Web-based Implementation for the Science of Enhancing Resilience Study
Condition: Burnout, Professional; Resilience, Psychological
MeSH terms: Burnout, Professional; Burnout, Psychological
Study type: Interventional

Summary: 
      Resilience means a healthcare provider's ability to cope, recover, and learn from stressful
      events, as well as their access to resources that promote health and well-being. Neonatal
      intensive care unit (NICU) health professionals' need to have particularly good resilience,
      because their work is extremely stressful and their patients, fragile preterm infants,
      require their undivided attention. The investigators propose a feasible and engaging
      intervention to enhance resilience among NICU health professionals promoting their ability to
      provide safe care.
    

Detailed description: 
      Optimizing provider well-being is critical to the delivery of safe and high quality care to
      the most vulnerable of patients: very preterm babies.

      Major innovative objectives of this proposal include testing the Web-based Implementation for
      the Science of Enhancing Resilience (WISER) program's effectiveness in enhancing resilience
      among Neonatal Intensive Care Unit (NICU) health workers, evaluating its effect on unit
      safety culture, and examining its effect on clinical outcomes in preterm infants. The WISER
      program is an established but low-intensity yet engaging intervention, which integrates
      education and behavior modification to boost provider well-being and resilience in order to
      create an organizational environment which prevents patient harm.

      Care for the more than 50,000 very low birth weight (VLBW; < 1500 gm) infants born annually
      in the United States is challenging and expensive. Quality of care and outcomes vary widely.
      Increasing technical demands and patient acuity have pushed burnout among health workers to
      the breaking point. The few tested interventions that improve caregiver resilience lack
      feasibility for widespread adoption. This study is designed to achieve the following aims:

        1. Test the effectiveness of WISER in improving NICU health professional resilience;

        2. Test the effectiveness of WISER in improving patient safety and organizational outcomes;

        3. Test the sustainability of WISER; and

        4. Describe the barriers and facilitators of the WISER program.

      The investigators will test the efficacy of the WISER Program in the NICU setting using a
      stepped-wedge mixed-methods randomized controlled trial (swRCT) at six tertiary care NICUs.
      The results of this trial will also provide insights into the causal relations between health
      worker resilience, the organizational environment, and clinical outcomes among infants born
      VLBW.

      Two blocks with 3 NICUs each will be randomly assigned to one of two intervention cohorts.
      The WISER NICUs program consists of six 10-minute videos delivered over the course of a
      six-month period. Following the end of the initial intervention, each NICU will receive
      individualized feedback/refresher webinar at 12 months, and a final follow-up at 24 months.
      The investigators will use measures of perception (surveys of health professional's
      perceptions) and quantifiable measures (clinical measures) to assess the efficacy of the
      intervention in different domains (resilience, organizational environment, and health).
      Qualitative methods will provide further insights into facilitators and barriers of the
      efficacy of WISER.
    

Intervention name(s): Three Good Things; Gratitude; Random Acts of Kindess; Awe; 1 Good Chat
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): In this tool participants reflect on "good things" that happened that day during evenings across 10 days. Participants are also able to voluntarily share their good things and read other participants' good things through the nightly anonymous log. By savoring good moments from earlier that day, participants are thought to shift from the natural focus on "what went poorly" due to negativity bias1 to an appreciation for what went well. This shift in focus is thought to reduce rumination and depression symptoms. In prior research, 3GTs was found to increase happiness and decrease depression in internet participants.2 In prior cohorts of 3GTs, we saw improvements in burnout, depression symptoms, work-life balance, and happiness. Participants also report benefiting from viewing nightly Three Good Things logs of others.; In this tool participants are offered the opportunity to cultivate gratitude toward others through a guided gratitude letter writing exercise.2 Through expressing gratitude, we learn more about our vital connections to others, often in surprising and meaningful ways. Previous research has found that gratitude interventions increase well-being in a number of ways, particularly in boosting positive affect.; In this tool, participants report kind acts that they have committed, received, and/or witnessed, each day. By committing random acts of kindness participants experience a boost of positive emotions, and report lower negative affect. Recipients of acts of kindness benefit as well.; This tool provides participants the opportunity to recount in detail one of their own experiences of awe, and encourages them to be on the lookout for new ones (even minor examples) over a few days. When we experience awe, our sense of time expands, we are kinder to others, we experience higher life satisfaction, and we prefer experiences over material things.; This tool uses the latest research on cultivating relationships and increasing social connection. Feeling socially connected is linked to health and well-being outcomes, including longevity.6 The 1 Good Chat tool asks participants to reflect on good conversations and to note the prosocial behaviors that he/she and the other person engaged in
Other intervention name(s): 3GT Tool; Grat Tool; RAK Tool; Awe Tool; Good Chat Tool
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Participants are individually randomized to one of two cohorts. 1 cohort will serve as the waitlist control for Cohort 1 before starting their version of the intervention. Each cohort will experience slightly different versions of WISER, which only differ by the spacing of the intervention. Cohort 1 will receive a 10-day sequential (Seq) and a 10-day non-sequential (NSeq) rollout of the resilience tools. Seq will receive the tools on ten consecutive days. NSeq will receive messages daily with the exception of Thursdays, Fridays and Saturdays. Our tracking of attrition in the first study showed marked declines in participation on Thursdays, Fridays, and to some extent on Saturdays, but an increase on Sundays, hence this design to test a new way of counteracting attrition.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: healthcare; burnout; resilience; fatigue; NICU; safety culture; quality of care