Domains of Wellbeing: Work Life
We’ve been diving deep into the emerging scientific field of wellbeing recently here on the blog. One of my favorite topics to discuss! More specifically, I love applying this knowledge to everyday life since it’s been proven time and again to make a significant difference in the lives of individuals.
Domains of Wellbeing
A quick internet search reveals models developed by different writers, bloggers, consultants, and therapists. While the word domain has many definitions, for our purposes we will use, “a sphere of knowledge, influence, or activity.” With this definition, we can safely narrow down the domains we will discuss as relevant to personal wellbeing.
Remember, we’re focused on individual wellbeing, not organizational wellbeing. In our last blog post we went through 5 reasons why individual wellbeing is worth this attention.
Who’s doing the research?
A review by the CDC reveals that different disciplines have examined the following aspects of wellbeing in research (1):
Physical wellbeing
Economic wellbeing
Social wellbeing
Development and activity
Emotional wellbeing
Psychological wellbeing
Life satisfaction
Domain specific satisfaction
Engaging activities and work
Gallup’s data, collected from people in more than 150 countries, narrows these to five domains, called five elements by the study authors: Career Wellbeing, Social Wellbeing, Financial Wellbeing, Physical Wellbeing, and Community Wellbeing (2). While 66% of people surveyed were doing well in at least one of the five elements, just 7% were thriving in all five. These studies also show that humans overrate the role of health and finances in their wellbeing and underrate the importance of the other elements. The Mayo Clinic’s Wellbeing Index measures wellbeing in the following six dimensions: meaning in work, likelihood of burnout, severe fatigue, work-life integration, quality of life, and suicidal ideation (3).
For practical purposes, and heuristic application, we will focus on the following four domains: Work Life, Personal Life, Health, and Wealth.
The research is easily applicable to both physicians and those not in the medical field. Additionally, the categories do not easily overlap but do interact with and affect each other.
In the next four posts, we will examine them all and discuss the interactions between them.
Today, we begin with Work Life.
Our first domain: Work Life
Work life is a term used in studies by Maslach, Leiter et al (4) to underscore that humans have a unique life at work.
All workers spend a significant amount of time at work. There are relationships at work. Work can be a source of stress and joy, sometimes both at the same time.
This has many implications for physicians and other clinicians. The lack of wellbeing and presence of illbeing, and their effect on healthcare staff has been a subject of study for several decades with physicians being the most studied group. It is understood that physicians are the proverbial canaries in this coal mine and newer studies focused on nurses show similar results (5).
The phenomenon of burnout at work is the aspect of illbeing that has been studied the most. According to the WHO, burnout is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed (6).
Burnout is characterized by...
Feelings of energy depletion or exhaustion
Increased mental distance from one’s job, or feelings of negativism, or cynicism related to one's job
Reduced professional efficacy
The WHO mentions that burnout refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life. Burnout is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon, but not classified as a medical condition.
Yet, while the WHO claims this phenomenon is confined to a person’s work life, there is evidence that it affects all parts of life including patient care and outcomes. Since the early 2000’s, many studies and surveys have assessed burnout in physicians. The 2019 Medscape Survey shows burnout rates range from 29-54% (7). These rates reflect a higher rate of burnout among physicians compared with the general U.S. population, which was reported to be 28% in 2014 (8).
This is both an individual and industry-wide issue, as physician burnout costs the healthcare industry between $2.6 billion and $6.3 billion each year with a calculated baseline of about $4.6 billion in costs from turnover, reduced productivity and other burnout-related factors (9).
Another major concern is patient care, as symptoms of burnout have been linked to suboptimal patient outcomes. In hospitals with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted 30-day mortality and failure-to-rescue rates, and nurses, in addition to physicians, are more likely to experience burnout and job dissatisfaction (10).
Furthermore, studies saw a significant association between nurses’ burnout and urinary tract infection and surgical site infection (11). With nurse and physician burnout on the rise, clinicians have fewer personal interactions with patients, leading to lower patient satisfaction and longer post discharge recovery time (12). Yet, units where nurses found their work meaningful, the patients were more satisfied with all aspects of their hospital stay (13). The units where nursing staff felt more exhausted or more frequently expressed the intention to quit, patients were less satisfied with their care. Patients cared for in units that nurses characterized as having adequate staff, good administrative support for nursing care, and good relations between doctors and nurses were more than twice as likely as other patients to report high satisfaction with their care.
Another problem in the work life domain is presenteeism.
Often associated with pain and depression, presenteeism is commonly defined as the practice of coming to work despite conditions which lead to diminished productivity such as illness, injury, or debilitating anxiety or overworking yourself with no real need to do so.
Additionally, frequently accompanied by a higher number of patient falls, a higher number of medication errors, and lower quality-of-care scores (14). Baseline cost estimates indicate that the increased falls and medication errors caused by presenteeism are expected to cost $1,346 - $9,000 per RN in North Carolina and between $2 billion and $13 billion for the United States annually. Furthermore, major medical errors reported by surgeons are strongly related to a surgeon's degree of burnout and their mental quality of life (15).
However, the primary challenge of work life in the medical field is reported to be the rules and regulations. Medscape Physician Compensation Report 2019 shows that 36% of physicians spend 20 or more hours per week at work on paperwork and administrative tasks (16). Nearly half of physicians report that their job is "extremely stressful," and 81% say they feel "overextended," "overworked," or "at full capacity". Physicians also note that they have "too many patient appointments," leading to increased time pressure during visits, which is also strongly associated with lower rates of satisfaction and higher rates of burnout. Long hours, many of which are spent on nonclinical tasks, and unsatisfactory work-life balance are the key factors in feeling stressed or overextended. Physicians work an average of 51 to 63 hours per week, 11 to 23 more hours than the general population. This domain, to say the least, has its challenges.
Presence of wellbeing or illbeing (or wherever an individual currently sits on the ladder of wellbeing) within a physician’s work life will necessarily ripple throughout other domains as well.
Next week we’ll continue our discussion of domains in an individual’s personal life. Looking at domains both individually and in relationship to each other will necessarily help us to understand how wellbeing functions in everyday reality.
Sources:
Wellbeing Concepts. Centers for Disease Control and Prevention. https://www.cdc.gov/hrqol/wellbeing.htm. Published October 31, 2018. Accessed June 8, 2020.
Rath T, Harter JK. Wellbeing: the Five Essential Elements. New York: Gallup Press; 2014.
6 Dimensions of Distress and Wellbeing: The Wellbeing Index. 6 Dimensions of Distress and Wellbeing | The Wellbeing Index. https://www.mededwebs.com/wellbeing-index/6-dimensions-of-distress-and-wellbeing. Accessed June 8, 2020.
Leiter MP, Maslach C. Six areas of worklife: a model of the organizational context of burnout. J Health Hum Serv Adm. 1999;21(4):472‐489.
Jennings BM. Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 26. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2668/
Burn-out an "occupational phenomenon": International Classification of Diseases. World Health Organization. https://www.who.int/mental_health/evidence/burn-out/en/. Published May 28, 2019. Accessed June 8, 2020.
Medscape.com https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056. Accessed June 8, 2020.
Shanafelt T, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general U.S. working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.
Han S, Shanafelt TD, Sinsky CA, et al. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. 2019;170(11):784‐790. doi:10.7326/M18-1422
Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987‐1993. doi:10.1001/jama.288.16.1987
Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection [published correction appears in Am J Infect Control. 2012 Sep;40(7):680]. Am J Infect Control. 2012;40(6):486‐490. doi:10.1016/j.ajic.2012.02.029
Halbesleben JR, Rathert C. Linking physician burnout and patient outcomes: exploring the dyadic relationship between physicians and patients. Health Care Manage Rev. 2008;33(1):29‐39. doi:10.1097/01.HMR.0000304493.87898.72
Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. Nurse burnout and patient satisfaction. Med Care. 2004;42(2 Suppl):II57‐II66. doi:10.1097/01.mlr.0000109126.50398.5a
Letvak SA, Ruhm CJ, Gupta SN. Nurses' presenteeism and its effects on self-reported quality of care and costs. Am J Nurs. 2012;112(2):30‐39. doi:10.1097/01.NAJ.0000411176.15696.f9
Shanafelt TD, Balch CM, Bechamps G, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010;251(6):995‐1000. doi:10.1097/SLA.0b013e3181bfdab3
Medscape.com https://www.medscape.com/slideshow/2019-compensation-overview-6011286. Accessed June 8, 2020.