Web-based Implementation for the Science of Enhancing Resilience Study (WISER)

Stanford University

Status: Completed

Conditions: Resilience, Psychological; Burnout, Professional

Treatments: Behavioral: Gratitude; Behavioral: 1 Good Chat; Behavioral: Three Good Things; Behavioral: Random Acts of Kindess; Behavioral: Awe

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02603133

R01HD084679 (U.S. NIH Grant/Contract)

IRB-34547

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 2,650 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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2,650 participants in 3 patient groups

Cohort 1

Other group

Description:

The intervention will begin for all NICUs, with baseline surveys as necessary pre-work. For those unable to attend, a link to the baseline survey will be emailed with site champion instructions to complete in groups at staff meetings and during shift change. Two weeks later, three randomly (random number generator) assigned NICUs (block 1) included in the first block webinar will then receive Module 1 of the intervention with Modules 2-6 being rolled out monthly. The second block of three NICUs starts approximately six-month later.

Treatment:

Behavioral: Awe

Behavioral: Random Acts of Kindess

Behavioral: Three Good Things

Behavioral: 1 Good Chat

Behavioral: Gratitude

Cohort 2

Other group

Description:

This second block of 3 NICUs will start approximately six-months after roll-out of group 1. At time point 0 this NICUs in this group will receive a lecture on safety culture, unrelated to the burnout intervention.

Treatment:

Behavioral: Awe

Behavioral: Random Acts of Kindess

Behavioral: Three Good Things

Behavioral: 1 Good Chat

Behavioral: Gratitude

Cohort 3 (July cohort) WISER 2.0

Experimental group

Description:

Individually randomized to one of two cohorts. Cohort 1 to start will serve as the waitlist control 1 before starting their version of the intervention. Each cohort will experience modified versions of WISER, which only differ by the spacing of intervention. Participants will receive 10-day sequential or 10-day non-sequential rollout of the resilience tools. Seq will receive the tools on ten consecutive days. NSeq will receive messages daily noThursdays, Fridays and Saturdays. Days 1 through 3 will be offered 3GT. Day 4 will continue with 3GT but add a single day activity for Gratitude. Day 5 adds a single activity for Awe. Day 6 adds a single day activity for RAK. Days 7 -10 the participant is offered the choice of Gratitude, Awe or RAK to accompany their daily 3GT. At 1 month follow-up time point, participants will receive 8 days of the 1 Good Chat tool, as a booster. At 6 month follow-up, participants will receive a gratitude exercise.

Treatment:

Behavioral: Awe

Behavioral: Random Acts of Kindess

Behavioral: Three Good Things

Behavioral: 1 Good Chat

Behavioral: Gratitude