The World Health Organization expects a global shortage of 10 million health workers by 2030. Burnout, long-term sick leave and staff leaving the profession put both the quality and the sustainability of healthcare at risk. Hospitals, governments and researchers are investing heavily in improving wellbeing, but almost every study measures wellbeing differently. That makes it nearly impossible to compare interventions, or to establish which of them actually work.
The CROWN study addresses this by developing a core outcome set: an agreed minimum set of outcomes that studies in this field should report. Starting from more than 250 candidate outcomes drawn from the literature, a panel of experts from 20 countries rated and prioritised them over three Delphi rounds. The panel deliberately brought together doctors, nurses, and allied health professionals, so that the resulting set is not tied to a single profession or healthcare system.
Ranked by priority, the ten core outcomes are work–life balance, job satisfaction, quality of life, motivation, mental health, meaning at work, income satisfaction, work culture, perceived professional growth and stress.
The top three come as no great surprise: a UK Delphi study among hospital doctors arrived at job satisfaction and work–life balance as well, suggesting these are stable anchor points rather than a local finding. More striking is what did not make the list. Relationships, often seen as central to job satisfaction, are absent, as are autonomy and job control. The authors suggest the panel views these as conditions that shape wellbeing rather than as outcomes in themselves. Satisfaction with income, by contrast, did make the top ten.
The set covers almost the full theoretical breadth of the concept ‘wellbeing’. For research, it means results can finally be compared and combined. For hospitals, it offers a framework for monitoring staff wellbeing and checking whether their own initiatives have any effect. The next step is a core outcome measurement set: agreeing which instruments should be used for each of the ten outcomes, and how often.
The study was led from the UMCG (Maarten van der Laan, Tom Bazuin and Amber Boskma), UMC Utrecht (Lotty Hooft), Amsterdam UMC (Sarah Mugge and Dave Dongelmans) and University of Zurich (Jesús Lopez-Alcalde).
