Organizational resilience: A novel strategy for improving ICU outcomes

项目摘要 重症监护病房(ICU)团队(即护士、医生和呼吸治疗师)拥有一些最高的 医疗机构的职业倦怠率。职业倦怠是一种由长期工作压力引起的职业现象 以精疲力竭、去人格化、降低职业效能为特征。精疲力竭一直是 与较差的安全评级、护理质量和患者结局相关。减少职业倦怠的干预措施 都专注于个别临床医生，但这种方法忽略了促成 因此，倦怠只起到了微不足道的作用。组织复原力是一种很有前途的 解决ICU团队的职业倦怠和改善急性呼吸疾病患者预后的方法 失败了。组织复原力是复杂适应系统预测压力源、执行 在有压力的条件下，适应前进。而组织弹性与组织弹性之间的关系 员工健康和绩效结果已经在其他环境中进行了描述，组织 复原力还没有在医疗保健环境中进行衡量。我们的科学前提是，提高 ICU临床医生职业倦怠及预防急性呼吸衰竭患者不良结局 探讨组织因素在ICU复原力中的作用。当ICU更具组织性时 有弹性的临床医生感觉自己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高质量护理。利用我们团队在ICU方面的专业知识 组织和调查研究，我们与美国第四大医疗保健公司Commonspirity Health的合作伙伴关系 系统与21个州的医院和我们的初步数据，我们提出了一种新的混合方法序贯 将复原力作为一种组织现象进行考察的解释性设计研究。我们将管理 关于复原力的调查(Connor-Davidson Resilience Scale和Lee等人的组织复原力测量 弹性)、工作倦怠(两个单项马斯拉赫工作倦怠量表)和幸福感(WHO-5)至6000 临床医生在两个时间点在60个ICU工作，检查个人和组织的动态 随着时间的推移恢复能力(目标1)。然后，我们将测试个人和组织的相互依赖的贡献 对患者结果(死亡率和无呼吸机天数)和临床医生结果(倦怠和 幸福)(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关怀，并表征感知的障碍和促进者 组织复原力(目标3)。我们的长期目标是发展一种多管齐下的干预措施， 增强ICU复原力。我们在这项建议中的目标是经验性地测试弹性和弹性之间的关系 以及患者和临床医生的结果，以便管理员、政策制定者和研究人员能够 适当地有针对性地支持ICU临床医生。该项目解决了在理解如何 以最好地支持宝贵的医疗资源：护理机械通风成人的临床医生。

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.