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Putting the Pieces Together: Addressing Health Systems Issues at ARM 2023

ARM Member Blogger Kyla Woodward offers reflections and key takeaways from the meeting regarding burnout and other health systems issues

I came away from the 2023 AcademyHealth Research meeting with pages of notes on my phone, notebooks full of scribbles, ideas, and connections for future work. Processing all I heard feels like putting together a puzzle—connections and relationships between different topics are clicking into place while I think about how to move forward. My research focuses on the health care workforce, so my reflections on the conference come through a lens of trying to understand the bigger systems and structures at play in the worker issues we see today like burnout and turnover.

The nursing perspective

As a nurse, I learned early on that to really understand a situation, I need to take a step back and assess the bigger picture. It’s too easy to get drawn in to fixing the immediate problem when what I really need is an overview and understanding of context. This has been true in my research experience as well. During my first stop at the conference, the Interdisciplinary Research Group on Nursing Issues preconference session, keynote speaker Dr. Monica McLemore asked us to think about matching the changes we make to the root of the problems we see. We need to understand if we are retrofitting practices to respond to changes in the system or if we should instead work on reforming policies or reimagining structures and processes which bring about different outcomes. I came away thinking about what situations and contexts have shaped the nursing profession over time, leading to both the strengths and the problems we see today, and what type of change might be needed to improve workforce outcomes.

Health workforce and burnout

Throughout the conference I continued to learn about the systems and structures affecting health care workers through organizational contexts such as nurse staffing models, relationships with pharmaceutical companies, and care delivery models like telehealth. At the Health Workforce Interest Group session, several experts offered their perspectives on clinician burnout. Dr. LaTonya Trotter  highlighted a major disconnect in our view of burnout, namely that we diagnose and treat burnout at the individual level when the causes lie in organizations and systems influenced by politics and power. Simply put, burnout is a symptom of a sick health care system, not an individual issue. From this standpoint, our work to help individuals manage burnout cannot ever fix the issue—reform and reimagination of health care structures are the only true solutions.

Amid a discussion about how some structures like reimbursement could be used to improve conditions, Dr. Trotter made a statement that I have been unable to forget, stating that we need to think about what structures should even have a role in changing or controlling the system: “you may be able to wring out efficiency in the system using mechanisms like value-based payments, but in a system designed to extract financial value from health care, things won’t really change.”

The bottom line

Reimbursement and financing are essential components of health care context, and several financial sessions at ARM helped me understand them more deeply. First, a set of debates pitting value-based payments versus fee for service and traditional Medicare versus Medicare Advantage offered expert commentary on how each model impacted care and the potential positive or negative impacts of that type of reimbursement on patient and clinician outcomes. These debates were an excellent opportunity for me to learn and think about reimbursement models as structural components of health care that impact operations at multiple levels and help create the contexts in which health care workers work and people receive health care.

I also attended a session on the financialization of health care, or how private equity and real estate interests have become involved in care delivery by purchasing or investing in organizations and using them as a short-term profit mechanism (see a recent article here). To be honest, at the end of the session I wasn’t sure if I wanted to find a punching bag or weep. How have we let things get to a point where shareholder profit is more important than people? And more critically, how can we hope to effect change in a profit driven system? Where do we go from here?

Pathways forward

In putting together the puzzle pieces I learned at these sessions--the forces at work behind health services, care delivery, and workforce outcomes--I have come to one main conclusion. My work as a health services researcher must include collaboration and communication with policymakers and the people who elect them. Health services researchers are uniquely positioned to bridge the gap between science and policy, so the difference we can make comes not just in the data we collect or the analyses we perform, but in our willingness, drive, and capability to bring our findings to light. We must develop skills and strategies in messaging that address different sets of priorities and show how providing optimal care gives the best health and financial outcomes for our communities and our country. We cannot continue to let shareholders and profits control the health care system contexts.

Let’s stop fixing the cracks in the walls and instead look at building a stronger foundation for our health care system that leads to care environments where health care workers, patients, and communities can thrive.


Kyla Woodward, Ph.D.

Postdoctoral Scholar - University of Washington

Kyla Woodward is a postdoctoral scholar at the University of Washington School of Nursing. Her research focuse... Read Bio

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