National Plan for
Health Workforce
Well-Being
National Academy of Medicine
Action Collaborative on
Clinician Well-Being and Resilience
NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This publication has undergone peer review according to procedures established by the National Academy of Medicine (NAM). Publication by the NAM signifies that it is the product of a carefully considered process and is a contribution worthy of public attention but does not constitute endorsement of conclusions and recommendations by the NAM. The views presented in this publication are those of individual contributors and do not represent formal consensus positions of the authors’ organizations; the NAM; or the National Academies of Sciences, Engineering, and Medicine.
International Standard Book Number-13: 978-0-309-69467-4
International Standard Book Number-10: 0-309-69467-1
Digital Object Identifier: https://doi.org/10.17226/26744
Library of Congress Catalog Number: 2022918777
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Printed in the United States of America.
Suggested citation: National Academy of Medicine. 2024. National Plan for Health Workforce Well-Being. V. J. Dzau, D. Kirch, V. Murthy, and T. Nasca, editors. NAM Special Publication. Washington, DC: The National Academies Press. https://doi.org/10.17226/26744.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
-GOETHE
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The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on issues of health, health care, and biomedical science and technology. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.
Learn more about the National Academy of Medicine at NAM.edu.
ACTION COLLABORATIVE ON CLINICIAN WELL-BEING AND RESILIENCE
Steering Committee (2022)
VICTOR J. DZAU (Collaborative Co-Chair), National Academy of Medicine
DARRELL G. KIRCH (Collaborative Co-Chair), Association of American Medical Colleges and Stanford University
VIVEK H. MURTHY (Collaborative Co-Chair), U.S. Department of Health and Human Services
THOMAS J. NASCA (Collaborative Co-Chair), Accreditation Council for Graduate Medical Education
ROBYN BEGLEY, American Hospital Association
DON BERWICK, Institute for Healthcare Improvement
KATIE BOSTON-LEARY, American Nurses Association
ROBERT CAIN, American Association of Colleges of Osteopathic Medicine
PAMELA CIPRIANO, University of Virginia School of Nursing and American Nurses Association
CAROLYN CLANCY, Veterans Health Administration
ERNEST J. GRANT, American Nurses Association
BRETT KESSLER, American Dental Association
LUCINDA L. MAINE, American Association of Colleges of Pharmacy
RICK POLLACK, American Hospital Association
BARRY RUBIN, Peter Munk Cardiac Centre, Toronto General Hospital
LEWIS G. SANDY, UnitedHealth Group
TAIT SHANAFELT, Stanford Medicine
RACHEL VILLANUEVA, National Medical Association
MICHELLE A. WILLIAMS, Harvard T.H. Chan School of Public Health
Action Collaborative Members
NANCY H. AGEE, Carilion Clinic
MEGAN AMAYA, The Ohio State University College of Nursing
ELISA ARESPACOCHAGA, American Hospital Association
DAVID BAKER, The Joint Commission
ALAN BALCH, Patient Advocate Foundation
CONNIE BARDEN, American Association of Critical-Care Nurses
KARI SUE BERNARD, American Academy of PAs Task Force on PA Burnout
CAROL A. BERNSTEIN, Albert Einstein College of Medicine/Montefiore Medical Center
JENNIFER BICKEL, Moffitt Cancer Center
ANDREA BORONDY KITTS, Rescue Lung Society
LEE DAUGHERTY BIDDISON, Johns Hopkins Medicine
STEVE BIRD, UMass Chan Medical School
TIMOTHY BRIGHAM, Accreditation Council for Graduate Medical Education
KIRK J. BROWER, University of Michigan
HELEN BURSTIN, Council of Medical Specialty Societies
NEIL BUSIS, Department of Neurology, NYU Langone Health
PASCALE CARAYON, University of Wisconsin–Madison
MARCELA DEL CARMEN, Massachusetts General Hospital
CHRISTINE CASSEL, University of California, San Francisco
CHIA-CHIA CHANG, CDC National Institute for Occupational Safety and Health
ROBERT A. CHERRY, UCLA Health System
LINDA HAWES CLEVER, RENEW
KEVIN COCKROFT, Penn State Health
MICHAEL F. COLLINS, UMass Chan Medical School
ELISHA DANMEIER, RENEW
SARAH DELGADO, American Association of Critical-Care Nurses
VANESSA DOWNING, ChristianaCare
LOTTE DYRBYE, University of Colorado School of Medicine
HEATHER FARLEY, ChristianaCare
JORDYN FEINGOLD, Icahn School of Medicine at Mount Sinai
SUSAN FORNERIS, National League for Nursing
JESSICA FRIED, University of Michigan
JEANE GARCIA-DAVIS, Office of the Surgeon General
SANDY GOEL, University of Michigan
JEFFERY P. GOLD, University of Nebraska Medical Center
THOMAS GRANATIR, American Board of Medical Specialties
HEATHER GUNNELL, Dartmouth-Hitchcock Medical Center
ROBERT E. HARBAUGH, Penn State Health
RICHARD HAWKINS, American Board of Medical Specialties ART
HENGERER, Federation of State Medical Boards
AMY HILDRETH, Atrium Health Wake Forest Baptist Health
SUSAN HINGLE, SIU School of Medicine and American College of Physicians
EVE HOOVER, American Academy of PAs
KEITH HORVATH, Association of American Medical Colleges
DAVID B. HOYT, American College of Surgeons
LISA ISHII, Johns Hopkins Health System
JAY (JULIUS A.) KAPLAN, LCMC Health and American College of Emergency Physicians
JOE KERSCHNER, Medical College of Wisconsin
ANDREA BORONDY KITTS, Rescue Lung Society
BAYLI LARSON, American Society of Health-System Pharmacists
ANNA LEGREID DOPP, American Society of Health-System Pharmacists
COLLEEN LENERS, American Association of Colleges of Nursing
SAUL LEVIN, American Psychiatric Association
LORNA LYNN, American Board of Internal Medicine
MICHAEL MAGUIRE, ChristianaCare and Alfred I. duPont Hospital for Children
ADITI MALLICK, The George Washington University Hospital
BEVERLY MALONE, National League for Nursing
BARRY MARX, Centers for Medicare and Medicaid Services
BERNADETTE MELNYK, The Ohio State University
DAVID MEYERS, Agency for Healthcare Research and Quality
EDITH MITCHELL, National Medical Association
AMY NGUYEN HOWELL, Optum
LOIS MARGARET NORA, Northeast Ohio Medical University
LAVONNE ORTEGA, Centers for Disease Control and Prevention
NISHA PATEL, UAB Medicine
STACEY PAUL, The Joint Commission
HAL PAZ, Stony Brook University
LAUREN PECCORALO, Icahn School of Medicine at Mount Sinai
JESSICA PERLO, Institute for Healthcare Improvement
THOMAS M. PRISELAC, Cedars-Sinai Health System
DAVID S. RAIFORD, Vanderbilt University Medical Center
NIKHIL RAJAPURAM, Icahn School of Medicine at Mount Sinai
JOHN R. RAYMOND, SR., The Medical College of Wisconsin
RICHARD RIGGS, Cedars-Sinai Health System
JON RIPP, Icahn School of Medicine at Mount Sinai and CHARM
DAVID A. ROGERS, UAB Medicine
JOE ROTELLA, American Academy of Hospice and Palliative Medicine
LUKE SATO, CRICO
MARGARET (GRETCHEN) SCHWARZE, University of Wisconsin–Madison
JULIE SEES, American Osteopathic Association
SRIJAN SEN, University of Michigan
TINA SHAH, TNT Health Enterprises, LLC
ROBERT SIMARI, University of Kansas Medical Center
STEVE SINGER, Accreditation Council for Continuing Medical Education
CHRISTINE SINSKY, American Medical Association
CYNTHIA (DAISY) SMITH, American College of Physicians
SONYA G. SMITH, American Dental Education Association
KEVIN SOWERS, Johns Hopkins Health System and Johns Hopkins Medicine
MARLO STEIRER, American Board of Medical Specialties
JAVEED SUKHERA, Institute of Living and Hartford Hospital
V. FAN TAIT, American Academy of Pediatrics
CHRISTINE TODD, SIU School of Medicine
TERRY TSUE, University of Kansas Health System
MARK UPTON, Veterans Health Administration
AMY VINSON, American Society of Anesthesiologists and Harvard Medical School
DAVID WEISSMAN, CDC National Institute for Occupational Safety and Health
ERIC WEISSMAN, Association of American Medical Colleges
AMY WINDOVER, Center for Excellence in Healthcare Communication, Cleveland Clinic
Development of this publication was facilitated by the contributions of the following people:
NAM Staff
KIMBER BOGARD, Deputy Executive Officer, Programs
T. ANH TRAN, Program Officer and Director
FARIDA AHMED, Associate Program Officer (from June 2022)
CATHERINE COLGAN, Research Assistant
SAMANTHA PHILLIPS, Communications Officer
JENNA L. OGILVIE, Deputy Director, Communications
Consultant
CHARLEE ALEXANDER, Independent Consultant
REVIEWERS
The products that compose this volume were reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with review procedures established by the National Academy of Medicine (NAM).
We wish to thank the following individuals for their contributions:
The reviewers listed above provided many constructive comments and suggestions, but they were not asked to endorse the content of the publication and did not see the final draft before it was published. Review of this publication was overseen by KIMBER BOGARD, Deputy Executive Officer, Programs; T. ANH TRAN, Program Officer and Director; FARIDA AHMED, Associate Program Officer; and CATHERINE COLGAN, Research Assistant. Responsibility for the final content of this publication rests entirely with the editors and the NAM.
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CONTENTS
1 Priority Area: Create and Sustain Positive Work and Learning Environments and Culture
2 Priority Area: Invest in Measurement, Assessment, Strategies, and Research
3 Priority Area: Support Mental Health and Reduce Stigma
4 Priority Area: Address Compliance, Regulatory, and Policy Barriers for Daily Work
5 Priority Area: Engage Effective Technology Tools
6 Priority Area: Institutionalize Well-Being as a Long-Term Value
7 Priority Area: Recruit and Retain a Diverse and Inclusive Health Workforce
A Background on the Clinician Well-Being Collaborative and National Plan Process
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DEFINITIONS
Burnout is a workplace “syndrome characterized by high emotional exhaustion, high depersonalization (e.g., cynicism), and a low sense of personal accomplishment” (NASEM, 2019).
Culture is the “combination of a body of knowledge, a body of belief, and a body of behavior…. This includes personal identification, language, thoughts, communications, actions, customs, beliefs, values, and institutions” (NIH, 2021).
Health equity is the “state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or other socially defined circumstance” (NASEM, 2017).
Health systems encompass organizations and people who work to “improve, maintain, or restore the health of individuals and their communities.” Health system settings include hospitals, medical practices, urgent care centers, and other places where health workers deliver care and engage in the “prevention and control of communicable disease and health promotion” (WHO, 2007).
Health workforce comprises a range of occupations, including health workers “such as registered nurses, physicians,” and allied health professionals, “as well as individuals in health care support roles, such as community health workers,” public health workers, “direct support professionals, and caregivers” (HRSA, 2021). “Health workers” is used to encompass the full range of health professionals, and more specific language is used when necessary.
Mental health is a “state of well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community” (WHO, 2022).
Moral distress occurs when an individual faces a dilemma of knowing their ethical responsibility (e.g., the appropriate care for their patients) but is unable to act upon it due to circumstances beyond
their control (Morley et al., 2017). Moral injury is related and occurs when individuals are repeatedly engaging with, failing to prevent, or witnessing such dilemmas (Litz et al., 2009).
Positive work and learning environments are safe and healthy, support the well-being of health workers and learners, and foster ethical and meaningful training and practice (NASEM, 2019).
Professional well-being is a “function of being satisfied with one’s job, finding meaning in work, feeling engaged at work, having a high-quality working life, and finding professional fulfillment in work” (Danna and Griffin, 1999; Doble and Santha, 2008).
Psychological safety is a climate of trust and respect in which people are comfortable expressing and being themselves, and share the belief that teammates will not embarrass, reject, or punish a colleague for speaking up (AMA, 2020; Center for Creative Leadership, 2022; Edmonson, 2018).
Resilience is the ability of an individual, organization, “community, or system to withstand, adapt, recover, rebound, or grow from adversity, stress, or trauma” (NASEM, 2019).
Social determinants of health are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These non-medical factors create socially-defined circumstances that can influence health outcomes (WHO, 2008).
Stigma is a “negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency. A stigma implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual” (APA, 2022).
Workplace stress is the “harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Workplace stress can lead to poor health or even injury” (NIOSH, 2016).
FIGURE AND TABLES
Figure
1 Clinician Well-Being Collaborative Systems Map
Tables
1 Create and Sustain Positive Work and Learning Environments and Culture
2 Invest in Measurement, Assessment, Strategies, and Research
3 Support Mental Health and Reduce Stigma
4 Address Compliance, Regulatory, and Policy Barriers for Daily Work
5 Engage Effective Technology Tools
6 Institutionalize Well-Being as a Long-Term Value
7 Recruit and Retain a Diverse and Inclusive Health Workforce
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ACRONYMS AND ABBREVIATIONS
AMA | American Medical Association |
CDC | Centers for Disease Control and Prevention |
CMS | Centers for Medicare & Medicaid Services |
COVID-19 | coronavirus disease 2019 |
CPT | Current Procedural Terminology |
EHR | electronic health record |
FSMB | Federation of State Medical Boards |
HHS | U.S. Department of Health and Human Services |
HRSA | Health Resources and Services Administration |
IT | information technology |
LGBTQIA+ | lesbian, gay, bisexual, transgender, queer/questioning, intersex, and ally/asexual |
NAM | National Academy of Medicine |
NIH | National Institutes of Health |
NIOSH | National Institute for Occupational Safety and Health |
PPE | personal protective equipment |
PTSD | posttraumatic stress disorder |
SDOH | social determinants of health |
WHO | World Health Organization |