NAM Panel Lays Out 6-Point Plan for Reducing Clinician Burnout

Marcia Frellick

October 23, 2019

The National Academy of Medicine (NAM) released a report today detailing six goals for preventing and reducing clinician burnout and promoting well-being, citing a need for "reasonable workload balances" and reducing the stigma often associated with the problem.

The burnout epidemic is a threat to all clinicians and trainees, and a threat to patient safety, Victor J. Dzau, MD, NAM president, said in a public briefing on the report this morning.

"Over 50% of physicians and 45% - 60% of medical students and residents have symptoms of burnout," he noted, adding that, "there are high prevalence rates of symptoms of post-traumatic stress disorder and emotional exhaustion among nurses and many other professionals."

The significance of this report is on par with two landmark reports published 2 decades ago, Dzau said: "To Err is Human" and "Crossing the Quality Chasm."

Pascale Carayon, PhD, co-chair of the 17-member consensus report committee, noted that the six goals were developed after a literature review of more than 4000 articles and external review by 14 experts.

The six directives in the report and their rationale include:

Create Positive Work Environments

Executives should be held accountable for creating an environment that promotes high-quality care, job satisfaction, and social support. Recommendations include creating a role at the C-suite level dedicated to clinician well-being and assessing how management decisions, such as introducing new technologies, will affect clinicians' jobs and burnout risk.

Validated tools should be used to monitor burnout levels in organizations and the results should be reported at least annually to leadership and clinicians.

Committee member Sharon Pappas, PhD, RN, chief nurse executive for Emory Healthcare in Atlanta, Georgia, said healthcare organizations should assess total workload and complexity of work expected, including continuing education requirements, maintenance of certification, and work performed outside scheduled hours.

Reduce Stress Starting in Training

Medical, nursing, and pharmacy schools should consider pass/fail grading, improve access to scholarships and loans, better monitor workload (including preparation for licensing exams), and build new loan repayment systems.

Committee member Lynn Crismon, PharmD, dean of the University of Texas at Austin College of Pharmacy, said, "When you look at the positive learning environment, you have to look at the faculty as well as the student learners. We must provide appropriate development of faculty in a positive environment so that they can be positive role models for learners. Clinical faculty are involved in patient care, they're involved in teaching and they are still expected to produce research and scholarship and we must look at reasonable workload balances."

Improve Usability and Relevance of Health IT

Systems including electronic health record systems (EHRs) must be easier for clinicians to use. Health information technology (IT) vendors and healthcare organizations should automate nonessential tasks and reduce documentation demands. Federal policymakers and private health IT companies should collaborate to enable shared decision-making between clinicians and patients.

Reduce Administrative Tasks That Don't Help Patients

Federal and state agencies and standard-setting entities should address burnout generated from laws and policies and eliminate policies that add little or no value to patient care. The entities should evaluate rules related to reimbursement, health IT, quality measures, and reporting and licensure requirements.

Reduce Stigma and Improve Burnout Recovery Services

The report recommends that state legislatures support access to employee assistance and peer support programs and mental health providers without the information being admissible in malpractice lawsuits. Medical licensure or renewal applications questions should focus only on current impairment from any health condition, rather than past diagnoses for a mental health condition.

Committee member Lotte Dyrbye, MD, professor of medicine and medical education at the Mayo Clinic in Rochester, Minnesota, said any collection of the data should be in conjunction with transparent explanation of how the data will be used.

She noted that some organizations require clinicians to reveal past or current diagnoses or treatment for emotional or mental health conditions "despite no evidence that having such a past diagnosis or treatment in any way places patients at risk."

Create a National Research Agenda on Well-Being

"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 on clinician burnout," the report states.

Priorities should include identifying burnout cause across career and life stages; burnout's implications for the workforce and patient safety; and potential systems-level interventions to improve the well-being of clinicians and trainees.

Carayon emphasized that burnout is not a mental health diagnosis.

"Burnout is anchored in the way work is organized and the way care processes are designed. We looked at the chronic imbalance between high job demands and low job resources as major factors that contribute to burnout," she said.

Darrell Kirch, MD, president emeritus of the Association of American Medical Colleges, who was one of the driving forces behind the report, noted that more than 31 organizations came together to underwrite and sponsor the report.

"I think that's a reflection of how broad the awareness is of this problem," he said. "It's a roadmap for where we need to go, but a roadmap isn't much use if you don't take the journey."

He said the medical profession up until about 6 or 7 years ago was in a state of denial about burnout, but this report is a testament to the escalating priority of the issue.

"The most brilliant aspect of the report is the systems framework," he said, "because we historically, I think, when clinicians have been burned out, have felt that it's somehow their fault or that the solution is to fix them, rather than acknowledge the underlying system's problems."

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