Interventions to Reduce Burnout and Improve Resilience: Impact on a Health System’s Outcomes

Abstract

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.

An analysis of resilience in dental students using the Resilience Scale for Adults

“…Another study found that resilience reduces the impact of certain dimensions of burnout in critical care professionals . A study of medical residents who had participated in mindfulness programs and resilience training, showed a 26% reduction in burnout . This study also showed an increase in resilience scores associated with reduced safety events and improved patient satisfaction …”

What works for whom in compassion training programs offered to practicing healthcare providers: a realist review

“…Some learners faced complex stressors in the healthcare setting, such as high workloads, staff shortages, resource constraints, conflicts with coworkers, and meeting the many needs of patients and their families [ 65 , 66 , 68 – 70 , 92 , 102 , 103 ]. These challenges have been associated with job-related absenteeism, burnout, and high turnover rates, and can impact the delivery of high-quality patient care [ 66 , 67 , 71 , 72 , 93 , 101 ]. Other learners lacked specific skills and knowledge, which reduced clinical engagement with their patients [ 73 – 77 , 94 ].…”

Embracing Change: A Mindful Medical Center Meets COVID-19

“…Burnout has been increasingly documented over the past decade, especially in high-stress professions such as HCPs 1,2,4–10,26,27 with health systems increasingly aware of the high costs associated with burnout. Mindfulness-based interventions addressing burnout among HCPs are in high demand as the evidence supporting the success of these interventions such as MIM is strong, 28,29 and the benefits span a range of outcomes.…”