Damian Sendler: Predicting clinical and operational outcomes in the workplace is critical to improving the quality of health care. There are only a handful of work environment variables that have this potent impact on health care worker well-being. From an operational standpoint, it’s helpful to think of HCW well-being as workers’ ability to “get the work done” and be ready for the next task or challenge, similar to leadership concerns about staffing levels. HCW emotional exhaustion is an essential metric that predicts clinical and operational outcomes, as well as patient and HCW outcomes. We will take a deep dive into this topic. Assessment and improvement of employee well-being are instructive for management and understanding of a workforce.
The impact and consequences of HCW burnout had already captured the attention of national and international health care leaders before the global pandemic of 2020 placed an even greater strain on busy and stressed HCWs. The World Health Organization, the National Academy of Medicine, the Combined Critical Care Societies, the Accreditation Council for Graduate Medical Education, and many others have all issued formal statements about the need to address burnout in the medical community.
Damian Jacob Sendler: Leaders are scrambling to make evidence-based decisions for several years now, and the existing peer-reviewed literature does not provide a clear road map. If you type “burnout” into PubMed, you’ll see an increase of more than 6-fold over the past two decades, with an even steeper increase in the last three years. There are fewer than 50 randomized controlled trials focusing on interventions to improve burnout among healthcare workers in the medical literature. Almost all of these studies have fewer than 100 participants and are classified as pilot studies because of the small sample size or short-term follow-up. The prevalence or epidemiology of burnout is discussed in many articles, but there is a lack of evidence to support theories and little guidance on possible solutions. Because of this lack of evidence, it’s not surprising that management struggles to manage employee well-being in a way that’s consistent and effective.
Dr. Sendler: Due to the lack of high-quality studies on HCW burnout, this review aims to identify environmental and psychologic factors that contribute to burnout, and synthesize evidence supporting effective interventions to reduce burnout and improve HCW well-being. It is our intention to present our findings from randomized controlled trials on brief tools to improve health care workers’ well-being, funded by the National Institutes of Health. One of the largest existing data sets for HCW well-being, these efforts have provided us with new insights and perspectives to add to the existing literature on tools to enhance well-being. HCWs, administrators, and researchers are encouraged to use this review as a framework for understanding the concept of HCW well-being and providing evidence-based interventions. In this review of HCW well-being, we will discuss the terminology, prevalence, causes, interventions, and the future of HCW work.
Dr. Christina Maslach’s classic definition of burnout is a psychologic syndrome characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment.
5 Psychological burnout has a similar effect on cognitive processing, altering the way people perceive and interact with the world around them. As a simpler and more general definition, we use in our research, burnout is characterized by a decreased capacity to benefit from the healing effects of positive emotions. 6,7 As a result, burnt-out people tend to focus on the bad things happening around them, rather than the good.
Burnout has been linked to lower levels of positive emotions9,10 just like depression and anxiety.
11 Positive emotions have been found to be a crucial link in the chain leading to a sense of greater meaning and purpose12, as well as a speedier recovery from emotional trauma. 13 Hope, for example, is a powerful tool for recharging our batteries. 14,15 Positive emotions have been shown to have a significant impact on a person’s cardiovascular health when compared to negative emotions and control groups. 16 In order to better understand how events or interventions affect burnout, we’ve conducted extensive research into the healing effects of positive emotions. This research helps us better understand how burnout can be increased or decreased in response to these effects.
In what ways has burnout changed over time? Using the job demands–resources model17 since 2001, it has been shown that increasing demands while decreasing resources creates stress on the workforce. 18 Burnout, low engagement, compassion fatigue, moral distress, and low-safety culture are all terms used to describe this phenomenon. Interestingly, the level of strain reported by the workforce is average rather than high when resources increase in line with demands, demonstrating how understanding the two fundamental principles of demands and resources is critical to understanding well-being in the workforce.
Gratitude, interest, and serenity are all examples of positive emotions that aid in the development of personal resources, such as social connections, intellectual abilities, and a desire to improve oneself.
19 Our well-being diminishes as we are unable to access positive emotions due to new or increasing demands at work. Not because the person is weak, but because our health care systems have failed to create environments that encourage employee well-being.
Consider the coronavirus disease 2019 (COVID-19) pandemic to illustrate the job demands–resources model. Stressors to the mental health of HCWs include social isolation, fear of infection, financial strain, unplanned homeschooling, and a lack of control over one’s own future. Additionally, the pandemic has provided HCWs with new resources, such as frequent and surprisingly meaningful opportunities for HCWs to see the inherent value of their work, to powerfully connect with patients, to be appreciated and seen as heroes, to exercise a sense of agency, and to experience deep camaraderie among their colleagues and connection to their organization.. At this time, it’s unclear if these and other resources found during the COVID-19 pandemic will be sufficient to prevent burnout in the event that demand exceeds supply.
As we talk about burnout and well-being, it’s important to define terms that are frequently misunderstood or misused. To be resilient, one must be in a state of psychological well-being that allows them to deal with and recover from a psychological setback. Resistant people are able to cope and have resources that support their health and well-being. 20 In other words, as we’ll see in the sections below under the heading “Addressing Burnout,” well-being is driven by factors and interventions at the individual and organizational (environmental) levels.
Is it possible to have both exhaustion as well as depressive symptoms at once? Despite the fact that depression and burnout share some characteristics, most researchers consider them to be two distinct concepts with their own set of criteria and features. Anhedonia, feelings of worthlessness, exhaustion, and changes in appetite or sleep are all symptoms of depression. It is a psychologic condition that can be either episodic or chronic. 21 The ICD-11 describes burnout as a syndrome caused by “chronic workplace stress that has not been successfully managed,” which is a phenomenon that occurs in the workplace. 21 According to the ICD-11, Dr. Maslach’s original definition of burnout includes feelings of exhaustion or depletion, increased mental distance from one’s job or feelings of negativism or cynicism about one’s job, and decreased professional efficacy as examples of the dimensions of burnout. A recent systematic review and meta-analysis found that burnout and depression are moderately (but not perfectly) correlated from 0.40 to 0.57 across large and diverse data sets, which is consistent with our own findings.6 23 Burnout and depression may appear to share some common characteristics (e.g., a lack of interest and impaired concentration), but the stigma associated with burnout is significantly lower than that of depression, so HCWs are much more willing to seek and use resources for burnout than for depression. Our empirical operationalization of burnout, which we define as “reduced access to positive emotions,” shows that the work environment has a significant effect on both individuals and groups. As a result of this acknowledgment, there is a shared responsibility between the individual and the organization, which suggests possible solutions to burnout.
Researchers often use a variety of psychometrically valid metrics for areas such as burnout, depression, work-life balance, and subjective well-being to assess well-being as a multidimensional construct. 24,25 The Maslach Burnout Inventory, first published in 1981, is currently the most widely used tool for assessing burnout. 26 Emotional exhaustion, depersonalization, and personal accomplishment, which is often equated to job satisfaction, are all assessed by this psychometrically valid and widely used survey27.
The Maslach Burnout Inventory’s emotional exhaustion domain is the most commonly used, despite its siblings, depersonalization and low personal accomplishment, both of which are also present. The first thing to note is that emotional exhaustion by itself has demonstrated sufficient reliability for use at the individual level. 28 According to ICD-10 revision criteria and the DSM-5, 5th edition, it can be used to distinguish between burnt-out outpatients and non-burnt-out outpatients who are suffering from work-related neurasthenia (DSM-V). 29,30 Third, emotional exhaustion consistently produces the highest and most consistent coefficient estimates, according to a psychometric meta-analysis (indicating that the items in the scale group together very well to assess the underlying construct). 31
A 5-item version of the original 9-item emotional exhaustion scale is frequently used to reduce the burden on participants when multiple well-being domains are being assessed. Using this 5-item version, HCWs can predict the prevalence of disruptive behaviors and symptoms of depression,22 as well as HCW work-life balance, Improvement readiness (HCPs’ ability to initiate and sustain quality improvement initiatives)34 and the use of Patient Safety Leadership WalkRounds are also associated with the HCW emotional exhaustion assessments with this 5-item version. 33 Using this scale, we found that assessments of health care workers were consistently responsive to treatment. 33 Supplemental digital content at https://meridian.allenpress.com/aplm in the September 2021 table of contents provides an overview of how to assess burnout, interpret results, and compare yourself to others.
Damian Jacob Markiewicz Sendler: The opposite of emotional exhaustion would be measures of well-being, which have historically been used less frequently on HCWs than on the general population. An important distinction is that the absence of something bad does not necessarily mean the presence of something good. In recent years, there has been a growing interest in assessing the positive aspects of well-being among healthcare workers (HCWs). Scales for measuring positive well-being in health care environments were found to be lacking, so we developed and tested new ones. 6 Resilience was found to be divided into two categories: One is Emotional Thriving, which asks about a person’s ability to thrive (eg, “I get to use my strengths every day at work”), and the other, Emotional Exhaustion, which asks about a person’s level of exhaustion. After adversity or emotional upheaval comes Emotional Recovery, which measures one’s ability to bounce back (eg, “My mood reliably recovers after frustrations and setbacks”)
It has been estimated that 40 to 50 percent of physicians in the United States are burned out, according to recent data.
37 It’s no surprise that there’s a wide range of differences based on regional specialties and geographic locations. 38–40 Burnout definitions and thresholds used in different studies are also a major source of variation. There is a higher rate of burnout among US doctors than among workers in other professions. 37,41 In contrast to other highly educated workers, physicians experience higher levels of burnout despite having more years of education under their belts than those in other professions. 41 Nurses, like physicians, report varying levels of burnout depending on their specialty, workplace, and country of residence. Nursing burnout is estimated to be in the 35–45 percent range, but this may vary significantly depending on the subspecialty or work environment in which the nurse works. However, evidence suggests that burnout isn’t significantly different for other roles such as therapists or technologists, even though there are fewer data on the prevalence of burnout in those fields. 6,22,48 Burnout can be measured in large populations, but it is more important for leaders to understand the local rate of burnout in any given work environment because of the wide variation in burnout.
Burnout has a wide range of negative effects on individuals, including job dissatisfaction and the desire to leave the profession,49 poor sleep, lower-quality interpersonal relationships, a weakened immune system, depression and suicide, and even a shorter lifespan.
50–54 Burnout has far-reaching consequences that go beyond the health care providers who suffer from it. It costs $4.6 billion per year in the United States alone because of the increased turnover and decreased productivity caused by burnout in the health care industry. A HCW’s ability to provide patient care is harmed in almost every way by burnout. 55 Medical errors, infections, hospital admissions, mortality, and patients’ dissatisfaction have all been linked to overworked doctors, who are more likely to suffer from burnout. 56–64 Nurse burnout was the only thing that remained after adjusting for severity of illness, nurse-to-patient ratio, and other potentially confounding variables in one study. 57 An extensive study of 831 work settings from 31 Michigan hospitals found that higher levels of emotional exhaustion were consistently linked to lower teamwork and safety norms, lower ratings of local leaders, poorer work-life balance, and higher levels of burnout in their peers, when work settings were compared by emotional exhaustion quartiles.
Burnout can be compared to a microbiologic disease process by many clinicians. The disease is burnout, the pathogen is the environment, and the immune system is the resiliency of the individual. Thus, an individual who works in a toxic environment (ie, an aggressive pathogen) is at risk of becoming ill, regardless of their personal resilience, whereas an individual who is immunosuppressed may be at risk of burnout even in supportive environments. This theory may shed light on why different people, even when confronted with the same problems, may or may not show signs of burnout.
Think of our surroundings like the pathogen that wears us down and leads to burnout when considering this analogy. However, just as a live attenuated vaccine helps the immune system get ready for future attacks, certain aspects of our work and home environments also help us become more resilient. Meaningful work with leadership recognition, opportunities for personal growth, considerate and supportive colleagues, and leaders who promote autonomy, psychological safety, and adaptability can all be found in these work environments. Personal health, family dynamics, and meaningful social interactions all contribute to a person’s ability to cope with stressful situations at work.
Changes to health care systems are strongly advocated in recent perspectives, taskforces, and national collaborations on HCW well-being. 267 These authors advocate a populist approach to burnout in their articles, urging someone else to take care of everything from the medical record to staffing to workflow. Systemic problems are a significant factor in burnout, and both of these viewpoints have merit. But we believe this approach is lacking in scope when it comes to the actions that must be taken. We must fix both the system and the people who were harmed by it in order to promote well-being. There is strong evidence that one-third to one-half of our health care workers are currently experiencing burnout. Burnout is a contentious issue, so don’t be surprised if an HCW shouts, “Don’t talk about burnou\t, you just fix the system!” at a burnout meeting. Be prepared for these encounters, listen with compassion, and figure out where they are coming from if you’re in charge of well-being initiatives in your company. Leaders can examine the root causes of HCW burnout in order to find ways to improve their employees’ well-being. As a result of the many different causes of burnout, it is important to realize that no single intervention will work for all workers. Consequently, it is critical to understand the context in which an organization operates before deciding on a particular organizational intervention. Leaders risk wasting time and money on an intervention only to discover later that it was only a short-term fix or made no difference in the level of employee burnout. However, patient safety leader walkarounds (described in the following section), for example, may have little or no effect in an environment with an already strong safety culture.
It is also important to note that burnout frequently results from cumulative stressors, so single interventions may be less effective than combined interventions, or opportunities for HCWs to choose between interventions. It is critical for health care leaders to take a comprehensive approach to both organizational and individual factors that influence well-being in order to reduce burnout. Burnout can be exacerbated if organizations fail to address the causes and potential remedies for it. By failing to do so, we risk inadvertently sending the message that a person is only burned out because they are weak or resilient. Messages like these only serve to exacerbate the underlying problem by making employees feel powerless and unsupported by their leaders. Organizational resilience efforts will benefit from an increased focus on personal interventions because many employees will not be able to address their own burnout through workplace interventions alone. It’s a huge undertaking to gather and comprehend the well-being offerings and resources available at the workplace, departmental, institutional, and health system levels. Duke University (Durham, NC) spent over two years cataloging and assembling all of its well-being resources, and it is constantly in need of updates. The ability of leaders to promote and support more comprehensive well-being efforts that give HCWs options is made easier by classifying resources as either organizational or individual in nature.
Burnout in healthcare workers (HCWs) can be reduced through both organizational and individual-level interventions, according to two meta-analyses of these interventions’ effectiveness.
68,69 As a result of these studies, it appears that organizational interventions can have a greater cumulative impact than individual interventions. Unfortunately, organizational interventions require more resources and may be more difficult to maintain than personal interventions.
Systematic alterations to work conditions, such as workloads, resources, and interactions with supervisors and coworkers, are the primary focus of organizational efforts to promote well-being. Aside from being in a position of authority, individuals have little power to influence aspects of the workplace that are the focus of an organization’s interventions.
HCW burnout has risen sharply in recent years, in part because of an increase in the demands placed on HCWs.
Damien Sendler: Healthcare workers face a slew of challenges, including the 24-hour nature of their work, increasing medical and social complexity of patients, increased documentation demands through electronic medical record systems, financial constraints, and a lack of administrative support for clerical tasks. However, physicians who are already feeling the effects of exhaustion are more likely to reduce their clinical effort in the next 48 months. 72
One of the most common methods for reducing physician burnout is to streamline workflow or add clinical support. A number of studies have found a reduction in burnout as a result of efforts to reduce workload. 72,73 Patient-to-nurse ratios can be reduced by adding more advanced practice providers or medical assistants or by offloading clerical duties. These are all examples of interventions. 73–75
The job demands–resources model shows that burnout is not solely a result of increased workload, but rather a result of a combination of factors. When increased demands are not met with increased resources and support from the organization, burnout occurs. Using this information, leaders can ensure that new demands on HCW time are balanced with an increase in resources allocated in order to improve workflow or workload.
HCW well-being is also influenced by work-life balance, which has been scientifically proven to be true.
32,36 Hours worked, number of nights in the hospital, long-duration shifts and consecutive days at work have been linked to burnout. 76–79 Data on work-life balance and burnout are inconclusive, so it’s difficult to draw conclusions. Burnout among medical students and residents hasn’t decreased significantly since the implementation of work-hour restrictions.
Many studies have shown a 20% to 60% higher risk of burnout in women compared to men, which is a significant difference.
82,83 A combination of rising household and child care costs and a growing sense of dissatisfaction with the state of work-life harmony may be to blame for these consequences. 84 Gender differences in burnout have decreased as more women have entered the health care field in recent years. 85 Those under the age of 55 are twice as likely to experience burnout as those over the age of 55. Another risk factor for burnout in the health care workforce is having a spouse or partner who is not a health care worker. 87 Health care leaders, medical schools, and the health care system may benefit from policies and programs designed to specifically counteract some of the culturally ingrained barriers to well-being (eg, robust antidiscrimination and bullying; equitable pay).
Personal well-being and burnout: a broader perspective
89 has prompted a slew of healthcare organizations to implement employee wellness initiatives. More than 4000 employees across 20 hospitals in the United States participated in a large randomized controlled trial of a wellness program that improved self-reported exercise and weight control, but there was no difference in clinical or employment outcomes. 59 Many organizational interventions for personal well-being face this challenge, which is exacerbated by conflicting data on the effects of work hours and the short-term nature of many workflow interventions. Their success is dependent on a significant investment of organizational resources, and they may fail to produce the desired results if they are not properly targeted, promoted, and maintained.
Employees who feel like they have a say in their work environment, as well as some degree of autonomy, are more likely to be engaged. When these highly-trained professionals feel like cogs in a wheel rather than partners, engagement drops and burnout rises. 38,90–92 The lack of engagement that results from employees believing they have no voice at work can be combated by leaders focusing on interventions to engage and empower frontline employees. Leader walkarounds, originally developed by Frankel et al93 and later modified by Pronovost et al94, are a method for executives to support and promote quality improvement efforts.. Leader walkarounds have been linked to improved safety culture93,95 and reduced burnout,96 especially when feedback is provided following the walkaround. 33
Another strategy to empower HCWs by leveraging resources for HCWs is to intentionally involve staff in decision-making and problem-solving. There are strong correlations between safety culture and well-being domains, such as improvement readiness, leadership, teamwork, emotional exhaustion, burnout climate and growth opportunities and career advancement when employees participate in decision-making. 33 If you’re involved in quality improvement projects, you’re less likely to get burned out even though it may increase your work load.73 Burnout appears to be countered by a sense of agency that comes from working to solve some of the day-to-day problems that cause it. You should, however, provide well-being resources, role model the use of them, and make options available to HCWs in work environments that are experiencing burnout before requesting them to show up early and stay late for new quality improvement–related projects.
Workers’ daily experiences and perceptions of work can be profoundly influenced by a sense that local leadership and the organization “has your back.”
92 Staff well-being is influenced by perceptions of local leadership, and a 3.3% reduction in burnout is associated with each point increase in the composite leadership rating. 90 We have also found that HCW assessments of effective leadership are associated with lower rates of emotional exhaustion (J.B.S. unpublished data, July 2020). “Second victims,” those who have been affected by an error, a bad outcome, or a crisis that is unrelated to patient care, need leadership support the most. 97 HCWs involved in medical errors are commonly referred to as second victims in the context of medical errors, with the primary victim being the patient who was harmed. Second victims often report feelings of guilt, shame, moral distress, professional inadequacy, and burnout,98 and in some cases, symptoms of Posttraumatic Stress Disorder (PTSD). 99 Second victims may also be afraid of retaliation or leave the field entirely. 100 A study of more than 1000 nurses found that higher levels of support from management, nurse peers, and physician colleagues buffered against the association between involvement in preventable adverse events and higher burnout. 101 Emotional exhaustion and a better safety culture are reported by HCWs who report that their organization supports second-victims.
The rudeness or incivility of coworkers or patients can have a profound effect on the mood of a team or work environment. 106 Many health care workers report higher levels of emotional exhaustion and depression when they are regularly exposed to rudeness and civility at work, according to a large study involving almost 8000 participants. 22 Staff turnover, deteriorating teamwork, and growing mistrust of management are all exacerbated in an environment marred by disruptive behaviors. Formal professionalism programs, policies that are clear, predictable, and enforced, and engaged leaders who are willing to have difficult conversations are all part of the organization’s efforts to combat disruptive behaviors. The first step is to create a culture where it is safe to discuss and provide feedback on these behaviors. 107 After this point, nonpunitive methods like peer messenger programs have been successfully implemented to reduce the frequency of routine disruptive behaviors, saving punishment for the most severe cases.
Damian Sendler
As a result of the Schwartz Center for Compassionate Healthcare’s efforts, the Schwartz Rounds were created to give healthcare providers an opportunity to openly and honestly discuss the social and emotional issues they encounter while caring for patients and their loved ones.
111 In these multidisciplinary case conferences, patients and health care professionals discuss the psychosocial aspects of challenging cases. With repeated attendance, healthcare workers who have participated in Schwartz rounds report a reduced sense of stress, improved interpersonal relationships, an enhanced ability to deal with psychosocial issues in care and an increased sense of shared purpose. 112–115 Expecting similar results from activities that focus on the psychosocial aspects of care and link HCWs’ daily work to patients’ and families’ benefit is reasonable.
Physicians’ meaning in their work and job satisfaction have been boosted by the Mayo Clinic’s COMPASS program (Colleagues Meeting to Promote and Sustain Satisfaction).
69 A meal is provided, and small groups of six to ten doctors meet during a designated period of time during the workday. Using question prompts, a group leader can elicit discussion on topics that are representative of the stresses that physicians face on a daily basis. Socialization and relationship-building activities were also included in the schedule. When compared to a control group, the COMPASS program showed improvements in empowerment and engagement, as well as a decrease in depersonalization, over the course of the study. Participants in the COMPASS study also reported higher levels of job meaning, but there were no differences between the COMPASS group and the control group in terms of stress, depression symptoms, or job satisfaction. Importantly, these organized efforts to increase the significance of groups of HCWs show promising first steps into a world of deliberate efforts to improve the well-being of organizations, which many leaders are afraid to enter or are completely unaware of.
The availability of various options for HCWs to select individual interventions that suit their particular situation and needs goes hand in hand with organizational efforts to improve well-being. There are a few common threads that run through the various interventions that people can use to improve their resilience and combat burnout. Preventing burnout by increasing positive emotions is the first and most important step you can take. The second set of strategies focuses on self-care activities such as meditation and other forms of introspection. An individual’s job satisfaction can also be improved by implementing techniques that help them find meaning in what they do. Taking part in activities that one enjoys, values, is not difficult, and does not cause one to feel guilty is the best way to improve one’s life, according to research. 116
Burnout sufferers are concerned about their tendency to focus on negative information and potential threats in the environment, rather than noticing positive aspects of the environment. People with higher levels of burnout spent less time looking at uplifting images and more time looking at images that made them feel bad, according to a study using eye tracking technology. 8 Because burnout prevents people from noticing positive events and interactions, their lives become an endless stream of negative experiences, which only serves to exacerbate their state of exhaustion.
Burnout is linked to a focus on negative events, but it is also a predictor of death. A strong link between heart disease mortality and the number of negative tweets (reflections on things going wrong) was found in a large study of Twitter feeds in the northeastern United States. 117 However, there was a link between fewer deaths and positive tweets. In a different study, researchers discovered that young nuns who showed a lot of happiness lived on average ten years longer than their less happy counterparts. 118 Reflecting on the positive is linked to global well-being, according to this article.
When it comes to a “negativity bias,” humans have a hard-wired preference for negative stimuli. “The negative screams at you, but the positive only whispers,” says Barbara Fredrickson, a pioneer in this field. 119 It is a survival mechanism for mammals to be able to recognize, remember, and respond quickly to things that could harm us. 120 The “flight or fight” response is activated at these times, and we see a host of physiological responses, including increased heart rate, blood pressure, and respiratory rate, as well as increased levels of stress hormones, such as adrenaline and cortisol. 121 When we think about the bad things that have happened in our lives, we tend to dwell on them for long periods of time, which can lead to chronic conditions, such as high blood pressure and heart disease. 122
Burnout can be countered by retraining the brain to focus on the good things in life instead of the bad.
24,123 Love, joy, amusement, hope, awe, serenity, inspiration, interest, pride, and gratitude are all positive emotions that can be cultivated. In this context, the goal of positive psychology is not to ignore negative experiences, but to restore a balance between positive and negative experiences in order to promote well-being and happiness. 124 As a result of September 11, 2001, research found that people of all well-being levels were affected by feelings of anxiety, distress, and anger, but those with higher levels of well-being were more likely to see the event as temporary rather than permanent.
Damian Jacob Sendler
“undoing effects of positive emotion” have been demonstrated by Barbara Fredrickson and her colleagues13, which refers to the ability of positive psychology to aid in physiologic recovery following stressful events. In her studies, she’s found that activities that increase feelings of well-being help the body’s vital signs return more quickly to normal after a stressful event. 13
“Three Good Things” has been the most extensively researched method for promoting positive emotions. According to Seligman and colleagues,24 this exercise asks participants to write down three things they are grateful for each night. At the conclusion of the study and six months later, a randomized controlled trial found increases in happiness and decreases in depressive symptoms as a result of using this tool. 24 After just 15 days, a study of healthcare workers found that practicing the “Three Good Things” method led to a decrease in emotional exhaustion and depression, as well as an increase in overall happiness and a more balanced work-life balance over the course of one month, six months, and 12 months of follow-up (Figure 4). 6 After 15 days, participants reported less emotional exhaustion and more emotional thriving and recovery, as well as fewer signs of depression and greater contentment in their work and personal lives, according to a second study. 7 At 6- and 12-month follow-ups, improvements in emotional exhaustion, emotional recovery, depressive symptoms, and work-life balance remained (Figure 5). 95.8 percent of Three Good Things participants said they would recommend the exercise to a friend; 85.3 percent said they had encouraged others to participate in the exercise; and 92.7 percent said they would participate in the exercise again in the future.
Another important predictor of happiness is the quality of one’s social relationships, which has been linked to better cardiovascular and immune system functioning as well as lower levels of stress and depression. 129–133 Social isolation has been found to be just as harmful to your health as smoking more than 15 cigarettes a day, and even more harmful than regular physical activity or a person’s BMI. 129 Similarly, a poor immune response to immunization has been linked to college students’ levels of loneliness. 134 Negative interactions with coworkers, as previously discussed in organizational interventions, appear to be a significant factor in HCW burnout. 22 Study of 20 intensive care units found that informal social interactions with coworkers outside of work and one-on-one conversations amongst colleagues were the most common interventions associated with improved staff well-being 112 This idea of “other people mattering”135 is embodied in our bite-sized well-being tool, 1 Good Chat, which aims to promote meaningful interactions with other people.
Mindfulness meditation, as well as its more recent iterations of self-compassion, have a lot going for them in terms of quality research.
143 Burnout can be alleviated with regular mindfulness meditation training, which has gotten a lot of attention recently. As it turns out, mindfulness training for healthcare workers has been found to have significant moderate effects on anxiety, depression, and psychologic distress as well as a small to moderate effect on burnout and wellbeing in recent meta-analyses of 38 randomized control trials. 144 It’s also been proven that integrating mindfulness into clinical practice is beneficial. At Krasner and colleagues145 we have an 8-week program for primary care physicians on mindfulness, communication and self-awareness. These results were consistent at a 15-month follow-up. They found that mindfulness training had a positive impact on burnout (emotional exhaustion, depersonalization, and personal accomplishment), empathy, and mood disturbances. Qualitative analysis revealed that doctors were satisfied with the training because it allowed them the chance (1) to connect with colleagues to lessen professional isolation, (2) to improve mindfulness skills to better attend patients’ needs and respond more effectively, and (3) develop greater self-awareness in their practice. 146 Some healthcare workers (HCWs) are interested in mindfulness programs for burnout, but others aren’t. A further drawback for many HCWs is the time it takes to complete the required training (typically 8 to 10 weeks or 75 total hours). 146,147 Many of these insights, such as the development of mindfulness, self-compassion, and serenity, have been condensed into our bite-sized well-being tools.
Data show that cultivating positive emotions, self-care and mindfulness can have a positive impact on one’s well-being even though evidence is still in its infancy in this area. Figure 4 shows a rough approximation that can be compared across a few of the interventions. When it comes to emotional exhaustion, the Three Good Things intervention is comparable to mindfulness meditation and coaching. Each intervention has a similar effect on the population as a whole, but the benefits to specific individuals will differ. To put it another way, cultivating positive emotions has long-term benefits, but the most impactful and long-lasting positive emotions will differ for different people. Our recommendation is to try one of these interventions, as well as to consider additional ones, for leaders and health care workers (HCWs).
There are many factors that contribute to the well-being of health care workers, but their impact on patient and organizational outcomes cannot be denied. As a result of their inability to cope with stressful and emotionally draining situations, health care workers suffer from a pathology known as health care worker burnout.
As health care leaders, it is critical that we demonstrate that the well-being of our employees is a top priority for our organization. There is no one-size-fits-all approach to improving the health of a healthcare organization. Using a variety of interventions in tandem is expected to have a greater impact on well-being, especially when addressing the various organizational and individual factors. In order to achieve long-term well-being, it is necessary to address existing HCW burnout while also implementing well-being strategies into the company’s culture.