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Letters to the Editor

From Clinician to Organizational Wellness

Egener, Barry MD

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doi: 10.1097/ACM.0000000000003669
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To the Editor:

In their recent discussion of the role of the health care chief wellness officer (CWO), Drs. Ripp and Shanafelt1 describe the activities in which a CWO should engage to most effectively reduce clinician distress. However, many other members of the health care organization also burn out—nurses and other nonphysician staff. Burnout among nonphysician staff at the Mayo Clinic is 23%.2 Should the CWO focus on the organizational factors that impact clinicians, or all employees?

There are clearly trade-offs between drawing the boundaries of the CWO’s position narrowly or widely. Effectiveness may be compromised if the task is too large, and important targets for intervention may be missed if the task is too small. Some interventions will apply to all staff and can be system-wide, such as conflict resolution skills. Other interventions may need to be discipline- or job-specific. For example, some groups may be more affected by lack of work–life balance, others by burnout.

In my own work, which initially focused on employed clinicians, I discovered similar well-being needs in other pockets of the system. Well-intentioned interventions were sometimes inconsistent or duplicative.

Leaving aside the humanistic goal of improving the well-being of all workers, the most compelling reason to broaden well-being efforts beyond clinicians is to improve patient care. Staff well-being is associated with patient outcomes.3 “The Charter on Physician Well-Being,” of which Dr. Ripp is an author, states “approaches to address physician well-being are most effective when contextualized within efforts to enhance the well-being of all health care team members.”4

Over time, we will learn much more about how health system structures impact the well-being of workers, and consequently, impact patient care. It is tempting to imagine that patients might experience a more healing environment when health care organizations attend to the well-being of all the staff with whom patients interact. What remains to be seen is whether a CWO focused on clinicians and collaborating with other leaders accomplishes this task better than a CWO transforming the entire system.


1. Ripp J, Shanafelt T. The health care chief wellness officer: What the role is and is not. Acad Med. 2020;95:1354–1358
2. Dyrbye LN, Major-Elechi B, Hays JT, Fraser CH, Buskirk SJ, West CP. Relationship between organizational leadership and health care employee burnout and satisfaction. Mayo Clin Proc. 2020;95:698–708
3. Salyers MP, Bonfils KA, Luther L, et al. The relationship between professional burnout and quality and safety in healthcare: A meta-analysis. J Gen Intern Med. 2017;32:475–482
4. Thomas LR, Ripp JA, West CP. Charter on physician well-being. JAMA. 2018;319:1541–1542
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