ABSTRACT
BACKGROUND: In health care, burnout remains a persistent and significant problem. Evidence now exists that organizational initiatives are vital to address health care worker (HCW) well-being in a sustainable way, though system-level interventions are pursued infrequently. METHODS: Between November 2018 and May 2020, researchers engaged five health system and physician practice sites to participate in an organizational pilot intervention that integrated evidence-based approaches to well-being, including a comprehensive culture assessment, leadership and team development, and redesign of daily workflow with an emphasis on cultivating positive emotions. RESULTS: All primary and secondary outcome measures demonstrated directionally concordant improvement, with the primary outcome of emotional exhaustion (0-100 scale, lower better; 43.12 to 36.42, pâ¯=â¯0.037) and secondary outcome of likelihood to recommend the participating department's workplace as a good place to work (1-10 scale, higher better; 7.66 to 8.20, pâ¯=â¯0.037) being statistically significant. Secondary outcomes of emotional recovery (0-100 scale, higher better; 76.60 to 79.53, pâ¯=â¯0.20) and emotional thriving (0-100 scale, higher better; 76.70 to 79.23, pâ¯=â¯0.27) improved but were not statistically significant. CONCLUSION: An integrated, skills-based approach, focusing on team culture and interactions, leadership, and workflow redesign that cultivates positive emotions was associated with improvements in HCW well-being. This study suggests that simultaneously addressing multiple drivers of well-being can have significant impacts on burnout and workplace environment.
Subject(s)
Burnout, Professional , Burnout, Professional/prevention & control , Delivery of Health Care , Humans , Leadership , Pilot Projects , WorkplaceSubject(s)
Caregivers/psychology , Health Personnel/psychology , Occupational Exposure/adverse effects , Stress, Psychological/complications , Adaptation, Psychological , Biofeedback, Psychology , Communication , Heart Rate , Humans , Professional-Patient Relations , Stress, Psychological/prevention & control , Stress, Psychological/therapyABSTRACT
This paper charts a course for assessing the impact of healing relationships in clinical medicine. The system of healing relationships is multidimensional, longitudinal, contextual, and emergent. In a new conceptual model, healing relationships are identified in terms of the conditions of healing intention, motivation, and information transfer, and in terms of the attributes of emotional engagement, mindfulness, and trust. Five components of quality in healing relationships--adaptability, cohesion, growth, caring-in-relation, and commitment--are noted, and the importance of timing, attunement, and cultural meaning systems are described. Communication, clinical method, caring, competence, and treatment characteristics are differentiated as mediating processes; expectancy and conditioning are positioned as antecedents of healing relationships. Multiple personal and contextual outcomes are addressed with a recommendation for assessing a minimal set of each, including symptom resolution, health status, sense of coherence, patient enablement, cost effectiveness, quality of care, efficiency, access, and healer satisfaction. A wheel of knowledge connects 3 ways of knowing--personal, connected, and objective--with appropriate methodology and research designs. Applying this wheel to the issue of assessing impact in healing relationships reveals the need for multiple methods, perspectives, and triangulations. A critical multiplist strategy is one means for advancing this area of research. A double-helix trial design is introduced, in which one strand consists of a standard quantitative approach and the other consists of qualitative methods. The 2 strands are bonded by the questions addressed and by the participants in the study.
