Ratliff, H. C., Lee, K. A., Buchbinder, M., Kelly, L. A., Yakusheva, O., & Costa, D. K. (2025). Organizational Resilience in Healthcare: A Scoping Review. Journal of healthcare management / American College of Healthcare Executives, 70(3), 165–188. https://doi.org/10.1097/JHM-D-24-00084
Goal: Healthcare organizations have always faced challenges, yet the past decade has been particularly difficult due to workforce shortages, the COVID-19 pandemic, and economic demands, all of which can impact quality of care. While some healthcare organizations have demonstrated the ability to adapt to such stressors-which has been termed "organizational resilience"-others have not. Most of the research on resilience in healthcare has been on individual clinicians; less is known about how extra-individual groups such as teams, units, and systems develop resilience. Understanding what organizational resilience is, how to measure it, and how healthcare organizations can develop it is essential to responding effectively to future acute and chronic stressors in the healthcare industry. The purpose of this scoping review is to synthesize how organizational resilience is defined and measured in the current healthcare literature and to inform future interventions to improve organizational resilience.
Methods: We searched PubMed and Scopus databases for articles mentioning organizational resilience in healthcare. Eligible sources were those published in English through December 2023 in any format, and that described or measured organizational resilience in healthcare. Titles and abstracts were screened, and information was extracted from eligible articles.
Principal findings: We screened 243 articles and included 97 in our review. Across these studies, organizational resilience was described as a healthcare system's ability to continue functioning and meet its objectives when exposed to stressful stimuli. Reactive and proactive strategies, as well as reflection, were identified as key components of organizational resilience. Four measures of organizational resilience were developed for use in healthcare, but only two have been validated.
Practical applications: Future studies should focus on validating and comparing existing measures of organizational resilience and using them to investigate how organizational resilience may impact quality of care and clinician well-being, allowing the field to move beyond the focus on individual clinician resilience.
Melvin, A., Pearson, A., Carrieri, D., Bramwell, C., Hancock, J., Scott, J., Foster Collins, H., McPhail, S., Pearson, M., Papoutsi, C., Wong, G., & Mattick, K. (2025). Support for hospital doctors' workplace well-being in England: the Care Under Pressure 3 realist evaluation. BMJ quality & safety, bmjqs-2024-017698. Advance online publication. https://doi.org/10.1136/bmjqs-2024-017698
Introduction: The vital role of medical workforce well-being for improving patient experience and population health while assuring safety and reducing costs is recognised internationally. Yet the persistence of poor well-being outcomes suggests that current support initiatives are suboptimal. The aim of this research study was to work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors' well-being and reduce negative impacts on the workforce and patient care.
Methods: Realist evaluation consistent with the Realist And Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) II quality standards. Realist interviews (n=124) with doctors, well-being intervention implementers/practitioners and leaders in eight hospital settings (England) were analysed using realist logic.
Results: There were four key findings, underpinned by 21 context-mechanism-outcome configurations: (1) solutions needed to align with problems, to support doctor well-being and avoid harm to doctors; (2) doctors needed to be involved in creating solutions to their well-being problems; (3) doctors often did not know what support was available to help them with well-being problems and (4) there were physical and psychological barriers to accessing well-being support.
Discussion and conclusion: Doctors are mandated to 'first, do no harm' to their patients, and the same consideration should be extended to doctors themselves. Since doctors can be harmed by poorly designed or implemented well-being interventions, new approaches need careful planning and evaluation. Our research identified many ineffective or harmful interventions that could be stopped. The findings are likely transferable to other settings and countries, given the realist approach leading to principles and causal explanations.
Keywords: health services research; humaneness; leadership; patient safety; teams.
Sears, D. M., Bejeck, A., Kilpatrick, L., Griggs, N., Farmer, L., Jackson, B., Janek, H., & Waddimba, A. C. (2025). Leadership development as a novel strategy to mitigate burnout among female physicians. PloS one, 20(3), e0319895. https://doi.org/10.1371/journal.pone.0319895
Background: Female physicians are more likely to experience burnout and less likely to hold leadership positions. Effective interventions are needed to support women physicians in the workforce.
Objective: To determine if a shared learning, social-based leadership development program will impact burnout and career trajectory for female physicians.
Design: Cohort study.
Setting: Multispecialty healthcare system and state medical society members.
Participants: Burnout and Engagement surveys were emailed to 5000 physicians within the Baylor Scott & White Health System (BSWH). The external control group consisted of 516 female physicians within the Texas Medical Association (TMA) and not associated with BSWH. Internal controls included both male (670) and female physicians (240) who did not participate in the program.
Intervention: The Women Leaders in Medicine (WLiM) program included twice-annual in person summits and support programs throughout the 2-year study period.
Measurements: The Maslach Burnout Index (MBI) was utilized to evaluate burnout. Surveys were conducted at three separate points and included interest in leadership, intent to retain current employment, and open comments.
Results: Participants in WLiM had decreased frequency of high emotional exhaustion (mean 2.9 decreased to 2.5), decreased occurrence of high depersonalization (mean 1.6 decreased to 1.3), and improved levels of personal accomplishment (mean 4.7 improved to 5.1) and leadership aspiration (mean 7.4 to 7.8). Intention to stay went from 4.0 to 4.1.
Conclusions: Burnout can be improved, and leadership aspirations fostered with a group leadership development in a cohort of female physicians.
Antico, L., & Brewer, J. (2025). Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach. JMIR formative research, 9, e63197. https://doi.org/10.2196/63197
Abstract
Background: Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules.
Objective: This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians.
Methods: Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up.
Results: Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P≤.04; r≥0.41 and follow-up: 33% reduction; P≤.04; r≥0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P≤.01, r≥0.49 at posttreatment; P≤.01, r≥0.54 at follow-up), intolerance of uncertainty (P≤.03, r≥.57 at posttreatment; P<.001, r≥0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P≤.02, r≥0.50 at posttreatment; P≤.006, r≥0.59 at follow-up) and mindfulness (nonreactivity: P≤.001, r≥0.69 at posttreatment; P≤.004, r≥0.58 at follow-up; nonjudgment: P≤.009, r≥0.50 at posttreatment; P≤.03, r≥0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r≥0.38; P≤.04; emotional exhaustion: r≥0.58; P≤.001).
Conclusions: To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians.
Trial registration: ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425.
Keywords: anxiety; app; burnout; chronic; compassion; cynicism; digital health; digital therapeutics; efficacy; empathy fatigue; health care provider; mHealth; meditation; mindfulness; mobile phone; physician; physician burnout; podcast; smartphone; training; treatment; workplace stress.
Safeer, R., Lucik, M., Davila, T. B., & Kalia, N. (2024). A Model for System-Level Change to Improve Workforce Well-Being. NEJM Catalyst Innovations in Care Delivery, 6(1), CAT-24. DOI: 10.1056/CAT.24.0290.
Health care organizations face unique challenges in addressing the health and well-being of their workforce. The Covid-19 pandemic generated heightened levels of stress and burnout among health care workers, contributing to high levels of turnover and staffing shortages. Although the pandemic period has concluded, the aftermath of its effects persists across the health care landscape. Many employers offer health and well-being resources to employees, but without considering the organizational infrastructure that is required to support healthy habits and a positive emotional state. More than a decade ago, Johns Hopkins Medicine (JHM) identified the importance of creating an infrastructure to support the health and well-being of its workforce. JHM leveraged the U.S. Centers for Disease Control and Prevention’s Worksite Health ScoreCard to assess the degree to which evidence-based health promotion strategies were implemented across the organization. Establishing a work environment that fosters a culture of well-being took ongoing commitment and leadership involvement. This tool, when utilized in conjunction with supplementary organizational initiatives, can help create a well-being culture. The tool became an impetus for change across the organization. Examples include the creation of new policies and leadership training to address mental health across the organization. Since the inception of the program, JHM has seen an increase in the percentage of total points earned on the ScoreCard from 68.52% in 2016 to 88.10% in 2024, an improvement of 19.58 percentage points.
Ho, S. S., Sosina, W., DePierro, J. M., Perez, S., Khan, A., Starkweather, S., Marin, D. B., Sharma, V., Ripp, J. A., Peccoralo, L. A., & Charney, D. S. (2024). Promoting Resilience in Healthcare Workers: A Preventative Mental Health Education Program. International journal of environmental research and public health, 21(10), 1365. https://doi.org/10.3390/ijerph21101365
Healthcare workers face greater risks for mental health conditions and chronic stress due to the demanding nature of their roles. The COVID-19 pandemic exacerbated these challenges and increased vulnerabilities to long-term mental health conditions. The present study adapts an existing resilience-based educational workshop program to address the time constraints and unique needs of the healthcare workforce in a post-COVID-19 world. Expanded from its initial focus on resilience, the workshop curriculum incorporates psychoeducation on common mental health issues. Between July 2022 and June 2024, a 15 min "huddle" format offered on-site training to equip HCWs in a large urban health system with coping strategies to prevent, manage, and recover from stress. Attendance and anonymous feedback were collected at each session via brief electronic surveys. Participant responses (n = 1403) obtained immediately post-huddle suggested positive impact on stress management, perceived leadership support, and resilience. Findings show the potential of brief huddles to improve mental health and resilience in healthcare workers and similar workforces. Our findings support the efficacy of brief, evidence-based educational huddles in enhancing resilience, mental health awareness, and coping skills among HCWs. This model holds significant potential for widespread implementation across healthcare and other high-stress workplaces.
Keywords: coping skills; educational workshops; healthcare workers; mental health; resilience-building.
Jordan, Joanne E.; Garner, Kerryn; Bones, Kate; McKenzie, Lisa; Linzer, Mark; Rathert, Cheryl; Goelz, Elizabeth; McCall, Jesse; Sawyer, Eleanor; Baass, Briana; Herco, Fiona. Improving joy at work and reducing burnout in health care workers in Victoria, Australia using the Institute for Healthcare Improvement joy in work framework: A mixed-methods study. Health Care Management Review ():10.1097/HMR.0000000000000420, October 28, 2024. | DOI: 10.1097/HMR.0000000000000420
Background: Burnout in health care workers (HCWs) has serious ramifications for individual well-being, patients, organizations, and health systems. Global evidence demonstrates the COVID-19 pandemic has amplified the risk of burnout. Scalable interventions to address burnout are critical to protect HCW well-being. Purpose: Underpinned by the Conservation of Resources theory, this study examines the impacts of a statewide improvement initiative (the Initiative), using the Institute for Healthcare Improvement Joy in Work (JiW) Framework, to reduce burnout and increase joy at work across participating health care organizations in Victoria, Australia. Methodology/Approach: An impact evaluation was undertaken utilizing a mixed-methods design. Quantitative outcomes included burnout and joy at work measured using an adapted Mini Z tool. In-depth interviews with implementation teams sought insights into the effectiveness of interventions. Results: Overall, 20 teams from 17 organizations across diverse health care settings and geographical locations participated. At a statewide level, outcomes in burnout and joy at work were inconclusive due to limited data. However, five out of eight teams reporting sufficient data achieved measurable improvements in one or more outcomes. Qualitative data revealed the Initiative increased workplace resources and supports such as providing “permission” for HCWs to prioritize well-being at work, improved communications between management and HCWs, and increased HCWs' teamwork and camaraderie, resulting in safer and more positive workplaces. Conclusion and Practice Implications: The JiW Framework, implemented across diverse settings, provided organizations with a structured process to develop multifaceted improvements that resulted in enhanced resources that appeared to improve HCW well-being. Compared to individual well-being support, this approach offers organization-level change and scalability potential.
Chan CC, Faherty C, Rahman N, Murrough JW, Benn EKT, Clark U, Mohamed N, DePierro JM, Ripp JA, Peccoralo LA. Suicidal ideation among non-physician hospital system staff: Prevalence and workplace correlates. J Affect Disord. 2024 Oct 1;362:638-644. doi: 10.1016/j.jad.2024.07.109. Epub 2024 Jul 17. PMID: 39029665; PMCID: PMC11325446.
Background: Research suggests that healthcare workers are at greater risk for suicide than other occupations, but most published studies focus on physicians. This study examines the prevalence of suicidal ideation (SI) and associated occupational factors among a broad group of non-physician healthcare staff.
Methods: An anonymous online survey was sent to a random sample of 30 % of non-physician healthcare staff at a large urban healthcare system between September and November 2022. Weighted multivariable binary logistic regressions were conducted to determine the workplace and mental health factors associated with SI.
Results: The 1084 respondents included nurses, administrative staff, research staff, medical assistants, nurse practitioners, physician assistants, and other roles. Of the sample, 8.8 % endorsed having SI over the prior two weeks. Results of the regression indicated that, after adjusting for demographic factors, greater odds of SI were associated with physical violence experienced from a patient or visitor (odds ratio [OR] = 2.15, 95 % confidence interval [CI] = 1.06-4.37), lower perceived leadership support (OR = 0.95, 95 % CI = 0.92-0.98), and positive screening for depression (OR = 4.66, 95 % CI = 2.45-8.86). Exploratory analysis suggests that depression may be a mediating factor between workplace stressors and SI.
Limitations: Limitations include the response rate, the use of a single item to assess SI, and the cross-sectional design.
Conclusion: Findings suggest that workplace violence and leadership support are important occupational factors associated with SI among healthcare workers. Reducing and mitigating workplace violence, enhancing leadership support, and improving access to mental health care should be considered targets for interventions to decrease suicide risk in this population.
Keywords: Depression; Healthcare staff; Leadership; Occupation; Suicide; Workplace violence.
Velando-Soriano, A., Pradas-Hernández, L., Membrive-Jiménez, M. J., Suleiman-Martos, N., Romero-Béjar, J. L., De La Fuente-Solana, E. I., & Cañadas-De La Fuente, G. A. (2024). Burnout and personality factors among surgical area nurses: a cross sectional multicentre study. Frontiers in public health, 12, 1383735. https://doi.org/10.3389/fpubh.2024.1383735
Objective: To determine levels of burnout among surgical area nurses in Andalusia (Spain), to identify the phase of burnout in each participant and to consider its relationship with sociodemographic, occupational variables and personality factors considered.
Data source: Data were collected by means of questionary. All nurses working in the surgical area on the date of data collection participated in the study. Sociodemographic and related to work variables were addressed in the questionnaire. Symptoms of anxiety and depression were measured using the Educational-Clinical Questionnaire: Anxiety and Depression (CECAD). Psychological personality variables were assessed using the NEO Five-Factor Inventory (NEO-FFI), adapted for a Spanish population. Burnout was measured using the Maslach Burnout Inventory (MBI).
Study design: Multicentre, cross-sectional, quantitative study carried out from August to October 2021.
Data analysis: Descriptive analysis, Student's t-test for independent samples, Pearson's correlation and multiple linear regression were performed with SPSS 25.0.
Data extraction methods: The study sample consisted of 214 surgical area nurses at 23 hospitals in Andalusia (Spain). Sociodemographic, occupational and personality variables were studied using the Maslach Burnout Inventory, the NEO Five-Factor Inventory (NEO-FFI) and the Educational-Clinical Questionnaire: Anxiety and Depression. The STROBE statement guidelines were applied.
Principal findings: 29.4% of the nurses in the sample presented high levels of emotional exhaustion, 25.7% suffered from depersonalization and 28% had low levels of personal accomplishment. These three dimensions were significantly correlated with the NEO-FFI subscales (neuroticism, agreeableness, openness, conscientiousness and extraversion), and with all the anxiety and depression items considered. Agreeableness was a statistically significant predictor (p < 0.001) for all three dimensions of burnout.
Conclusion: Nurses in the surgical area present high levels of Burnout. There is evidence that relates Burnout to personality factors and socio-demographic variables.
Maloney, L. M., Hoffman, J., Peralta, E., Princi, R., Thode, H. C., Jr, DiDonato, C., LaBarbera, A., & Williams, S. (2024). Informal Peer Support and Intentional Acts of Kindness May Attenuate the Impact of Work-Related Stressors on Compassion Satisfaction, Secondary Traumatic Stress, and Burnout of Emergency Medical Services Clinicians. Air medical journal, 43(4), 333–339. https://doi.org/10.1016/j.amj.2024.03.005
Objective: Emergency medical services (EMS) Code Lavender was developed to support EMS clinicians after stressful events via consistent recognition of events, informal peer support, and intentional acts of kindness. This study evaluated changes in burnout screening tool responses of EMS clinicians in response to program implementation and the coincidental start of coronavirus disease 2019.
Methods: Anonymous surveys with demographic questions and 2 burnout screening tools were distributed before program implementation (spring 2020) and 20 months later (fall 2021). Analysis included t-tests, Fisher exact tests, and multivariable linear regression.
Results: Seventy-seven preprogram (59% response rate) and 108 intraprogram (88% response rate) survey responses were included. No changes existed between preprogram and intraprogram responses across all subscale scores. Sex was associated with depersonalization subscale scores, with men having scores 1.53 (95% confidence interval [CI] 0.11-2.95) higher than women. Compared with emergency medical technicians, paramedics had higher compassion satisfaction (OR 3.50; 95% CI 1.79-5.70) and personal accomplishment scores (OR 2.40; 95% CI 1.08-3.71). Transport nurses had higher personal accomplishment (OR 3.29; 95% CI 1.18-5.40), depersonalization (OR 3.73; 95% CI 1.19-6.26), and rates of burnout symptoms (OR 0.54; 95% CI 0.09-0.98) than emergency medical technicians.
Conclusion: The organizational commitment, peer support, and authentic leadership of EMS Code Lavender may attenuate work-related stressors among EMS clinicians.