Special Edition Digest – Workforce Engagement & Well-Being, Vol. 1

A Newsletter from the Health Resources & Services Administration (HRSA)

HRSA BPHC Primary Health Care Digest

May 2, 2019

Strategies to Promote Workforce Engagement and Well-being

Special Edition: Workforce Engagement & Well-Being, Volume 1

This special edition of the Primary Health Care Digest provides health centers with tools and resources, including promising practices, to promote a healthy and engaged workforce. This is the first of two special editions focused on workforce engagement and well-being.

The health center workforce is nearly 233,000 strong and plays a crucial role in providing access to high-quality, comprehensive care and reducing costs. HRSA is engaged in several initiatives to support workforce well-being through the development of a national health center workforce satisfaction and well-being survey and collaborative learning system. This special edition is also a key part of our efforts. 

Nearly half of physicians, nurses and other health care providers report experiencing job burnout. Burnout can take many forms including emotional exhaustion, depersonalization, and a low sense of personal accomplishment at work. Far too often, health center staff feel unable to achieve their mission of delivering high-quality, patient-centered care due to demanding workloads, insufficient capacity to serve complex patient populations, and workflow inefficiencies. 

Work conditions can negatively affect staff engagement and well-being, quality of care, patient safety, and patient outcomes. These effects can lead to increased medical errors, workforce turnover, difficulties with recruitment and retention, and productivity loss with implications to providers, patients, and sustainability of the health care system.

What can health centers do to improve their workforce’s engagement and well-being?

Promising Practices

El Rio Santa Cruz Neighborhood Health Center; Tucson, AZ
Douglas Spegman, Chief Clinical Officer

  • Five-year effort of cultural transformation including defining six cultural principles.
  • Developing transformative leadership with skill development supported by consultant.
  • Focus on optimizing EHR and health information technology (HIT) and hired Clinician Leader in Informatics.
  • Optimizing multidisciplinary teams and workflows.
  • Provides one to four hours per week to staff to focus on areas of interest (e.g. teaching, advocacy, quality improvement).
  • Senior leadership is lead for workforce engagement and well-being: commits to cultural principles, provides resources, and holds meetings and committees to engage staff.
  • Well-Being and Health Builder Team arranges well-being activities for all employees.
  • Quarterly staff satisfaction surveys; staff turnover rate: <6%, decreased from under 20% four years ago; increased primary care provider workforce by 72% in last five years.
  • Able to move from a “counting widget mentality” due to increasing proportion of value-based revenue. Recognizes downstream return on investment.

RiverStone Health; Billings, MT 
Megan Littlefield, Chief Medical Officer

  • Using AMA framework, implementing a three-pronged approach to promoting workforce wellness and resilience: organizational changes, workflow efficiencies, individual staff, and team support.
  • Workforce wellness a strategic focus; resources made available; organizational structure for wellness and resilience; led by Executive Leadership Group with CMO as champion, advised by interdisciplinary Wellness and Resilience Steering group.
  • Two medical assistants (MAs) per provider—one for rooming and second for in-room support, which is a promotion and career track for MAs; charting efficiency.
  • Enhanced onboarding and mentoring; provider-focused employee assistance program; meaningful administrative time to foster leadership roles (e.g., teaching, program development); team wellness-projects; structured debriefs of complex cases. 
  • Yearly assessments of burnout and work life with follow-up data on annual assessments pending; staff turnover rate is 10%.
  • Return on investment in reduced recruitment costs and preventing consequences of staff turnover and burnout.

Westside Family Healthcare; Wilmington, DE
Megan Werner, Associate Medical Director of Population Health and Quality

  • Optimizing workflows and minimizing care team stressors; focusing on having appropriate staffing levels, doing meaningful work, and removing inefficiencies.
  • Six-month mentoring process for new providers: slow ramp up of patient panels, structured approach to EHR training, routine check-ins with Associate Medical Director, case-based mentoring.
  • Spreading work across the care team members; expanded role of MAs, which required protocols, competency training, and buy-in of providers.
  • Providing career advancement opportunities for staff (e.g., supervisor position for MAs, nurse care manager positions for chronic disease and prenatal care management).
  • CEO is champion, supported by clinical leadership team, which drives the interventions.
  • Prioritize wants and needs; be ready to respond to funding opportunities to finance priorities. 

Assessment Tools

Valid and reliable assessment tools can help health centers accurately measure and understand workforce engagement and well-being and identify solutions. Assessment tools to consider include:

Organizational assessments:

Upcoming Webinar

The Power of Resiliency: Unlocking the Quadruple Aim

Hosted by HRSA
Wednesday, May 8
12:00-1:30 p.m. ET
Register here


Websites with Multiple Resources

STAR2 CENTER (Solutions Training and Assistance for Recruitment & Retention)

A project of the Association of Clinicians for the Underserved (ACU), which has a national cooperative agreement with HRSA. Includes articles, assessment tools, links to other websites, and the STAR2 Center Strategies to Reduce Burnout webinar series. 

AMA Educational Hub: STEPS Forward

A practice improvement initiative from AMA that includes practice transformation tools and resources and modules on leading change, optimizing workflows and EHR use, and professional well-being.

NAM: Action Collaborative on Clinician Well-Being and Resilience  

NAM-hosted collaborative of organizations committed to reversing trends in clinician burnout. Resources include NAM Clinician Well-Being Knowledge Hub, webcasts, perspective articles and a conceptual model for clinician well-being.

ACGME Tools and Resources for Resident and Faculty Member Well-Being

Resources for residents and faculty members on well-being, including improving the learning and working environment and assessing and addressing emotional and psychological distress, depression, and suicide.

Archived Presentations

STAR2 Center Five-Part Webinar Series: Administrative Strategies to Reduce Burnout

HRSA Health Workforce Grand Rounds Webinar Series: Provider Well-Being: Moving from Triple to Quadruple Aim in Clinical Training

SAMHSA-HRSA Center for Integrated Health Solutions: Improving Workplace Experience and Reducing Burnout in Integrated Care Environments: Mindfulness and Psychological Flexibility and Compassion Fatigue and Self-Care

CMS Quality Conference 2019: Provider Wellness: A Self and System Imperative in a Value Based Model (see Day 2 Presentations, Folder 78)

NACHC Policy and Issues Forum 2019: The Opioid Epidemic: How Do We Take Care of the Compassionate Care Team?