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Physician stress and burnout is a serious and common concern in healthcare, with over half of physicians in the USA meeting at least one criterion for burnout. The paper aims to discuss these issues.

A review on current state of physician stress and burnout research, from 2008 to 2016, was undertaken. A subsequent perspective paper was shaped around these reviews.

Findings reveal research strength in prevalence and incidence with opportunities for stronger intervention studies. While descriptive studies on causes and consequences of physician burnout are available, studies on interventions and prevention of physician burnout are lacking. Future research on physician stress and burnout should incorporate intervention studies and take care to avoid limitations found in current research. Accountability and prevention of physician burnout is the responsibility of the healthcare industry as a whole, and organizational strategies must be emphasized in future research.

The value of this research comes in the original comprehensive review, international inclusion and succinct summary of physician burnout research and strategies.

This paper aims at the implementation and early evaluation of a comprehensive, formative annual physician performance feedback process in a large academic health-care organization.

A mixed methods approach was used to introduce a formative feedback process to provide physicians with comprehensive feedback on performance and to support professional development. This initiative responded to organization-wide engagement surveys through which physicians identified effective performance feedback as a priority. In 2013, physicians primarily affiliated with the organization participated in a performance feedback process, and physician satisfaction and participant perceptions were explored through participant survey responses and physician leader focus groups. Training was required for physician leaders prior to conducting performance feedback discussions.

This process was completed by 98 per cent of eligible physicians, and 30 per cent completed an evaluation survey. While physicians endorsed the concept of a formative feedback process, process improvement opportunities were identified. Qualitative analysis revealed the following process improvement themes: simplify the tool, ensure leaders follow process, eliminate redundancies in data collection (through academic or licensing requirements) and provide objective quality metrics. Following physician leader training on performance feedback, 98 per cent of leaders who completed an evaluation questionnaire agreed or strongly agreed that the performance feedback process was useful and that training objectives were met.

This paper introduces a physician performance feedback model, leadership training approach and first-year implementation outcomes. The results of this study will be useful to health administrators and physician leaders interested in implementing physician performance feedback or improving physician engagement.

This paper proposes an organizational change process to prepare physicians and other health professionals for their new roles in patient-centered medical homes (PCMHs). It provides physician-centered tools, models, concepts, and the language to implement transformational patient-centered medical care.

To improve care delivery, quality, and patient engagement, a systems approach to care is required. This paper examines a systems approach to patient care where all inputs that influence patient interactions and participation are considered in the design of health care delivery and follow-up treatment plans. Applying systems thinking, organizational change models, and team-building, we have examined the continuum of this change process from ideation through the diffusion of new methods and behaviors.

PCMHs make compelling business sense. Studies have shown that the PCMH improves patient satisfaction, clinical outcomes and reduces underuse and overuse of medical services. Patient-centered care necessitates transitioning from an adversarial to a collaborative culture. It is a transformation process predicated on strong leadership able to align an organization toward a vision of patient-centered care, creating a collaborative culture committed to health-goal achievement.

This paper proposes that the PCMH is a rigorous team-building transformational organizational change, a radical departure from the current hierarchical, silo-oriented, medical practice model. It requires that participants within and across health care organizations learn new skills and behaviors to achieve the anticipated quality and efficiency improvements. It is an innovative health care organization model of the future whose success is premised on teams supplanting the individual as the building block and unit of health care performance.

Despite growing attention to physician engagement there is a lack of literature to guide the development of physician-led interventions. A scoping review was conducted to describe physician-led strategies that have been implemented to promote increased physician engagement in acute care settings. Strategies are viewed through the theoretical lens of institutional work to advance the understanding about how the theory can be applied. The paper aims to discuss this issue.

Searches were conducted in English-language publications (2012–2017). Of 35 retained articles, 15 were from the gray literature; and 20 were peer reviewed. The review was guided by Arskey and O’Malley’s (2005) five-stage process.

Five themes reflecting different foci of physician-led activity were examined from the perspective of institutional work: systematically analyze context using participatory methods; work collaboratively toward locally defined, shared targets and build in processes to monitor progress; expand physicians’ role and capacity to include leadership toward shared organizational goals; promote appropriate rewards and incentives for work that builds engagement; and invest in opportunities for formal and informal communication and interaction.

Physicians considering action to increase their engagement in system improvement may benefit from analysis of local opportunities and barriers in selecting context-relevant activities that will motivate participation and build engagement through a balance of institutional work.

The paper considers the potential for physicians to initiate and support activity that will increase their engagement. It provides pragmatic strategies for designing intervention and research using the theoretical lens of institutional work.

The purpose of this paper is to describe the self-reported long-term conditions of medical officers and allied health staff working in a regional public health service in northern Australia and how these conditions are managed.

A cross-sectional survey design was used. The sample was all medical officers and allied health staff employed in mid-2015.

Of the 365 respondents, 217 (59.5 per cent) reported having at least one long-term condition. There was a statistically significant association between professional group and the number of long-term conditions reported, χ²=10.24, p<0.05. A greater proportion of medical officers (n=29, 43.9 per cent) reported having only one long-term condition compared with allied health staff (n=36, 24.5 per cent). The top four categories of conditions were respiratory, musculoskeletal, mental health and episodic and paroxysmal, although the patterns varied amongst the professional groups, and across age groups. Respondents usually managed their main long-term conditions with personal strategies, rarely using workplace strategies.

Although somewhat low, the response rate of 32 per cent was similar to previous surveys in this health service. Since this survey, the health service has implemented a broad Health and Wellness Programme to support their qualified workforce. Future evaluations of this programme will be undertaken, including whether the programme has assisted health professionals to manage their long-term conditions.

There is an urgent need for targeted, workplace-based health promotion strategies to support staff with long-term conditions. Such strategies would complement self-management approaches, and also provide an important recruitment and retention initiative.

This study adds empirical evidence regarding the long-term conditions among health professionals and their self-management strategies. Little is known about the long-term conditions among the various health professional groups and the findings thus make an important contribution to the existing literature.

Purpose: To demonstrate how an online coaching intervention can support well-being management (mental health and mood) of medical students, by increasing psychological awareness, emotional management, and healthy/positive action repertoires.

Design/methodology/approach: A two-group randomized control trial design using a waitlist as a control was used with a sample of 176 medical students. Half were randomly assigned the 5P© coaching intervention and the remaining half assigned to the waitlist group, scheduled to receive the intervention after the initial treatment group completed the intervention. Participant baseline data on stress, anxiety, depression, positive and negative affect, and psychological capital were obtained prior to commencing the study, after completion of the first treatment group, and again postintervention of the waitlisted group, and then at the end of the year.

Findings: Coaching the students to reflect on their emotions and make solution-focused choices to manage known stresses of medical education was shown to decrease medical student stress, anxiety, and depression, thereby increasing the mental health profiles of medical students.

Research limitations/implications: The findings suggest that an online coaching tool that increases psychological awareness and positive action can have a positive effect on mental health and mood of medical students.

Practical implications: The framework developed and tested in this study is a useful tool for medical schools to assist medical students in managing their well-being, thereby decreasing the incidence and prevalence of mental illness in medical students. The implications of this research are significant in that positively affecting the psychological well-being of medical students could have a significant effect not only on each medical student but also on every patient that they treat, and society as a whole. Better mental health in medical students has the potential to decrease dropout rates, increase empathy and professionalism, and allow for better patient care.

Originality/value: This study contributes to the literature on online coaching for improved psychological well-being and emotional regulation, mental health, and medical students. It is one of the first studies using a coaching protocol to make a positive change to the known stress, anxiety, and depression experienced by medical students worldwide.

Leadership decisions occur frequently throughout the day, yet as clinicians, who balance multiple roles and responsibilities, the authors seldom label them explicitly. This translates to missed opportunities to foster the requisite skill sets junior trainees to require in their current and future contexts. While there is clear evidence for a purposeful leadership curriculum, developing, implementing and assessing these competencies remains challenging. The purpose of this paper is to provide educators with a curricular approach to incorporate leadership opportunities in their own teaching and supervisory practices.

A dyadic “teaching and assessment” strategy may overcome leadership curricular challenges. The authors propose a new framework that breaks down leadership opportunities into their requisite learning settings. Like fine wine and cheese, these learning experiences are paired with assessment strategies to provide further formative and summative feedback, all in the context of educational theories and frameworks.

In this paper, the authors recommend six unique learning environments for educators to consider, captured in the abbreviation ABC’S3 for administrative, bedside, classroom, simulation, self-awareness and summarization, all of which lend themselves to leadership development opportunities for resident physicians. The authors provide tested examples and pair these teaching options with a variety of assessment strategies to choose from.

Three practical implications are put forth in this paper, namely, leadership competencies are needed for everyone, not just for those with leadership titles or positions; multiple learning settings (and all aspects of work) can be harnessed to provide diverse leadership opportunities; and advancement beyond Miller’s knows is needed to create opportunities to hone practical leadership competencies in the shows how and does levels.

This paper uniquely pairs learning opportunities with assessment strategies across diverse practical settings and environments. These techniques and opportunities will serve to stimulate ideas and kick-start dialogue about incorporating a practical leadership curriculum within clinical training programs.

This article describes the development of scenarios to stimulate public dialog concerning healthcare values. Different values lead to different futures. America’s current healthcare system has serious difficulties and must be transformed, but the underlying problems will not be addressed until the public has enough understanding to develop a consensus on the values it desires in a new system that meets societal needs. Value driven scenarios can help by illustrating the consequences of different alternatives and thereby stimulating thinking about key value‐driven components that must be included for a functional and sustainable solution.

The purpose of this paper is to describe the 4C's of Infuence framework and it's application to medicine and medical education. Leadership development is increasingly recognised as an integral physician skill. Competence, character, connection and culture are critical for effective influence and leadership. The theoretical framework, “The 4C’s of Influence”, integrates these four key dimensions of leadership and prioritises their longitudinal development, across the medical education learning continuum.

Using a clinical case-based illustrative model approach, the authors provide a practical, theoretical framework to prepare physicians and medical learners to be engaging influencers and leaders in the health-care system.

As leadership requires foundational skills and knowledge, a leader must be competent to best exert positive influence. Character-based leadership stresses development of, and commitment to, values and principles, in the face of everyday situational pressures. If competence confers the ability to do the right thing, character is the will to do it consistently. Leaders must value and build relationships, fostering connection. Building coalitions with diverse networks ensures different perspectives are integrated and valued. Connected leadership describes leaders who are inspirational, authentic, devolve decision-making, are explorers and foster high levels of engagement. To create a thriving, learning environment, culture must bring everything together, or will become the greatest barrier.

The framework is novel in applying concepts developed outside of medicine to the medical education context. The approach can be applied across the medical education continuum, building on existing frameworks which focus primarily on what competencies need to be taught. The 4C’s is a comprehensive framework for practically teaching the leadership for health care today.

The Healthy Work Place (HWP) study investigated methods to improve clinicians’ dissatisfaction and burnout. The purpose of this paper is to identify factors that influenced study enrollment and completion and assess effects of initial clinic site enrollment rates on clinician outcomes, including satisfaction, burnout, stress and intent to leave practice.

In total, 144 primary care clinicians (general internists, family physicians, nurse practitioners and physician assistants) at 14 primary care clinics were analyzed.

In total, 72 clinicians enrolled in the study and completed the first survey (50 percent enrollment rate). Of these, 10 did not complete the second survey (86 percent completion rate). Gender, type, burnout, stress and intervention did not significantly affect survey completion. Hence, widespread agreement about most moral/ethical issues (72 percent vs 22 percent; p=0.0060) and general agreement on treatment methods (81 percent vs 50 percent; p=0.0490) were reported by providers that completed both surveys as opposed to just the initial survey. Providers with high initial clinic site enrollment rates (=50 percent providers) obtained better outcomes, including improvements in or no worsening of satisfaction (odds ratio (OR)=19.16; p=0.0217) and burnout (OR=6.24; p=0.0418).

More providers experiencing workplace agreement completed the initial and final surveys, and providers at sites with higher initial enrollment rates obtained better outcomes including a higher rate of improvement or no worsening of job satisfaction and burnout.

There is limited research on clinicians’ workplace and other factors that influence their participation in survey-based studies. The findings help us to understand how these factors may affect quality of data collecting and outcome. Thus, the study provides us insight for improvement of quality in primary care.