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Clinician burnout and wellness is an operations issue at its core. By developing an institutional wellness dashboard that measures burnout across a health system and its attributable costs, health care leaders can target resources accordingly.
Health care leaders know clinician burnout is problem and possible ways to address it, but there is a disconnect between how leaders view and approach well-being and what those on the front lines feel they need. Wellness is an operations issue at its core, driven by inflation. To actionize this knowledge, the Sugarman Practitioner in Residence and Visiting Fellow at the Kahneman-Treisman Center for Behavioral Science and Public Policy at Princeton University, formerly Chief Wellness Officer at Rush University System for Health, suggests creating an institutional wellness dashboard that measures the prevalence of burnout across a health system combined with its attributable cost, from which health system leaders can identify and address operational issues causing hot spots.
From the NEJM Catalyst eventFrom Clinician Burnout to Wellness: Three Systemic Steps, sponsored by Optum, June 23, 2022.
Health care has crossed three chapters over the past 2 decades in relation to wellness and burnout, says Bryant Adibe, MD, Sugarman Practitioner in Residence and Visiting Fellow at Princeton University’s Kahneman-Treisman Center for Behavioral Science and Public Policy.
Chapter 1: We identified the prevalence of burnout and understood that wellness should be top of mind for health care leaders.
Chapter 2: We began to identify promising ideas at the programmatic level for reducing burnout and impacting providers’ well-being.
Chapter 3, today: We know burnout is a problem and possible ways to address it, but what do we do as leaders with that information? “How do we thread that across the clinical enterprise and ensure that our workforce is operating within a frame of well-being?” asks Adibe. “How do we create actionable data that allows us to take the effects that we know will have a positive impact?”
“Today, there exists a disconnect between how health system leaders often view and approach well-being and how those on the front lines approach it, and what they feel they need,” Adibe says, pointing to the common refrain “no more yoga, no more meditation.”
Providers are looking for more. They know that wellness is really an operations issue at its core, that the system they work in is often the primary contributor to their burnout and overall sense of well-being. Adibe shares the example of a chair of surgery asking him to provide wellness resources to a struggling surgeon, only to find out directly from the surgeon that he was receiving the last operating room bookings of the day, causing him to miss dinner with his family and time with his children.
“Wellness has always been an operations issue,” says Adibe, “but today it has become more apparent than ever as a result of the Great Resignation, as health care looks to move on forward from the Covid-19 pandemic.” Health care has lost around 20% of its workforce to turnover,¹ including 30% of nurses,² because of burnout and lack of flexibility during the pandemic.
There exists a disconnect between how health system leaders often view and approach well-being and how those on the front lines approach it, and what they feel they need.
The disconnect between the front line and executives is neither group’s fault, but rather a macroeconomic phenomenon in the United States, Adibe explains. Over the past several decades, reimbursement rates for physicians have decreased. As a result of inflation, the absolute dollars that physicians are reimbursed for today is lower than it was 10 years prior for the same services.³ To make up that difference, one of the most common ways health systems reduce costs is by increasing the amount of service from physicians to meet the same productivity thresholds — thus resulting in burnout.
One way to actionize our knowledge of burnout is to examine its attributable cost.⁴ For example, Adibe says that for a health system with 3,000 physicians, the annual attributable cost due to burnout is over $20 million per year.
From there, an impactful way institutional leaders can reframe wellness is by developing an institutional wellness dashboard, Adibe says. This empiric data set measures the prevalence of burnout across the health system and combines it with burnout’s attributable costs at that organization and various other factors. “This will allow institutional leaders to identify hot spot areas that are costing more relative to the rest of the institution and will allow them to target resources accordingly,” he says.
“By and large, when we investigate these hot spots, we find that there is an operational issue that is driving the level of burnout, driving the cost, and ultimately impacting the performance of the health system,” Adibe adds.
He shares three key questions to ask when identifying these hot spots and the use of wellness data:
What is burnout costing us as a health system?
Where is burnout costing us the most?
Why is burnout costing us so much there? What are some of the contributors that could be playing a role, and how can we mitigate those?
“With these three questions, health system leaders can use empiric data to develop baseline target interventions that address the root of the issue, and lead to not only a greater sense of well-being within the organization, but a better economic performance and better economic health of the organization overall,” says Adibe.
Bryant Adibe has nothing to disclose.
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Clinician burnout and wellness is an operations issue at its core. By developing an institutional wellness dashboard that measures burnout across a health system and its attributable costs, health care leaders can target resources accordingly.
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The July 2022 issue of NEJM Catalyst Innovations in Care Delivery showcases solutions to health care challenges and looks ahead at what leaders and clinicians will face in the coming years.

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