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Project Information

Project Information

Systems Approaches to Improve Patient Care by Supporting Clinician Well-Being

Project Scope:

An ad hoc committee under the auspices of the National Academies of Sciences, Engineering, and Medicine will examine the scientific evidence regarding the causes of clinician burnout as well as the consequences for both clinicians and patients, and interventions to support clinician well-being and resilience. The committee will examine components of the clinical training and work environment that can contribute to clinician burnout in a variety of care settings, as well as potential systems interventions to mitigate those outcomes. The committee will identify promising tools and approaches to support clinician well-being, identify gaps in the evidence base, and propose a research agenda to address areas of uncertainty. In developing its report, the committee will consider key components of the health care system, including: 

  • factors that influence clinical workflow, workload, and human-systems interactions;
  • the composition and function of care teams
  • the ongoing movement toward outcomes-based payment and quality improvement programs;
  • current and potential use and impact of technologies and tools such as electronic health records (EHRs) and other informatics applications; and
  • regulations, guidance, policies, and accreditation standards that define clinical documentation and coding requirements, as well as institutional expectations and interpretations of those requirements.

The committee may develop a conceptual framework that encapsulates their findings and will issue a report with recommendations for system changes to streamline processes and reduce complexity, minimize the burden of documentation requirements, and enhance workflow and teamwork to support the well-being of all clinicians and trainees on the care team, prevent clinician burnout, and facilitate high-quality patient care.

Status: Current

PIN: HMD-HCS-17-09

Project Duration (months): 18 month(s)

RSO: Aiuppa, Laura


Behavioral and Social Sciences
Health and Medicine
Industry and Labor

Committee Membership

Committee Post Date: 08/10/2018

Pascale Carayon - (Co-Chair)
Pascale Carayon, Ph.D., is Procter & Gamble Bascom Professor in Total Quality in the Department of Industrial and Systems Engineering, the Director of the Center for Quality and Productivity Improvement (CQPI), and she leads the Systems Engineering Initiative for Patient Safety (SEIPS) at the University of Wisconsin-Madison. Dr. Carayon has three decades of research experience analyzing, designing and improving complex work systems such as those found in health care. In the last 20 years, her research has focused on patient safety and other healthcare quality issues such as design and implementation of health information technologies. As an industrial and systems engineer, she is renowned for her groundbreaking contributions in modeling complex system interactions in healthcare processes that can lead to medical errors and other adverse outcomes for patients and healthcare professionals. Dr. Carayon is the editor of the Handbook of Human Factors and Ergonomics in Health Care and Patient Safety. Dr. Carayon is a Fellow of the Human Factors and Ergonomics Society, Fellow of the International Ergonomics Association, member of the editorial boards of Behavior and Information Technology, Work and Stress and The Journal of Patient Safety. Dr. Carayon is currently chair of the Board on Human-Systems Integration in the Division of Behavioral and Social Sciences and Education (DBASSE) of The National Academies of Sciences, Engineering, and Medicine.
Christine K. Cassel - (Co-Chair)
Christine K. Cassel, MD, is Presidential Chair at the University of California, San Francisco, School of Medicine and Visiting Professor in the Department of Medicine. Recently, Dr. Cassel served as Planning Dean of the new Kaiser Permanente School of Medicine. An internist and geriatrician , Dr. Cassel was President and CEO of the National Quality Forum, and served as President and CEO of the American Board of Internal Medicine (ABIM) and the ABIM Foundation, and as the former President of the American College of Physicians. She served on the President's Council of Advisors on Science and Technology (PCAST) under President Barack Obama and was the co-Chair and Physician Leader of a PCAST working group on issues relating to health information technology, advances in technology for hearing, technology and aging, and ensuring the safety of the nation's drinking water A national leader in efforts to inspire quality care, she was a founding member of the Commonwealth Fund's Commission on a High Performance Health System, and served on the IOM committees that wrote the influential reports, To Err is Human and Crossing the Quality Chasm. In addition to having chaired Institute of Medicine (IOM) reports on end-of-life care and public health, she served on the IOM's Comparative Effective Research (CER) Committee mandated by Congress to set priorities for the national CER effort. She is an active scholar and lecturer on geriatric medicine, aging, bioethics and health policy.
Elisabeth Belmont
Elisabeth Belmont, J.D., serves as Corporate Counsel for MaineHealth, an integrated healthcare delivery network. She is responsible for a myriad of complex issues faced by an integrated delivery system on a daily basis and has a specialty concentration in health information and technology. Ms. Belmont has participated in a number of national initiatives where quality improvement, patient safety and information technology intersect including events sponsored by the DHHS Office of the National Coordinator, DHHS Office of the Inspector General, American Health Lawyers Association, American Society of Healthcare Risk Management and American Association for the Advancement of Science. Ms. Belmont is a former member of the Board on Health Care Services of the Health and Medicine Division of the National Academies of Sciences, Engineering and Medicine, and participated as a member of the National Academies’ Committee on Diagnostic Error in Health Care. Additionally, she is a Past President of the American Health Lawyers Association, former Chair of the Association’s Health Information & Technology Practice Group, and former Chair of the Association’s Quality in Action Task Force. Ms. Belmont also was appointed co-Chair of the National Quality Forum’s Health IT Patient Safety Measures Standing Committee. Ms. Belmont was named by the National Academies of Sciences, Engineering, and Medicine as a 2016 National Associate for outstanding contributions to the work of the National Academies.
Neil Busis
Neil A. Busis, M.D., FAAN is Director of Community Neurology and Director of the General Teleneurology Program of the University of Pittsburgh Physicians Department of Neurology. He is Clinical Professor of Neurology at the University of Pittsburgh School of Medicine and Chief of Neurology and Director of the Neurodiagnostic Laboratory at UPMC Shadyside. He serves on the UPMC Physician Wellness Committee. Prior to joining University of Pittsburgh Physicians in 2012, Dr. Busis was in the private practice of neurology for 27 years. Dr. Busis has expertise in practice issues--especially coding, billing, reimbursement and regulatory agency advocacy-- and in health information technology, including electronic health records and the use of telemedicine, and Web-based resources and mobile devices to enhance medical practice. Dr. Busis has been co-chair of the American Academy of Neurology's (AAN) Neurologist Wellness Task Force Study Group and principal investigator of their neurologist burnout study. He serves on the AAN Medical Economics and Management's (MEM) Coding Subcommittee and Neurology Outcome Quality Measure Development Work Group and is the AAN’s Alternate Advisor on the AMA CPT Advisory Committee. Dr. Busis is a member of the Steering Committee and Publications and Art Show Working Group and co-leads the Messaging and Communications Working Group of the National Academy of Medicine Action Collaborative on Clinician Well-being and Resilience.
M. Lynn Crismon
M. Lynn Crismon, Pharm.D., FCPP, BCPP, is Dean, James T. Doluisio Regents Chair and Behrens Centennial Professor, College of Pharmacy, and Professor of Psychiatry, Dell Medical School, at The University of Texas at Austin. He is board certified in psychiatric pharmacy by the Board of Pharmacy Specialties, and he is a Diplomate of the American Board of Clinical Pharmacology. Prior to becoming dean, he developed a nationally recognized training program in psychiatric pharmacotherapy and mental health outcomes research and supervised post Pharm.D., psychiatric pharmacy residents, research fellows, and graduate students. His research, scholarship, and practice have focused on the development and evaluation of strategies to improve the pharmacotherapy and health outcomes of adults and children with severe mental disorders. Dr. Crismon is a past chair of the American Association of Colleges of Pharmacy (AACP) Council of Deans, past member of the AACP Board of Directors, a past member of the American College of Clinical Pharmacy (ACCP) Board of Regents, ACCP Research Institute Board of Trustees, and current member of the National Institute for Pharmaceutical Technology and Education (NIPTE) Board of Directors.
Liselotte Dyrbye
Liselotte Dyrbye, M.D., MHPE, is Professor of Medicine & Medical Education and Associate Director, Program on Physician Well-Being at Mayo Clinic. Dr. Dyrbye is a general internist in Community Internal Medicine, Mayo Clinic, Minnesota, and holds many key positions including Department of Medicine Associate Chair for Faculty Development, Staff Satisfaction, and Diversity, Director of Faculty Development for Mayo Clinic School of Graduate Medical Education, and Executive Director of the Mayo Clinic Academy of Educational Excellence. Her research addresses the prevalence, drivers and consequences of burnout and mitigating strategies. She collaborates with numerous national organizations in an ongoing effort to translate the body of knowledge generated by herself and others into meaningful and substantive changes for the medical profession. Dr. Dyrbye is a member of the National Academy of Medicine Action Collaborative on Clinician Well-being and Resilience, the National Board of Medical Examiners Effort on Wellness task force, and the Physician Well-Being Taskforce of the Accreditation Council for Graduate Medical Education.
Pooja Kinkhabwala
Pooja Kinkhabwala, D.O., is an Endocrinology Fellow at Larkin Community Hospital. She completed her Internal Medicine Residency at resident physician at Hackensack Meridian Health Palisades Medical Center. In addition to her experience as a practicing physician in internal medicine, Dr. Kinkhabwala has been engaged in activities to address physician and resident wellness. She is a member of a Resident Wellness Task Force and is a coauthor on the paper, Addressing Burnout, Depression, and Suicidal Ideation in the Osteopathic Profession: An Approach that Spans the Physician Life Cycle, published by the National Academy of Medicine in 2017. Dr. Kinkhabwala is the Immediate Past President of the American Association of Physicians of Indian Origin-MSRF and current member of the Board of Trustees.
Wanda Lipscomb
Wanda Lipscomb, Ph.D., is the Senior Associate Dean for Diversity and Inclusion and the Associate Dean for Student Affairs at the Michigan State University College of Human Medicine. Dr. Lipscomb is a tenured Associate Professor of Psychiatry. Trained as a psychologist, Dr. Lipscomb has an active interest in the areas of medical student development and engagement, medical student health and wellness, mental health, improving diversity in the health professions workforce, and improving health care services. In her role as Associate Dean for Student Affairs, Dr. Lipscomb oversees health and wellness, career development, professional development, community engagement, records, enrollment, financial aid, and services for medical students. Dr. Lipscomb is the National Chair-Elect of the Group on Student Affairs of the Association of American Medical Colleges. The Group on Student Affairs coordinates constituency activities in medical student affairs including wellness, careers in medicine, admissions, financial advising, student records, and student diversity. Dr. Lipscomb also currently serves on the GSA National Committee on Student Affairs and is the President of the National Council on Diversity in the Health Professions.
Saranya Loehrer
Saranya Loehrer, MD, MPH, is Head of the North America Region, Institute for Healthcare Improvement (IHI). She leads a team responsible for the development and execution of regional priorities in service of achieving IHI’s mission. Her team works in partnership with others at IHI to cultivate collaborative relationships and design large-scale initiatives that help organizations meet their aims and aspirations. Current regional efforts include accelerating the volume-to-value transformation in health care, attending to the joy of the health care workforce, and nurturing cross-sector partnerships that support the equitable achievement of health in the communities we serve.
M.A.J. Lex MacNeil
M.A.J. Lex MacNeil, D.D.S., FAGD, FICD, FACD is Professor and Founding Dean, College of Dental Medicine–Illinois (CDMI) at Midwestern University. Prior to this position, Dr. MacNeil was a full-time general dental practitioner and then spent 15 years as the Associate Dean for Clinical Affairs and as a tenured Associate Professor in the Department of Oral Health Sciences at the University of British Columbia. Dr. MacNeil has extensive expertise in program planning and operations for dental education programs, including the development and implementation of a Hybrid Problem Based Learning curriculum and the development of patient-centered care and group practice models to support clinical education. Dr. MacNeil is a graduate of the Midwestern University Costin Institute for Medical Educators, a program for medical personnel involved in teaching and academic management. Dr. MacNeil is past-president of the Association of Canadian Faculties of Dentistry, the national association for dental education in Canada. Dr. MacNeil has worked collaboratively with private sector software developers on the development of electronic oral health records and patient management software systems. His current focus includes the development and implementation of improved and interoperable electronic health records (EHRs) that will enhance healthcare and learning in dentistry and interprofessionally.
Jose A. Pagan
José A. Pagán, Ph.D., is Professor and Chair of the Department of Public Health Policy and Management in the College of Global Public Health at New York University. He is also Director of the Center for Health Innovation at The New York Academy of Medicine, Adjunct Senior Fellow of the Leonard Davis Institute of Health Economics at the University of Pennsylvania, and Chair of the National Advisory Committee of the Robert Wood Johnson Foundation’s Health Policy Research Scholars. Dr. Pagán is a health economist who has led research, implementation, and evaluation projects on the redesign of delivery and payment systems. His research interests include population health science, health care payment and delivery system reform, and the social determinants of health.
Sharon Pappas
Sharon H. Pappas, R.N., Ph.D., NEA-BC, FAAN is the Chief Nurse Executive for Emory Healthcare. She is a member of Emory Healthcare and the Woodruff Health Science Center’s senior leadership teams and is responsible for nursing practice across Emory’s hospitals, ambulatory care, and post-acute agencies. Dr. Pappas served on the Colorado Board of Nursing and served on the Governor’s Task Force for Nurse Staffing. Throughout her career, Dr. Pappas has focused on the role nurses and the nursing environment play in patient safety and hospital costs. She serves as professor for the Nell Hodgson Woodruff School of Nursing. Dr. Pappas is a member of the American Nurses Association, the Council on Graduate Education for Administration in Nursing, and the American Organization of Nurse Executives (AONE) where she served as a Board member and currently represents AONE on the Commission on Magnet® for the American Nurses Credentialing Center. Dr. Pappas is a Fellow in the American Academy of Nursing where she co-chairs the Expert Panel on Building Health Care System Excellence.
Cynda H. Rushton
Cynda Rushton, Ph.D., R.N., FAAN, is the Anne and George L. Bunting Professor of Clinical Ethics in the Johns Hopkins Berman Institute of Bioethics and the School of Nursing, with a joint appointment in the School of Medicine’s Department of Pediatrics. A founding member of the Berman Institute of Bioethics, Dr. Rushton co-chairs the Johns Hopkins Hospital’s Ethics Committee and Consultation Service. An international leader in nursing ethics, Dr. Rushton in 2014 co-led the first National Nursing Ethics Summit, convened by the Johns Hopkins Berman Institute of Bioethics and School of Nursing. In 2016 she co-led a national symposium focusing on transforming moral distress by cultivating moral resilience and ethical practice. Her current scholarship in clinical ethics focuses on moral suffering of clinicians, the development of moral resilience, palliative care, and designing a culture of ethical practice in healthcare. She has served on the Institute of Medicine's Committee on increasing rates of organ donation and was a consultant to its project When Children Die. She also was appointed the first chair of the Maryland State Council on Quality Care at the End-of-Life. She is editor of the forthcoming book, Moral Resilience: Transforming Moral Suffering in Healthcare.
Tait Shanafelt
Tait Shanafelt, M.D., is Associate Dean and Chief Wellness Officer at Stanford Medicine. A medical oncologist by training, Dr. Shanafelt is a leading researcher on physician burnout and its impact on quality of care, access, and physician availability. Prior to his position at Stanford, Dr. Shanafelt was on the faculty of the Mayo Clinic Division of Hematology, was a Professor of Medicine and Hematology, and served as president of the Mayo Clinic voting staff from 2013-2016. At Mayo Clinic he led an number of initiatives to counter burnout and improve physicians’ sense of fulfillment and well-being. He has published over 120 peer reviewed manuscripts and research studies on the topic of physician well-being. His research in this area has involved physicians at all stages of their career, from medical school to practice, and has included several multi-center and national studies.
George E. Thibault
George Thibault, M.D., is former president for the Josiah Macy Jr. Foundation. Prior to that position, he served as vice president of clinical affairs at Partners Healthcare System in Boston and director of the Academy at Harvard Medical School (HMS). Dr. Thibault previously served as chief medical officer at Brigham and Women's Hospital and as chief of medicine at the Harvard-affiliated Brockton/West Roxbury VA Hospital. He was associate chief of medicine and director of the Internal Medical Residency Program at the Massachusetts General Hospital (MGH), where he also served as director of the medical intensive care unit and the founding director of the Medical Practice Evaluation Unit. For nearly four decades at HMS, Dr. Thibault played leadership roles in many aspects of undergraduate and graduate medical education. He has been Chairman of the Board of the MGH Institute of Health Professions and the New York Academy of Medicine. He currently serves on the Boards of the New York Academy of Medicine and the Arnold P. Gold Foundation. In 2017 he was the recipient of the Abraham Flexner Award for Distinguished Service to Medical Education from the AAMC, and he is a member of the National Academy of Medicine.
Vindell Washington
Vindell Washington, M.D., is chief medical officer at Blue Cross and Blue Shield of Louisiana. Dr. Washington has extensive experience in leading clinical teams and in health IT, most recently as the national coordinator for healthcare information technology in the U.S. Department of Health and Human Services. Prior to that, Washington was at the Franciscan Missionaries of Our Lady Health System in Baton Rouge for more than seven years, leaving as president of the medical group. While at the health system, he also served as vice president of performance excellence and technology and chief medical information officer. A board-certified emergency medicine physician, Dr. Washington is the former chief executive officer of Piedmont Emergency Medicine Associates, a large private group in Charlotte, North Carolina.
Matthew Weinger
Matthew B. Weinger, M.D., is a fellow of the Human Factors and Ergonomics Society, holds the Norman Ty Smith chair in patient safety and medical simulation and is a professor of anesthesiology, biomedical informatics, and medical education at the Vanderbilt University School of Medicine. He is the director of Center for Research and Innovation in Systems Safety (CRISS) at Vanderbilt University Medical Center, and is a professor of civil and environmental engineering in the Vanderbilt University School of Engineering. Dr. Weinger has been teaching and conducting research in human factors in healthcare, patient safety, and clinical decision making for three decades. He has done research on burnout, distraction, fatigue and the effects of information technology on clinician performance. He served as vice chair for research on the Board of Directors of the Association for the Advancement of Medical Instrumentation (AAMI) and as the cochair of their Human Factors Engineering standards committee for 13 years. He continues to be a member of that committee as well as on the AAMI committee developing national standards for health information technology. He is currently a member of a committee of the American Board of Anesthesiology developing a new simulation-based assessment exam for primary certification of anesthesiologists. He is a member of the Board on Human-Systems Integration in the Division of Behavioral and Social Sciences and Education (DBASSE) at the National Academies of Sciences, Engineering, and Medicine.
Laura Aiuppa Denning - (Staff Officer)



Keck Center
500 5th St NW, Washington, DC 20001
Event Type :  

Description :   

Keck Center of the National Academies, E Street Conference Room
500 Fifth Street, NW
Washington, DC 20001

Welcome and introductory remarks
Pascale Carayon and Christine Cassel, Committee Co-chairs

Overview of the NAM Action Collaborative on Clinician Well-Being and Resilience
Victor Dzau, MD, President, National Academy of Medicine; Charlee Alexander, Director, NAM Action Collaborative on Clinician Well-Being and Resilience

1:45 (15 min break at 3pm)
Invited presentations from sponsors of the study (15-min each):

Association of American Medical Colleges
Darrell G. Kirch, MD, President and CEO

Accreditation Council for Graduate Medical Education
Thomas J. Nasca, MD, MACP, President and CEO

Josiah Macy Jr. Foundation
Stephen C. Schoenbaum, MD, MPH, Special Advisor to the President (via webconference)

American College of Occupational and Environmental Medicine
Bill Bruce, CAE, MBA, Executive Director

Arnold P. Gold Foundation
Richard I. Levin, MD, President and CEO

The Doctors Company Foundation
William C. Rupp, MD, Chair and Director

American Hospital Association (invited)

Gordon and Betty Moore Foundation (invited)

The Mont Fund (Invited)

Brief comments from other study sponsors

Brief comments from the public

Break (adjourn open session)


If you would like to attend the sessions of this event that are open to the public or need more information please contact

Contact Name:  -
Contact Email:
Contact Phone:  -

Is it a Closed Session Event?
Some sessions are open and some sessions are closed

Closed Session Summary Posted After the Event

The following committee members were present at the closed sessions of the event:

Pascale Carayon
Christine Cassel
Elisabeth Belmont
Neil Busis
M. Lynn Crismon
Liselotte Dyrbye
Pooja Kinkhabwala (via telephone)
Wanda Lipscomb
Saranya Loehrer
Lex MacNeil (via phone on day 1; in person on day 2)
Jose Pagan
Sharon Papas
Cynda Rushton
Tait Shanafelt
Matthew Weinger

The following topics were discussed in the closed sessions:

-Study schedule
-Bias and Conflict on Interest discussion
-Literature search
-Report outline
-November 2018 meeting ideas

The following materials (written documents) were made available to the committee in the closed sessions:

-Meeting agenda
-Committee roster
-Project schedule
-Statement of task
-List of study sponsors
-Draft report outline
-Selection of published background literature

Date of posting of Closed Session Summary:
October 03, 2018


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