Change implementation: the association of adaptive reserve and burnout among inpatient medicine physicians and nurses

Abstract

Adaptive Reserve (AR) is positively associated with implementing change in ambulatory settings. Deficits in AR may lead to change fatigue or burnout. We studied the association of self-reported AR and burnout among providers to hospitalized medicine patients in an academic medical center. An electronic survey containing a 23-item Adaptive Reserve scale, burnout inventory, and demographic questions was sent to a convenience sample of nurses, house staff team members, and hospitalists. A total of 119 self-administered, online surveys collected from June 2014 to March 2015 were analyzed. Ordinal regression analyses were used to examine the association between AR and burnout. Eighty percent of participants reported either level 1 or 2 burnout. Additionally, 10.9% of participants responded level 0% and 7.6% of participants reported level 3. Participants reporting higher burnout were about three times more likely to report lower AR levels. AR is strongly associated with self-reported burnout by physicians and nurses providing inpatient care at this academic medical center. Growing evidence supports the positive association of AR to successful change implementation in ambulatory settings. Similar studies are needed to determine whether certain levels of AR can predict successful change in hospital settings.

Practitioner wellbeing as an interprofessional imperative

“…While burnout and intention-to-leave have primarily been studied through a simpler, profession-centric lens and, more recently, described as a result of organizational factors (Shanafelt et al, 2016), wellbeing may also be a product of the complex interactions among multiple health-care practitioners across professions. We have some exemplars of better collaboration supporting greater joy in practice and better health outcomes (Friese et al, 2008;Gittell et al, 2000;Havens et al, 2010;Huynh et al, 2018;Lanham et al, 2009;Nelson et al, 2014;Reid et al, 2011;Sinsky et al, 2013) possibly through creating more resilient teams (Huynh et al, 2018). Certain settings, such as ICUs and primary care, are also better studied.…”

Strategies Used by Interprofessional Teams to Counter Healthcare Marginalization and Engage Complex Patients

“…Despite these buffers reducing burnout severity, professional frustration and exhaustion were still side effects of team engagement efforts. While research on professional burnout shows organizational factors contribute more strongly to provider burnout compared to patient factors (Huynh et al, 2018), burnout in this research stems from both patient complexity and organizational resource limits. OITs describe burnout due to the prevalence of high illness severity and multiple diagnoses in the patient population, as well as the prevalence of poverty and social isolation among their patients.…”

“…Specifically, OITs demonstrate nurturing team communication and relationships during weekly face-to-face meetings, facilitating teamwork through dividing tasks and reinforcing each other’s efforts as needed, as well as allowing time for team reflection, such as coming together to process feelings when a patient dies. Survey research assessing burnout mitigation among nurses and physicians finds these traits are significantly associated with lower levels of burnout during change implementation (Huynh et al, 2018). OITs illustrate that elements of adaptive reserve also may function to protect against burnout in other health care contexts, namely, among interprofessional teams working with marginalized patient populations in need of diverse forms of health and social care.…”

Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study

“…Adoption of TIPS was sustained over time. While implementation fatigue is often a barrier to consistent evidence-based practice implementation in hospital settings [36], TIPS was well sustained. Organizational theory supports middle managers as key to staff engagement [37] and quality improvement integration within the hospital setting [38].…”