Mental Health SIG Member Publishes Study on Grit, Resilience

Mental Health SIG Member Publishes Study on Grit, Resilience


Join me in congratulating Mental Health and Psychological Well-being Member, Dr. Louise Underdahl and colleagues for the acceptance of their study, "Reframing physician engagement: An analysis of physician resilience, grit, and retention" to the International Journal of Healthcare Management. Below is the Abstract, provided by Dr. Underdahl. Congratulations, all!


Reframing Physician Engagement: An Analysis of Physician Resilience, Grit, and Retention

Louise Underdahl, Terri Jones-Meineke, and Lunthita Duthely


The healthcare sector is challenged by negative economic and organizational consequences of physician turnover. The ramifications of physician turnover can be “costly and disruptive” (Fibuch & Ahmed, 2015, p, 22), create financial burdens for healthcare organizations (Waldman, Kelly, Arora, & Smith, 2004), sabotage patient safety (Nahrgang et al., 2011; Swensen & Shanafelt, 2017), disrupt continuity of patient care (Johnson et al., 2017; O'Hare & Kudrle, 2007), and undermine institutional profitability. From 2011 to 2014, overall physician burnout rates in the United States increased by 10%, with specialty-specific burnout rates ranging from 37% to 61% (Back et al., 2016; Dimou, Ecklebarger, & Riall, 2016; Kamal et al., 2014; Schrijver, 2016; Shanafelt & Noseworthy, 2017).

The emerging literature suggests that health care institutions should consider reframing their business models to include the construct of Grit as a viable characteristic to assess and promote, with the ultimate goal of increasing physician engagement and well-being. Focusing on challenges associated with physician retention, this meta-analysis assessed contemporary themes and strategies for reducing physician turnover and burnout by promoting physician resilience, engagement, and Grit. The study may contribute to disruptive innovation, defined as reframing past and present approaches to reducing physician turnover and burnout and promoting a culture of safety (Swensen & Shanafelt, 2017) by stimulating physician resilience and Grit.

Research is needed to validate that reframing physician engagement strategies to incorporate Grit-strengthening elements may effectively reduce turnover and burnout. In the next phase, physician staff of a healthcare system in the southwest United States will complete a short Grit survey; results will be analyzed in the context of attrition, burnout, and turnover patterns to identify factors that may contribute to engagement and retention. Innovative institutional, departmental, and leadership initiatives promoting resilience, Grit, flow, and engagement may effectively mitigate social, economic, and cultural factors contributing to physician burnout (Swenson & Shanafelt, 2017).


Citation: Underdahl, L., Jones-Meineke, T., & Duthely, L. M.  (2017, September).  Reframing physician engagement: An analysis of physician resilience, grit, and retention. International Journal of Healthcare Management.  Accepted for publication September 28, 2017





Ahgren, B., & Axelsson, R. (2007). Determinants of integrated health care development: chains of care in Sweden. International Journal of Health Planning Management, 22(2), 145-157. doi:10.1002/hpm.870

Back, A. L., Steinhauser, K. E., Kamal, A. H., & Jackson, V. A. (2016). Building resilience for palliative care clinicians: an approach to burnout prevention based on individual skills and workplace factors. Journal of Pain and Symptom Management, 52(2), 284-291. Retrieved from

Dimou, F. M., Eckelbarger, D., & Riall, T. S. (2016). Surgeon burnout: a systematic review. Journal of the American College of Surgeons, 222(6), 1230-1239.

Edgren, L., & Barnard, K. (2012). Complex adaptive systems for management of integrated care. Leadership in Health Services, 25(1), 39-51. doi:10.1108/17511871211198061

Fibuch, E., & Ahmed, A. (2015). Physician turnover: a costly problem. Physician Leadership Journal, 2(3), 22.

Glasser, M., MacDowell, M., Hunsaker, M., Salafsky, B., Nielsen, K., Peters, K., & Meurer, M. (2010). Factors and outcomes in primary care physician retention in rural areas. South African Family Practice, 52(4), 336-340.

Johnson, J., Louch, G., Dunning, A., Johnson, O., Grange, A., Reynolds, C., ... & O'Hara, J. (2017). Burnout mediates the association between depression and patient safety perceptions: A cross‐sectional study in hospital nurses. Journal of Advanced Nursing. Retrieved from

Kamal, A., Bull, J. H., Wolf, S. P. et al. (2014). Burnout among palliative care clinicians in the United States: Results of a national survey. Journal of Clinical Oncology. Retrieved from

Mazurenko, O., & O'Connor, S. (2012). The impact of physician job satisfaction on the sustained competitive advantage of Health care organizations. Journal of Management Policy and Practice, 13(4), 21-34.

Nahrgang, J. D., Morgeson, F. P., Hofmann, D. A. (2011, January). Safety at work: A meta-analytic investigation of the link between job demands, job resources, burnout, engagement, and safety outcomes. Journal of Applied Psychology, 96(1), 71-94. Retrieved from

O'Hare, D., & Kudrle, V. (2007, May/June). Increasing physician engagement. Physician Executive, 38-45.

Schrijver, I. (2016). Pathology in the medical profession? Taking the pulse of physician wellness and burnout. Archives of Pathology & Laboratory Medicine, 140(9), 976-982.

Shanafelt, T. D., & Noseworthy, J. H. (2017, January). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129-146).

Swensen, S. J., & Shanafelt, T. (2017, February 28). An organizational framework to reduce professional burnout and bring back joy in practice. The Joint Commission Journal on Quality and Patient Safety. Retrieved from

Wai, P. Y., Dandar, V., Radosevich, D. M., Brubaker, L., & Kuo, P. C. (2014). Engagement, workplace satisfaction, and retention of surgical specialists in academic medicine in the United States. Journal of the American College of Surgeons, 219(1), 31-42.

Waldman, J. D., Kelly, F., Arora, S., & Smith, H. L. (2004). The shocking cost of turnover in

Mental Health and Psychological Well-being Research Community

Recent News