Stanford University, Palo Alto, California.
National University of Singapore Business School, Singapore.
JAMA Intern Med. 2017 Dec 1;177(12):1826-1832. doi: 10.1001/jamainternmed.2017.4340.
Widespread burnout among physicians has been recognized for more than 2 decades. Extensive evidence indicates that physician burnout has important personal and professional consequences.
A lack of awareness regarding the economic costs of physician burnout and uncertainty regarding what organizations can do to address the problem have been barriers to many organizations taking action. Although there is a strong moral and ethical case for organizations to address physician burnout, financial principles (eg, return on investment) can also be applied to determine the economic cost of burnout and guide appropriate investment to address the problem. The business case to address physician burnout is multifaceted and includes costs associated with turnover, lost revenue associated with decreased productivity, as well as financial risk and threats to the organization's long-term viability due to the relationship between burnout and lower quality of care, decreased patient satisfaction, and problems with patient safety. Nearly all US health care organizations have used similar evidence to justify their investments in safety and quality. Herein, we provide conservative formulas based on readily available organizational characteristics to determine the financial return on organizational investments to reduce physician burnout. A model outlining the steps of the typical organization's journey to address this issue is presented. Critical ingredients to making progress include prioritization by leadership, physician involvement, organizational science/learning, metrics, structured interventions, open communication, and promoting culture change at the work unit, leader, and organization level.
Understanding the business case to reduce burnout and promote engagement as well as overcoming the misperception that nothing meaningful can be done are key steps for organizations to begin to take action. Evidence suggests that improvement is possible, investment is justified, and return on investment measurable. Addressing this issue is not only the organization's ethical responsibility, it is also the fiscally responsible one.
医生普遍存在职业倦怠已经有 20 多年了。大量证据表明，医生职业倦怠会对个人和职业产生重要影响。
由于缺乏对医生职业倦怠经济成本的认识，以及对组织能够采取何种措施来解决这个问题的不确定性，许多组织都没有采取行动。虽然从道德和伦理角度来看，组织有责任解决医生职业倦怠问题，但财务原则（例如，投资回报率）也可以用来确定倦怠造成的经济成本，并指导适当的投资来解决问题。解决医生职业倦怠问题的商业案例是多方面的，包括与人员流动相关的成本、因生产力下降而导致的收入损失，以及由于倦怠与护理质量下降、患者满意度降低和患者安全问题之间的关系而给组织带来的财务风险和长期生存威胁。几乎所有美国医疗保健组织都使用类似的证据来证明他们在安全和质量方面的投资是合理的。在此，我们提供了基于组织现有特征的保守公式，以确定减少医生职业倦怠的组织投资的财务回报。本文还提出了一个概述典型组织解决这个问题的步骤的模型。领导层的优先排序、医生的参与、组织科学/学习、指标、结构化干预、开放沟通以及在工作单位、领导层和组织层面推动文化变革，这些都是取得进展的关键要素。
了解减少倦怠和促进敬业度的商业案例，以及克服认为无法采取有意义的行动的误解，是组织开始采取行动的关键步骤。有证据表明，改善是可能的，投资是合理的，投资回报率是可衡量的。解决这个问题不仅是组织的道德责任，也是财务责任。
