Evidence-based work design could transform patient care, reduce burnout

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A new perspective published in the New England Journal of Medicine (NEJM) proposes a framework to bridge the divide between frontline clinicians and health care administrators. Written by Marisha Burden, MD, MBA, and Liselotte Dyrbye, MD, MHPE, the article introduces “evidence-based work design” — a strategic approach that integrates clinical outcomes, workforce well-being, and financial sustainability into health care decision-making.

The model seeks to mitigate administrative harm — a term used to describe the unintended negative consequences of organizational decisions on health care workers and patient care.

The cost of administrative harm

The corporatization of health care has led to a work environment where financial pressures often overshadow clinical priorities, the authors argue. With many physicians now employed rather than independent, their ability to shape their own work has diminished, leading to increased administrative harm.

“Administrative harm… is pervasive and often overlooked,” the authors wrote. “Despite the direct effect of organizations’ administrative decisions on job demands and resources, as well as subsequent organizational outcomes — such as patient safety, health care quality, workforce retention and well-being, and operational and financial outcomes — there’s no equivalent evidence-based approach on the administrative front.”

The authors emphasize that ineffective work structures contribute to physician burnout, moral injury, and a growing trend of unionization among health care workers seeking better working conditions.

Evidence-based work design

The proposed framework for evidence-based work design integrates best practices from implementation science, systems science, quality improvement, and occupational health to craft a more structured, research-backed approach to work design. Their goal is to help health care organizations balance financial sustainability with frontline realities.

Burden notes that, while various improvement models exist, few explicitly connect frontline worker experience with financial and operational decision-making.

The focus of evidence-based work design is to tie organizational decision-making to real-world outcomes — patient safety, quality of care, workforce well-being, and long-term organizational success — rather than relying solely on short-term productivity and financial metrics.

“We have seen many promising frameworks from many different disciplines, yet none have truly bridged the gap between organizational decision-makers, frontline health care workers, and decisions around work design — integrating short- and long-term financial results, productivity, workforce well-being, and patient outcomes. In fact, this integration is almost entirely missing,” Burden said.

“Our goal is to spark a transformation that acknowledges the real challenges of balancing financial sustainability with the need to consider how work design impacts the well-being and safety of both patients and health care workers.”

Despite widespread agreement that excessive workloads harm both patients and providers, there’s little consensus on what an ideal workload actually looks like. The same is true for structuring care teams — there’s no clear evidence guiding when a physician, an advanced practice provider, or a combination of both is best suited for specific patient populations.

The perspective piece sets the stage for larger studies aimed at refining and implementing evidence-based work design in health care organizations nationwide. Moving forward, the authors suggest that leveraging data from electronic health records (EHRs) could help health care leaders understand workload patterns, patient caseloads, and team dynamics — allowing for smarter, real-time decisions about staffing and resource allocation.

“Health care’s future depends on aligning work design, specifically job demands and resources, with workforce well-being and safety, patient safety and quality outcomes, and organizational outcomes,” Dyrbye said in a university release. “Organizations that embrace evidence-based work design will likely not only retain top talent but also deliver higher-quality care while achieving long-term success.”