Experts propose new approach for bridging the gap between administrative and clinical priorities

AURORA, Colo. (March 13, 2025) – In a recently published article in the New England Journal of Medicine, Marisha Burden, MD, MBA, and Liselotte Dyrbye, MD, MHPE, introduce evidence-based work design, a unique approach that confronts the growing divide between frontline clinicians and administrative leaders in health care.

While various organizational methods and process-improvement approaches exist in pockets of the health care industry, this new framework presents a unified strategy for rethinking how decisions are made on health care work design, such as workloads and team structures, to achieve better outcomes for patients, health care workers, and health systems.

Administrative harm, defined as the adverse consequences of administrative decisions that shape work structures, processes, and programs, is often overlooked yet pervasive in health care. At a time when the health care industry is contending with high burnout rates, moral injury, and a growing trend of physician unionization, many of these issues stem in part from organizational decision-making around work design. The good news is that many of these challenges are both addressable and potentially preventable through more effective work design strategies.

 At the heart of evidence-based work design is a focus on tying organizational decision-making to real-world outcomes—such as patient safety, quality of care, workforce well-being, and long-term organizational success—instead of 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,” Dr. 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.” 

Dr. Burden and Dr. Dyrbye’s perspective piece sets the stage for multiple large-scale studies now underway to test and refine this approach. Ultimately, they hope to equip health care leaders with robust evidence and practical tools to rethink how work is structured in ways that benefit the health care workforce, patients, and ultimately organizational outcomes including financials.

“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,” Dr. Dyrbye says. “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.”

About the University of Colorado Anschutz Medical Campus

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education and patient care. The campus encompasses the University of Colorado health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado - that treat more than two million adult and pediatric patients each year. Innovative, interconnected and highly collaborative, the University of Colorado Anschutz Medical Campus delivers life-changing treatments, patient care and professional training and conducts world-renowned research fueled by over $704 million in research grants. For more information, visit www.cuanschutz.edu.