New evidence from six European countries and the US reveals that simple, achievable hospital improvements, such as adequate nurse staffing and stronger interdisciplinary teamwork, are strongly linked to better physician well-being and reduced turnover.
Study: Informing Hospital Physician Well-Being Interventions in Europe and the US. Image credit: PeopleImages/Shutterstock.com
An international study published in JAMA Network Open finds that better nurse staffing and work environments in hospitals are associated with improved physicians’ wellbeing and job satisfaction.
Drivers of hospital strain
A high level of work-related physical and mental exhaustion is significantly increasing the likelihood of physicians leaving hospitals worldwide. This global crisis of a physician shortage can potentially compromise patient care and safety, as well as restrict access to hospital and emergency care.
Many studies on physician wellbeing have primarily focused on problems unrelated to work environments within hospitals, such as income concerns. However, designing effective interventions for physician well-being requires an in-depth analysis of internal issues, such as excessive workloads, unresponsive administration, job dissatisfaction, inadequate resources and infrastructure, and a lack of supporting staff.
The current study, led by researchers from the University of Pennsylvania, aimed to address these internal issues and provide evidence to inform interventions for improving physician well-being and reducing turnover.
Study design
The researchers surveyed 56 U.S. hospitals in 2021 and 49 hospitals in six European countries in 2023. The survey population consisted of 1,149 European physicians, 5,334 US physicians, 3,044 European nurses, and 11,869 US nurses.
In the survey, nurses reported on hospital environments, including nurse staffing adequacy, quality of the clinical care environment, and interdisciplinary teamwork between nurses and physicians.
Physicians, on the other hand, reported on their well-being and job outcomes, including work-related exhaustion, job dissatisfaction, intention to leave, and willingness to recommend their hospital.
Identified well-being trends
The survey findings revealed poor physician well-being in hospitals across Europe and the US. Among enrolled physicians, approximately 17 % to 45 % reported high-level exhaustion, 16 % to 40 % reported job dissatisfaction, and 20 % to 44 % expressed an intent to leave their hospital within the next year.
Notably, the survey indicated that physician job satisfaction in European and US hospitals was higher in hospitals with better nurse staffing, a more favorable clinical care environment, and effective physician-nurse teamwork.
Specifically, the findings revealed that in US hospitals, a 10% improvement in the clinical care environment was associated with a 22 % lower risk of physicians intending to leave, a 25 % lower risk of not recommending their hospital, and a 10 % lower risk of work-related exhaustion.
In European hospitals, a 10 % increase in nurse staffing adequacy was similarly associated with a lower risk of exhaustion and job dissatisfaction.
Implications for hospital change
The study identifies several crucial factors that can potentially challenge the retention of enough physicians in European and US hospitals to ensure adequate access to healthcare services.
The study also identifies modifiable organizational features of hospitals that can be considered as potential intervention targets for improving physician wellbeing and retention.
Previous studies on physician well-being and preventive interventions have primarily focused on individual physicians rather than the institution. Several systematic reviews and meta-analyses have highlighted that interventions such as coaching, mindfulness practices, or discussion groups have a minimal or no meaningful impact on physician outcomes.
Hospitals operating with too few nurses and unfavorable work environments have been found to have higher rates of physician burnout and turnover. The present study’s findings are consistent with this literature.
The current study design involved two distinct groups of healthcare professionals: nurses, who reported on hospital environments, and physicians, who reported on their well-being and job outcomes. This helped avoid bias where the same healthcare professionals provide information on two interconnected variables.
Overall, the study's evidence highlights the significance of organizational interventions, specifically adequate nurse staffing, supportive care environments, and strong interdisciplinary teamwork, in improving physician well-being and addressing the physician shortage.
The study collected data in two phases. The US data was collected during the peak phase of the coronavirus disease 2019 (COVID-19) pandemic in 2021, while the European data was collected in 2023. This variation in data collection timing may have some influence on the findings.
The US hospitals included in the study are Magnet-recognized, meaning that these hospitals provide a supportive work environment that attracts and retains skilled nurses. The European hospitals, on the other hand, had agreed to participate in the study to improve their work environment. These hospitals are not necessarily representative of all hospitals in European countries.
Such country-level differences in health systems may have impacted the findings. However, the study found significant variations in physician well-being across hospitals within the same countries. This variation further supports the significance of organizational interventions in improving physician well-being regardless of country-level differences in health systems.
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