Evaluation of Institutional Resources and a Novel Mindfulness Tool on Burnout Intensity
Condition: Burnout, Professional
MeSH terms: Burnout, Professional; Burnout, Psychological
Study type: Interventional

Summary: 
      : The problem of physician burnout has been well documented. As health care providers (HCP)
      encounter the demands and resources of a rapidly changing health care system, navigate their
      place and performance within it, deal with the demands of an internet informed patient
      populace and balance daily work load with family life, stressors arise. These stressors can
      contribute to burnout and this burnout has both interpersonal and health care system wide
      effects. Studies have shown that HCP burnout has personal physiologic consequences and
      predicts external objective associations with health care acquired infection rates, medical
      errors, medical litigation, patient satisfaction, job satisfaction, health care system costs,
      alcohol abuse and suicidal ideation, among others. As our population ages and its medical
      co-morbidities and system demands increase, the premature curtailing, cessation or turnover
      of an HCP's clinical practice due to emotional exhaustion is a concerning trend. While
      studies have shown that HCP's are no more prone to burnout then other professionals, a
      growing body of literature has shown that an intentional focus on institutional processes
      that nurture clinician well-being through multiple modalities is both important and
      effective. Additionally, insights into the role that forgiveness plays in personal well-being
      prompts our presentation of a novel mindfulness tool that focuses on improving clinician
      well-being through self-help exercises in meditation and forgiveness. In light of recent
      studies that have cautioned against the tendency to dichotomize and/or pathologize peoples'
      responses to their work environment, we will use the JD-R (Job demands-resources model) and
      the CBI (Copenhagen burnout inventory) to quantify these processes and responses. These
      factors have prompted us to present a unique study design a) to evaluate the wellness process
      affecters inside the culture of a regional health care center and b) to evaluate the
      effectiveness of a personal mindfulness intervention which aims at spectrum based burnout
      quantification and facilitated self-help, with an eye on both for institution wide
      application.
    

Detailed description: 
      Title: Evaluation of Institutional Job Demands-Resources and a Novel Mindfulness Tool on
      Burnout intensity in a Cross-Sectional Cohort of Colorado Health Care Practitioners Author:
      Doug Duffee MD, Mdiv, FACP, Attending Physician Parkview Internal Medicine Residency Program,
      Pueblo Colorado 2019 Intro: The problem of physician burnout has been well documented. As
      health care providers (HCP) encounter the demands and resources of a rapidly changing health
      care system, navigate their place and performance within it, deal with the demands of an
      internet informed patient populace and balance daily work load with family life, stressors
      arise. These stressors can contribute to burnout and this burnout has both interpersonal and
      health care system wide effects. Studies have shown that HCP burnout has personal physiologic
      consequences and predicts external objective associations with health care acquired infection
      rates, medical errors, medical litigation, patient satisfaction, job satisfaction, health
      care system costs, alcohol abuse and suicidal ideation, among others. As our population ages
      and its medical co-morbidities and system demands increase, the premature curtailing,
      cessation or turnover of an HCP's clinical practice due to emotional exhaustion is a
      concerning trend. While studies have shown that HCP's are no more prone to burnout then other
      professionals, a growing body of literature has shown that an intentional focus on
      institutional processes that nurture clinician well-being through multiple modalities is both
      important and effective. Additionally, insights into the role that forgiveness plays in
      personal well-being prompts our presentation of a novel mindfulness tool that focuses on
      improving clinician well-being through self-help exercises in meditation and forgiveness. In
      light of recent studies that have cautioned against the tendency to dichotomize and/or
      pathologize peoples' responses to their work environment, we will use the JD-R (Job
      demands-resources model) and the CBI (Copenhagen burnout inventory) to quantify these
      processes and responses. These factors have prompted us to present a unique study design a)
      to evaluate the wellness process affecters inside the culture of a regional health care
      center and b) to evaluate the effectiveness of a personal mindfulness intervention which aims
      at spectrum based burnout quantification and facilitated self-help, with an eye on both for
      institution wide application.

      Aims and Objectives: Using the Health Care Provider Wellness Assessment as quantified through
      the revised Job Demands-Resources Model (JD-R), the Copenhagen Burnout Inventory (CBI)
      (20)and a novel mindfulness tool called "Psalm 19: Insights and Exercises in Personal
      Forgiveness", we propose to 1) Identify unique institutional job demands-resources whose
      presence-absence contribute to HCP strain and subsequent health impairment and 2) Assess the
      ability of said novel mindfulness tool as a personal job resource component to positively
      affect well-being and subsequent job motivation amongst a cohort of Colorado health care
      providers at a regional medical center. As beneficial process effectors are identified
      (more/better/culturally focused resources, less/better efficiency demands) , multi-factorial
      interventions on wellness outcomes can subsequently be studied and implemented.

      Methods:

      Diagram Current Environment Wellness Process Wellness Outcomes

        -  Health impairment process Job Demands + >Strain/burnout + >Health Problems l- /- l- \-
           l- Job Resources + >Well-being/engagement +>Performance

        -  Motivational process

             1. Design: Single blinded cohort controlled Cross-sectional survey research design
                using the JD-R, CBI and Wellness Tool to determine associations and affects on HCP
                burnout

                •identify cross-sectional intervention with survey cohort AND survey only control
                cohort>>>survey (with or without intervention) >>>analyze data

             2. Population: Colorado health care clinicians (DO, MD, PA, NP, RN, PharmD and MA) at
                a single regional health care system (PMC) anonymously and voluntarily responding
                to the Parkview Medical Center Health Care Provider Wellness Assessment

             3. Ethics: Blinded and voluntary participation

      Survey:

      Parkview Medical Center Health Care Provider Wellness Assessment

        1. Parkview Medical Center Process Effectors (from JD-R revised): "on a scale of 1-5
           (never/almost never, seldom, sometimes, often, always), rate your interaction with the
           following:"

           I. Job Demands:

             1. Centralization

             2. Cognitive demands

             3. Complexity

             4. Computer problems

             5. Demanding contact with patients

             6. Downsizing

             7. Emotional demands

             8. Emotional dissonance

             9. Interpersonal conflict

            10. Job insecurity

            11. Negative spillover from family to work

            12. Harassment by patients

            13. Performance demands

            14. Problems planning

            15. Pupil's misbehavior

            16. Qualitative workload

            17. Reorganization

            18. Remuneration

            19. Responsibility

            20. Risks and hazards

            21. Role ambiguity

            22. Role conflict

            23. Sexual harassment

            24. Time pressure

            25. Unfavorable shift and work schedule

            26. Unfavorable work conditions aa. Work pressure bb.Work-home conflict cc.Work
                overload

           II. Job Resources:

           a. Job based i. Advancement ii. Appreciation iii. Autonomy iv. Craftsmanship v.
           Financial rewards vi. Goal clarity vii. Information viii. Innovative climate ix. Job
           challenge x. Knowledge xi. Leadership xii. Opportunities for professional development
           xiii. Participation in decision making xiv. Performance feedback xv. Positive spillover
           from family to work xvi. Professional pride xvii. Procedural fairness xviii. Positive
           patient contacts xix. Quality of the relationship with the supervisor xx. Safety climate
           xxi. Safety routine violations xxii. Social climate xxiii. Social support from
           colleagues xxiv. Social support from supervisor xxv. Skill utilization xxvi. Strategic
           planning xxvii. Supervisory coaching xxviii. Task variety xxix. Team cohesion xxx. Team
           harmony xxxi. Trust in management b. Personal based i. Emotional and mental competencies
           ii. Extraversion iii. Hope iv. Intrinsic motivation v. Low neuroticisim vi. Need
           satisfaction (autonomy, belongingness, competence) vii. Optimism viii.
           Organization-based self esteem ix. Regulatory focus (prevention and promotion focus x.
           Resilience xi. Self-efficacy xii. Value orientation (intrinsic and extrinsic values)
           III. Measurement Outcomes, Negative (for future study, once process effectors are
           identified and intervened upon)

             1. Absenteeism (self-report and company registered)

             2. Accidents and injuries

             3. Adverse events

             4. Depression

             5. Determination to continue

             6. Unsafe behaviors

             7. Negative work-home interference

             8. Physical ill-health

             9. Psychsomatic health complaints

            10. Psychological strain (General Health Questionairre, GHQ)

            11. Turnover intention IV. Measurement Outcomes, Positive (for future study, once
                process effectors are identified and intervened upon)

             1. Extra-role performance (self or other rated)

             2. Innovativeness

             3. In-role performance (self or other rated)

             4. Life satisfaction

             5. Organizational commitment

             6. Perceived health

             7. Positive work-home interference

             8. Service quality

             9. Team sales performance

            10. Workability

            11. Happiness

        2. Copenhagen Burnout Inventory: "on a scale of 1-5 (never/almost never, seldom, sometimes,
           often, always), rate your interaction with the following:" a. Personal burnout i. How
           often do you fell tired? ii. How often are you physically exhausted? iii. How often are
           you emotionally exhausted? iv. How often do you think: "I can't take it anymore"? v. How
           often do you feel worn out? vi. How often do you feel weak and susceptible to illness?
           b. Work-related burnout i. Is your work emotionally exhausting? ii. Do you feel burnt
           out because of your work? iii. Does your work frustrate you? iv. Do you feel worn out at
           the end of the working day? v. Are you exhausted in the morning at the thought of
           another day at work? vi. Do you feel that every working hour is tiring for you? vii. Do
           you have enough energy for family and friends during leisure time? (reverse the scoring:
           1-5 is (always, often, sometimes, seldom, never/almost never) c. Client-related burnout
           i. Do you find it hard to work with clients? ii. Do you find it frustrating to work with
           clients? iii. Does it drain your energy to work with clients? iv. Do you feel that you
           give more than you get back when you work with clients? v. Are you tired of working with
           clients? vi. Do you sometimes wonder how long you will be able to continue working with
           clients?
    

Intervention name(s): IEPF Wellness Tool
Intervention type(s): Behavioral
Intervention description(s): A daily 5 minute mindfulness exercise over 28 days
Other intervention name(s): Insights and Exercises in Personal Forgiveness from Psalm 19
Intervention model: Single Group Assignment
Intervention model description: Cross sectional study design with intra cohort voluntary intervention participation
Masking: None (Open Label)
Primary purpose: Diagnostic
Keywords: burnout; wellness; mindfulness; physician burnout