyk says. “It is protective against burnout, and it is protective against depression and anxiety. There is a big misperception about resiliency. A lot of people think you are either born with it or not. That could not be further from the truth. Resiliency skills can be built across your lifetime.”
Clinicians should not view resiliency training as a form of victim blaming, she says.
“To fix the burnout problem, you cannot just put it on the clinicians and the nurses because we have major system problems that need to be fixed. When you spend more of your time in the electronic health record than you do taking care of your patients—which is the main reason nurses and physicians came into the profession—you have a system problem that is taking away purpose and joy in work. So, we must fix the system, but we also must give clinicians permission to take good self-care. How can we be at our best or fully engaged in our practices and in our jobs if we are totally burned out?”
3. Focus on mental health
Health systems and hospitals should require confidential mental health and addiction screening, provide referral and treatment services for healthcare students and clinicians, and address mental health and addiction prejudice such as stigmatizing language on clinician licensure applications.
Provision of mental health services is a key factor in promoting clinician wellness, Melnyk says. “In a national study I did, depression among nurses was the leading cause of medical errors. In this sample, I had nearly 1,800 nurses from across the country. Depression also is the biggest predictor of suicide.”
4. Statewide reporting system
Health systems and hospitals should participate in a statewide reporting mechanism to monitor and track data on healthcare student and clinician wellness.
This kind of reporting system can play a pivotal role in boosting clinician wellness and addressing burnout, Melnyk says. “You need reporting so you can hot-spot problem areas and target them with interventions.”
A statewide reporting system should not only include clinician outcomes such as depression, burnout, anxiety, and suicidal intent, she says.
“In addition to tracking clinician outcomes, you need to track key outcome indicators for the hospitals and health systems. With that information, you can see what is predictive of factors such as clinician turnover, patient complications, and medical errors.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.