Optimizing workforce well-being and retention in integrated health systems: A multidisciplinary approach to combating burnout
Keywords:
workforce retention, burnout management, organizational culture, staff satisfaction, nursing leadership, pharmacy leadership, resilience training, healthcare systemsAbstract
Background: Workforce retention, staff satisfaction, and the quality of patient care are critically influenced by burnout and turnover rates, which are significant concerns in healthcare systems. Burnout, characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment, results in high turnover, increased costs, and poorer patient outcomes. Addressing burnout is essential for ensuring the efficiency and sustainability of healthcare organizations. Aim: This study aims to explore the complex relationship between burnout and staff retention within integrated health systems, identify key contributing factors, and evaluate evidence-based strategies to mitigate burnout and enhance retention, specifically in nursing and pharmacy sectors. Methods: A systematic review of peer-reviewed literature published was conducted, focusing on burnout and staff retention in healthcare settings. Additionally, qualitative interviews with healthcare leaders, including nurses, pharmacists, and administrators, were analyzed to gain insights into organizational practices and effective interventions. Outcomes of these interventions were assessed using validated burnout scales, staff satisfaction surveys, and retention metrics. Results: The review identified workload demands, insufficient staffing, lack of organizational support, and poor leadership practices as the primary contributors to burnout in integrated health systems.
Downloads
References
Bakker, A. B., & Demerouti, E. (2007). The job demands-resources model: State of the art. Journal of Managerial Psychology, 22(3), 309–328. DOI: https://doi.org/10.1108/02683940710733115
Schaufeli, W. B., & Taris, T. W. (2014). A critical review of the job demands-resources model: Implications for improving work and health. Bridging Occupational, Organizational and Public Health, 43–68. DOI: https://doi.org/10.1007/978-94-007-5640-3_4
Bass, B. M., & Riggio, R. E. (2006). Transformational Leadership. Mahwah, NJ: Lawrence Erlbaum Associates.
Shanafelt, T., Ripp, J., & Trockel, M. (2021). Understanding and addressing sources of anxiety among healthcare professionals during the COVID-19 pandemic. JAMA, 323(21), 2133–2134. DOI: https://doi.org/10.1001/jama.2020.5893
Greenberg, N., Docherty, M., Gnanapragasam, S., & Wessely, S. (2021). Managing mental health challenges faced by healthcare workers during the COVID-19 pandemic. BMJ, 368, m1211. DOI: https://doi.org/10.1136/bmj.m1211
West, M. A., & Dawson, J. F. (2012). Employee engagement and NHS performance. The King’s Fund.
Leiter, M. P., & Maslach, C. (2021). Understanding burnout: New models and their implications. Burnout Research, 3(4), 89–100. DOI: https://doi.org/10.1016/j.burn.2016.09.001
Aiken, L. H., Clarke, S. P., Sloane, D. M., et al. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50(4), 187–194.
McHugh, M. D., & Ma, C. (2014). Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Medical Care, 53(1), 52–59.
Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout engagement. Journal of Nursing Administration, 36(5), 259–267. DOI: https://doi.org/10.1097/00005110-200605000-00019
Shanafelt, T. D., & Noseworthy, J. H. (2022). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
Gittell, J. H., Godfrey, M., & Thistlethwaite, J. (2013). Interprofessional collaborative practice and relational coordination: Improving healthcare through relationships. Journal of Interprofessional Care, 27(3), 210–213. DOI: https://doi.org/10.3109/13561820.2012.730564
Moss, M., Good, V. S., Gozal, D., Kleinpell, R., & Sessler, C. N. (2021). An official critical care societies collaborative statement: Burnout syndrome in critical care healthcare professionals: A call for action. Critical Care Medicine, 44(7), 1414–1421. DOI: https://doi.org/10.1097/CCM.0000000000001885
Montgomery, A., & Spânu, F. (2020). Burnout in healthcare: The case for organizational change. Burnout Research, 2(2–3), 80–89.
West, M. A., & Dawson, J. F. (2012). Employee engagement and NHS performance. The King’s Fund.
Dyrbye, L. N., Shanafelt, T. D., Sinsky, C. A., et al. (2022). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. The Joint Commission Journal on Quality and Patient Safety, 43(11), 611–617.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576.
Dyrbye, L. N., Varkey, P., Boone, S. L., et al. (2013). Physician satisfaction and burnout at different career stages. Mayo Clinic Proceedings, 88(12), 1358–1367. DOI: https://doi.org/10.1016/j.mayocp.2013.07.016
Jones, C. B. (2008). Revisiting nurse turnover costs: Adjusting for inflation. Journal of Nursing Administration, 38(1), 11–18. DOI: https://doi.org/10.1097/01.NNA.0000295636.03216.6f
Shanafelt, T. D., Gorringe, G., Menaker, R., et al. (2020). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432–440.
Gittell, J. H., Seidner, R., & Wimbush, J. (2010). A relational model of how high-performance work systems work. Organization Science, 21(2), 490–506. DOI: https://doi.org/10.1287/orsc.1090.0446
Tawfik, D. S., Profit, J., Morgenthaler, T. I., et al. (2022). Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clinic Proceedings, 93(11), 1571–1580. DOI: https://doi.org/10.1016/j.mayocp.2018.05.014
West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2021). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388(10057), 2272–2281.
Prentice, T. M., Engel, M., Tapley, A., et al. (2022). Communication skills training for medical practitioners to improve patient satisfaction: A systematic review. BMJ Open, 7(7), e015491.
Maslach, C., & Leiter, M. P. (2021). Understanding burnout: New models and their implications. Burnout Research, 3(4), 89–100.
Montgomery, A., & Spânu, F. (2020). Burnout in healthcare: The case for organizational change. Burnout Research, 2(2–3), 80–89.
Melamed, S., Shirom, A., Toker, S., et al. (2006). Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions. Psychological Bulletin, 132(3), 327–353. DOI: https://doi.org/10.1037/0033-2909.132.3.327
Wallace, J. E., Lemaire, J. B., & Ghali, W. A. (2009). Physician wellness: A missing quality indicator. The Lancet, 374(9702), 1714–1721. DOI: https://doi.org/10.1016/S0140-6736(09)61424-0
Bass, B. M., & Riggio, R. E. (2006). Transformational Leadership. Mahwah, NJ: Lawrence Erlbaum Associates. DOI: https://doi.org/10.4324/9781410617095
Laschinger, H. K. S., Wong, C. A., & Grau, A. L. (2013). Authentic leadership, empowerment, and burnout: A comparison in new graduates and experienced nurses. Journal of Nursing Management, 21(3), 541–552.
Avolio, B. J., & Gardner, W. L. (2005). Authentic leadership development: Getting to the root of positive forms of leadership. The Leadership Quarterly, 16(3), 315–338. DOI: https://doi.org/10.1016/j.leaqua.2005.03.001
Wong, C. A., & Laschinger, H. K. S. (2020). The influence of frontline manager job strain on burnout, commitment, and turnover intention: A cross-sectional study. International Journal of Nursing Studies, 52(12), 1824–1833. DOI: https://doi.org/10.1016/j.ijnurstu.2015.09.006
Shanafelt, T. D., Gorringe, G., Menaker, R., et al. (2020). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432–440.
Gittell, J. H. (2009). High performance healthcare: Using the power of relationships to achieve quality, efficiency, and resilience. New York, NY: McGraw Hill.
Aiken, L. H., Clarke, S. P., Sloane, D. M., et al. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50(4), 187–194.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576.
McHugh, M. D., & Ma, C. (2014). Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Medical Care, 53(1), 52–59. DOI: https://doi.org/10.1097/MLR.0b013e3182763284
Buchan, J., & Seccombe, I. (2012). Overstretched. Under-resourced. The UK nursing labour market review 2012. Royal College of Nursing.
Hayhurst, A., Saylor, C., & Stuenkel, D. (2005). Work environmental factors and retention of nurses. Journal of Nursing Care Quality, 20(3), 283–288.
Scott, E. S., & Miles, J. (2013). Advancing leadership capacity in nursing. Nursing Administration Quarterly, 37(1), 77–82. DOI: https://doi.org/10.1097/NAQ.0b013e3182751998
Drennan, V. M., & Ross, F. (2022). Global nurse shortages: The facts, the impact and action for change. British Medical Bulletin, 130(1), 25–37.
Laschinger, H. K. S., Wong, C. A., & Grau, A. L. (2013). Authentic leadership, empowerment, and burnout: A comparison in new graduates and experienced nurses. Journal of Nursing Management, 21(3), 541–552.
Avolio, B. J., Walumbwa, F. O., & Weber, T. J. (2009). Leadership: Current theories, research, and future directions. Annual Review of Psychology, 60(1), 421–449. DOI: https://doi.org/10.1146/annurev.psych.60.110707.163621
Shanafelt, T. D., & Noseworthy, J. H. (2022). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
Shore, L. M., Randel, A. E., Chung, B. G., et al. (2011). Inclusion and diversity in work groups: A review and model for future research. Journal of Management, 37(4), 1262–1289. DOI: https://doi.org/10.1177/0149206310385943
Nembhard, I. M., & Edmondson, A. C. (2006). Making it safe: The effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams. Journal of Organizational Behavior, 27(7), 941–966. DOI: https://doi.org/10.1002/job.413
McAllister, M., & McKinnon, J. (2009). The importance of teaching and learning resilience in the health disciplines: A critical review of the literature. Nurse Education Today, 29(4), 371–379. DOI: https://doi.org/10.1016/j.nedt.2008.10.011
Krasner, M. S., Epstein, R. M., Beckman, H., et al. (2009). Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. Journal of the American Medical Association, 302(12), 1284–1293. DOI: https://doi.org/10.1001/jama.2009.1384
West, C. P., Dyrbye, L. N., Shanafelt, T. D. (2021). Physician burnout: Contributors, consequences, and solutions. Journal of Internal Medicine, 283(6), 516–529. DOI: https://doi.org/10.1111/joim.12752
Attridge, M. (2009). Employee assistance programs: Evidence and outcomes. The Psychologist-Manager Journal, 12(3), 227–244.
Shanafelt, T. D., & Noseworthy, J. H. (2022). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146.
Edmondson, A. C. (2004). Psychological safety, trust, and learning in organizations: A group-level lens. Annual Review of Psychology, 59(1), 105–131.
Zwack, J., & Schweitzer, J. (2013). If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Academic Medicine, 88(3), 382–389. DOI: https://doi.org/10.1097/ACM.0b013e318281696b
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576.
Holden, R. J., Carayon, P., Gurses, A. P., et al. (2013). SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics, 56(11), 1669–1686. DOI: https://doi.org/10.1080/00140139.2013.838643
Poksinska, B., Fialkowska-Filipek, M., & Engström, J. (2022). Does lean healthcare improve patient satisfaction? A mixed-method investigation into primary care. BMJ Quality & Safety, 26(2), 95–103. DOI: https://doi.org/10.1136/bmjqs-2015-004290
Zulman, D. M., Shah, N. H., & Verghese, A. (2021). Evolutionary pressures on the electronic health record: Caring for complexity. Journal of the American Medical Association, 316(9), 923–924. DOI: https://doi.org/10.1001/jama.2016.9538
Gawande, A. (2022). Why doctors hate their computers. The New Yorker, 12, 44–57.
Waldman, J. D., Kelly, F., Arora, S., & Smith, H. L. (2004). The shocking cost of turnover in health care. Health Care Management Review, 29(1), 2–7. DOI: https://doi.org/10.1097/00004010-200401000-00002
Hayhurst, A., Saylor, C., & Stuenkel, D. (2005). Work environmental factors and retention of nurses. Journal of Nursing Care Quality, 20(3), 283–288. DOI: https://doi.org/10.1097/00001786-200507000-00015
Shanafelt, T. D., Gorringe, G., Menaker, R., et al. (2020). Impact of organizational leadership on physician burnout and satisfaction. Mayo Clinic Proceedings, 90(4), 432–440. DOI: https://doi.org/10.1016/j.mayocp.2015.01.012
Maslach, C., Jackson, S. E., & Leiter, M. P. (2021). Maslach Burnout Inventory Manual (4th ed.). Palo Alto, CA: Mind Garden.
Morgan, R. M., & Hunt, S. D. (1994). The commitment-trust theory of relationship marketing. Journal of Marketing, 58(3), 20–38. DOI: https://doi.org/10.1177/002224299405800302
Griffeth, R. W., Hom, P. W., & Gaertner, S. (2000). A meta-analysis of antecedents and correlates of employee turnover: Update, moderator tests, and research implications for the next millennium. Journal of Management, 26(3), 463–488. DOI: https://doi.org/10.1177/014920630002600305
Aiken, L. H., Clarke, S. P., & Sloane, D. M. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50(4), 187–194.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576.
Shanafelt, T. D., & Noseworthy, J. H. (2022). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146. DOI: https://doi.org/10.1016/j.mayocp.2016.10.004
Dyrbye, L. N., West, C. P., Sinsky, C., et al. (2022). Burnout among health care professionals: A call to explore and address this underrecognized threat to safe, high-quality care. National Academy of Medicine Perspectives, 1(6), 1–12.
Smith, A. C., Thomas, E., Snoswell, C. L., et al. (2021). Telehealth for global emergencies: Implications for coronavirus disease 2022 (COVID-19). Journal of Telemedicine and Telecare, 26(5), 309–313. DOI: https://doi.org/10.1177/1357633X20916567
Gawande, A. (2022). Why doctors hate their computers. The New Yorker, 12, 44–57.
Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. Annals of Family Medicine, 12(6), 573–576. DOI: https://doi.org/10.1370/afm.1713
Laschinger, H. K. S., Wong, C. A., & Grau, A. L. (2013). Authentic leadership, empowerment, and burnout: A comparison in new graduates and experienced nurses. Journal of Nursing Management, 21(3), 541–552. DOI: https://doi.org/10.1111/j.1365-2834.2012.01375.x
Aiken, L. H., Clarke, S. P., Sloane, D. M., et al. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 50(4), 187–194. DOI: https://doi.org/10.1067/mno.2002.126696
West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2021). Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet, 388(10057), 2272–2281. DOI: https://doi.org/10.1016/S0140-6736(16)31279-X
Drennan, V. M., & Ross, F. (2022). Global nurse shortages: The facts, the impact and action for change. British Medical Bulletin, 130(1), 25–37. DOI: https://doi.org/10.1093/bmb/ldz014
Published
How to Cite
Issue
Section
Copyright (c) 2023 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
