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

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.

Assessment of Virtual Mindfulness-Based Training for Health Care Professionals: Improved Self-Reported Respiration Rates, Perceived Stress, and Resilience.

Background: Mindfulness in Motion (MIM) is a workplace resilience-building intervention that has shown reductions in perceived stress and burnout, as well as increased resilience and work engagement in health care workers. Objective: To evaluate effects of MIM delivered in a synchronous virtual format on self-reported respiratory rates (RR), as well as perceived stress and resiliency of health care workers. Methods: Breath counts were self-reported by 275 participants before and after 8 weekly MIM sessions. MIM was delivered virtually in a group format as a structured, evidence-based workplace intervention including a variety of mindfulness, relaxation, and resilience-building techniques. Participants counted their breaths for 30 seconds, which was then multiplied by 2 to report RR. Additionally, participants completed Perceived Stress Scale and Connor-Davidson Resiliency Scale. Results: According to mixed effect analyses there were main effects of MIM Session (P < .001) and Weeks (P < .001), but no Session by Week interaction (P = .489) on RR. On average, RR prior to MIM sessions were reduced from 13.24 bpm (95% CI = 12.94, 13.55 bpm) to 9.69 bpm (95% CI = 9.39, 9.99 bpm). When comparing average Pre-MIM and Post-MIM RR throughout the MIM intervention, Week-2 (mean = 12.34; 95% CI = 11.89, 12.79 bpm) was not significantly different than Week-1 (mean = 12.78; 95% CI = 12.34, 13.23 bpm), but Week-3 through Week-8 demonstrated significantly lower average Pre-MIM and Post-MIM RR compared to Week-1 (average weekly difference range: 1.36 to 2.48 bpm, P < .05). Perceived stress was reduced from Week-1 (17.52 ± 6.25) to after Week-8 (13.52 ± 6.04; P < .001), while perceived resiliency was increased from Week-1 (11.30 ± 5.14) to after Week-8 (19.29 ± 2.58); P < .001). Conclusion: Thus far, completion of MIM sessions has shown acute and long-term effects on self-reported RR, but more research is required to determine the extent of improved parasympathetic (relaxed) states. Collectively, this work has shown value for mind-body stress mitigation and resiliency-building in high stress acute health care environments.

Embracing Change: A Mindful Medical Center Meets COVID-19.

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.

Feasibility of a Mindfulness-Based Intervention for Surgical Intensive Care Unit Personnel.

BACKGROUND: Surgical intensive care unit personnel are exposed to catastrophic situations as they care for seriously injured or ill patients. Few interventions have been developed to reduce the negative effects of work stress in this environment. OBJECTIVE: This pilot study evaluated the feasibility of a workplace intervention for increasing resilience to stress. The intervention was implemented within the unique constraints characteristic of surgical intensive care units. METHODS: Participants were randomly assigned to an intervention or control group. The mindfulness-based intervention included meditation, mild yoga movement, and music and was conducted in a group format 1 hour a week for 8 weeks in a surgical intensive care unit during work hours. Assessments were performed 1 week before and 1 week after the intervention. RESULTS: The intervention was well received, with a 97% overall retention rate and 100% retention in the intervention group. Work satisfaction, measured with the Utrecht Work Engagement Scale, increased significantly in the intervention group with no change in the control group. Negative correlations were found between the vigor subscale scores of the Utrecht Work Engagement Scale and scores for emotional exhaustion on the Maslach Burnout Inventory and scores for burnout on the Professional Quality of Life scale. Participants rated recognizing their stress response as a main benefit of the intervention. CONCLUSION: Workplace group interventions aimed at decreasing the negative effects of stress can be applied within hospital intensive care units. Despite many constraints, attendance at weekly sessions was high. Institutional support was critical for implementation of this program.

Mindfulness in Motion (MIM): An Onsite Mindfulness Based Intervention (MBI) for Chronically High Stress Work Environments to Increase Resiliency and Work Engagement.

A pragmatic mindfulness intervention to benefit personnel working in chronically high-stress environments, delivered onsite during the workday, is timely and valuable to employee and employer alike. Mindfulness in Motion (MIM) is a Mindfulness Based Intervention (MBI) offered as a modified, less time intensive method (compared to Mindfulness-Based Stress Reduction), delivered onsite, during work, and intends to enable busy working adults to experience the benefits of mindfulness. It teaches mindful awareness principles, rehearses mindfulness as a group, emphasizes the use of gentle yoga stretches, and utilizes relaxing music in the background of both the group sessions and individual mindfulness practice. MIM is delivered in a group format, for 1 hr/week/8 weeks. CDs and a DVD are provided to facilitate individual practice. The yoga movement is emphasized in the protocol to facilitate a quieting of the mind. The music is included for participants to associate the relaxed state experienced in the group session with their individual practice. To determine the intervention feasibility/efficacy we conducted a randomized wait-list control group in Intensive Care Units (ICUs). ICUs represent a high-stress work environment where personnel experience chronic exposure to catastrophic situations as they care for seriously injured/ill patients. Despite high levels of work-related stress, few interventions have been developed and delivered onsite for such environments. The intervention is delivered on site in the ICU, during work hours, with participants receiving time release to attend sessions. The intervention is well received with 97% retention rate. Work engagement and resiliency increase significantly in the intervention group, compared to the wait-list control group, while participant respiration rates decrease significantly pre-post in 6/8 of the weekly sessions. Participants value institutional support, relaxing music, and the instructor as pivotal to program success. This provides evidence that MIM is feasible, well accepted, and can be effectively implemented in a chronically high-stress work environment.

A small randomized pilot study of a workplace mindfulness-based intervention for surgical intensive care unit personnel: effects on salivary α-amylase levels.

OBJECTIVE: To determine whether a workplace stress-reduction intervention decreases reactivity to stress among personnel exposed to a highly stressful occupational environment. METHODS: Personnel from a surgical intensive care unit were randomized to a stress-reduction intervention or a waitlist control group. The 8-week group mindfulness-based intervention included mindfulness, gentle yoga, and music. Psychological and biological markers of stress were measured 1 week before and 1 week after the intervention. RESULTS: Levels of salivary α-amylase, an index of sympathetic activation, were significantly decreased between the first and second assessments in the intervention group with no changes in the control group. There was a positive correlation between salivary α-amylase levels and burnout scores. CONCLUSIONS: These data suggest that this type of intervention could decrease not only reactivity to stress but also the risk of burnout.