Building a data-driven evaluation framework of physician wellness initiatives: a rapid review

While there exist many individual and organisation-level initiatives aimed at reducing physician burnout and promoting wellness, there are no comprehensive frameworks or guidelines for evaluating initiatives targeted at physicians. To address this gap, we conducted a rapid review to understand the current state of initiative evaluation in this field and develop an evaluation framework for initiatives aimed at physician burnout and wellness.

A rapid review based on the Cochrane rapid review methods guidance.

MEDLINE, Embase and PsycInfo were searched from database inception to 2 May 2024 for concepts related to physicians, wellness initiatives and burnout, and organisational efforts.

We included studies with initiatives aimed at physician burnout, wellness or experience; targeted physicians, residents, fellows and/or physician faculty; were evaluated in some format; and took place within healthcare settings.

Two independent reviewers extracted data according to a standard template. For each study, we noted information related to the type of wellness initiative, evaluation approach, components measured in evaluations ('evaluation indicators') and gaps in evaluation. The same reviewers analysed the data quantitatively and thematically. Findings were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

The database search yielded a total of 3786 references, of which 105 were included based on predefined inclusion and exclusion criteria. Various types of wellness initiatives (eg, mindfulness, peer support programmes, communities of practice) were delivered multimodally, or via curriculums and workshops, among other formats. Common evaluation approaches included surveys (95%, n=100/105) and interviews or focus groups (17%, n=18/105). Evaluation indicators spanned five categories: impacts (94.3%, n=99/105), participants' reactions (65.7%, n=69/105), perspective and behaviour changes (46.7%, n=49/105), implementation (45.7%, n=48/105) and continuous improvement (6.7%, n=7/105). Evaluation gaps included limited responses from participants, failure to capture certain indicators (eg, physician turnover) and limited longitudinal measures.

Based on the findings and existing models, we developed a physician-focused evaluation framework, constituting two domains: implementation and impacts. This framework can enable organisations to better understand, assess and improve initiatives aimed at physician well-being, which can have positive impacts on patient care and the healthcare system.