Most health care organizations now recognize the high prevalence of occupational distress among clinicians and its links with quality of care, productivity, and patient experience.¹ Given the impact on organizational performance, many hospitals and systems have created senior leadership positions (eg, chief wellness officers) tasked with developing and overseeing the implementation of an organizational strategy to address this issue. Organizations should aspire to not only minimize occupational distress but also foster occupational well-being, characterized by meaning, purpose, self-efficacy, and satisfaction at work. A timely question the health care delivery system is now wrestling with is how best to hold organizations accountable to advance these outcomes. Measurement of clinician well-being and professional fulfillment, as well as the workplace drivers influencing occupational well-being, is critical for identifying internal hot spots, understanding contributing factors (which vary by work unit), and measuring change over time.² To date, organizations have assessed these occupational well-being metrics and drivers to aid their internal efforts to identify and advance well-being improvement initiatives.³

As US national efforts to advance clinician worker well-being have gained momentum, there has been consideration as to whether health system鈥搇evel measures of burnout should be publicly reported and organizations should be ranked in this domain. The intent behind this consideration is to foster transparency, organizational action, and public accountability. Advocates suggest that such reporting would enable clinicians who are considering employment at the health care entity to consider this organizational characteristic. Further, rankings may spur more organizations to prioritize clinician well-being, galvanizing action based on a motivation to rise in the rankings, akin to public rankings in domains such as quality, patient satisfaction, or overall prestige (eg, US News & World Report Best Hospitals).

While these considerations are well intended, we believe public reporting of organizational well-being survey data is misguided, would have potentially deleterious consequences, and is not likely to advance the efforts of organizations and the health care system to promote occupational well-being for clinicians. Although we fully support organizational accountability, publicly reporting organizational well-being measures is neither consistent with the recommendations crafted by the nation鈥檚 experts who authored the National Academy of Medicine consensus report (which cautioned against public reporting)⁴ nor congruent with the concept of psychological safety (ie, feeling safe to raise concerns without negative repercussions and avoiding pressure to conceal problems). Although psychological safety is most often considered from the vantage of individuals within an organizational workforce, it also applies to organizational leaders. Public reporting is likely to rely on shame as a primary motivator for organizations and is antithetical to the creation of psychological safety.⁵ The perceived responsibility for leaders to safeguard their organization鈥檚 reputation may influence whether the organization is willing to seek honest feedback, which is essential for organizational learning. In fact, public reporting of clinician well-being data may motivate the leaders of many organizations to collect favorable rather than honest feedback to avoid tarnishing the organization鈥檚 reputation. This creates potentially perverse incentives for organizations to gather these data in a euphemistic fashion (ie, 鈥済aming the system鈥�), as has happened with ranking systems in other domains. Although standardized, the primary measures of clinician well-being are based on self-report, making them at high risk for manipulation. Hence, organizations would have both an incentive and the opportunity to engage in subtle or overt coercion to manipulate results.

Even without conscious manipulation or gaming, public reporting may encourage individuals to provide less truthful responses about their experience. Clinicians鈥� livelihoods are tied to their organization鈥檚 success. Public report of suboptimal well-being culture scores may be economically harmful to their organization鈥檚 viability, particularly in competitive markets. Such barriers to honest feedback, in turn, become barriers to organizational learning and improvement of the work environment.

Public reporting could also make it more difficult to improve clinician well-being for organizations that are authentically trying to do so. Take the example of an organization experiencing low well-being scores due to short-staffed and overworked teams. The organization鈥檚 efforts to address the root cause of low well-being in the organization by hiring additional personnel could be stymied by recruitment challenges due to publicly reported well-being metrics that suggest the organization is not a good place to work. A vicious cycle may ensue in which public reporting is a barrier to improvement.

Well-being metrics are also influenced by many factors outside the control of the organization (eg, a national health care payment model in which an organization鈥檚 economic health is driven by payer mix, a burdensome insurance preauthorization process, or regulatory factors). A number of these factors disproportionally affect safety net and low-resource hospitals, which may result in public reporting being particularly damaging to these critical components of the health care delivery system. Percentile scores and rankings also create a zero-sum game in which organizations compete with each other.⁶ For one organization to rise, another must decline. This structure discourages the transparent sharing of best practices that enable organizations to help each other improve.

How then should organizations collect and use clinician well-being data and be held accountable to drive improvement? First, to ensure honest reporting, it is critical that data be collected in a psychologically safe fashion (ie, anonymous, deidentified, confidential, and ideally from an independent third party rather than the organization directly), so that clinicians can report on their experience honestly. Second, organizations should use standardized instruments for which external benchmarks are available to assess clinician experience鈥攁n approach that provides both accurate information and context for how the experience of the organization鈥檚 clinicians compares with that of their peers.⁷ Third, the data should be transparently shared both within the organization (ie, with the clinicians who provided it) and with the organization鈥檚 oversight board, which is ultimately responsible for the overall health of the organization and holding its management team accountable. Fourth, the data should be used to inform and advance organizational efforts to improve the work environment.² Fifth, results should be viewed as performance metrics of the entire leadership team (ie, similar to organizational assessment of financial performance and quality), and well-being improvement targets should be designed to align with organizational structure (eg, the percentage of work units scoring favorably relative to benchmark).²

While public reporting of well-being survey data has many pitfalls, we do advocate for public accountability regarding an organization鈥檚 well-being process metrics as part of hospital accreditation. Over the last 12 years, the Accreditation Council for Graduate Medical Education has used this approach to evaluate organizational efforts to advance resident/fellow well-being, as well as the well-being of faculty and other team members through their Clinical Learning Environment Review visit process. The Joint Commission has begun to take exploratory steps to evaluate the adequacy of an organization鈥檚 structure and process to foster clinician well-being, a potential sign that incorporating these aspects into formal hospital accreditation processes may be forthcoming.³ In addition to expecting all organizations to engage in a minimum set of foundational improvement activities, recognition programs (eg, American Nurses Credentialing Center MAGNET Program; 西瓜视频 Joy in Medicine Health System Recognition Program [JIMRP]) that acknowledge those organizations that take more substantive action can be marks of distinction and an incentive for organizations to do more. For example, the JIMRP evaluates an organization鈥檚 structure and process in 6 domains (assessment, commitment, efficiency of practice environment, teamwork, leadership, support) with criteria defining 3 levels of maturity within each domain.

Health care professionals deserve a practice environment that supports them. Regular assessment of clinician well-being using standardized instruments is a foundational component of organizational efforts to improve the practice environment. Although public reporting of well-being survey data may seem alluring, for a host of reasons it will likely hinder, rather than promote, organizational improvement. Instead, organizations should be held accountable for structure and process measures to improve occupational well-being, which may be incorporated into accreditation criteria over time. The fundamental goal is not to determine an organization鈥檚 percentile score on a distribution curve at any one moment but rather to foster genuine and ongoing improvement across all organizations, thereby shifting the entire distribution in a favorable direction and creating a better health care workplace for clinicians as well as the patients and communities they serve.

Corresponding Author: Jonathan Ripp, MD, MPH, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029 (Jonathan.ripp@mountsinai.org).

Published Online: August 8, 2024. doi:10.1001/jama.2024.12015

Conflict of Interest Disclosures: Dr Ripp reported receiving honoraria for teaching in professional development courses from Stanford University, the Institute for Healthcare Improvement, and HCA Healthcare; receiving consulting fees from Marvin Inc, an organization that provides mental health services to health care professionals; serving as a site visit consultant (single day) to provide expert consultation regarding the development of a well-being program at NYU School of Medicine; speaking and lecturing widely in his area of expertise at a variety of academic institutions, state medical societies, accrediting bodies, and professional organizations, for which he frequently receives honoraria; receiving royalties from Oxford University Press; that he is the principal investigator on, and his institution is the recipient of, a Health Resources and Services Administration grant to support health care workforce well-being; serving on the steering committee of the National Academy of Medicine's Action Collaborative to Address Clinician Well-Being; and serving as a board member for the Dr Lorna Breen Heroes Foundation. Dr Shanafelt reported holding a patent for the Well-Being Index and Mayo Leader Index, with royalties paid from Mayo Clinic; and serving as an expert on the well-being of health care professionals, giving grand rounds/keynote lecture presentations, and providing advising for health care organizations, for which he sometimes receives honoraria.