Background: Burnout negatively impacts healthcare professionals’ well-being, leading to an increased risk of human errors and patient harm. There are limited assessments of burnout and associated stressors among acute care and trauma surgery teams. Methods: Acute care and trauma surgery team members at a US academic medical center were administered a survey that included a 2-item Maslach Burnout Inventory and 21 workplace stressors based on the National Academy of Medicine’s systems model of clinician burnout and professional well-being. Stressors were summarized and presented to participants in focus groups. Contextual inquiries (CIs) were conducted to gather additional information about key stressors. Qualitative data were used to generate an affinity model, which participants then validated and used to prioritize top stressors. Participants rated stressors by level of impact and level of effort, and improvement recommendations were made based on these results. Results: 74% (n=14/19) acute care and trauma surgery team members reported high burnout. Key stressors included inadequate staffing, organizational culture, excessive workload, and inefficient workflows. Attending faculty (surgeons) classified the following key priorities for improvement: (i) improve throughput and patient flow, (ii) provide better information technology support, and (iii) improve rewards and support. Non-faculty (advanced practice providers (APPs), nurses, staff) classified the following for improvement: (i) align APP job responsibilities, (ii) improve lack of recognition from leadership, and (iii) robust and consistent APP training. Conclusions: A contextual design approach to studying burnout using surveys, focus groups, CIs, modeling, and validation and prioritization is a feasible method for identifying key stressors and improvements that may enable more impactful and appropriately targeted interventions. Results indicate high levels of burnout among acute care and trauma surgery team members, requiring prioritized attention to operational and relationship issues necessary to care for patients. Efforts to improve surgery teams’ workflows, auxiliary support, compensation, and relationships with leadership may address burnout. Level of evidence: Level V.

Quality checklists have demonstrated benefits in healthcare and other high-reliability organizations, but there remains a gap in the understanding of design approaches and levels of stakeholder engagement in the development of these quality checklists. This scoping review aims to synthesize the current knowledge base regarding the use of various design approaches for developing quality checklists in healthcare. Secondary objectives are to explore theoretical frameworks, design principles, stakeholder involvement and engagement, and characteristics of the design methods used for developing quality checklists. The review followed the Preferred Reporting Items for Systematic Reviews 2020 checklist. Seven databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, ACM Digital Library, and IEEE Xplore) were searched for studies using a comprehensive search strategy developed in collaboration with a health sciences librarian. Search terms included “checklist” and “user-centered design” and their related terms. The IAP2 Spectrum of Participation Framework was used to categorize studies by level of stakeholder engagement during data extraction. Twenty-nine studies met the inclusion criteria for this review. Twenty-three distinct design methods were identified that were predominantly non-collaborative in nature (e.g., interviews, surveys, and other methods that involved only one researcher and one participant at a given time). Analysis of the levels of stakeholder engagement revealed a gap in studies that empowered their stakeholders in the quality checklist design process. Highly effective, clear, and standardized methodologies are needed for the design of quality checklists. Future work needs to explore how stakeholders can be empowered in the design process, and how different levels of stakeholder engagement might impact implementation outcomes.

The well‐being of medical physicists can impact overall system performance, patient safety, and quality of patient care. There are limited formal assessments of factors contributing to physicists well‐being. Nine medical physicists at a US academic medical center were surveyed on 21 workplace factors, drawn from the National Academy of Medicine's systems model of clinician burnout and professional well‐being between May 2022 and August 2022. Highly rated factors were summarized and presented to medical physicists in focus groups. Contextual inquiries (a form of shadowing) were conducted to gather additional information about factors contributing to well‐being. Qualitative data from the survey, focus groups, and contextual inquiries were used to generate an affinity model, which medical physicists then validated and used to prioritize top factors. Twenty‐two medical physicists at the academic medical center and three other US academic medical centers rated these factors by level of impact and level of effort, and improvement recommendations were made based on these results. Key factors affecting medical physicist well‐being included inadequate staffing, work‐life integration, excessive workload, and time pressure. Twenty‐two medical physicists across four institutions prioritized the following top factors for improvement: (i) retain the hybrid work model, (ii) hire additional medical physicists to cover clinic responsibilities, (iii) limit or compensate after hours work, (iv) improve scheduling workflows, and (v) improve communication and visibility from organization‐level leadership and administration. High impact, low effort priorities to improve medical physicist well‐being across the four institutions include work‐life integration, scheduling workflows, and relationships with leadership. These factors seem to be within the improvement control of each radiation oncology center. Further research is needed to establish the generalizability of our findings and spearhead broad policy changes.

Quality checklists have demonstrated benefits in healthcare and other high-reliability organizations, but there remains a gap in the understanding of design approaches and levels of stakeholder engagement in the development of these quality checklists. This scoping review aims to synthesize the current knowledge base regarding the use of various design approaches for developing quality checklists in healthcare. Secondary objectives are to explore theoretical frameworks, design principles, stakeholder involvement and engagement, and characteristics of the design methods used for developing quality checklists. The review followed the Preferred Reporting Items for Systematic Reviews 2020 checklist. Seven databases (PubMed, APA PsycInfo, CINAHL, Embase, Scopus, ACM Digital Library, and IEEE Xplore) were searched for studies using a comprehensive search strategy developed in collaboration with a health sciences librarian. Search terms included “checklist” and “user-centered design” and their related terms. The IAP2 Spectrum of Participation Framework was used to categorize studies by level of stakeholder engagement during data extraction. Twenty-nine studies met the inclusion criteria for this review. Twenty-three distinct design methods were identified that were predominantly non-collaborative in nature (e.g., interviews, surveys, and other methods that involved only one researcher and one participant at a given time). Analysis of the levels of stakeholder engagement revealed a gap in studies that empowered their stakeholders in the quality checklist design process. Highly effective, clear, and standardized methodology are needed for the design of quality checklists. Future work needs to explore how stakeholders can be empowered in the design process, and how different levels of stakeholder engagement might impact implementation outcomes.

Burnout among internal medicine (IM) and internal medicine–pediatrics (Med–Peds) residents is at epidemic levels, yet few studies use systems-based methods to identify the specific work-system factors that drive it. Guided by the National Academy of Medicine (NAM) systems model of clinician burnout, we conducted a five-phase sequential mixed-methods study—survey, focus groups, contextual inquiry, affinity modeling and validation, and impact–effort prioritization—among 119 IM and Med–Peds residents at one academic medical center. Burnout (two-item Maslach Burnout Inventory [MBI]), resilience (two-item Connor–Davidson Resilience Scale), and 21 NAM-derived work-system factors were assessed, along with analyses report means, standard deviations (SD), 95% confidence intervals (CIs), and internal-consistency reliability. Among 36 respondents (30% response rate), 55.6% screened positive for burnout (95% CI 39.6–70.5%); mean emotional exhaustion was 3.78 (SD 1.12), and depersonalization was 3.17 (SD 1.38). The 21-item severity scale showed good reliability (Cronbach’s α = 0.85). The highest-severity factors were interruptions/distractions, excessive workload, time pressure, and work-life integration. Focus groups (n = 30), contextual inquiries (n = 14, ~80 observation hours), and validation sessions (n = 8) yielded 167 breakdowns and 11 priorities. An impact–effort analysis (n = 19) identified clinic workflows and in-basket workload as high-impact/lower-effort priorities. This participatory, systems-based method yields contextually grounded, prioritized targets for reducing resident burnout that survey data alone would not surface.

Background: Burnout among internal medicine (IM) and internal medicine pediatrics (Med-Peds) residents has reached epidemic levels. While burnout prevalence is well documented, limited research has employed systems-based approaches to identify the specific, contextually grounded work-system factors that drive burnout in these residents. This study aimed to identify and prioritize modifiable work-system factors contributing to burnout among IM and Med-Peds residents using a theory-based, participatory, and data-driven mixed-methods approach. Methods: A sequential mixed-methods design incorporating the National Academy of Medicine's (NAM) systems model of clinician burnout was employed at a single academic medical center across five phases: (1) survey, (2) focus groups, (3) contextual inquiry, (4) modeling and validation, and (5) prioritization and recommendations. IM and Med-Peds residents (N=119) were administered a 25-item survey including demographics, a 2-item Maslach Burnout Inventory (MBI) measuring emotional exhaustion (EE) and deperson-alization (DP), a 2-item Connor-Davidson Resilience Scale, and 21 work-system factor items rated for severity and improvement priority. Five focus groups gathered contextual information. Contextual inquiries (CIs) involving 4–6 hours of in-situ shadowing were conducted with 14 residents. Qualitative data were synthesized into an affinity model, which residents validated and used to rank their five priorities for improvement. Par-ticipants then rated each priority by level of impact and effort to generate prioritized improvement recommendations. Results: The survey response rate was 27% (n=32/119). Of respondents, 56% met criteria for burnout (combined EE and DP score >3), with mean EE of 3.84 (SD 1.19) and mean DP of 3.22 (SD 1.47). Mean resilience score was 8.09 (SD 0.96). The four workplace factors contributing most to burnout by severity were interruptions and distractions (mean 3.75, SD 0.95), excessive workload (3.59, SD 0.84), time pressure (3.38, SD 1.10), and poor work-life integration (3.28, SD 1.37). Focus groups (25%, n=30/119) and CIs (11.7%, n=14/119) provided rich contextual data organized into an affinity model with 167 discrete breakdowns across four major work-system categories. Validation sessions (6.7%, n=8/119) yielded 11 distinct improvement priorities. Impact-effort analysis identified high-impact, low-effort priorities (improve clinic workflows; reduce in-basket workload) and high-impact, high-effort priorities (improve work conditions; improve staffing; reduce patient load; improve Epic Chat and paging). Conclusions: This study demonstrates the feasibility and value of a contextual design approach for identifying actionable work-system factors contributing to resident burnout. By integrating quantitative data with rich qualitative observations, the methodology produces prioritized, context-specific recommendations for targeted improvement. Healthcare systems may utilize this participatory approach to efficiently identify and address the most impactful sources of resident burnout.