Fit Their Masks First: National Academy of Medicine Publication Review
In October 2019, the National Academy of Medicine released, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being, a publication of the Committee on Systems Approaches to Improve Patient Care. The focus of the Consensus Study Report centers on improving patient care by supporting clinician well-being. The foundation of quality and safety in patient care is grounded in physician well-being.
Think of airline safety videos instructing passengers to always fit their own mask on before helping any other persons requiring assistance. You can’t help others if you are suffocating yourself.
By first ensuring that physicians are working in the healthiest, most efficient work environment possible, only then are they able to extend their best clinical care to those in need.
There’s much to unpack in the report, but persistent across all opinions on the issue is that burnout is bad for clinicians and for patients. Causes of burnout are complex and multifactorial but there is an indisputable burden on healthcare organizations, technology companies, and regulatory agencies to scrutinize their own contributors. Key issues that need to be addressed include:
- Tactics need to pivot to preventative measures
- The external environment plays the largest role in burnout
- Technology should reduce burnout
- Medical societies, licensing boards, medical education and healthcare delivery organizations need to take concrete steps to make assistance more easily available and reduce the stigma for those seeking help
The report is 312 pages and covers topics, including: extent and consequences of burnout, contributing factors, the influence of the external environment and health information technology, and conclusions. As there is no single solution for reducing burnout, the committee takes a systems-based approach where there is collective, coordinated action across all levels of the health care system. Utilizing principles of human-centered design, human factors and systems engineering, organizational design, and change management, the committee concluded the following recommendations target the factors that are known contributors to burnout and foster well-being. Note: each goals and recommendations are accompanied by prescriptive actions. An abbreviated summary of goals and recommendations are:
1. Create Positive Work Environments: Transform health care work systems by creating positive work environments that prevent and reduce burnout, foster professional well-being, and support quality care.
1A. Health care organizations should develop, pilot, implement, and evaluate organization-wide initiatives to reduce the risk of burnout, foster professional well-being, and enhance patient care by improving the work environment.
1B. To guide new systems that have been designed to promote professional well-being and patient care quality, health care organizations should adopt and apply the following principles that improve the work environment and balance job demands and job resources.
1C. Health care organizations should routinely measure and monitor clinician burnout and ameliorate the work system factors that erode professional well-being.
2. Create Positive Learning Environments: Transform health professions education and training to optimize learning environments that prevent and reduce burnout and foster professional well-being.
2A. Health professions educational institutions and affiliated clinical training sites should develop, pilot, implement, and evaluate initiatives to improve the learning environment and support learner professional well-being.
2B. Health professions educational institutions and affiliated clinical training sites should routinely assess the learning environment and factors that erode professional well-being and contribute to learner burnout. The data should guide systems-oriented efforts to optimize the learning environment, prevent and reduce learner burnout, and improve professional well-being.
2C. Accreditors, regulators, national educational organizations, health professions educational institutions, and other related external entities should partner to support the professional well-being and development of learners.
3. Reduce Administrative Burden: Prevent and reduce the negative consequences on clinicians’ professional well-being that emanate from laws, regulations, policies, and standards promulgated by health care policy, regulatory, and standards-setting entities, including government agencies (federal, state, and local), professional organizations, and accreditors.
3A. Health care policy, regulatory, and standards-setting entities at the federal and state level, such as the U.S. Department of Health and Human Services’ Centers for Medicare & Medicaid Services and The Office of the National Coordinator for Health Information Technology, the National Quality Forum, state legislatures, professional boards, and departments of health, should systematically assess laws, regulations, policies, and standards to determine their effects on clinician job demands and resources as well as the effects on patient care quality, safety, and cost.
3B. Health care policy, regulatory, and standards-setting entities, in conjunction with health care organizations, should appreciably reduce documentation requirements and adopt approaches to documentation and reporting that incorporate human-centered design and human factors and systems engineering approaches and that also are technology-enabled.
4. Enable Technology Solutions: Through collaboration and engagement of vendors, clinicians, and expert health information technology system developers, develop health information technologies to support clinicians in providing high-quality patient care.
4A. Stakeholders should engage clinicians in the design and deployment of health information technology (IT), including electronic health records, using human-centered design and human factors and systems engineering approaches to ensure the effectiveness, efficiency, usability, and safety of the technology.
4B. Federal and state policy makers should facilitate the optimal flow of useful information among all members of the health care community through regulation and rulemaking. Health information sources should be shared efficiently, safely, and securely, including but not limited to electronic health records, electronic pharmacy records, digital health applications, medical devices, and quality data repositories.
4C. Federal policy makers, in collaboration with private sector health IT companies and innovators and other relevant stakeholders, should develop the infrastructure and processes that will lead to a truly patient-centered and clinically useful health information system. This would be an electronic interface that gives the entire care team, including the patient, the ability to collect and use timely and accurate data to achieve high-quality care. A major goal of this new health information system should be to allow clinicians to focus on optimizing patient and population health, while adjuvant processes and technologies derive, to the extent possible, the essential business, administrative, and research data necessary to deliver high-value care efficiently and effectively.
5. Provide Support to Clinicians and Learners: Reduce the stigma and eliminate the barriers associated with obtaining support needed to prevent and alleviate burnout symptoms, facilitate recovery from burnout, and foster professional well-being among learners and practicing clinicians.
5A. State licensing boards, health system credentialing bodies, disability insurance carriers, and malpractice insurance carriers should either not ask about clinicians’ personal health information or else inquire only about clinicians’ current impairments due to any health condition rather than including past or current diagnosis or treatment for a mental health condition. They should be transparent about how they use clinicians’ health data and supportive of clinicians in seeking help.
5B. State legislative bodies should create legal protections that allow clinicians to seek and receive help for mental health conditions as well as to deal with the unique emotional and professional demands of their work through employee assistance programs, peer support programs, and mental health providers without the information being admissible in malpractice litigation.
5C. Health professions educational institutions, health care organizations, and affiliated training sites should identify and address those aspects of the learning environment, institutional culture, infrastructure and resources, and policies that prevent or discourage access to professional and personal support programs for individual learners and clinicians.
6. Invest in Research: Provide dedicated funding for research on clinician professional well-being.
6A. By the end of 2020 federal agencies, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, the Health Resources and Services Administration, and the U.S. Department of Veterans Affairs, should develop a coordinated research agenda to examine:
- Organizational, learning environment, and health care system factors that contribute to occupational distress and threaten or promote the professional well-being of health care learners and practicing professionals;
- The implications of clinician and learner distress and degraded professional well-being on health care and workforce outcomes as well as personal outcomes;
- Potential system-level interventions to improve clinician and learner professional well-being and help those with burnout to recover.
6B. Federal agencies, including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, the Health Resources and Services Administration, and the U.S. Department of Veterans Affairs, should pursue and encourage opportunities for public–private partnerships among a broad range of stakeholders, such as health professional associations, foundations, payers, health care industry, health care organizations, health professions educational institutions, and professional liability insurers, to support research on clinician and learner professional well-being and burnout.
To read the full report, please access the National Academy of Medicine’s website: https://nam.edu/systems-approaches-to-improve-patient-care-by-supporting-clinician-well-being/
There, users can access report highlights, key messages, recommendations and slides.