Workplace interventions to improve well-being and reduce burnout for nurses, physicians and allied healthcare professionals: a systematic review

To address burnout, we need to instate comprehensive solutions that prioritize healthcare professionals’ well-being because of its complex nature. Let’s envision a world that values healthcare workers, supports them, and empowers them to excel without sacrificing their own health. As described earlier, many physicians and surgeons across the United States have independently developed personal routines and methods to protect themselves from burnout and its sequelae; many local health care organizations have launched multiple, well-intentioned initiatives and programs to eliminate or mitigate burnout and restore well-being in their environment. Dr. Christine Sinsky, a practicing internist and vice president for professional satisfaction at the American Medical Association (AMA), estimates that the modern health care workplace is likely causing 80% of the burnout among American physicians (Christine Sinsky, M.D., personal communication, September 22, 2016).14

Interpersonal conflict and poor workplace culture

Healthcare burnout is a complex and Supporting wellness in health care colleagues pervasive issue that threatens the well-being of medical professionals and the quality of patient care. Technology and tools can play a crucial role in supporting healthcare professionals. Organizational approaches to healthcare burnout prevention should focus on creating a supportive work environment.

The results of the data extraction, particularly related to the topics of intervention group content/exercise and implications for future interventions, were summarized and discussed by the reviewers (JB & DA) and other members of the research team. Relaxation techniques targeted at the secondary interventional level (designed to manage stress in the individual worker) were the predominant well-being strategy of choice. Overall, MBE interventions were successful with all but two reporting significantly positive outcomes, however, out of 20 MBE studies, only 6 conducted follow-ups beyond the intervention period and only two implemented active style control groups. Gratitude, self-efficacy, psychological distress and job performance improved significantly postintervention. Postintervention, no significant interaction effects with time or other changes were found for the hassle group, suggesting it was indistinguishable from the control group.12 The gratitude group reported significantly less perceived stress, following the intervention, which was also documented at the 3-month follow-up.

Job Demand-Control Model

Intervention modules that required less time were more likely to be completed. Statistical dropout analyses showed that dropouts were related to intervention assignment and occupational and demographic characteristics. These problems are also reflected in the high drop-out rates; in one study it was as high as 82.5% (41). This is because the main cause of burnout lies in the working conditions of the respective work environment (4). For this, supplementary action at the organizational level is necessary. One study applied a blended learning format, which is a combination of face-to-face meetings and online trainings (web-based) (40).

And, as individuals, surgeons and other physicians have a personal and professional responsibility to keep striving to take care of ourselves and each other, beginning with accepting the limits of our species. In the meantime, local organizations do have the obligation to keep striving to (1) understand the factors underlying burnout in their own environment and (2) find ways to change their own culture to better support well-being. Those that are primarily individual or “personal” tend to have short-term results, whereas structural interventions are both longer lasting and more effective. Data suggest that the best outcomes result from both individual and organizational interventions to build resilience.

• Some research suggests the use of psychological micro-practices, which are activities that focus on better management of the emotional aspects of stress 23, 24, with mindfulness practices to manage the emotional symptoms of exhaustion and depersonalization 25-28.
• Organizational approaches to healthcare burnout prevention should focus on creating a supportive work environment.
• Hsu K, Marshall V. Prevalence of depression and distress in a large sample of Canadian residents, interns, and fellows.
• Mehta et al., evaluated the efficacy of the Relaxation Response Resiliency Program for Palliative Care Clinicians, with positive results (reductions in perceived stress and improvements in perspective-taking).
• The 9-item emotional exhaustion (EE) scale measures feelings of emotional overextension and exhaustion.

Lowering the barriers to participation in exercise and fitness programs and providing ready-to-heat meals, breastfeeding rooms, facilitated medical appointments, and skills training in individual relaxation and stress reduction techniques can be helpful in the context of real organizational restructuring. As mentioned earlier, it has been observed that physicians who allot 20% of their time to patient care pursuits they are passionate about are more resilient and express greater satisfaction at work. The COMPASS (Colleagues Meeting to Promote and Sustain Satisfaction) groups started at Mayo Clinic involve specific dedicated time subsidized by the health system for colleagues to directly meet and discuss relevant issues related to culture, workflow, policy, and patient care. Dr. Tait Shanafelt (now Chief Wellness Officer for Stanford Medicine) and his group at Mayo Clinic have been pioneers in the study of physician burnout and interventions to promote resilience. Individual intervention begins by assessing stressors by questionnaire or interview with a mental health professional followed by intervention aimed at changing behavioral patterns.