A Multidepartment Investigation of Occupational Well-being, Systemic Features, and Organizational Outcomes in...

High rates of distress and intention to leave threaten workforce stability and patient care in anesthesiology. Meaningful action is believed to require evidence-based insight into the systemic origins of occupational well-being shaping these risks. However, the field has lacked large-scale insights into these systemic features and their influence on well-being and its consequences using validated tools. The Well-Being Influencers Survey for Healthcare (WISH) was developed to provide a framework and metric for understanding organizational foundations of well-being. This study evaluated WISH's generalizability across a multicenter cohort, examined the relevance of system-oriented assessment, and characterized the current profile of well-being culture in anesthesiology.

Participants across 11 academic anesthesiology departments completed WISH alongside occupational well-being correlates. Mediation models examined theoretical relationships among well-being influencers, cognitive-affective states, and organizational outcomes. Analysis of variance assessed differences in WISH by influencer, department, and professional role. Psychometric techniques were used to extend validity evaluation of WISH, pooling data for higher power and using meta-analysis to assess generalizability.

Newly collected responses from 1,470 health workers were analyzed. Multidimensional psychometric models met fit criteria. In meta-analytic summaries of departmental-level estimates, WISH significantly predicted intention to leave ( b = -0.45) and affective commitment ( b = 0.81), including after controlling for well-being correlates. Mediation results were consistent with a model in which WISH influencers are upstream of cognitive-affective states and, in turn, organizational outcomes; of the total association between WISH and organizational outcomes, most (53% for intention to leave, 64% for affective commitment) was attributable to WISH directly. Analysis of variance identified significant differences between WISH influencers: organizational justice scored lowest, whereas perceived social support, psychological safety, and inclusion and belonging scored highest.

WISH identifies systemic features associated with well-being and its consequences, including intention to leave. Multicenter findings extend validation evidence for WISH, clarify the relevance of system-oriented assessment, and characterize the profile of well-being culture in academic anesthesiology.