Wellbeing: Overview + SIG resources

Abstract
Purpose: This study aims to investigate autonomy support and self-valuation as potential mechanisms by which supportive leadership improves physician well-being. Supportive leadership is one of the strongest predictors of physician well-being. However, mechanisms by which leadership behavior influences well-being remain unknown. The authors hypothesized that autonomy support and self-valuation mediate this relationship.

Design/methodology/approach: This was a cross-sectional survey-based study of physicians in a tri-hospital cardiovascular health system in southwestern USA. An anonymized multidimensional questionnaire comprising standardized and pre-validated measures of leadership behavior, self-valuation, autonomy support, fulfillment and burnout was e-mailed to 815 eligible physicians in February 2024. Hypothesized multivariable pathways were investigated via structural equation modeling.

Findings: In total, 122 participants answered the survey, 99 providing complete responses. Respondents were 75.76% male, 54.54% aged 41 to < 65 years, 44.44% white, 21.21% Asian and 52.52% in practice for ≥ 15 years. Reliabilities of ordinal scales were all ≥ 0.700, and univariate correlations were in expected directions. Fully, 24.24% of respondents were burned out, 63.64% professionally fulfilled, 70.71% had high autonomy support and 55.56% high self-valuation. Indirect effects of leadership support on fulfillment and burnout, mediated via autonomy support and self-valuation, were more significant than direct effects. Findings supported the study hypothesis that leadership support improves fulfillment and reduces burnout among physicians partly by fostering autonomy and self-valuation.

Originality/value: Autonomy support and self-valuation within physician teams are highlighted as factors whose improvement well-being-centered leadership training programs specifically should target.

Keywords: Indigenous health; Social determinants of health.

Abstract
Background: Improving healthcare professional well-being and reducing burnout requires improving work ecosystems and cultures. Current well-being metrics focus on distal outcomes within individuals ( e.g. , professional fulfillment or burnout). This study developed and evaluated the performance of an inventory measuring perceptions of modifiable workplace dimensions-termed "influencers"-that shape healthcare professionals' well-being.

Methods: A core team developed the Well-Being Influencers Survey for Healthcare (WISH), an inventory designed to measure these systemic, occupational well-being influencers ( e.g. , leadership support, psychologic safety, working conditions). After content validation and refinement, 223 healthcare professionals from an academic department of anesthesiology completed WISH alongside established well-being measures, including the Maslach Burnout Inventory; the Professional Fulfillment Index; the Perceived Stress Scale; the Patient-Reported Outcomes Measurement Information System short forms for meaning, purpose, and life satisfaction; as well as standard items of affective commitment (a measure of engagement) and a standard item assessing intention to leave. Factor analysis was used to assess WISH's internal structure, while correlation and regression analyses assessed its criterion-related validity using the above established measures.

Results: WISH showed the expected relationships with established well-being measures and outperformed established metrics in predicting affective commitment and intention to leave after adjusting for those measures and/or covariates. Factor analysis indicated that most WISH variance reflects a single common factor, supporting the use of an instrument-level score. Unique variance at the influencer level highlights the added value of examining influencer scores.

Conclusions: WISH fills a key gap in healthcare professional well-being improvement science by assessing causal factors of well-being and burnout rather than the conditions themselves. This study established initial validity of this unique inventory and further reinforced the relevance of system-level and cultural factors in influencing healthcare professionals' well-being. WISH is well suited to assist healthcare professional well-being improvement efforts driven by system-improvement mindsets.