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Principal Investigator: Mara Helene Buchbinder
Organization: YALE UNIVERSITY
Fiscal Year: 2024
Award: $579,896
Funding agency: National Heart Lung and Blood Institute
PROJECT ABSTRACT
Intensive care unit (ICU) teams (i.e., nurses, physicians, and respiratory therapists) have some of the highest
rates of burnout in healthcare. Burnout is an occupational phenomenon resulting from chronic workplace stress
and is characterized by exhaustion, depersonalization, and reduced professional efficacy. Burnout has been
associated with poorer safety ratings, quality of care, and patient outcomes. Interventions to reduce burnout
have focused on individual clinicians, but this approach neglects the organizational factors contributing to
burnout, and consequently, has been only marginally effective. Organizational resilience is a promising
approach for addressing burnout in ICU teams and improving outcomes in patients with acute respiratory
failure. Organizational resilience is the capacity of a complex adaptive system to anticipate stressors, perform
under stressful conditions, and adapt moving forward. While the relationships among organizational resilience
and employee health and performance outcomes have been described in other settings, organizational
resilience has not been measured in healthcare settings. Our scientific premise is that the key to improving
ICU clinician burnout and preventing adverse outcomes in patients with acute respiratory failure is to
investigate the role of organizational factors in ICU resilience. When ICUs are more organizationally
resilient, clinicians feel better equipped to manage workplace stressors, and thus are more likely to provide
high-quality care for patients with acute respiratory failure. Capitalizing on our team’s expertise in ICU
organization and survey research, our partnership with CommonSpirit Health, the 4th largest U.S. healthcare
system with hospitals in 21 states, and our preliminary data, we propose a novel mixed-methods sequential
explanatory design study that examines resilience as an organizational phenomenon. We will administer
a survey about resilience (Connor-Davidson resilience scale and Lee et al’s measure of organizational
resilience), burnout (two single-item Maslach Burnout Inventory measures), and wellbeing (WHO-5) to 6000
clinicians working in 60 ICUs at two timepoints to examine the dynamics of individual and organizational
resilience over time (Aim 1). We will then test the interdependent contributions of individual and organizational
resilience to patient outcomes (mortality and ventilator-free days) and clinician outcomes (burnout and
wellbeing) (Aim 2). Lastly, we will qualitatively describe the relationships between work environment, ICU
organizational resilience, and interprofessional care and characterize perceived barriers and facilitators of
organizational resilience (Aim 3). Our long-term goal is to develop a multi-pronged intervention that will
enhance ICU resilience. Our objective in this proposal is to empirically test the relationship between resilience
and patient and clinician outcomes so that administrators, policymakers, and researchers can more
appropriately target efforts to support ICU clinicians. This project addresses a major gap in understanding how
to best support a valuable healthcare resource: the clinicians that care for mechanically ventilated adults.
Terms: <21+ years old><Acute respiratory failure><Address><Administrator><Adult><Adult Human><Affect><Attention><Buffers><COVID crisis><COVID epidemic><COVID pandemic><COVID-19 crisis><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><Caring><Chronic><Communication><Community Hospitals><Complex><Data><Depersonalization><Development><Electronic Health Record><Employee Health><Engineering><Ensure><Equipment and supply inventories><Fatigue><Focus Groups><Future><Goals><Health><Health Care Systems><Healthcare><Healthcare Systems><Hospitals><Individual><Intensive Care Units><Intervention><Intervention Strategies><Interview><Inventory><Investigators><Job Location><Job Place><Job Setting><Job Site><Lack of Energy><Measures><Mechanical ventilation><Medical><Medicine><Methods><NHLBI><National Academy of Sciences><National Heart, Lung, and Blood Institute><Network Analysis><Nurses><Occupational><Operative Procedures><Operative Surgical Procedures><Organization administrative structures><Organizational Unit><Outcome><Pathway Analysis><Patient Care><Patient Care Delivery><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Perception><Performance><Performance at work><Personal Satisfaction><Physicians><Policy Maker><QOC><Quality of Care><Relaxation Therapy><Reporting><Research><Research Design><Research Personnel><Research Resources><Researchers><Resources><Risk Reduction><Role><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Safety><Sampling><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Severity of illness><Shapes><Stress><Structure><Study Type><Surgical><Surgical Intensive Care><Surgical Interventions><Surgical Procedure><Survey Instrument><Surveys><System><Testing><Time><United States National Academy of Sciences><Ventilator><Work><Work Location><Work Place><Work-Site><Workplace><Worksite><acute care><adulthood><adverse consequence><adverse outcome><build resilience><build resiliency><burn-out><burnout><care for patients><care of patients><care outcomes><caring for patients><coping><coronavirus disease 2019 crisis><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19 global pandemic><coronavirus disease-19 pandemic><cultural health><data modeling><death risk><develop resilience><develop resiliency><developmental><disease severity><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><enhance resilience><enhance resiliency><exhaustion><experience><health care><health care outcomes><health care settings><healthcare outcomes><healthcare settings><improve resilience><improve resiliency><improved><improved outcome><increase resilience><increase resiliency><instrument><interventional strategy><job environment><job performance><mechanical respiratory assist><mechanically ventilated><methods to study multiple-level influences><mindfulness><model of data><model the data><modeling of the data><mortality><mortality risk><multi-level analysis><multi-level model><multilevel analysis><multilevel model><multilevel modeling><neglect><new approaches><novel><novel approaches><novel strategies><novel strategy><nurse><patient oriented outcomes><peer><prevent><preventing><professional atmosphere><promote resilience><promote resiliency><reduce risk><reduce risks><reduce that risk><reduce the risk><reduce these risks><reduces risk><reduces the risk><reducing risk><reducing the risk><relaxation training><resilience><resilience development><resilience scale><resiliency scale><resilient><respiratory><risk-reducing><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><skills><social role><stressor><study design><success><surgery><well-being><wellbeing><work atmosphere><work environment><work performance><work setting><workplace climate><workplace environment>