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Rethinking Autonomy: Relationships as a Source of Resilience in a Changing Healthcare System

In the face of health system change, there is growing concern about the well-being of care providers and their ability to meet the needs of patients. Some scholars have called for expanding the goal of quality, access, and patient experience to a broader goal that includes the well-being of care providers themselves (Bodenheimer and Sinsky 2014). Scholars have found that stress at work is a source of job dissatisfaction, disengagement, burnout, and adverse health outcomes for employees, particularly for employees who feel they have little control (Karasek 1979; Parker and Sprigg 1990), and a source of negative outcomes for their clients as well (Schaubroek and Fink 1998; Gawande et al. 2003). As health care systems respond to pressures to provide higher quality care in an increasingly resource-constrained environment, there is a real risk of declining satisfaction and engagement for care providers and declining satisfaction for the patients they serve (Sexton, Thomas, and Helmreich 2000; Vincent et al. 2004).

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