J. Ripp is chief wellness officer, Mount Sinai Health System, professor of medicine, Departments of Medicine, Medical Education and Geriatrics and Palliative Medicine, and senior associate dean for well-being and resilience, Icahn School of Medicine at Mount Sinai, New York, New York.
T. Shanafelt is chief wellness officer, Stanford Medicine, Jeanie and Stewart Ritchie Professor of Medicine, and associate dean, Stanford School of Medicine, Stanford, California.
Acad Med. 2020 Sep;95(9):1354-1358. doi: 10.1097/ACM.0000000000003433.
Occupational distress among clinicians and its impact on quality of care is a major threat to the health care delivery system. To address threats to clinician well-being, many institutions have introduced a new senior leadership position-the health care chief wellness officer (CWO). This role is distinct from CWOs or other wellness leadership positions that have historically existed outside of medicine. The health care CWO role was established to reduce widespread occupational distress in clinicians by improving the work environment rather than by promoting health behaviors to reduce health insurance costs. A complex array of system-level drivers has contributed to clinician distress. Developing and overseeing the execution of a strategy to address these challenges and working in partnership with other operational leaders to improve well-being require a correctly placed senior leader with the appropriate authority and resources, such as a CWO.Health care CWOs must focus primarily on improving their organizations' work environment and culture, not on developing individual-level interventions, such as personal resilience, mindfulness, and self-care offerings. The goal of this work is to address what is wrong with the practice environment, not to make individuals better able to tolerate a broken system. Metrics to evaluate organizational progress as well as the efficacy of the health care CWO and his or her team are discussed in this Perspective. Occupational distress in clinicians is widespread and has implications for quality of care. Vanguard organizations have begun to put into place the leaders, infrastructure, and improvement teams necessary to address this issue. The health care CWO plays a critical role in the effectiveness of these efforts.
临床医生的职业困扰及其对医疗质量的影响是医疗保健系统的主要威胁。为了解决临床医生福祉受到的威胁，许多机构引入了一个新的高级领导职位——医疗首席健康官（CWO）。这个角色与 CWOs 或其他历史上存在于医学之外的健康领导力职位不同。设立医疗保健 CWO 角色是为了通过改善工作环境而不是通过促进健康行为来降低医疗保险成本，从而减少临床医生普遍存在的职业困扰。一系列复杂的系统层面驱动因素导致了临床医生的困扰。制定和监督解决这些挑战的策略的执行，并与其他运营领导者合作以提高幸福感，需要一位具有适当权力和资源的高级领导者，例如 CWO。医疗保健 CWO 必须主要关注改善组织的工作环境和文化，而不是开发个人层面的干预措施，例如个人韧性、正念和自我保健服务。这项工作的目的是解决实践环境中的问题，而不是让个人更能够容忍一个破碎的系统。本文从观点的角度讨论了评估组织进展以及医疗保健 CWO 及其团队的功效的指标。临床医生的职业困扰很普遍，对医疗质量有影响。先锋组织已经开始部署必要的领导者、基础设施和改进团队来解决这个问题。医疗保健 CWO 在这些努力的有效性中起着关键作用。
