Organizational resilience: A novel strategy for improving ICU outcomes

项目摘要 重症监护室（ICU）团队（即，护士，医生和呼吸治疗师）有一些最高的 医疗保健中的倦怠率。职业倦怠是一种职业现象，是由长期的工作压力引起的 其特征是疲惫、人格解体和职业效能降低。Burnout是 与较差的安全评级、护理质量和患者结局相关。减少倦怠的干预措施 关注个体临床医生，但这种方法忽略了组织因素， 倦怠，并因此，一直只有轻微的效果。组织复原力是一个有希望的 一种解决ICU团队倦怠和改善急性呼吸道疾病患者预后的方法 失败组织弹性是复杂适应系统预测压力源、执行 在紧张的条件下，并适应前进。虽然组织复原力之间的关系 和员工健康和绩效成果已经在其他环境中描述， 在医疗保健环境中尚未衡量复原力。我们的科学前提是， 急性呼吸衰竭患者ICU临床医生倦怠和不良结局的预防 研究组织因素在ICU恢复力中的作用。当重症监护室在组织上 有弹性，临床医生觉得更有能力管理工作场所的压力源，因此更有可能提供 为急性呼吸衰竭患者提供优质护理。利用我们团队在ICU的专业知识 组织和调查研究，我们与美国第四大医疗保健公司CommonSpirit Health的合作伙伴关系 系统与医院在21个州，我们的初步数据，我们提出了一种新的混合方法顺序 解释性设计研究，将弹性作为一种组织现象进行研究。我们将管理 一项关于弹性的调查（Connor-Davidson弹性量表和Lee等人的组织弹性测量） 弹性），倦怠（两个单项Maslach倦怠量表测量）和幸福感（WHO-5）到6000 在两个时间点在60个ICU工作的临床医生， 随着时间的推移恢复力（目标1）。然后，我们将测试个人和组织的相互依赖的贡献， 对患者结局（死亡率和无呼吸机天数）和临床医生结局（倦怠和 （目标2）。最后，我们将定性地描述工作环境、ICU 组织复原力和跨专业护理，并描述感知的障碍和促进因素， 组织复原力（目标3）。我们的长期目标是制定多管齐下的干预措施， 加强ICU的恢复能力。我们在这个建议中的目标是实证检验弹性之间的关系， 以及患者和临床医生的结果，以便管理人员，政策制定者和研究人员可以更多地 适当地有针对性地努力支持ICU临床医生。这个项目解决了一个主要的差距，在理解如何 以最好地支持宝贵的医疗资源：护理机械通气成人的临床医生。

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.