Organizational resilience: A novel strategy for improving ICU outcomes

组织弹性：改善 ICU 治疗结果的新策略

• 批准号: 10586383
• 负责人: Mara Helene Buchbinder
• 金额: $ 64.62万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10586383
• 关键词: Acute respiratory failure; Address; Administrator; Adult; Affect; Attention; Buffers; COVID-19 pandemic; 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; Healthcare; Healthcare Systems; Hospitals; Individual; Intensive Care Units; Intervention; Interview; Measures; Mechanical ventilation; Medical; Medicine; Methods; National Heart, Lung, and Blood Institute; Nurses; Occupational; Operative Surgical Procedures; Organization administrative structures; Outcome; Pathway Analysis; Patient Care; Patient-Focused Outcomes; Patients; Perception; Performance; Performance at work; Personal Satisfaction; Physicians; Policy Maker; Quality of Care; Relaxation Therapy; Reporting; Research; Research Design; Research Personnel; Resources; Risk Reduction; Role; Safety; Sampling; Severity of illness; Shapes; Stress; Structure; Surgical Intensive Care; Surveys; System; Testing; Time; United States National Academy of Sciences; Ventilator; Work; Workplace; acute care; adverse outcome; burnout; care outcomes; coping; cultural health; data modeling; exhaustion; experience; health care settings; improved; improved outcome; instrument; mindfulness; mortality; mortality risk; multilevel analysis; neglect; novel; novel strategies; peer; prevent; professional atmosphere; promote resilience; resilience; resilience scale; respiratory; skills; stressor; success

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.

项目摘要