Most health care workers desire to provide essential, high-quality care to their patients and ensure their safety. Motivated to "do no harm," clinicians have the welfare of their patients first and foremost, often sacrificing sleep, meals, and personal and family time to be available to their patients. While noble, the financial pressures to reduce health care costs and the introduction of the electronic medical record increased pressure for clinicians to improve productivity while simultaneously requiring them to use technologies that reduce productivity, contributing significantly to clinicians' burdens. Indeed, 80% of physicians report being overextended or at capacity, with no time to see additional patients1 and physicians now spend a significant portion of their time completing paperwork or working within electronic health records. As a result, stress and burnout are at an all-time high, with more than half of physicians reporting at least 1 burnout symptom2 and 54% reporting negative morale.1 Simply put, many clinicians are struggling to experience joy or meaning at work.
Fortunately, increasing attention is being paid to issues of health care worker well-being and, if improved, clinicians, their families, their patients, and their organizations will benefit. First, positive affect engenders job success,3 supporting the notion that provider well-being impacts care and quality of services provided such that healthier and happier providers do a better job. Indeed, evidence shows that care quality and safety decrease as clinician burnout increases.4 A strong culture of health at work is related to improved positive affect (eg, happiness) and reduced negative stress.
Second, focus on employee well-being helps retain talent.5 As the saying goes, "nurses talk with their feet." This wisdom extends to other health care professionals as well. Nearly half of physicians plan to cut back on hours, retire, or seek other means as a mechanism for protecting against the strain of job demands.1 Ensuring that the physical and psychological needs of health care workers are an organizational priority is one way to retain talent and minimize absenteeism and presenteeism (ie, the inability to fully function while at work). Employees who feel supported by their employers are more likely to want to keep their jobs and will help attract and retain the best employees. Thus, when organizations focus on employee well-being, they create an environment that promotes flourishing, which positively impacts the organization's bottom line.
Finally, perhaps most importantly, attending to employee well-being is the right thing to do. Health care workers care deeply about their work and the well-being of those patients and family members whom they serve. It is the organization's moral responsibility to care as deeply for those responsible for patient safety.
WHAT IS NEEDED
Fortunately, health care provider and worker well-being are becoming a central conversation in many health care organizations and professional societies. Showcasing this trend, the World Medical Association's modern successor to the Hippocratic oath now addresses physician's well-being: "I will attend to my own health, well-being, and abilities in order to provide care of the highest standard." While encouraging, the practical and meaningful benefits of current approaches to fulfill this commitment to well-being may be limited for several reasons. First, as even the language of the oath itself suggests, many efforts rely on individual interventions such as practicing mindfulness or building resiliency. Although individual efforts are important, they are less potent than addressing system issues at work such as workload, toxic cultures, and a burdensome electronic health record. Instead, organization-directed interventions are more effective at reducing burnout and improving well-being because they address systemic issues of the job and work environment, such as increasing job control and participation in decision making.6
Second, most efforts focus on "fixing" what is wrong (eg, burnout, depression, turnover). This deficit-based approach is limiting. It requires us to ask the question, "how do I cure illness?" This question is myopic; it focuses on a negative attribute and assumes that a reasonable solution is to reach some satisfactory level of well-being. The problem is that health and well-being exist on a fuller continuum (Figure). This continuum ranges from mortality or complete inability to cope on its most negative end to total vitality and flourishing on its most positive end. Deficit-based approaches are not sufficient for exploring the positive side of the well-being continuum. A more productive question is "how do I prevent illness and create health and happiness?" This abundance-based approach facilitates exploring what would be necessary for health care workers to flourish, that is, to feel their best and perform at their peak, not just at some good enough standard of getting by.
A WAY FORWARD
We suggest that health care organizations need to take a more systematic approach to clinician's well-being that operates with 2 logics. Programming must seek to anticipate risks so that they can prevent them and recover from mistakes by building resiliency. Such a systematic approach would draw upon improvement science to develop a multifaceted intervention, shaped by local context and include measurement and feedback. This multifaceted approach would include interventions aimed toward individuals and would identify, prioritize, and mitigate the main organizational risks to well-being. A systems effort would be framed with shared accountability for both the individual and the organization working to cocreate an organizational culture that helps people thrive. A research agenda is also essential to fill knowledge gaps in order to inform successful wellness initiatives.
This type of systems approach can adopt the organizational framework found to reduce bloodstream infections. This includes (1) declaring and communicating that well-being is a goal; (2) creating an enabling infrastructure to coordinate and manage interventions, providing needed training, design interventions, and measure results; (3) engaging frontline clinicians and connecting them in peer learning communities, and (4) reporting transparently and creating shared accountability.7
The focus on well-being is well placed. Let us hope that health care draws upon improvement science and takes a systematic approach to improve.
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