The WIT and the WES: Tools for Categorizing and Evaluating Physician Well-Being Programs.
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ABSTRACT:
SUBMITTER: Philibert I
PROVIDER: S-EPMC7012522 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Purpose of review:Symptoms of burnout affect approximately half of pediatricians and pediatric subspecialists at any given time, with similarly concerning prevalence of other aspects of physician distress, including fatigue, depressive symptoms, and suicidal ideation. Physician well-being affects quality of care, patient satisfaction, and physician turnover. Organizational factors influence well-being, stressing the need for organizations to address this epidemic. Recent findings:Organizational characteristics, policies, and culture influence physician well-being, and specific strategies may support an environment where physicians thrive. We highlight four organizational opportunities to improve physician well-being: developing leaders, cultivating community and organizational culture, improving practice efficiency, and optimizing administrative policies. Leaders play a key role in aligning organizational and individual values, promoting professional fulfillment, and fostering a culture of collegiality and social support among physicians. Reducing documentation burden and improving practice efficiency may help balance job demands and resources. Finally, reforming administrative policies may reduce work-home conflict, support physician's efforts to attend to their own well-being, and normalize use of supportive resources. Summary:Physician well-being is critical to organizational success, sustainment of an adequate workforce, and optimal patient outcomes. Because burnout is primarily influenced by organizational factors, organizational interventions are key to promoting well-being. Developing supportive leadership, fostering a culture of wellness, optimizing practice efficiency, and improving administrative policies are worthy of organizational action and further research.
| S-EPMC6801108 | biostudies-literature
Project description:ObjectiveTo measure well-being at a community level using a valid instrument.Patients and methodsWritten surveys were mailed to a random sample of residents in Olmsted County, Minnesota, in 2015 and 2019 including the 5-item World Health Organization Well-being Index (0-100; for which 100 is the best imaginable well-being or quality of life). Multivariable hierarchical regression was used to evaluate the association between well-being and demographic characteristics, comorbid conditions, and environmental factors.ResultsThe survey was returned by 1232 of 4000 individuals (response rate, 30.80%). The average well-being score was 70.02. Impaired well-being was identified in 223/1187 individuals (18.79%). Adjusted regression models showed that impaired well-being was independently associated with household poverty, financial stress, reduced access to medical or mental health care, ever having depression diagnosed, living in an unsafe community, or being socially isolated.ConclusionOne in 5 people in a county in the US Midwest have impaired well-being. Well-being was associated with several modifiable factors. Data provide a rationale for policies that align transportation and housing and create opportunities for community members to connect and interact in a safe environment.
| S-EPMC8488461 | biostudies-literature
Project description:Policymakers and business leaders often use peer comparison information-showing people how their behavior compares to that of their peers-to motivate a range of behaviors. Despite their widespread use, the potential impact of peer comparison interventions on recipients' well-being is largely unknown. We conducted a 5-mo field experiment involving 199 primary care physicians and 46,631 patients to examine the impact of a peer comparison intervention on physicians' job performance, job satisfaction, and burnout. We varied whether physicians received information about their preventive care performance compared to that of other physicians in the same health system. Our analyses reveal that our implementation of peer comparison did not significantly improve physicians' preventive care performance, but it did significantly decrease job satisfaction and increase burnout, with the effect on job satisfaction persisting for at least 4 mo after the intervention had been discontinued. Quantitative and qualitative evidence on the mechanisms underlying these unanticipated negative effects suggest that the intervention inadvertently signaled a lack of support from leadership. Consistent with this account, providing leaders with training on how to support physicians mitigated the negative effects on well-being. Our research uncovers a critical potential downside of peer comparison interventions, highlights the importance of evaluating the psychological costs of behavioral interventions, and points to how a complementary intervention-leadership support training-can mitigate these costs.
| S-EPMC9303988 | biostudies-literature
Project description:Part One of this two-article series reviews assessment tools to measure burnout and other negative states. Physician well-being goes beyond merely the absence of burnout. Transient episodes of burnout are to be expected. Measuring burnout alone is shortsighted. Well-being includes being challenged, thriving, and achieving success in various aspects of personal and professional life. In this second part of the series, we identify and describe assessment tools related to wellness, quality of life, resilience, coping skills, and other positive states.
| S-EPMC6404719 | biostudies-literature
Project description:Managing ecosystems for multiple ecosystem services and balancing the well-being of diverse stakeholders involves different kinds of trade-offs. Often trade-offs involve noneconomic and difficult-to-evaluate values, such as cultural identity, employment, the well-being of poor people, or particular species or ecosystem structures. Although trade-offs need to be considered for successful environmental management, they are often overlooked in favor of win-wins. Management and policy decisions demand approaches that can explicitly acknowledge and evaluate diverse trade-offs. We identified a diversity of apparent trade-offs in a small-scale tropical fishery when ecological simulations were integrated with participatory assessments of social-ecological system structure and stakeholders' well-being. Despite an apparent win-win between conservation and profitability at the aggregate scale, food production, employment, and well-being of marginalized stakeholders were differentially influenced by management decisions leading to trade-offs. Some of these trade-offs were suggested to be "taboo" trade-offs between morally incommensurable values, such as between profits and the well-being of marginalized women. These were not previously recognized as management issues. Stakeholders explored and deliberated over trade-offs supported by an interactive "toy model" representing key system trade-offs, alongside qualitative narrative scenarios of the future. The concept of taboo trade-offs suggests that psychological bias and social sensitivity may exclude key issues from decision making, which can result in policies that are difficult to implement. Our participatory modeling and scenarios approach has the potential to increase awareness of such trade-offs, promote discussion of what is acceptable, and potentially identify and reduce obstacles to management compliance.
| S-EPMC4460479 | biostudies-other
Project description:BACKGROUND: Medical knowledge and clinical performance ratings are major criteria for assessing the competence of resident physicians. However, these assessments may be influenced by residents' mental health. The relationship between residents' well-being and empathy and assessments of their global performance remains unclear. OBJECTIVE: To determine whether resident well-being and empathy are associated with assessments of their medical knowledge and clinical performance. DESIGN, SETTING, AND PARTICIPANTS: We studied 730 clinical performance assessments completed by peers, supervising residents, and allied health professionals; 193 mini-clinical evaluation exercise (mini-CEX) evaluations; and 260 in-training examinations (ITE) of Mayo Clinic internal medicine residents between January 2009 and August 2010. Multivariate generalized estimating equations were used to evaluate associations between residents' well-being and empathy and assessments of their knowledge and clinical performance. MEASUREMENTS: Independent variables were empathy using the Interpersonal Reactivity Index (IRI), burnout using the Maslach Burnout Inventory, depression using a standardized two-question screening instrument, and quality of life using a Linear Analog Self-Assessment item and the Medical Outcomes Study Short Form (SF-8). Dependent variables were mini-CEX, ITE, and the validated six-item Mayo clinical performance assessment. RESULTS: 202 residents (64.7%) provided both well-being and at least one category of assessment data. In multivariate models, residents' scores on the IRI empathy measure of "the tendency to adopt the psychological view of others" were associated with higher peer ratings on "desirability as a physician for a family member" (beta?=?0.023, 95% CI?=?0.007-0.039, p?=?0.004). Additionally, burnout was associated with higher supervisor ratings of communication (beta?=?0.309, 95% CI?=?0.100-0.517, p?=?0.004). There were no observed associations between ITE or mini-CEX scores and resident quality of life, burnout, fatigue, depression, or empathy. CONCLUSIONS: Most dimensions of resident well-being were not associated with residents' knowledge scores and assessments of their clinical performance by other members of the health care team, which supports the trustworthiness of these measures. Nonetheless, correlations of resident empathy and burnout with assessments completed by peers and supervising residents suggest that some ratings of residents may be influenced by interpersonal factors.
| S-EPMC3286555 | biostudies-literature
Project description:Physician well-being is a complex and multifactorial issue. A large number of tools have been developed in an attempt to measure the nature, severity, and impact of both burnout and well-being in a range of clinical populations. This two-article series provides a review of relevant tools and offers guidance to clinical mentors and researchers in choosing the appropriate instrument to suit their needs, whether assessing mentees or testing interventions in the research setting. Part One begins with a discussion of burnout and focuses on assessment tools to measure burnout and other negative states. Part Two of the series examines the assessment of well-being, coping skills, and other positive states.
| S-EPMC6404708 | biostudies-literature
Project description:BACKGROUND: Resident well-being impacts competence, professionalism, career satisfaction, and the quality of care delivered to patients. OBJECTIVE: We established normative scores and reported evidence of relationship between the Physician Well-Being Index (PWBI) score to other variables and consequence validity for the PWBI in a national sample of residents, and evaluated the performance of the index after substituting the original fatigue item with an item not associated with driving a car. METHODS: We conducted a cross-sectional survey study of a national sample of 20 475 residents. The survey included the PWBI, instruments assessing mental quality of life (QOL) and fatigue, and items on recent suicidal ideation and medical error. Fisher exact test or Wilcoxon/2-sample t test procedures were used with a 5% type I error rate and a 2-sided alternative. RESULTS: Of 7560 residents who opened the e-mail to participate in the study, 1701 (22.5%) completed the survey. Residents with low mental QOL, high fatigue, or recent suicidal ideation were more likely to endorse each of the PWBI items and a greater number of total items (all P < .001). At a threshold score of ≥ 5, the PWBI's specificity for identifying residents with low mental QOL, high fatigue, or recent suicidal ideation was 83.6%. PWBI score also stratified residents' self-reported medical errors. The PWBI performed similarly using either fatigue item. CONCLUSIONS: The 7-item PWBI appears to be a useful screening index to identify residents whose degree of distress may negatively impact the quality of care they deliver.
| S-EPMC3963800 | biostudies-other
Project description:ImportanceBurnout among physicians is high, with resulting concern about quality of care. With burnout beginning early in physician training, much-needed data are lacking on interventions to decrease burnout and improve well-being among resident physicians.ObjectivesTo design a departmental-level burnout intervention, evaluate its association with otolaryngology residents' burnout and well-being, and describe how residents used and perceived the study intervention.Design, setting, and participantsA prospective, nonrandomized crossover study was conducted from September 25, 2017, to June 24, 2018, among all 19 current residents in the Department of Otolaryngology at the University of Minnesota. Statistical analysis was performed from June 28 to August 7, 2018.InterventionsAll participants were assigned 2 hours per week of protected nonclinical time alternating with a control period of no intervention at 6-week intervals.Main outcomes and measuresBurnout was measured by the Maslach Burnout Inventory and Mini-Z Survey. Well-being was measured by the Resident and Fellow Well-Being Index and a quality-of-life single-item self-assessment. In addition to a baseline demographic survey, participants completed the aforementioned surveys at approximately 6-week intervals during the study period.ResultsAmong the 19 residents in the study (10 men [53%]), the overall protected time intervention (week 0 to week 32) was associated with a mean decrease of 0.63 points (95% CI, -1.03 to -0.22 points) in the Maslach Burnout Inventory emotional exhaustion score, indicating a clinically meaningful decrease in burnout, and a mean decrease of 1.26 points (95% CI, -2.18 to -0.34 points) in the Resident and Fellow Well-Being Index score, indicating a clinically meaningful improvement in well-being. The baseline to week 32 mean changes in the Maslach Burnout Inventory depersonalization score, Maslach Burnout Inventory personal accomplishment score, and quality-of-life single-item self-assessment were not clinically meaningful. There were clinically meaningful improvements in 4 of 6 tested Mini-Z Questionnaire items from baseline to week 32: job stress (weighted κ statistic, 0.21; 95% CI, -0.11 to 0.53), burnout (weighted κ statistic, 0.25; 95% CI, -0.02 to 0.53), control over workload (weighted κ statistic, 0.26; 95% CI, -0.01 to 0.53), and sufficient time for documentation (weighted κ statistic, 0.31; 95% CI, 0.08 to 0.54).Conclusions and relevanceThis study found that 2 hours per week of protected nonclinical time was associated with decreased burnout and increased well-being in a small sample of otolaryngology residents. Future randomized clinical studies in larger cohorts are warranted to infer causality of decreased burnout and increased well-being as a result of protected nonclinical time.
| S-EPMC7018397 | biostudies-literature
Project description:Background: The dearth of data on adolescents highlighted in the UN's data disaggregation against the agenda 'no one left behind' calls for research on 'the second decade'. Moreover, India is a country with the world's largest adolescent population, and as such, studies and policies for developing competencies of adolescents are crucial to the country's development; interventions instilling confidence to aspire to a better future in underprivileged adolescents are vital to mitigate inequity. Methods: This intervention study adopted a quasi-experimental design to measure the effectiveness of social groupwork in raising the psychological well-being of adolescents in child sponsorship programs in Kerala. Forty adolescents from a Child Sponsorship Program (CSP) center in Kochi were recruited for the study. Those suggested by the CSP center considering their poor academic performance and behavior problems were allocated to the intervention group and the rest to the comparison group. The intervention was designed in response to the information garnered through a preliminary study and administered to the intervention group (n=20). We conducted pre-test and post-test for both the intervention group and comparison group (n=20). Results: Comparison between pre- and post-measurements carried out using paired sample t-test for the intervention group and comparison group separately gave a p-value of <0.05 for the intervention group and >0.05 for the comparison group. Thus, it was proved that psychological well-being of participants in the intervention group was raised significantly due to the social group work intervention. Conclusions: Applying refined granularity, this research adds data specifically on adolescents enrolled in child sponsorship programs and sets a blueprint for social groupwork to improve their psychological well-being. Proposing a conceptual framework for child sponsorship programs, this study recommends further research in all aspects of its functioning, and interventions at group, family, and community levels, for the well-being and empowerment of marginalized adolescents.
| S-EPMC8276187 | biostudies-literature