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 重症监护室（ICU）团队（即护士，医师和呼吸治疗师）的一些最高 医疗保健倦怠率。倦怠是由慢性工作场所压力引起的占用现象 并以精疲力尽，人格化和降低专业效率为特征。倦怠一直在 与较差的安全等级，护理质量和患者结局有关。减少倦怠的干预措施 专注于个别临床医生，但是这种方法忽略了组织因素 倦怠，因此，仅略有效率。组织弹性是一个承诺 解决ICU团队中倦怠的方法，并改善急性呼吸系统患者的结局 失败。组织的弹性是复杂的自适应系统的能力，可以预测压力源，执行 在压力的条件下，并适应前进。而组织弹性之间的关系 以及在其他环境中描述了员工的健康和绩效成果 弹性尚未在医疗机构中衡量。我们的科学前提是改善的关键 ICU临床倦怠和防止急性呼吸衰竭患者的不良结果是 研究组织因素在ICU弹性中的作用。当ICU在组织上更具组织 韧性，临床医生感觉更有能力管理工作场所的压力源，因此更有可能提供 急性呼吸衰竭患者的高质量护理。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Commonspirit Health的合作伙伴关系，美国第四大医疗保健 在21个州拥有医院的系统，以及我们的初步数据，我们提出了一种新型的混合方法 剥夺设计研究，以组织现象的弹性检查。我们将管理 一项有关弹性的调查（Connor-Davidson的弹性量表和Lee等人的组织衡量 弹性），倦怠（两个单项Maslach倦怠量措施）和福利（WHO-5）至6000 在两个时间点在60个ICU工作的临床医生检查个人和组织的动态 随着时间的推移弹性（目标1）。然后，我们将测试个人和组织的相互依存贡献 对患者结局（无死亡和无呼吸机）和临床结果（倦怠和倦怠和 福利）（目标2）。最后，我们将定性地描述工作环境之间的关系，ICU 组织的韧性，跨专业护理，并表征了感知的障碍和促进者 组织弹性（目标3）。我们的长期目标是开发多管齐下的干预措施 增强ICU的弹性。我们在此提案中的目标是经验测试弹性之间的关系 以及患者和临床结果，使管理员，政策制定者和研究人员可以更多 适当针对支持ICU临床医生的努力。该项目解决了了解如何 为了最好地支持宝贵的医疗资源：照顾机械通风的成年人的临床医生。