With the continuously changing health care environment and dramatic shift in patient demographics, institutions have the responsibility of identifying and dedicating resources for maintaining and improving wellness and resilience among front line providers to assure the quality of patient care. Our institution, the Ohio State University Wexner Medical Center (OSUWMC), has addressed the goal to decrease burnout for providers in a multistep, multiprofessional, and multiyear program starting firstly with institutional cultural change then focused provider interventions, and lastly, proactive resilience engagement. We describe herein our approach and outcomes as measured by provider wellness and health system outcomes. In addition, we address the overall feasibility and effectiveness of these programs in promoting provider compassion and mindfulness while reducing burnout and improving resilience. Institutional culture change and readiness were initiated in 2010 with the introduction of Crew Resource Management training for all providers across the OSUWMC. This multiyear program was implemented and has been sustained to the current day. Focused interventions to improve mindfulness were undertaken in the form of both Mindfulness in Motion (MIM) training for intensive care unit personnel and a “flipped classroom” mindfulness training for faculty and residents. Lastly, sustainable changes were introduced in the form of the Gabbe Health and Wellness program which consists of interprofessional MIM training and other wellness offerings for staff, faculty, and residents embedded across the entire medical center. The introduction of Crew Resource Management in 2010 continues to be endorsed and supported throughout OSUWMC for all providers, including residents and students. The improvements seen have not only improved patient satisfaction but also reduced patient safety events and improved national reputation for the institution as a whole. Subsequently, MIM training for intensive care unit providers has resulted in improved resilience as well as decreased patient safety events. In addition, the “flipped classroom” mindfulness training for residents and faculty has resulted in improvements in providing calm and compassionate care, improvements in physician wellbeing, and reductions in emotional exhaustion and depersonalization. Lastly, implementing the Gabbe Health and Wellness program inclusive of interprofessional MIM training for staff, faculty, and residents has resulted in significant reductions in burnout while significantly increasing resilience postintervention. The engagement from staff and enthusiasm to continue this program have escalated and been positively accepted across OSUWMC. To reduce the incidence of burnout, improve resilience, and ultimately improve patient outcomes, a health system must identify and prioritize a commitment and dedication of resources to develop and sustain a multimodal and interprofessional approach to change. These initiatives at OSU originated with cultural transformation allowing the acceptance of change in the form of mindfulness training, resilience building, and the engagement of organizational science, so as to demonstrate the outcomes and impact to the health system and academic peers. Herein we describe the work that has been done thus far, both published and in progress, to understand our journey.
Background Healthcare professional (HCP) burnout transcends clinician job title and role, thus creating a need for interprofessional strategies to address burnout. The organizational framework of offering employer-sponsored mindfulness programming to HCPs sets the stage for an orchestrated, mindful response to COVID-19. Objective This single arm pre-post interventional research tested changes in measures of burnout, resilience, perceived stress and work engagement for interprofessional HCP faculty and students participating in Mindfulness in Motion (MIM), a novel eight-week multimodal evidenced–based onsite intervention. Methods A Graduate Medical Education (GME) pilot of MIM was expanded to target inter-professional resiliency within an academic health center. MIM is the core offering of the Gabbe Health and Wellness program for students, staff, faculty, and residents and is embedded across the entire medical center. Results The faculty/student role demographic categories (n = 267) included resident physicians, resident chaplains, attending physicians, medical center faculty, and hospital administrative/managerial clinical staff. These cohorts demonstrated significant 27% reduction in participants meeting burnout criteria. Total burnout was determined by scores on subscales of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) of the Maslach Burnout Inventory (MBI). There was a highly significant pre/post decrease in the in the emotional exhaustion (p < 0.00001) and depersonalization scores (p < 0.001), with highly significant increase in the personal accomplishment (p < 0.00001) scores. Resilience, as measured by the Connor Davidson Resiliency Scale (CDRS), significantly increased (p < 0.00001), alongside a significant increase (p < 0.00001) in the total Utrecht Work Engagement Score (UWES) and a significant decrease in scores on the Perceived Stress Scale (PSS) (p < 0.00001). Conclusion MIM significantly reduced burnout and perceived stress, for interprofessional (HCP) faculty and staff, while increasing resilience and work engagement in a large healthcare system. These results paved the way for an organizational response that utilized mindfulness to empower HCPs to navigate through the novel challenges presented by COVID-19.
RESULTS:Forty-nine program directors (62%) completed the survey and provided data on 1042 graduates from 46 programs. Of those graduates, 26.4% (n = 275) practice as hospitalists, and none had completed an HM fellowship. Approximately two-thirds (65%) of med-peds hospitalists provide care to hospitalized children and adults, with one-third providing care solely to hospitalized adults. Approximately one-half (53.5%) have an appointment with a medical school and roughly one-quarter (28%) practice in a freestanding children's hospital. CONCLUSIONS:An increasing percentage of recent med-peds graduates are pursuing careers in HM, and two-thirds are providing care to hospitalized children. As consideration for an accredited pediatric HM fellowship continues, certifying and accrediting bodies should consider how this will impact the med-peds workforce and allow med-peds graduates fl exibility in their training requirements that will permit them to acquire the necessary skills to care for hospitalized children and adults.
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