381 - Always Look on the Bright Side of Life: Combatting Burnout with a Pediatric Cardiac Intensive Care Unit Joy in Work Program

Poster Number: 381
Publication Number: 381.243

Tina Schade Willis, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Melissa Cleveland, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Lee D. Murphy, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Emily L. Mueller, Indiana University School of Medicine, Indianapolis, IN, United States; Larry W. Markham, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States

Background: Healthcare burnout has reached a crisis level that negatively impacts adequate staffing, costly turnover, high-quality patient care, and the mental well-being of healthcare professionals. A recent study found that personnel who felt valued by their employers reported less burnout. Efforts to address burnout often assume that interventions should focus on building resilience or changing the electronic health record. Yet, these often do not address impediments to experiencing Joy in Work (JIW). Much like health is not the mere absence of disease, JIW is not the mere absence of burnout. Therefore, finding impediments to joy are necessary prior to implementing tailored interventions addressing healthcare burnout.

Objective: Using a pediatric cardiac intensive care unit (CICU) to build a JIW program with a goal of identifying and addressing impediments while preserving positive drivers to joy.

Design/Methods: The project team conducted 1:1 structured interviews with CICU Nurse Practitioners (NP), Intensivists, and Cardiologists. Responses were de-identified and analyzed in Pareto charts using five drivers of joy:
1. Teamwork/Camaraderie
2. Connection to Meaning of Work
3. Equity and Fairness
4. Psychological/Physical Safety
5. Choice and Autonomy
A facilitator from each team shared data with the groups, feedback was obtained, and internal and external solutions were brainstormed. A real-time measurement of joy was implemented using a QR code and short descriptors (1-2 words). Teams utilized improvement science to design interventions.

Results: Interviews were completed with 11/12 NPs, 7/7 intensivists, and 13/14 cardiologists. To date, 139 real-time measurements of joy were submitted from nurses (52%), NPs (21%), physicians (14%), respiratory therapists (4%), pharmacists/other (3%), nursing assistants (4%), and fellows (2%). The most important impediments to JIW were issues related to teamwork/camaraderie. The predominant positive drivers included connections to the meaning and purpose of work. No responses mentioned the electronic healthcare record as an impediment to joy. Teams created interventions such as team agreements, changes to rounds, and the formation of subgroups focusing on better partnerships between clinical teams.Conclusion(s): Impediments and positive drivers to JIW can be assessed utilizing focused interviews and real-time measurements within a complex multi-disciplinary healthcare team. Addressing JIW with ongoing real-time measurement and tailored interventions is feasible and necessary to address the crisis of burnout.
Run Chart: Weekly Average Joy in Work Score Submitted by Frontline CICU Team MembersAfter multiple Plan Do Study Act tests of change for real-time measurement of Joy in Work, a QR code was made available throughout the Cardiac Intensive Care Unit for any team member to submit a slider score of joy ranging 1-5 with a changing emoji happy or sad face for ease of scoring. Staff were encouraged to submit once per shift though participation has varied widely. Short 1-2 word phrases to add to the score were also encouraged for frontline dashboard display and leadership review. A decline in score in December 2021 coincided with the region's 3rd COVID-19 surge and a time of high CICU acuity and volume.
Example Pareto Chart: Impediments to Drivers of Joy in Work Identified by CICU NP Team MembersStructured interviews with CICU NP team members identified positive drivers of joy as well as impediments to joy in work. Interview results were grouped into identified drivers of joy for prioritization of tailored interventions. Camaraderie and Teamwork was the primary driver of joy in work with the most identified opportunities for improvement.