Beyond Resilience and Burnout: The Need for Organizational Change to Promote Humanistic Practice and Teaching in Healthcare

Rapid changes in healthcare organization and practice environments, increasingly driven by business models and commercial interests, are associated with widespread burnout and dissatisfaction among healthcare professionals and pose barriers to humanistic relationship-centered quality care. Studies show burnout and significant stress currently affect over half of US physicians and nurses. Clinicians’ ability to provide compassionate care is significantly challenged. Most solutions to date have included individual interventions designed to enhance well-being and promote resilience. We examined organizational factors that inhibit or promote humanistic practice by faculty physicians in today’s healthcare environment. In this qualitative study, physician faculty who completed a one-year faculty development program in humanism at eight US academic medical centers provided written answers to two open-ended questions: a) What institutional or specific organizational unit-related factors promote humanism for you and others? b) What institutional or specific organizational unit-related factors inhibit or pose barriers, to humanism for you and others? 74% (68/92) of the physicians participated. The constant comparative method was used to analyze responses. We found that organizational culture was the central theme. Motivators of humanism included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities promoting humanism, and practice structures that facilitate humanism. Factors that inhibited humanism included “top down” organizational culture, non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures. Our findings suggest that organizational culture is, at a minimum, equally important as individual interventions. We describe features of organizational culture that reinforce humanistic practice and care in healthcare institutions and offer recommendations for organizational change that support the primacy of humanistic, compassionate, high quality patient care. 

Relationship Between Number of Breast Cancer Operations Performed and 5-Year Survival After Treatment for Early-Stage Breast Cancer

Objectives. We examined the association between number of breast cancer operations performed in a hospital (hospital volume) and all-cause and breast cancer–specific mortality using a national database and statistical methods appropriate for clustering and reducing confounding. Methods. In a retrospective cohort study, we linked Surveillance, Epidemiology, and End Results tumor registry data with Medicare claims data. The cohort included 11225 Medicare patients who had undergone surgery for early-stage breast cancer from 1994 to 1996 in 457 different hospitals. Primary outcomes were all-cause and breast cancer–specific survival rates at a mean follow-up time of 62.5 months. Results. In comparison with treatment in a low-volume hospital, treatment in a high-volume hospital was associated with hazard ratios of 0.83 (95% confidence interval [CI]=0.75, 0.92) for all-cause mortality and 0.80 (CI=0.66, 0.97) for breast cancer–specific mortality. Conclusions. An association between the volume of breast cancer operations performed in a hospital and 5-year survival rates was observed for both all-cause and breast cancer–specific mortality. Further work investigating the aspects of hospital volume that contribute to increased survival is warranted

Evaluating the career impact of faculty development using matched controls

© 2019, Society of Teachers of Family Medicine. All rights reserved. BACKGROUND AND OBJECTIVES: Faculty development (FD) is required for medical educators, yet few studies address its long-term career impact on graduates. This project presents the impact of FD on career development, as perceived by physician faculty graduates of a longitudinal primary care FD educator program, compared to nonenrollees. METHODS: Between 2011 and 2016, 33 physician faculty from three departments participated in monthly half-day in-class FD for 20 months, emphasizing educator skills and career development. After physician-graduates were stratified by year, 10 were randomly selected and matched with 10 nonparticipants (controls) by specialty, gender, academic rank, and time in academic medicine. Narrative responses from semistructured interviews were recorded in a common template. Qualitative analysis methods identified themes, with agreement obtained by researchers. RESULTS: Median time in academic medicine for FD graduates (50% male) was 5.5 years; controls 7.5 years (40% male). Common themes across all respondents included that they: value their roles as clinical teachers; define success as training high-quality, competent physicians; align their professional aims with organizational priorities; manage commitments; develop and sustain colleague networks; and seek continued growth. Within themes, FD graduates differed from controls, detailing greater perceived success and growth as educators, placing higher value on scholarly products and academic promotion, and having more expansive local and national colleague networks. CONCLUSIONS: FD graduates, compared to matched controls, report expanded clinician-educator scope and roles, and a greater value on scholarly activity. This evaluation provides the groundwork for further investigations