NHS FPX 6008 Assessment 4 Lobbying for Change
Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Lobbying for Change To, Dr. James,Health Commissioner,Albany, NY 12237 Dr. James, I am writing to advocate for immediate measures to address the ongoing staffing shortages in the Mount Sinai Hospital (MSH) Geriatric Unit in New York. This shortage significantly impacts both patient safety and healthcare workforce well-being. Overworked nurses experience high levels of burnout, which leads to increased turnover, higher incidence of medical errors, and diminished patient satisfaction (Bae, 2024). These challenges are particularly acute in vulnerable communities, such as Harlem, where health disparities are already pronounced. What Are the Implications of Staffing Shortages at MSH’s Geriatric Unit? Staffing deficits in the Geriatric Unit have wide-ranging consequences. Increasing nurse-to-patient ratios has the potential to enhance patient safety, reduce medical errors, and improve health outcomes among older adults in Harlem. Adequate staffing can also mitigate nurse burnout, improve job satisfaction, decrease turnover, and maintain a stable and experienced workforce. Furthermore, a fully staffed unit reduces dependence on costly temporary personnel and prevents avoidable readmissions. Conversely, continued shortages will exacerbate staff stress, increase turnover, and raise operational costs. Patients in Harlem and similar communities may experience longer wait times, lower quality care, and worsening health disparities. Hospitals risk legal penalties if staffing requirements are unmet, threatening both institutional finances and reputation (Griffiths et al., 2021). How Does This Issue Relate to National Healthcare Trends? MSH’s situation reflects a broader national nursing crisis. Projections indicate a shortfall of 275,000 registered nurses nationwide and 40,000 in New York by 2030 (Haddad et al., 2023). These shortages correlate with higher medical errors, increased infection rates, and poorer patient outcomes, particularly in underserved areas like Harlem (Griffiths et al., 2021). Financial impacts are also substantial, with turnover costs ranging from $21,515 to $88,000 per nurse, in addition to recruitment and training expenditures (Bae, 2024). What Are the Consequences of Staffing Shortages on Patients and Institutions? The effects of staffing gaps extend beyond immediate patient care. Institutions face higher operational costs due to reliance on temporary staff, risk of violating mandated nurse-patient ratios, and potential legal liability. Harlem, for instance, exhibits readmission rates of 75.5% and premature mortality rates of 21.4%, underscoring the impact of staffing shortages and structural health inequities (MSH, 2023). Workforce imbalances threaten both equitable access to healthcare and financial sustainability at local and state levels. NHS FPX 6008 Assessment 4 Lobbying for Change Question Response What strategies can be implemented to address staffing shortages? Investment in professional development, implementation of nurse retention programs, optimized resource allocation, and leveraging technology such as Epic’s electronic health record (EHR) system can enhance workforce efficiency and care quality (Judson et al., 2022). How do these strategies support ethical and equitable care? They promote patient safety, nurse well-being, and equitable access to healthcare for diverse populations, aligning with ethical principles of justice and beneficence. What are the anticipated outcomes of implementing these strategies? Expected outcomes include improved patient outcomes, reduced readmission rates, enhanced nurse satisfaction, lower turnover, and long-term financial sustainability for hospitals. How Do Personal Experiences Reinforce the Need for Change? My professional observations at MSH’s Geriatric Unit have highlighted the urgent need for appropriate nurse-to-patient ratios. Witnessing burnout, stress, and compromised patient safety has guided my recommendations toward retention-focused resource planning and professional development initiatives. Proactive risk analysis based on these experiences underscores the importance of workforce stability and financial sustainability. Conclusion Addressing staffing shortages in the MSH Geriatric Unit is essential to protect both patient and nurse well-being. Implementing retention strategies, optimizing resources, and integrating supportive technologies will strengthen care delivery, promote equity, and ensure sustainable healthcare outcomes for Harlem’s aging population. These interventions are crucial for upholding the ethical responsibilities of the institution while maintaining its operational and financial integrity. Sincerely, References Bae, S.-H. (2024). Nurse staffing, work hours, mandatory overtime, and turnover in acute care hospitals affect nurse job satisfaction, intent to leave, and burnout: A cross-sectional study. International Journal of Public Health, 69, 1607068. https://doi.org/10.3389/ijph.2024.1607068 Griffiths, P., Saville, C., Ball, J. E., Jones, J., & Monks, T. (2021). Beyond ratios – Flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study. International Journal of Nursing Studies, 117, 103901. https://doi.org/10.1016/j.ijnurstu.2021.103901 NHS FPX 6008 Assessment 4 Lobbying for Change Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2023). Nursing shortage. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK493175/ Judson, T. J., Pierce, L., Tutman, Mourad, M., Neinstein, A. B., Shuler, G., Gonzales, R., & Odisho, A. Y. (2022). Utilization patterns and efficiency gains from use of a fully EHR-integrated COVID-19 self-triage and self-scheduling tool: A retrospective analysis. Journal of the American Medical Informatics Association, 29(12), 2066–2074. https://doi.org/10.1093/jamia/ocac161 MSH. (2023). Community health needs assessment. The Mount Sinai Hospital. https://www.mountsinai.org/files/MSHealth/Assets/MSH/MSH-&-MSQ-CHNA-2023.pdf
NHS FPX 6008 Assessment 3 Business Case for Change
Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Business Case for Change Hi, I am _______. Today, I will present a business case about St. Vincent Medical Center (SVMC)’s rehospitalization issue. What is the Issue of Rehospitalization at SVMC? Rehospitalization at St. Vincent Medical Center (SVMC) is significantly influenced by environmental factors such as poor air quality, substandard housing, and exposure to harmful substances. These conditions disproportionately affect vulnerable populations in South Los Angeles, contributing to higher rates of chronic diseases including asthma, cardiovascular disease, and diabetes. Such health challenges often result in frequent hospital readmissions, creating financial burdens for the healthcare system and complicating care management (Chapman et al., 2022). For instance, chronic respiratory conditions alone account for approximately 800,000 hospitalizations annually in the United States, with about 20% of patients readmitted for complications sometimes unrelated to their initial admission (Neira et al., 2021). The financial impact is substantial, exceeding $13 billion nationally. In Los Angeles, high ozone levels and particulate matter exacerbate these health challenges, making rehospitalization a pressing issue requiring strategic intervention (ALA, 2023). What is the Impact on Individuals and the Community? The consequences of frequent readmissions extend beyond patients to affect healthcare providers, the organization, and the broader community. Healthcare staff at SVMC face increased workloads due to the management of chronic conditions, leading to stress, burnout, and high turnover. Statistics indicate that physicians are 1.6 times more likely to leave, and one-third of nursing staff may consider leaving within two years due to these pressures (Kelly et al., 2020). The Hispanic and Black communities in South Los Angeles are particularly affected due to socioeconomic disparities. Poor environmental conditions worsen chronic health issues in these populations, creating a cycle of illness and financial instability. Addressing these factors is critical to promoting health equity and improving overall community well-being (Betancourt et al., 2024; Murray et al., 2021). Stakeholder Impact of Rehospitalization Supporting Evidence Healthcare Staff Increased workload, burnout, high turnover Kelly et al., 2020 SVMC Organization Financial penalties, reputational risk Murray et al., 2021 Hispanic & Black Community Disproportionate health risks, chronic disease exacerbation Betancourt et al., 2024 How Feasible Are the Proposed Solutions, and What Are the Cost-Benefits? Feasibility Implementing strategies to address rehospitalization due to environmental factors at SVMC is feasible. Proposed solutions include air quality monitoring systems in high-risk areas, providing air purifiers for patients with respiratory conditions, and integrating environmental health data into electronic health records (EHRs). Initial investments are moderate: approximately $500,000 for air quality monitoring equipment and patient education programs, with an additional $200,000 for EHR integration. These investments leverage SVMC’s existing infrastructure and can be incorporated into ongoing operations without major disruption (Chen et al., 2020; Wimalasena et al., 2021). Cost-Benefit Analysis Hospital readmissions due to environmental conditions cost SVMC significantly. For example, each readmission for chronic conditions like asthma averages $11,200. Reducing readmissions by 10% could save the hospital over $1.12 million annually. Nationally, improving air quality could reduce related hospitalizations by 15%, highlighting the financial and health benefits of these preventive interventions (ALA, 2023; Neira et al., 2021). Intervention Estimated Cost Potential Benefits Payback Period Air quality monitoring & EHR integration $700,000 Improved patient outcomes, reduced readmissions 3–5 years Patient education programs $300,000 annually Enhanced self-management, fewer emergency visits Within first year Resource optimization $250,000 annually Reallocation to environmental health initiatives Continuous How Can SVMC Mitigate Financial Risks? Primary risks include high upfront costs, potential funding shortfalls, and uncertain ROI. SVMC can mitigate these by developing a dedicated financial plan, establishing partnerships for funding, and using metrics to track readmission reduction and improved patient outcomes (Zavorka & Paar, 2022). What Changes Are Proposed to Reduce Rehospitalization? To address environmental causes of rehospitalization, SVMC proposes: These interventions aim to reduce readmissions while promoting equity, cultural sensitivity, and community engagement (Bogin et al., 2022; Ramirez et al., 2022). What Are the Potential Benefits to the Organization, Colleagues, and Community? Organizational Benefits: Reducing readmissions by even 10% could save SVMC $1.12 million annually and enhance the hospital’s reputation while mitigating regulatory penalties (Neira et al., 2021). Healthcare Staff Benefits: Reduced patient volumes with exacerbated chronic conditions decrease workload and burnout, improving staff satisfaction and retention (Caviness et al., 2021). Community Benefits: Targeted interventions can reduce exposure to environmental hazards, decreasing the prevalence of chronic illnesses and improving the quality of life for residents in South Los Angeles (ALA, 2023). How Does the Proposed Solution Ensure Cultural Sensitivity, Ethics, and Equity? Culturally Sensitive: Educational materials and workshops are tailored to the linguistic and cultural diversity of South Los Angeles, with translations into Spanish and other relevant languages. The content respects cultural beliefs regarding health and environmental risks, fostering better engagement and adoption (Griffith et al., 2023; Ramirez et al., 2022). Ethical Principles: The initiative adheres to beneficence (promoting well-being), nonmaleficence (preventing harm), autonomy (informed decision-making), and justice (equitable access to interventions) (Holden et al., 2023). Equitable Access: All interventions are accessible regardless of income, with subsidies for air purifiers and housing remediation services. Collaboration with community organizations ensures that vulnerable populations receive appropriate support (Sokhi et al., 2022). Conclusion Addressing rehospitalization due to environmental factors at SVMC requires a comprehensive approach encompassing air quality monitoring, patient education, and housing improvements. Implementing these measures can reduce hospital readmissions, improve patient outcomes, and alleviate financial and operational pressures. The proposed solutions are culturally sensitive, ethical, and equitable, ensuring fair access and support for all residents in South Los Angeles. By addressing the root causes of environmentally linked chronic illnesses, SVMC can achieve long-term sustainability and enhanced community health. References ALA. (2023, April 19). Nation’s air quality divided: New report reveals growing disparities in exposure to air pollution. Www.lung.org. https://www.lung.org/media/press-releases/state-of-the-air-2023 Betancourt, J. R. (2024). Guide to preventing readmissions among racially and ethnically diverse Medicare beneficiaries. www.cms.gov. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/OMH_Readmissions_Guide.pdf Bogin, M. H., Chandra, A., Manggaard, J., Thorsteinsdottir, B., Hanson, G. J., & Takahashi, P. Y. (2022). Telehealth use and hospital readmission rates in long-term care facilities in southeastern Minnesota during the COVID-19 pandemic. Mayo Clinic Proceedings: Innovations, Quality
NHS FPX 6008 Assessment 2 Needs Analysis for Change
Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Needs Analysis for Change Homelessness in California poses significant economic and public health challenges. The growing population of people experiencing homelessness (PEH) places immense pressure on healthcare systems, driving up costs and contributing to disparities in access and outcomes. Limited availability of preventive and routine healthcare services results in higher rates of emergency department visits and hospitalizations, creating a feedback loop of increased strain on healthcare providers. Vulnerable populations—particularly those with chronic medical conditions or mental health issues—are disproportionately affected. Addressing these issues requires immediate and comprehensive interventions, including investment in affordable housing, integrated healthcare services, and targeted policy reforms to promote equity and improve overall outcomes. Summary of Homelessness as Economic Issue Homelessness represents a critical economic concern in California, with both direct and indirect costs affecting healthcare systems, communities, and individual providers. In 2023, California reported 337,735 homeless individuals, of whom 73.4% were unsheltered, 55% were men, and 45% were women (CHCF, 2024). People experiencing homelessness encounter significant barriers to care, which contributes to higher prevalence of chronic illnesses such as hypertension (30.1%), diabetes (11.1%), heart disease (15.1%), and pulmonary disorders (25.2%) (Statista, 2024). These conditions increase the likelihood of hospital admissions, emergency visits (37.2%), and readmissions (27.4%) (Miyawaki et al., 2020), amplifying both economic and operational pressures on healthcare systems. The financial impact extends to housing and shelter services, with estimated costs averaging $208,000 per bed and $278,000 per unit (Hoover Institution, 2023). For healthcare professionals, homelessness increases patient complexity and requires more care coordination. Hospitals experience strain due to frequent readmissions and uncompensated care, while communities face higher public health risks, widening disparities, and increased economic pressure. Key Statistics of Health and Economic Burden Indicator Percentage / Cost Source Unsheltered PEH 73.4% CHCF, 2024 Hypertension prevalence 30.1% Statista, 2024 Diabetes prevalence 11.1% Statista, 2024 Heart disease prevalence 15.1% Statista, 2024 Pulmonary illness prevalence 25.2% Statista, 2024 Emergency visits 37.2% Miyawaki et al., 2020 Readmissions 27.4% Miyawaki et al., 2020 Shelter cost per bed $208,000 Hoover Institution, 2023 Shelter cost per unit $278,000 Hoover Institution, 2023 The rationale for addressing homelessness is reinforced by its widespread impact on healthcare access, cost, and equity. In 2020, PEH represented 3.4% of hospital admissions and 2.8% of emergency visits in California (CHCF, 2024). Unhoused individuals face a mortality risk 2.7 times higher than the general population (Liu et al., 2020). The core gaps involve insufficient integrated healthcare, limited affordable housing, and inadequate social support networks. Policy reforms, expanded healthcare access, and housing-focused interventions are essential to mitigate these disparities. Socioeconomic or Diversity Disparities Homelessness disproportionately affects minority populations in California, revealing systemic inequities. Black, American Indian, and Pacific Islander communities experience disproportionately higher rates of housing instability. For example, Black Californians constitute only 5.3% of the state population but represent 26.6% of unhoused individuals receiving assistance. American Indian/Alaska Native individuals account for 1.2% of the unhoused population despite comprising just 0.03% of the state’s total population (Davalos & Kimberlin, 2023). These disparities reflect historical and structural barriers, including discriminatory housing policies, economic instability, and limited access to high-wage employment. Effective interventions must include expanded affordable housing, economic support programs, and policy measures that dismantle structural inequities affecting marginalized groups. Evidence-Based Sources for Combating Homelessness Research underscores the importance of evidence-based interventions in reducing homelessness and addressing systemic disparities. Housing-first programs, which prioritize stable housing before addressing other social or health needs, have demonstrated significant improvements in long-term housing stability for marginalized populations (Sandu et al., 2021). The shortage of affordable housing disproportionately impacts renters of color. According to the National Low Income Housing Coalition (2023), 19% of Black households, 17% of American Indian or Alaska Native households, and 14% of Latino households have extremely low incomes, compared with 6% of White non-Latino households. Expanding rental assistance and permanent supportive housing can reduce homelessness among Black and Latinx populations (Olivet et al., 2021). Integrating job training and workforce development further promotes long-term financial independence and economic stability, bridging the racial gap in housing security (Aubry et al., 2020). Opportunities and Predicted Outcomes Expanding housing-first initiatives and rental assistance programs in California offers significant economic and social benefits. Stable housing reduces healthcare utilization, particularly emergency visits and hospitalizations, which are disproportionately high among PEH (Olivet et al., 2021). Additionally, permanent supportive housing programs lower interactions with the criminal justice system, mitigating public expenditures (Aubry et al., 2020). Targeted interventions—such as workforce training and rental subsidies—enhance economic mobility for marginalized populations, reducing dependence on public assistance and emergency shelters (Sandu et al., 2021). Over time, these measures contribute to improved health outcomes, equity, and a more resilient local economy. Conclusion Addressing homelessness in California requires a holistic, evidence-based approach that integrates housing-first models, rental assistance, and workforce development initiatives. Tackling systemic disparities while expanding access to affordable housing and healthcare can alleviate economic burdens on hospitals, reduce recidivism, and improve stability for vulnerable populations. Through community-driven, policy-supported interventions, California can promote health equity, economic empowerment, and long-term social sustainability. References Aubry, T., Bloch, G., Brcic, V., Saad, A., Magwood, O., Abdalla, T., Alkhateeb, Q., Xie, E., Mathew, C., Hannigan, T., Costello, C., Thavorn, K., Stergiopoulos, V., Tugwell, P., & Pottie, K. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. The Lancet Public Health, 5(6), 342–360. https://doi.org/10.1016/s2468-2667(20)30055-4 NHS FPX 6008 Assessment 2 Needs Analysis for Change CHCF. (2024). People experiencing homelessness in California Almanac. California Health Care Foundation. https://www.chcf.org/publication/people-experiencing-homelessness-in-california-almanac/#related-links-and-downloads Davalos, M., & Kimberlin, S. (2023, March). Who is experiencing homelessness in California? California Budget and Policy Center. https://calbudgetcenter.org/resources/who-is-experiencing-homelessness-in-california/ Hoover Institution. (2023). Sheltering California’s homeless is insanely expensive. It doesn’t have to be. Hoover Institution. https://www.hoover.org/research/sheltering-californias-homeless-insanely-expensive-it-doesnt-have-be Liu, C. Y., Chai, S. J., & Watt, J. P. (2020). Communicable disease among people experiencing homelessness in California. Epidemiology and Infection, 148. https://doi.org/10.1017/s0950268820000722 Miyawaki, A., Hasegawa, K., Figueroa, J. F., & Tsugawa, Y. (2020). Hospital readmission and emergency department revisits of homeless patients treated at homeless-serving hospitals
NHS FPX 6008 Assessment 1 Identifying a Local Health Care Economic Issue
Student Name Capella University NHS-FPX 6008 Economics and Decision Making in Health Care Prof. Name Date Identifying a Local Health Care Economic Issue This assessment focuses on a pressing local healthcare economic issue and its implications for a specific population. The paper discusses the rationale for choosing this issue, analyzes its effects on diverse and low-socioeconomic groups, and identifies key gaps contributing to the problem based on substantial evidence. Understanding these dynamics helps to formulate strategies that enhance community well-being and healthcare system sustainability. Local Health Care Economic Issue The shortage of healthcare staff represents a critical economic challenge within the healthcare system. This issue is multifactorial, influenced by increasing healthcare demands due to population growth, rising chronic disease prevalence, and high turnover rates caused by stressful work environments (Itodo et al., 2020; Willard-Grace et al., 2019). Workforce shortages impact patient care and healthcare system efficiency. In the United States, the American Hospital Association has described this shortage as a “national emergency,” estimating a deficit of 1.1 million healthcare professionals by the end of 2022 (Johnson, 2022). The COVID-19 pandemic intensified this shortage, prompting over 1,100 healthcare workers to leave their professions, thereby exacerbating the strain on communities (Johnson, 2022). Tampa General Hospital, where I have firsthand experience, illustrates this issue vividly. Staff shortages lead to increased operational costs, delayed patient care, and economic burdens on both the community and healthcare institutions. Projections indicate that by 2030, the United States will face a shortfall of approximately 121,000 physicians, further emphasizing the urgency of addressing this problem (Harp, 2023). Factor Description Impact Rising Demand Population growth and chronic diseases Increased patient load and pressure on healthcare system High Turnover Stressful work conditions, burnout Workforce attrition, decreased quality of care Pandemic Effect COVID-19 related resignations Exacerbated shortages and delayed treatments Financial Burden Unmet patient needs and increased costs Economic strain on communities and organizations The Rationale for Selecting Shortage of Healthcare Staff The decision to focus on healthcare workforce shortages is grounded in both professional relevance and personal experience. First, a declining workforce directly affects patient care and outcomes. Patients experience delays, leading to potential deterioration in health conditions (Mascha et al., 2020). Second, the healthcare sector is an essential economic driver, and workforce insufficiency impacts productivity, institutional stability, and the broader community economy (Sharifi et al., 2021). My personal experience at Tampa General Hospital informed this selection. I observed nurses and physicians leaving their positions, resulting in negative consequences for both patients and the organization, including higher morbidity and mortality rates and reduced financial efficiency. According to the Florida Hospital Association, nurse shortages in Florida are projected to reach 59,000 by 2030 (USF Foundation, 2023). Equity considerations also motivate this choice; a sufficient and well-distributed workforce ensures that patients from all backgrounds receive equitable and timely care. Impact of Shortage of Healthcare Staff on Diverse or Low Socioeconomic Groups Staff shortages affect patients, healthcare workers, and community members, particularly those from diverse or low-income backgrounds. Limited staff increases workload, leading to burnout, errors, and further attrition (Chemali et al., 2019). In my experience, high patient loads at Tampa General Hospital resulted in extended working hours, occasional medication errors, and heightened stress among staff. Organizational outcomes included reduced care quality, near-miss events, lower patient satisfaction, and economic instability. Diverse and low-socioeconomic groups face heightened vulnerability due to these shortages. Culturally diverse patients require care from providers who are culturally competent. When staffing is inadequate, their needs may not be fully addressed, delaying treatments and diagnoses (Billings et al., 2021). Financially disadvantaged patients also face delayed care, exacerbating healthcare disparities and increasing risks of poor health outcomes and mortality (Adugna et al., 2020). Affected Group Specific Impacts Outcomes Healthcare Workers Increased workload, burnout Turnover, stress, reduced job satisfaction Diverse Communities Delayed care, lack of cultural competence Poorer health outcomes, delayed diagnoses Low Socioeconomic Patients Financial barriers, delayed treatments Increased morbidity and mortality Organizations Reduced quality of care, operational stress Economic strain, decreased patient satisfaction Gap Contributing to Shortage of Healthcare Staff A primary gap contributing to workforce shortages is the imbalance between growing healthcare demands and the insufficient supply of trained professionals. This shortage is well-documented; the World Health Organization predicts a global deficit of 10 million healthcare workers by 2030, particularly in low- and lower-middle-income countries (World Health Organization, 2019). Another contributing factor is the diminished well-being of healthcare staff. High patient loads and insufficient staffing lead to physical and mental health challenges, prompting many professionals to leave their positions (McDougall et al., 2020). Consequently, hospitals struggle to provide essential services, which negatively affects community health and economic stability due to rising healthcare costs and decreased workforce productivity. Gap Description Consequences Workforce Supply vs. Demand Shortage of trained professionals Inability to meet patient needs, delayed treatments Staff Well-being Burnout, mental and physical health strain Increased turnover, reduced quality of care Community Impact Limited access to care Poor health outcomes, economic burden Conclusion The shortage of healthcare staff in the United States is a critical economic and public health issue. It affects healthcare organizations like Tampa General Hospital, where staff burnout, delayed treatments, and high turnover rates are prominent. The key contributing gap is the mismatch between growing healthcare demands and the availability of qualified professionals. Addressing this shortage requires strategic interventions in workforce planning, staff well-being, and equitable resource allocation to safeguard both community health and economic stability. References Adugna, M. B., Nabbouh, F., Shehata, S., & Ghahari, S. (2020). Barriers and facilitators to healthcare access for children with disabilities in low and middle income sub-Saharan African countries: A scoping review. BMC Health Services Research, 20(1). https://doi.org/10.1186/s12913-019-4822-6 Billings, J., Ching, B. C. F., Gkofa, V., Greene, T., & Bloomfield, M. (2021). Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: A systematic review and qualitative meta-synthesis. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-06917-z Chemali, Z., Ezzeddine, F. L., Gelaye, B., Dossett, M. L., Salameh, J., Bizri, M., Dubale, B., & Fricchione, G. (2019). Burnout among healthcare providers in the complex