Methodology & Framework Development

Methodology and Framework Development

The HRSA funded Workplace Change Collaborative (WCC) was tasked under the award to develop a “national framework that supports the rapid deployment of evidence informed or evidence-based strategies to reduce and address burnout, suicide, mental health conditions and substance use disorders and enhance resiliency.”

We developed the National Framework using an iterative process, including:

Literature review, particularly building from the seminal 1999 work of Leiter and Maslach, Six Areas of Worklife: A Model of the Organizational Context of Burnout;
Environmental scan, including a review of national and global reports addressing burnout and moral injury in health and public safety workers, as well as interviews with key national experts;
Review of 44 HRSA grantees’ target populations, planned activities, intended outcomes, and evaluations; and
External review of the draft National Framework by a broad group of 40+ national experts, health and public safety workers, and learners.

Over the course of the framework development process, seven major reports were released from national and international organizations related to burnout and well-being. All informed the development of the National Framework. These included:

Addressing Health Worker Burnout: The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce. Release Date: May 27, 2022
Strengthening the Health Care Workforce: Strategies for Now, Near, and Far by the American Hospital Association. Release Date: June 21, 2022
Addressing Burnout in the Behavioral Health Workforce through Organizational Strategies by the Substance Abuse and Mental Health Services Administration (SAMHSA). Release Date: September 1, 2022
National Plan for Health Workforce Well-Being by the National Academy of Medicine. Release Date: October 4, 2022
Our Duty of Care: A Global Call to Action to Protect the Mental Health of Health and Care Workers by the Qatar Foundation, World Innovation Summit for Health (WISH), in collaboration with the World Health Organization (WHO). Release date: October 5, 2022
The U.S. Surgeon General’s Framework for Workplace Mental Health & Well-Being. Release Date: October 20, 2022
The VA Clinician Burnout Research Agenda: Summary Draft Report by the U.S. Department of Veterans Affairs, Veterans Health Administration and AcademyHealth. Release Date: November 30, 2022

Reviewers

Between January and March 2023, a draft National Framework was reviewed by over 40 individuals with diverse viewpoints and expertise in health and public safety work and learning environments; burnout; moral injury; moral distress; resilience; suicide; diversity, equity, and inclusion; and many other areas. We would like to express our gratitude for their time and critical review. Their comments significantly shaped the final National Framework. Reviewers included:

Lillian Agyei, American Society of Health-System Pharmacists

Farida Ahmed, National Academy of Medicine

Amy Benton, School of Social Work, Texas State University

Christine Cassel, University of California at San Francisco

Catherine Colgan, National Academy of Medicine

Anna Legreid Dopp, American Society of Health-System Pharmacists

Leila Durr, AdventHealth West Florida Division

Leo Eisenstein, New York City Health + Hospitals-Kings County

Margaret Flinter, Community Health Center, Inc.

Jeane Garcia-Davis, Office of the U.S. Surgeon General

Elizabeth Goelz, Institute for Professional Worklife, Hennepin Healthcare

Brian Hughes, Optum

Fred Hyde, Fred Hyde & Associates, Inc.

Maria Koeppel, National Development and Research Institutes (NDRI) USA

Lisa Ladendorff, Northeast Oregon Network

Alden Landry, Harvard Medical School; Beth Israel Deaconess Medical Center

Anne Laux, Office of the Ohio Attorney General

Karly Low, American Society of Health-System Pharmacists

Gina Galanou Luchen, American Society of Health-System Pharmacists

Rachael McGarry, American Society of Health-System Pharmacists

Sneha Mantri, Trent Center for Bioethics, Humanities, and History of Medicine; Duke University Movement Disorders Center

Kedar Mate, Institute for Healthcare Improvement

Deborah Morris, Centre for Developmental and Complex Trauma, St. Andrews Healthcare

Erica Moseley, American Society of Health-System Pharmacists

Christine Yu Moutier, American Foundation for Suicide Prevention

Mytien Nguyen, Yale School of Medicine

John Oates, International Public Safety Data Institute

Stephanie Ortega, Emergency Physicians of Saint Clare’s Denville, NJ

Patricia Patrician, School of Nursing, University of Alabama at Birmingham

Michael Privitera, University of Rochester Medical Center

Rebecca Reindel, AFL-CIO

Jonathan Ripp, Icahn School of Medicine at Mount Sinai

Taylor Rogers, University of California at San Francisco Healthforce Center and Philip R. Lee Institute for Health Policy Studies

Elizabeth Royal, SEIU Healthcare

Hal Ruddick, Alliance of Healthcare Unions

Cynda Rushton, Johns Hopkins School of Nursing

Tina Shah, Abridge

Christine Sinsky, American Medical Association

Thu Anh Tran, National Academy of Medicine

Elanor Webb, Centre for Developmental and Complex Trauma, St. Andrews Healthcare

Richard Westphal, School of Nursing, University of Virginia

We would also like to thank the HRSA Health and Public Safety Workforce Resiliency Training Program (HPSWRTP) grantees and the Promoting Resilience and Mental Health among the Health Professional Workforce (PRMHW) grantees for sharing their proposals, work, and insights with us. As leaders in the space of addressing mental health, burnout, and moral injury in the health and public safety workforce, their work was foundational to the development of the National Framework for Addressing Burnout and Moral Injury in the Health and Public Safety Workforce.

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Framework Team

Patricia Pittman, Fitzhugh Mullan Institute for Health Workforce Equity

Candice Chen, Fitzhugh Mullan Institute for Health Workforce Equity

Lauren Muñoz, Fitzhugh Mullan Institute for Health Workforce Equity

Randl Dent, Fitzhugh Mullan Institute for Health Workforce Equity

Margaret Ziemann, Fitzhugh Mullan Institute for Health Workforce Equity

Julia Strasser, Fitzhugh Mullan Institute for Health Workforce Equity

Wendy Dean, Moral Injury of Healthcare

Simon Talbot, Moral Injury of Healthcare

Jessica Perlo, ABIM Foundation [formerly, Institute for Healthcare Improvement]

Ariel Morton, formerly, Moral Injury of Healthcare

Janice Blanchard, George Washington University School of Medicine

Kelly Nedrow, AFT Healthcare

Kimberly Fleming, Moral Injury of Healthcare

Samantha Meeker, Fitzhugh Mullan Institute for Health Workforce Equity

Becka DeSmidt, Institute for Healthcare Improvement

Jamar Slocum, George Washington University School of Medicine

Maria Portela-Martinez, George Washington University School of Medicine