Could “Choosing Wisely” help fight health worker burnout?
Managers should involve clinicians in efforts to cut back on unneeded or unproven tasks, team says
Peer-Reviewed PublicationAs hospitals, clinics and health systems seek to overcome the wave of burnout and departures among their clinical staff, they might want to adopt an approach that they’ve used over the past decade in clinical care: choosing wisely.
That’s the recommendation of a team of University of Michigan and Dartmouth College experts who call for managers overseeing health care staff to focus more on asking clinicians to spend their time on the tasks that are most needed, and reduce unnecessary or unproven work that contributes to burnout.
Writing in JAMA Health Forum, the team calls for the adoption of the same approach that the Choosing Wisely campaign has used for the past 10 years.
That campaign, founded by the American Board of Internal Medicine Foundation and embraced by medical professional societies representing many different specialties, has armed clinicians and patients with rules of thumb about which screenings, tests, scans and treatments they can safely avoid ordering for their patients due to lack of evidence that they make a difference.
When it comes to the health care workforce, they write in a new Viewpoint, the same principles could apply to administrative management practices:
- Crowdsource: Ask clinicians to share which aspects of their electronic health record system, clinical management protocols and required administrative or training tasks eat up time without providing value.
- Evaluate: Where possible, check the evidence behind different practices and what might happen if some of them are stopped.
- Prioritize: Reduce the burden on clinicians by stopping, modifying
- Work for change: If “time sucking” tasks are required by regulations, health care organizations can elevate concerns to those in a position to evaluate and potentially modify the requirements. And types of care that lack evidence for their efficacy either way could be ripe for research studies to develop evidence that could guide decisions.
“Choosing Wisely has had an incredible impact on the way we practice medicine,” says Eve Kerr, M.D., M.P.H., the lead author of the new piece, chief of the Division of General Medicine at Michigan Medicine and researcher who has studied the Choosing Wisely movement. “If we can apply these same principles to the way we manage the time and duties of our health care professionals, we could potentially improve workforce satisfaction and retention at a time when this is a critical issue for our nation.”
Kerr and her colleagues cite the National Academy of Medicine’s new National Plan for Health Workforce Well-Being and the American Medicine Association’s new Saving Time Playbook as sources of specific ideas for reducing unnecessary burdens on clinicians and enhancing their well-being.
The Michigan Program on Value Enhancement, a joint effort of the U-M Institute for Healthcare Policy and Innovation and Michigan Medicine, is a good example of how researchers and clinicians can collaborate to drive change, says Kerr, who helped launch MPrOVE several years ago. The program now has a wide range of projects under way to bring evidence to our approaches for enhancing the value of clinical care, approaches that could be easily applied to improving the value of clinical work.
The other authors of the piece are Christopher Friese, Ph.D., R.N., AOCN, of the U-M School of Nursing and Joanne Conroy, M.D. of Dartmouth Health and Dartmouth College’s Geisel School of Medicine.
Enhancing the Value of Clinical Work—Choosing Wisely to Preserve the Clinician Workforce JAMAHealthForum.2022;3(11):e224018.doi:10.1001/jamahealthforum.2022.4018
JOURNAL
JAMA Health Forum
METHOD OF RESEARCH
Commentary/editorial
SUBJECT OF RESEARCH
Not applicable
ARTICLE TITLE
Enhancing the Value of Clinical Work—Choosing Wisely to Preserve the Clinician Workforce
Psychological First Aid training could help improve care workers’ wellbeing
A new study has shown that Psychological First Aid, training originally created for people to support others, can help healthcare workers in care homes improve their own mental wellbeing.
Peer-Reviewed PublicationA new study has shown that Psychological First Aid, training originally created for people to support others, can help healthcare workers in care homes improve their own mental wellbeing.
First developed by the World Health Organisation, Psychological First Aid (PFA) is the globally recommended training for people, such as healthcare workers, who support others during emergencies.
It offers guidance on delivering psychosocial care in the immediate aftermath of an emergency event.
Although PFA training was originally created for people to support others, scientists from Northumbria University and the University of Highlands and Islands (UHI) have now also identified it as a suitable way of helping care workers look after their own mental health and wellbeing.
As part of the national response to the COVID-19 pandemic, in June 2020 the UK government introduced free to access online PFA training in an effort to support frontline staff, such the 1.8 million people working in care homes across the country.
Evaluating the effectiveness of this initiative, academics at Northumbria and UHI investigated the uptake of PFA training among healthcare workers in UK care homes and assessed its effects on their wellbeing.
Funded by the Royal College of Nursing Foundation, the study was the first of its kind and makes recommendations regarding further implementation of Psychological First Aid.
The researchers found that while the uptake of PFA training was low among healthcare workers - less than 10% of study participants had done the training - those who had undertaken PFA coped better.
The results suggest that PFA training helped in overcoming stress and coping via self-growth and improving relationships with others, but there was a concern around accessibility, which academics say could possibly explain the low uptake of training.
Some research participants described that it helped them cope better when thinking of giving up their job and promoted resilience, with one person commenting: “(PFA) has helped me cope better, it was a position I was thinking of giving up at one time and now I have the strength to carry on.”
Others described how it helped support them in their experiences of bereavement to overcome the trauma of the pandemic: “I found it (PFA) useful as it helped me cope with bereavement as well as the experience of seeing relatives affected by COVID-19.” Another participant went as far as to say that PFA training “should be made compulsory for all staff especially in nursing and care homes during the pandemic or not.”
Dr Mariyana Schoultz, the project lead and Associate Professor in Mental Health in Northumbria’s Department of Nursing, Midwifery and Health, said: “Findings suggest that PFA training has the potential to: strengthen resilience for staff in health and social care; promote anti-stigma messages and normalise help seeking behaviour; PFA holds the potential to minimise the risk of developing more serious psychological problems such as Post-Traumatic Stress Disorder (PTSD). But we need more research in this area.
“We therefore recommend that consideration be given to funding an integrated programme of research and development to further develop, implement, and evaluate a co-produced iteration of PFA for use in the UK care home sector and beyond.”
Deepa Korea, Director of the RCN Foundation, said “Staff working in social care during the pandemic faced significant pressures which inevitably had an impact on their own mental health and emotional wellbeing. That’s why I am delighted that the RCN Foundation was able to commission this important study which adds to the body of evidence about the practical ways in which we can support health and social care staff.”
The study, ‘Uptake and Effects of Psychological First Aid Training For Healthcare Workers’ Wellbeing in Nursing Homes: A UK National Survey’ has been published in scientific journal PLOS One.
JOURNAL
PLoS ONE
SUBJECT OF RESEARCH
People
ARTICLE TITLE
‘Uptake and Effects of Psychological First Aid Training For Healthcare Workers’ Wellbeing in Nursing Homes: A UK National Survey’
ARTICLE PUBLICATION DATE
3-Nov-2022
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