Web-based Implementation for the Science of Enhancing Resilience Study

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.

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.

Eligibility Criteria:
Inclusion Criteria:

1. Location: newborn center, i.e. the NICU or a step down unit
2. Provider:

   1. Primary work place is the Newborn Center
   2. Full time equivalent of \>=40%
   3. Date of hire more than 4 weeks prior to start of the intervention
3. Provider groups:

   1. Attendings that identify your newborn center as their primary site of work (not physicians from satellite NICUs)
   2. NICU fellows
   3. Nurse practitioners
   4. Physician Assistants
   5. Nurses, including nurse leadership (managers, educators)
   6. Nurse Assistant
   7. Respiratory care providers
   8. Transport specialists if primarily neonatal transport team
   9. Newborn Center Social workers
   10. Newborn Center Clerks
   11. Newborn Center Pharmacists
   12. Newborn Center Physical, Occupational, Speech, and Developmental Therapists
   13. Newborn Center Nutritionists
   14. Newborn Center Lactation Consultants

Exclusion Criteria:

1. Location: Labor and delivery or the newborn nursery
2. Provider: Work is delivered mostly outside the newborn center (this may affect providers who delivery services across the hospital such as residents, surgeons, anesthesia, consultants, nutritionists, PT/OT (these are included if they are mostly dedicated to the newborn center)
3. Float personnel
4. Does not speak english
5. Cannot operate computer or smart phone