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National Framework for Addressing Burnout and �Moral Injury in the Health and Public Safety Workforce

Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University

Institute for Healthcare Improvement

Moral Injury of Healthcare

AFT Healthcare

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Disclaimer

This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $5,940,548 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

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Framework Development Process

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State of Burnout Work

May 2022

June 2022

Sept 2022

Oct 2022

Dec 2022

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Burnout: A syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment occurring from chronic workplace stress
Resilience: The ability of a person, community, or system to withstand, adapt, recover, rebound, or even grow from adversity, stress, or trauma
Moral injury: The impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations. Integral to the concept is the perception of betrayal by those in positions of authority and the inability (for a variety of reasons) to speak up to address the issue.

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Definitions

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The National Framework consists of two parts: 1) the drivers, process, and outcomes of burnout and moral injury and 2) actionable strategies for addressing burnout and moral injury. This slide shows the first part.

Distal drivers of burnout and moral injury include environmental factors that occur on multiple levels. Proximal drivers can loosely fit into two categories: those that contribute to relational breakdown and those that contribute to operational breakdown.

The processes for burnout and moral injury are distinct but also appear to be related. The connection between them has not been fully elucidated.

Burnout and moral injury result in harmful outcomes for workers and learners, patients and community, organizations, and society. Additionally, as the arrow at the bottom of the graphic indicates, the outcomes of burnout and moral injury can feed back to the drivers, creating a vicious cycle. For example, as organizations experience recruitment and retention challenges because of burnout and moral injury, the workers who remain at an organization may have even more excessive demands placed upon them and encounter more situations that raise values conflicts, heightening the risk of burnout and moral injury.

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Strategies: Creating Better Working & Learning Environments

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Relational Strategies: Creating Better Working & Learning Environments for Healthcare Organizations

Values Alignment

Center patients & communities
Acknowledge moral injury

Worker/Learner Voice & Trust

Psychological safety
Engage workers & learners in co-designing solutions

Diversity, Equity, �& Inclusion

Improve diversity
Establish equitable & inclusive environments

wpchange.org/actionable-strategy/health-organizations

Leadership

Leadership development
Assess & establish accountability

Commitment & Governance

Well-being infrastructure
Shared governance

Measurement & Accountability

Measure retention, turnover, burnout, & MI
Measure leader behaviors

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Operational Strategies: Creating Better Working & Learning Environments for Healthcare Organizations

Physical & Mental Health Safety

Occupational safety
Workplace violence prevention
Address mental health
Provide stress/trauma & resilience supports

Workload & Workflows

Safe & appropriate staffing
Optimizing teams
Reducing administrative burdens
Maximizing technology

Reward & Recognition

Fair & adequate compensation
Career supports & development

wpchange.org/actionable-strategy/health-organizations

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Government Strategies

Leadership, Governance & Voice

Invest in programs and evaluations
Worker & Learner Protections

Aligning Values & DEI

Polices to align/center patients and communities
Improve workforce DEI

Measurement & Accountability

Directly measure well-being
Develop organizational metrics for well-being
Workforce analysis

Physical & Mental Health Safety

Strengthen OSHA policies
Address mental health stigma & protect right to access services

Workloads & Workflows

Advance Team-Based Care
Safe Staffing standards & workforce development
Reduce admin burden

Rewards & Recognition

Ensure adequate compensation & brunch
Invest in career development programs

wpchange.org/actionable-strategy/government

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wpchange.org

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For More Information...

Workplace Change Collaborative website & email:

https://wpchange.org/

workplacechange@gwu.edu

Patricia (Polly) Pittman, PhD, FAAN

Email: ppittman@gwu.edu

Lauren Muñoz, PhD, RN

Email: lauren.munoz@gwu.edu

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This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $5,940,548 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.