Confronting Health Worker Burnout and Well-Being

V. Murthy

NEJM, July 13, 2022

DOI: 10.1056/NEJMp2207252

Here is an excerpt:

Burnout manifests in individuals, but it’s fundamentally rooted in systems. And health worker burnout was a crisis long before Covid-19 arrived. Causes include inadequate support, escalating workloads and administrative burdens, chronic underinvestment in public health infrastructure, and moral injury from being unable to provide the care patients need. Burnout is not only about long hours. It’s about the fundamental disconnect between health workers and the mission to serve that motivates them.

These systemic shortfalls have pushed millions of health workers to the brink. Some 52% of nurses (according to the American Nurses Foundation) and 20% of doctors (Mayo Clinic Proceedings) say they are planning to leave their clinical practice. Shortages of more than 1 million nurses are projected by the end of the year (U.S. Bureau of Labor Statistics); a gap of 3 million low-wage health workers is anticipated over the next 3 years (Mercer). And we face a significant shortage of public health workers precisely when we need to strengthen our defenses against future public health threats. Health worker burnout is a serious threat to the nation’s health and economic security.

The time for incremental change has passed. We need bold, fundamental change that gets at the roots of the burnout crisis. We need to take care of our health workers and the rising generation of trainees.

On May 23, 2022, I issued a Surgeon General’s Advisory on health worker burnout and well-being, declaring this crisis a national priority and calling the nation to action with specific directives for health systems, insurers, government, training institutions, and other stakeholders. The advisory is also intended to broaden awareness of the threat that health worker burnout poses to the nation’s health. Public awareness and support will be essential to ensuring sustained action.

Addressing health worker well-being requires first valuing and protecting health workers. That means ensuring that they receive a living wage, access to health insurance, and adequate sick leave. It also means health workers should never again go without adequate personal protective equipment (PPE) as they have during the pandemic. Current Biden administration efforts to enhance domestic manufacturing of PPE and maintain adequate supplies in the Strategic National Stockpile will continue to be essential. Furthermore, we need strict workplace policies to protect staff from violence: according to National Nurses United, 8 in 10 health workers report having been subjected to physical or verbal abuse during the pandemic.

Second, we must reduce administrative burdens that stand between health workers and their patients and communities. One study found that in addition to spending 1 to 2 hours each night doing administrative work, outpatient physicians spend nearly 2 hours on the electronic health record and desk work during the day for every 1 hour spent with patients — a trend widely lamented by clinicians and patients alike. The goal set by the 25×5 initiative of reducing clinicians’ documentation burden by 75% by 2025 is a key target. To help reach this goal, health insurers should reduce requirements for prior authorizations, streamline paperwork requirements, and develop simplified, common billing forms. Our electronic health record systems need human-centered design approaches that optimize usability, workflow, and communication across systems. Health systems should regularly review internal processes to reduce duplicative, inefficient work. One such effort, Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” program, has saved 1700 nursing hours per month across the health system.

The info is here.

In Japan, more people died from suicide last month than from Covid in all of 2020

S. Wang, R. Wright, & Y. Wakatsuki

CNN.com

Originally posted 29 Nov 20

Here is an excerpt:

In Japan, government statistics show suicide claimed more lives in October than Covid-19 has over the entire year to date. The monthly number of Japanese suicides rose to 2,153 in October, according to Japan's National Police Agency. As of Friday, Japan's total Covid-19 toll was 2,087, the health ministry said.

Japan is one of the few major economies to disclose timely suicide data -- the most recent national data for the US, for example, is from 2018. The Japanese data could give other countries insights into the impact of pandemic measures on mental health, and which groups are the most vulnerable.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.

"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

(cut)

Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.

Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.

The info is here.

Workism Is Making Americans Miserable

Derek Thompson
The Atlantic
Originally published 24 Feb 20

Here is an excerpt:

The decline of traditional faith in America has coincided with an explosion of new atheisms. Some people worship beauty, some worship political identities, and others worship their children. But everybody worships something. And workism is among the most potent of the new religions competing for congregants.

What is workism? It is the belief that work is not only necessary to economic production, but also the centerpiece of one’s identity and life’s purpose; and the belief that any policy to promote human welfare must always encourage more work.

Homo industrious is not new to the American landscape. The American dream—that hoary mythology that hard work always guarantees upward mobility—has for more than a century made the U.S. obsessed with material success and the exhaustive striving required to earn it.

No large country in the world as productive as the United States averages more hours of work a year. And the gap between the U.S. and other countries is growing. Between 1950 and 2012, annual hours worked per employee fell by about 40 percent in Germany and the Netherlands—but by only 10 percent in the United States. Americans “work longer hours, have shorter vacations, get less in unemployment, disability, and retirement benefits, and retire later, than people in comparably rich societies,” wrote Samuel P. Huntington in his 2005 book Who Are We?: The Challenges to America’s National Identity.

One group has led the widening of the workist gap: rich men.

In 1980, the highest-earning men actually worked fewer hours per week than middle-class and low-income men, according to a survey by the Minneapolis Fed. But that’s changed. By 2005, the richest 10 percent of married men had the longest average workweek. In that same time, college-educated men reduced their leisure time more than any other group. Today, it is fair to say that elite American men have transformed themselves into the world’s premier workaholics, toiling longer hours than both poorer men in the U.S. and rich men in similarly rich countries.

This shift defies economic logic—and economic history. The rich have always worked less than the poor, because they could afford to. The landed gentry of preindustrial Europe dined, danced, and gossiped, while serfs toiled without end. In the early 20th century, rich Americans used their ample downtime to buy weekly movie tickets and dabble in sports. Today’s rich American men can afford vastly more downtime. But they have used their wealth to buy the strangest of prizes: more work!

The info is here.

Rebuilding the Economy Around Good Jobs

Zeynep Ton
Harvard Business Review
Originally posted 22 May 20

One thing we can predict: Customers who are struggling economically will be looking more than ever for good value. This will give the companies that start building a good jobs system a competitive advantage over those that don’t. After the financial crisis of 2008, Mercadona — Spain’s largest grocery chain and a model good jobs company — reduced prices for its hard-pressed customers by 10% while remaining profitable and gaining significant market share. Hard work and input from empowered front lines had a lot to do with it.

The pandemic is likely to accelerate the ongoing shakeup of U.S. retailing. The United States has 24.5 square feet of retail space per person versus 16.4 square feet in Canada and 4.5 square feet in Europe. This is almost certainly too much and the mediocre — the ones that don’t make their customers want to keep coming back — will not survive.

The pandemic is likely to speed up the adoption of new technologies. Although typically seen as a way to reduce headcount, adopting, scaling, and leveraging new technologies require a capable and motivated (even if smaller) workforce.

There is an alternative: A good jobs system that has already proven successful. Long before the pandemic, there were successful companies — including Costco and QuikTrip — that knew their frontline workers were essential personnel and treated and paid them as such. Even in very competitive, low-cost retail sectors, these companies adopted a good jobs system and used it to win.

There’s a strong financial case for good jobs. Offering good jobs lowers costs by reducing employee turnover, operational mistakes, and wasted time. It improves service, which increases sales both in the short term and — through customer loyalty — in the long term.

The info is here.

Restoring the Economy Is the Last Thing We Should Want

Douglas Rushkoff
medium.com
Originally published 27 April 20

Everyone wants to know when we’re going to get the economy started up again, and just how many lives we’re willing to surrender before we do. We’ve all been made to understand the dilemma: The sooner we “open up” American and get back to our jobs, the more likely we spread Covid-19, further overwhelming hospitals and killing more people. Yet the longer we wait, the more people will suffer and die in other ways.

I think this is a false choice. Yes, it may be true that every 1% rise in unemployment leads to a corresponding 1% rise in suicides. And it’s true that an extended freeze of the economy could shorten the lifespan of 6.4 million Americans entering the job market by an average of about two years. But such metrics say less about the human cost of the downturn than they do about the dangerously absolute dependence of workers on traditional employment for basic sustenance — an artifact of an economy that has been intentionally rigged to favor big banks and passive shareholders over small and local businesses that actually provide goods and services in a sustainable way.

In reality, the sooner and more completely we restore the old economy, the faster we simply recreate the conditions that got us sick in the first place and rendered us incapable of mounting an effective response. The economy we’re committed to restoring is no more the victim of the Covid-19 crisis than it is the cause. We have to stop asking when will things get back to normal. They won’t. There is no going back. And that’s actually good news.

The info is here.

The coming battle for the COVID-19 narrative

Samule Bowles & Wendy Carlin
voxeu.org
Originally posted 10 April 20

The COVID-19 pandemic is a blow to self-interest as a value orientation and laissez-faire as a policy paradigm, both already reeling amid mounting public concerns about climate change.  Will the pandemic change our economic narrative, expressing new everyday understandings of how the economy works and how it should work? 

We think so. But it will not be simply a shift to the left on the now anachronistic one-dimensional markets-versus-government continuum shown in Figure 1. A position along the blue line represents a mix of public policies – nationalisation of the railways, for example, towards the left; deregulation of labour markets, for example, towards the right.

COVID-19, for better or worse, brings into focus a third pole in the debate: call it community or civil society. In the absence of this third pole, the conventional language of economics and public policy misses the contribution of social norms and of institutions that are neither governments nor markets – like families, relationships within firms, and community organisations.

There are precedents for the scale of changes that we anticipate. The Great Depression and WWII changed the way we talked about the economy: left to its own devices it would wreak havoc on people’s lives (massive unemployment), “heedless self-interest [is] bad economics” (FDR),1 and governments can effectively pursue the public good (defeat fascism, provide economic security). As the memories of that era faded along with the social solidarity and confidence in collective action that it had fostered, another vernacular took over: “there is no such thing as society” (Thatcher) – you get what you pay for, government is just another special interest group.

Another opportunity for a long-needed fundamental shift in the economic vernacular is now unfolding. COVID-19, along with climate change, could be the equivalent of the Great Depression and WWII in forcing a sea change in economic thinking and policy.

The info is here.

BlackRock’s New Morality Marks the End for Coal

Nathaniel Bullard
Bloomberg News
Originally posted 17 Jan 20

Here is an excerpt:

In the U.S., the move away from coal was well underway before the $7 trillion asset manager announced its restrictions. Companies have been shutting down coal-fired power plants and setting “transformative responsible energy plans” removing coal from the mix completely, even in the absence of robust federal policies. 

U.S. coal consumption in power generation fell below 600 million tons last year. This year, the U.S. Energy Information Administration expects it to fall much further still, below 500 million tons. That’s not only down by more than 50% since 2007, but it would also put coal consumption back to 1978 levels.

That decline is thanks to a massive number of plant retirements, now totaling more than 300 since 2010. The U.S. coal fleet has not had any net capacity additions since 2011. 2015 is the most significant year for coal retirements to date, as a suite of Obama-era air quality standards took effect. 2018 wasn’t far behind, however, and 2019 wasn’t far behind 2018.

The base effect of a smaller number of operational coal plants also means that consumption is declining at an accelerating rate. Using the EIA’s projection for 2020 coal burn in the power sector, year-on-year consumption will decline nearly 15%, the most since at least 1950.

Coal’s decline doesn’t exist in isolation. Most coal in the U.S. travels from mine to plant by rail, so there’s a predictable impact on rail cargoes. A decade ago, U.S. rail carriers shipped nearly 7 million carloads of coal. Last year, that figure was barely 4 million.

The info is here.

Ethics and automation: What to do when workers are displaced

Tracy Mayor
MIT School of Management
Originally published July 8, 2019

As companies embrace automation and artificial intelligence, some jobs will be created or enhanced, but many more are likely to go away. What obligation do organizations have to displaced workers in such situations? Is there an ethical way for business leaders to usher their workforces through digital disruption?

Researchers wrestled with those questions recently at MIT Technology Review’s EmTech Next conference. Their conclusion: Company leaders need to better understand the negative repercussions of the technologies they adopt and commit to building systems that drive economic growth and social cohesion.

Pramod Khargonekar, vice chancellor for research at University of California, Irvine, and Meera Sampath, associate vice chancellor for research at the State University of New York, presented findings from their paper, “Socially Responsible Automation: A Framework for Shaping the Future.”

The research makes the case that “humans will and should remain critical and central to the workplace of the future, controlling, complementing and augmenting the strengths of technological solutions.” In this scenario, automation, artificial intelligence, and related technologies are tools that should be used to enrich human lives and livelihoods.

Aspirational, yes, but how do we get there?

The info is here.

U.S. companies put record number of robots to work in 2018

Reuters
Originally published February 28, 2019


U.S. companies installed more robots last year than ever before, as cheaper and more flexible machines put them within reach of businesses of all sizes and in more corners of the economy beyond their traditional foothold in car plants.

Shipments hit 28,478, nearly 16 percent more than in 2017, according to data seen by Reuters that was set for release on Thursday by the Association for Advancing Automation, an industry group based in Ann Arbor, Michigan.

Shipments increased in every sector the group tracks, except automotive, where carmakers cut back after finishing a major round of tooling up for new truck models.

The info is here.

Trump's 'America First' Policy Puts Economy Before Morality

Zeke Miller, Jonathan Lemire, and Catherine Lucey
www.necn.com
Originally posted October 18, 20198

Here is an excerpt:

Still, Trump's transactional approach isn't sitting well with some of his Republican allies in Congress. His party for years championed the idea that the U.S. had a duty to promote U.S. values and human rights and even to intervene when they are challenged. Some Republicans have urged Trump not to abandon that view.

"I'm open to having Congress sit down with the president if this all turns out to be true, and it looks like it is, ... and saying, 'How can we express our condemnation without blowing up the Middle East?" Sen. John Kennedy, R-La., said. "Our foreign policy has to be anchored in values."

Trump dismisses the notion that he buddies up to dictators, but he does not express a sense that U.S. leadership extends beyond the U.S. border.

In an interview with CBS' "60 Minutes" that aired Sunday, he brushed aside his own assessment that Putin was "probably" involved in assassinations and poisonings.

"But I rely on them," he said. "It's not in our country."

Relations between the U.S. and Saudi Arabia are complex. The two nations are entwined on energy, military, economic and intelligence issues. The Trump administration has aggressively courted the Saudis for support of its Middle East agenda to counter Iranian influence, fight extremism and try to forge peace between Israel and the Palestinians.

The info is here.

AI will make life meaningless, Elon Musk warns

Zoe Nauman
The Sun
Originally published February 17, 2017

Here is an excerpt:

“I think some kind of universal income will be necessary.”

“The harder challenge is how do people then have meaning – because a lot of people derive their meaning from their employment.”

“If you are not needed, if there is not a need for your labor. What’s the meaning?”

“Do you have meaning, are you useless? That is a much harder problem to deal with.”

The article is here.

The Simple Economics of Machine Intelligence

Ajay Agrawal, Joshua Gans, and Avi Goldfarb
Harvard Business Review
Originally published November 17, 2016

Here are two excerpts:

The first effect of machine intelligence will be to lower the cost of goods and services that rely on prediction. This matters because prediction is an input to a host of activities including transportation, agriculture, healthcare, energy manufacturing, and retail.

When the cost of any input falls so precipitously, there are two other well-established economic implications. First, we will start using prediction to perform tasks where we previously didn’t. Second, the value of other things that complement prediction will rise.

(cut)

As machine intelligence improves, the value of human prediction skills will decrease because machine prediction will provide a cheaper and better substitute for human prediction, just as machines did for arithmetic. However, this does not spell doom for human jobs, as many experts suggest. That’s because the value of human judgment skills will increase. Using the language of economics, judgment is a complement to prediction and therefore when the cost of prediction falls demand for judgment rises. We’ll want more human judgment.

The article is here.

A Bright Robot Future Awaits, Once This Downer Election Is Over

By Andrew Mayeda
Bloomberg
Originally published October 24, 2016

Here is an excerpt:

‘Singularity Is Near’

An hour’s drive away, in San Francisco, the influx of tech workers has helped push the median single-family home price to $1.26 million. Private buses carry them to jobs at Apple Inc., Alphabet Inc.’s Google, or Facebook. Meanwhile, one former mayor has proposed using a decommissioned aircraft carrier to house the city’s homeless, who throng the sidewalks along Market Street, home to Uber and Twitter Inc.

How much will the “second machine age” deepen such divisions? Last month, a trio of International Monetary Fund economists came up with some chilling answers. Even if humans retain their creative edge over robots, they found, it will likely take two decades before productivity gains outweigh the downward pressure on wages from automation; meanwhile, “inequality will be worse, possibly dramatically so.”

And if the robots become perfect substitutes, the paper envisages an extreme scenario in which labor becomes wholly redundant as “capital takes over the entire economy.” The IMF economists even invoke futurist Ray Kurzweil’s 2006 bestseller, “The Singularity Is Near.”

Silicon Valley executives say alarm bells have been ringing for decades about job-killing technology, and they’re usually false alarms.

The article is here.

‘Economic suicides’ shake Europe

By Arianna Eunjung Cha
The Washington Post - Business
Originally published August 14, 2012

Here is part of the article.

So many people have been killing themselves and leaving behind notes citing financial hardship that European media outlets have a special name for them: “economic suicides.” Surveys are also showing increasing signs of mental stress: a jump in the use of antidepressants and illicit drugs, a rise in depression and anxiety among workers worried about salary cuts or being laid off, and an increase in the use of sick leave due to psychological problems.

“People are more and more uncertain about their future, which is leading to a sharp rise in mental health problems,” said Maria Nyman, director of Brussels-based Mental Health Europe, a multinational coalition of mental health organizations and educational institutions.

In recent years, researchers in the United States and elsewhere have repeatedly identified a correlation between suicides and unemployment or other economic distress. The U.S. Centers for Disease Control and Prevention reported last year that suicides increased during periods of economic stress, including the Great Depression, the oil crisis of the 1970s and the double-dip recession of the 1980s. Other studies have estimated that people with employment difficulties are two to three times as likely to commit suicide than the population as whole.

The entire story is here.

Greek woes drive up suicide rate to highest in Europe

By Helena Smith
The Guardian

Homeless man begs for money

The suicide rate in Greece has reached a pan-European record high, with experts attributing the rise to the country's economic crisis.

Painful austerity measures and a seemingly endless economic drama is exacting a deadly toll on the nation. Statistics released by the Greek ministry of health show a 40% rise in those taking their own lives between January and May this year compared to the same period in 2010.

Before the financial crisis first began to bite three years ago, Greece had the lowest suicide rate in Europe at 2.8 per 100,000 inhabitants. It now has almost double that number, the highest on the continent, despite the stigma in a nation where the Orthodox church refuses funeral rights for those who take their lives. Attempted suicides have also increased.

"It's never just one thing, but almost always debts, joblessness, the fear of being fired are cited when people phone in to say they are contemplating ending their lives," said Eleni Beikari, a psychiatrist at the non-governmental organisation, Klimaka, which runs a 24-hour suicide hotline.

Klimaka received around 10 calls a day before the crisis; it now gets more than 100 in any 24-hour period.

"Most come from women aged between 30 and 50 and men between 40 and 45 despairing over economic problems," said Beikari. "In my experience it's the men, suffering from hurt dignity and lost pride, who are most serious."

The entire story is here.