CANDOR can boost job satisfaction in healthcare workers and potentially prevent burnout

There is widespread concern across the US about the high incidence of burnout among healthcare workers. The symptoms of burnout include emotional exhaustion, depersonalization—a feeling of disconnection with one’s identity—and a low sense of personal accomplishment. Concerns about burnout have been exacerbated by the COVID-19 pandemic, and the exit of healthcare workers may result in people having less access to care. This situation could result in fewer healthcare workers being available to take care of an increasingly aging and ill population.

In 2021, the Surgeon General released a report titled “Addressing Healthcare Workforce Burnout.” Furthermore, the Surgeon General has spoken extensively across the US about the problem of worker burnout. He was quoted in an AJC article saying that it is estimated that there will be a shortage of 3 million essential low-wage healthcare workers by 2027. The Surgeon General also was featured on a Dr. Glaucomflecken video webcast (which has over 750,000 subscribers, mostly healthcare professionals) about how the Federal Government is working to improve the well-being of healthcare workers.

The US Bureau of Labor Statistics has indicated that there could be an urgent need for 1.1 million new nurses by the end of 2022. Many burnout experts believe that professional environment and work culture form the major sources of healthcare workers’ burnout. In 2022, Congress passed the Dr. Lorna Breen Health Care Provider Protection Act. The Act requires the Department of Health and Human Services to award grants to hospitals and other healthcare entities for programs to promote mental health and resiliency among healthcare providers. But what programs should hospitals implement?

A new study suggests CANDOR programs could help hospitals improve staff’s well-being, and hopefully increase the number of staff who stay on at their medical facility. To the extent that CANDOR programs do this, there is some new hope for improving access to future care. The study was published in JAMA Network Open by Health Economist Andrew Friedson and coauthors.

CANDOR is a patient safety, medical liability, and healthcare professional wellness program designed for when patients suffer an unexpected bad outcome. CANDOR’s basic premise emphasizes honesty in medical error situations. It aims to help patients experiencing unexpected bad outcomes, prevent the recurrence of medical errors, and help healthcare professionals cope with the aftermath when their patient suffers an adverse outcome. Hospitals establish a peer support group to counsel healthcare providers when their patient suffers a bad outcome. Studies have found evidence suggesting that, compared to the common US practice “Deny, Delay, and Defend,” using CANDOR not only benefits current and future patients but also improves the well-being of healthcare professionals. For example, a survey of anesthesiologists found that anesthesiologists who did not feel supported by their hospital leaders had 6.5 times more symptoms of burnout than those who felt supported. Other, earlier, studies have found evidence that CANDOR can also improve patient care. Presently, over 800 U.S. hospitals have implemented or are in the process of implementing CANDOR.

In this study, the authors found that there was an association between CANDOR implementation and workers feeling more confident in hospital leadership and feeling more likely to still be working in the hospital in the future. Confidence in senior leadership may particularly be an important factor in retaining employees.

“This is early evidence on the value of CANDOR programs in improving healthcare worker job satisfaction. It’s exciting to find something that could help improve these metrics. Quality of the work environment and job satisfaction are important for keeping workers in the sector,” says Andrew Friedson.

Dr Tim McDonald, one of the architects of the CANDOR Toolkit and Chief Patient Safety and Risk Officer at RLDatix states, “We are very pleased to see the data from Friedson et al. that demonstrates improvement in healthcare professional perceptions of workplace satisfaction and trust in hospital leadership associated with the application of CANDOR principles. This offers hope that CANDOR may be one of the solutions to help address the unprecedented HCP burnout we are currently experiencing.”

This study builds on prior and ongoing work showing that CANDOR programs can improve how hospitals interact with patients by demonstrating that CANDOR also improves how hospitals support their workforce. Friedson concludes, “CANDOR programs in particular may be fertile ground for improving worker satisfaction and with it, hopefully, retention. It may not be enough for healthcare workers to take pride in their work. They may be more likely to stay when they can also take pride in how their institution handles itself.”

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References

Helena Oliviero, Ariel Hart
Surgeon General Warns of Workers Burnout. Nation should bear moral responsibility to provide aid, he says.
Atlanta Journal Constitution May 28, 2022, p. A 8

DOI: https://doi.org/10.1001/jamanetworkopen.2023.2302

Authors: Andrew I. Friedson, PhD¹; Abigail Humphreys¹, BA; Florence LeCraw, MD^2,3; Barbara Pelletreau, RN; MPH^3,4; Priscilla Vierra, BS^3,4; Thomas A. Mroz, PhD^3,5

Affiliations:

1. Department of Economics, University of Colorado, Denver
2. Northside Healthcare System, Atlanta, Georgia
3. Andrew Young School of Policy Studies, Georgia State University, Atlanta
4. CommonSpirit Health (former or should we say retired?), Chicago, Illinois
5. Federal Reserve Bank of Atlanta, Atlanta, Georgia