Top 10 Culture Change Interventions to Reduce Burnout and Improve Physician Well-being

Interventions you and your colleagues can use in your practice to reduce burnout and promote a culture of well-being.

1. Limit work hours and offer flexible work arrangements.

• Organization-Level Interventions Best for Reducing Physician Burnout - Medscape - Dec 05, 2016.
• Shanafelt TD, Noseworthy JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017;92(1):129-146. doi:10.1016/j.mayocp.2016.10.004.

2. Invest in leadership development.

• Shanafelt T, Gorringe G, Menaker R, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc 2015;90(4):432-440. doi: 10.1016/j.mayocp.2015.01.012.

3. Create a “Wellness Committee.” Identify a “Wellness Champion and create a “Wellness Toolbox” that includes ingredients for changing residency culture to be in support of wellness, as opposed to simply “preventing burnout.”

• Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the conversation from burnout to wellness: Physician wellbeing in residency training programs. J Grad Med Ed 2009;1(2):225-30.doi: 10.4300/JGME-D-09-00026.1.

4. Establish wellness as a quality indicator for the practice. Distribute an annual wellness survey and use the results to create interventions to address burnout and enhance well-being.

• Preventing Physician Burnout – STEPS Forward. STEPSforward.org https://www.stepsforward.org/modules/physician-burnout

5. Conduct facilitated physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning.  Offer humanistic teaching, role modeling and narrative reflection combined with skills training using experiential learning techniques.

• Branch WT, Frankel RM, Hafler JP, et al. A Multi-Institutional Longitudinal Faculty Development Program in Humanism Supports the Professional Development of Faculty Teachers. Acad Med. 2017;XX(X):1-7. doi:10.1097/ACM.0000000000001940.
• West CP, Dyrbye LN, Rabatin JT, et al. Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism. JAMA Intern Med. 2014;174(4):527. doi:10.1001/jamainternmed.2013.14387.

6. Establish a culture (time, space, training) in which teamwork and relationships are prioritized: relationships with patients and relationships with peers and colleagues.

• Sinsky CA, Willard-Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: A report of 23 high-functioning primary care practices. Ann Fam Med. 2013;11(3):272-278. doi:10.1370/afm.1531.

7. Provide relationship-centered communications skills training for physicians.

• Boissy A, Windover AK, Bokar D, et al. Communication Skills Training for Physicians Improves Patient Satisfaction. J Gen Intern Med. 2016;31(7):755-761. doi:10.1007/s11606-016-3597-2. Epub 2016 Feb 26. PMID: 26921153

8. Conduct workflow and Qi projects aimed at addressing clinician concerns.

• Linzer M, Poplau S, Grossman E, et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015;30(8):1105-1111. doi:10.1007/s11606-015-3235-4. Epub 2015 Feb 28.

9. Implement the “Listen-Act-Develop” model which is based on organizational psychology and social science, with integration from institutional efforts related to quality improvement, safety culture, burnout- engagement and leadership development.

• Swensen S, Kabcenell A, Shanafelt T, Clinic M. Physician-Organization Collaboration Reduces Physician Burnout and Promotes Engagement: The Mayo Clinic Experience. J Healthc Manag. 2016;61(2):105-127. PMID: 27111930.
• Eckleberry-Hunt J, Van Dyke A, Lick D, Tucciarone J. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs. J Grad Med Educ. 2009;1(2):225-230. doi:10.4300/JGME-D-09-00026.1.

10. Proactively work to reduce the stigma associated with mental illness to encourage clinicians to seek help when they need it.

• Kishore S, Dandurand DE, Mathew A, Rothenberger D. Breaking the Culture of Silence on Physician Suicide. National Academy of Medicine. https://nam.edu/breaking-the-culture-of-silence-on-physician-suicide/.

Additional Research

• Panagioti M, Panagopoulou E, Bower P, et al. Controlled Interventions to Reduce Burnout in Physicians. JAMA Intern Med. 2017;177(2):195. doi:10.1001/jamainternmed.2016.7674.
• Linzer M, Sinsky CA, Poplau S, et al. Joy In Medical Practice: Clinician Satisfaction In The Healthy Work Place Trial. Health Aff. 2017;36(10):1808-1814. doi:10.1377/hlthaff.2017.0790.
• Shanafelt T, Goh J, Sinsky C. The Business Case for Investing in Physician Well-being. JAMA Intern Med. 2017. doi:10.1001/jamainternmed.2017.4340.