Clinician wellbeing and patient care and safety resource page

In partnership with The Ohio State University College (OSU) of Nursing Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, the Health Policy Institute of Ohio has developed this page to describe the relationship between clinician wellbeing and patient care and safety; highlight examples of evidence-informed policies and programs to improve clinician wellbeing; and provide relevant data, information, and resources.


Background

A growing body of research indicates that healthcare clinicians face serious problems related to their overall health and wellbeing, including high rates of burnout, depression, addiction and suicide.

Poor clinician wellbeing contributes to an increased risk for medical errors, adverse patient events, increased costs due to clinician absenteeism, presenteeism and high turnover rates:

  • A 2016 analysis estimated medical errors as the third leading cause of death in the United States, resulting in over 250,000 deaths per year.1 Poor clinician wellbeing is not the only factor contributing to medical errors, however, its increasing prevalence poses a significant threat to patient outcomes.
  • Each year in the United States, burnout is estimated to be responsible for about $4.6 billion in costs related to physician turnover and reduced clinical hours.2 Total costs associated with nurse turnover for an average hospital were estimated to range from $4.4 million to $6.9 million in 2018.3

3 Key takeaways

From the publication A call to action: Improving clinician wellbeing and patient care and safety


This resource page provides a:

  • Framework for the relationship between clinician wellbeing and patient care and safety
  • Data on clinician wellbeing and patient care and safety
  • Examples of evidence-informed policies, programs and practices that improve clinician wellbeing and support high-quality patient care
  • Links to national and Ohio-based organizations working to improve clinician outcomes

Relationship between clinician wellbeing and patient care and safety

The figure below outlines the bidirectional relationship between clinician wellbeing and patient care and safety:

  • Improving clinician wellbeing, including preventing and treating burnout, mental health conditions and addiction, improves patient care and safety.
  • Improving patient care and safety, including decreasing rates of medical errors and adverse patient events, improves clinician wellbeing.

 

Understanding the relationship between clinician wellbeing and patient care and safety enables state policymakers and healthcare leaders to allocate resources and implement policies and programs to improve outcomes for clinicians and their patients.

There are also a number of mediating factors that impact clinician wellbeing and patient care and safety highlighted below.

Clinician wellbeing

Resources

Data on clinician wellbeing and patient care and safety

Examples of evidence-informed policies and programs to improve clinician wellbeing

  • E-Couch: A self-help interactive program with modules for depression, generalized anxiety & worry, social anxiety, relationship breakdown, and loss & grief. E-couch provides evidence-based information and teaches strategies drawn from cognitive, behavioral and interpersonal therapies as well as relaxation and physical activity.
  • Surveys on Patient Safety Culture™ (SOPS™): SOPS surveys ask health care providers and staff about the extent to which their organizational culture supports patient safety. Each SOPS survey is designed to assess patient safety culture in a specific health care setting.
  • STEPSforward™, American Medical Association (AMA): A series of practice transformation modules designed to improve the health and wellbeing of patients by improving the health and wellbeing of physicians. These online modules focus on improving physician wellness, preventing burnout and increasing resilience.
  • Valid and Reliable Survey Instruments to Measure Burnout, Well-Being, and Other Work-Related Dimensions: NAM has developed a summary of established tools to measure work-related dimensions of wellbeing. Each tool has advantages and disadvantages, and some are more appropriate for specific populations or settings. This information is being provided by the Research, Data, and Metrics Working Group of the National Academy of Medicine.
  • Building Capacity for Change: AHRQ has developed tools that can help organizations build the capacity for change to make health care safer. By understanding patient safety concepts and how the team and individual behaviors and attitudes influence safety culture, teams build the foundations for a future of more reliable care.
  • Ohio Patient Safety Institute (OPSI): OPSI works with hospitals and healthcare workers to improve healthcare outcomes in Ohio. Its mission is to be the leader and catalyst in developing and transforming health care into a reliable and safe delivery system. OPSI was the first state-designated Patient Safety Organization by AHRQ.
  • UC San Diego HEAR ProgramUC San Diego School of Medicine: The UC San Diego HEAR program was created to offer confidential support and resources to trainees and healthcare providers that may be dealing with personal and emotional challenges. The HEAR service is independent of the service provided by the UC San Diego Physician Well-Being Committee (PWBC).
  • Center for Integrative Health and WellnessOhio State University Integrative Medicine provides conventional and complementary medicine to promote optimal health, prevent and treat disease and meet each patient’s unique physical, emotional and spiritual health goals.
  • MINDSTRONG: The OSU College of Nursing presents MINDSTRONG, an evidence-based cognitive-behavioral skill-building program to improve resiliency and self-protective factors for the overall wellbeing of students, as well as faculty and staff and their families. Our goal is to leverage consistent, evidence-based interventions to help you modify and develop lifestyle behaviors that improve overall mental health and physical well-being.
  • Mind-Body Skills Training for Resilience, Effectiveness, and Mindfulness (STREAM) Program: An innovative online education program for health professionals. The purpose of this program is to help you learn and practice skills that will help you personally and professionally to become more resilient in the face of stress, more clinically effective in helping patients, and more mindful in your daily life as you learn the latest scientific research about mind-body skills, engage in reflective practices, and use our free online recordings of evidence-based mind-body practices.
  • WELL-BEING index for Pharmacist, American Pharmacists Association (APhA), A validated screening tool invented by the Mayo Clinic to evaluate fatigue, depression, burnout, anxiety/stress, and mental/physical quality of life. The Well-Being Index represents one of the many efforts APhA has undertaken in its commitment to address pharmacist burnout and pave the way for real opportunities to improve the well-being and resiliency of pharmacists and pharmacy personnel.

Reports and consensus studies on clinician wellbeing and patient care and safety

  • A Crisis in Health Care: A Call to Action on Physician Burnout, Massachusetts Medical Society: Provides physician and patient perspectives to influence health-related legislation at both state and federal levels, works in support of public health, provides expert advice on physician practice management, and addresses issues of physician wellbeing.
  • Physician Wellness and BurnoutFederation of State Medical Boards (FSMB): FSMB Report and Recommendations of the Workgroup on Physician Wellness and Burnout.
  • Healing the Healers: Legal Remedies for Physician Burnout: Healing the Healers provides legal remedy recommendations for Physician Burnout. Healing the Healers has partnered with the Institute for Collective Trauma and Growth to help leaders to address long-term emotional and spiritual care needs, build trauma-informed programs and ministries and partner across professional sectors for whole community care.
  • “Joy in Work” white paperInstitute for Healthcare Improvement (IHI): This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to understand the barriers to joy in work better, and co-create meaningful, high-leverage strategies to address these issues.
  • Enhancing Well-being and Resilience Among the Pharmacist Workforce, A National Consensus Conference, American Pharmacists Association, American Association of Colleges of Pharmacy, Accreditation Council for Pharmacy Education, National Association of Boards of Pharmacy, and the National Alliance of State Pharmacy Associations: In response to rapid changes in pharmacy practice models and a changing and evolving healthcare system that impacts the wellbeing of the nation’s pharmacists, 85 individuals representing pharmacists and employers from across practice settings, schools and colleges of pharmacy, regulators, accreditors and professional organizations have agreed to a set of 50 recommendations to address critical issues related to pharmacist wellbeing.
  • Ohio Children’s Hospital Solutions for Patient Safety (OCHSPS): The OCHSPS formed as the first network of its kind in the country to achieve a goal that is broader in scope and bolder in ambition — eliminating all serious harm in Ohio’s children’s hospitals. The network is focused on eliminating Serious Safety Events (SSEs) in Ohio children’s hospitals.
  • Patients over Paperwork initiativeCenters for Medicare & Medicaid Services (CMS): CMS Administrator Seema Verma launched the “Patients over Paperwork” initiative, which is in accord with President Trump’s Executive Order that directs federal agencies to “cut the red tape” to reduce burdensome regulations. Through “Patients over Paperwork,” CMS established an internal process to evaluate and streamline regulations to reduce unnecessary burden, increase efficiencies and to improve the beneficiary experience.
  • Regulation: Addressing Nursing Practice Breakdown: An Alternative Approach to Remediation, Journal of Nursing:This article presents a new approach to nursing practice assessment and remediation for nurses sanctioned for a practice violation and includes case studies of two registered nurses (RNs) who entered an agreed order to complete a remediation discipline program as an alternative to traditional discipline.
  • Physician Wellness and BurnoutFederation of State Medical Boards (FSMB): FSMB Report and Recommendations of the Workgroup on Physician Wellness and Burnout.
  • Healing the Healers: Legal Remedies for Physician Burnout: Healing the Healers provides legal remedy recommendations for Physician Burnout. Healing the Healers has partnered with the Institute for Collective Trauma and Growth to help leaders to address long-term emotional and spiritual care needs, build trauma-informed programs and ministries and partner across professional sectors for whole community care.
  • “Joy in Work” white paperInstitute for Healthcare Improvement (IHI): This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to understand the barriers to joy in work better, and co-create meaningful, high-leverage strategies to address these issues.
  • Enhancing Well-being and Resilience Among the Pharmacist Workforce, A National Consensus Conference, American Pharmacists Association, American Association of Colleges of Pharmacy, Accreditation Council for Pharmacy Education, National Association of Boards of Pharmacy, and the National Alliance of State Pharmacy Associations:In response to rapid changes in pharmacy practice models and a changing and evolving healthcare system that impacts the wellbeing of the nation’s pharmacists, 85 individuals representing pharmacists and employers from across practice settings, schools and colleges of pharmacy, regulators, accreditors and professional organizations have agreed to a set of 50 recommendations to address critical issues related to pharmacist wellbeing.
  • Ohio Children’s Hospital Solutions for Patient Safety (OCHSPS): The OCHSPS formed as the first network of its kind in the country to achieve a goal that is broader in scope and bolder in ambition — eliminating all serious harm in Ohio’s children’s hospitals. The network is focused on eliminating Serious Safety Events (SSEs) in Ohio children’s hospitals.
  • Patients over Paperwork initiativeCenters for Medicare & Medicaid Services (CMS): CMS Administrator Seema Verma launched the “Patients over Paperwork” initiative, which is in accord with President Trump’s Executive Order that directs federal agencies to “cut the red tape” to reduce burdensome regulations. Through “Patients over Paperwork,” CMS established an internal process to evaluate and streamline regulations to reduce unnecessary burden, increase efficiencies and to improve the beneficiary experience.
  • Regulation: Addressing Nursing Practice Breakdown: An Alternative Approach to Remediation, Journal of Nursing:This article presents a new approach to nursing practice assessment and remediation for nurses sanctioned for a practice violation and includes case studies of two registered nurses (RNs) who entered an agreed order to complete a remediation discipline program as an alternative to traditional discipline. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3244831 A Crisis in Health Care: A Call to Action on Physician Burnout, Massachusetts Medical Society: Provides physician and patient perspectives to influence health-related legislation at both state and federal levels, works in support of public health, provides expert advice on physician practice management, and addresses issues of physician wellbeing.
  • Physician Wellness and BurnoutFederation of State Medical Boards (FSMB): FSMB Report and Recommendations of the Workgroup on Physician Wellness and Burnout.
  • Healing the Healers: Legal Remedies for Physician Burnout: Healing the Healers provides legal remedy recommendations for Physician Burnout. Healing the Healers has partnered with the Institute for Collective Trauma and Growth to help leaders to address long-term emotional and spiritual care needs, build trauma-informed programs and ministries and partner across professional sectors for whole community care.
  • “Joy in Work” white paperInstitute for Healthcare Improvement (IHI): This white paper is intended to serve as a guide for health care organizations to engage in a participative process where leaders ask colleagues at all levels of the organization, “What matters to you?” — enabling them to understand the barriers to joy in work better, and co-create meaningful, high-leverage strategies to address these issues.
  • Enhancing Well-being and Resilience Among the Pharmacist Workforce, A National Consensus Conference, American Pharmacists Association, American Association of Colleges of Pharmacy, Accreditation Council for Pharmacy Education, National Association of Boards of Pharmacy, and the National Alliance of State Pharmacy Associations:In response to rapid changes in pharmacy practice models and a changing and evolving healthcare system that impacts the wellbeing of the nation’s pharmacists, 85 individuals representing pharmacists and employers from across practice settings, schools and colleges of pharmacy, regulators, accreditors and professional organizations have agreed to a set of 50 recommendations to address critical issues related to pharmacist wellbeing.
  • Ohio Children’s Hospital Solutions for Patient Safety (OCHSPS): The OCHSPS formed as the first network of its kind in the country to achieve a goal that is broader in scope and bolder in ambition — eliminating all serious harm in Ohio’s children’s hospitals. The network is focused on eliminating Serious Safety Events (SSEs) in Ohio children’s hospitals.
  • Patients over Paperwork initiativeCenters for Medicare & Medicaid Services (CMS): CMS Administrator Seema Verma launched the “Patients over Paperwork” initiative, which is in accord with President Trump’s Executive Order that directs federal agencies to “cut the red tape” to reduce burdensome regulations. Through “Patients over Paperwork,” CMS established an internal process to evaluate and streamline regulations to reduce unnecessary burden, increase efficiencies and to improve the beneficiary experience.
  • Regulation: Addressing Nursing Practice Breakdown: An Alternative Approach to Remediation, Journal of Nursing:This article presents a new approach to nursing practice assessment and remediation for nurses sanctioned for a practice violation and includes case studies of two registered nurses (RNs) who entered an agreed order to complete a remediation discipline program as an alternative to traditional discipline.


Organizations working to improve clinician wellbeing

National

  • American Society of Health Systems Pharmacy (ASHP),Wellbeing & You: Launched as a resource for pharmacists, pharmacy residents, student pharmacists, and pharmacy technicians. This website is also a place for colleagues to share their experiences with burnout and to pledge their commitment to strengthening personal and workplace resilience. See the ASHP Statement on Commitment to Clinician-Well Being and Resilience.
  • Accreditation Council for Graduate Medical Education (ACGME)- Improving Physician Well-Being Hub: Committed to exploring causes of and solutions for physician wellbeing for as long as the organization has been serving the graduate medical education (GME) community.
  • American Medical Association (AMA), Joy in Medicine™ Recognition: AMA research summaries discuss physician burnout, its causes and the impact burnout has on physicians, patients and healthcare organizations.


State

  • Ohio Nurses Association (ONA)Members who are labor, nursing practice and health policy experts have formed the Workplace Violence Task Force; a group tasked with setting in motion action items ONA and its members will be taking on. See ONA resources on workplace violence.
  • OSU: Home to the Wexner Medical Center and seven health sciences colleges, the largest health sciences campus in the country, and is fully committed to clinician wellbeing. See OSU Commitment Statement.
  • Ohio Physician Wellness Coalition: The Ohio Physician Wellness Coalition (OPWC) was established in 2017 by Ohio’s major physician associations. Led by their Physician Advisory Council (PAC), their goal is to address physician burnout by providing physician wellness initiatives. See Physician Wellness Series – free CME credit offered

Health professional boards and associations

Boards


State-wide associations

Note: List is not exhaustive



Last updated 2/11/2020

  • Makary, Martin A., and Michael Daniel. “Medical error—the third leading cause of death in the US.” Bmj 353 (2016): i2139.
  • Han, Shasha, et al. “Estimating the Attributable Cost of Physician Burnout in the United States.” Annals of Internal Medicine 170, no. 11 (2019): 784-790. doi:10.7326/M18-1422. 
  • Colosi, Brian. 2019 NSI National Health Care Retention & RN Staffing Report. East Petersburg, PA: NSI Nursing Solutions, Inc, 2019.