Stress Reduction Strategies for Burnout

Overseen By John Brodhead, MD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of Southern California

Disqualifiers: Non-faculty, Non-clinical staff

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 6

400 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment for reducing burnout?

Research shows that optimizing electronic health records (EHR) can help reduce burnout by improving user satisfaction and reducing the time and effort required to manage patient information. Studies indicate that involving clinicians in EHR design and providing technical support can decrease burnout and enhance the utility of EHR systems. ^{1 2 3 4 5}

Is the treatment generally safe for humans?

The use of electronic health records (EHRs) has been associated with both improvements and potential risks to patient safety. While EHRs can enhance the quality of care, they may also contribute to system flaws and patient harm if not properly designed and implemented. ^{1 6 7 8 9}

How does the stress reduction treatment for burnout differ from other treatments?

This treatment is unique because it focuses on stress reduction strategies specifically designed for burnout, potentially incorporating digital tools like apps or web-based interventions, which are convenient for busy healthcare workers. Unlike traditional methods, these interventions can be accessed anytime, making them more flexible and accessible for individuals with demanding schedules. ^{1 10 11 12 13}

What is the purpose of this trial?

Burnout and job dissatisfaction among clinicians are one of the greatest challenges facing healthcare today. Clinicians report feeling less engaged in their work and are leaving their fields in large numbers which reflects increasing stress from the pandemic coupled with increased administrative and regulatory demands and a decreased sense of autonomy. To attenuate these factors the current study will enact a series of interventions that would decrease mental distress, increase self-efficacy, and attenuate inefficiencies in their work environment to achieve sustainable improvement. The investigators will offer psychological training using techniques that have been shown to impact individual's mental health that target feelings of demoralization, depression and anxiety that result from chronic stress. Additionally, the investigators will offer individualized training on optimization of the Electronic Health Record (EHR) to help clinicians from different fields and settings reduce their time and effort needed for documentation. The investigators will also engage clinicians in systemic redesign to empower clinician-directed changes to the health system environment. The investigators anticipate that each intervention will positively affect emotional wellbeing, skills mastery of the Electronic Health Record (EHR), and environmental dissatisfaction to reduce overall burnout.

Research Team

Steven Siegel, M.D., Ph.D.

Principal Investigator

University of Southern California

Eligibility Criteria

This trial is for credentialed clinicians within the Keck medical system, including M.D.s across all specialties and clinical Ph.D./M.D. It aims to help those experiencing burnout by improving emotional wellbeing, EHR skills, and work environment.

Inclusion Criteria

Credentialed providers (e.g., MD/PA/NP across all specialties or clinical Ph.D./MS) or direct care providers/clinicians (e.g., RN, LVN, OT, PT, SLP, RT) within the Keck Medical System.

Exclusion Criteria

Clinicians that exclusively work in student health and only use Point n' Click and not Cerner.

Non-faculty or non-clinical staff (e.g., residents, administrators, etc.) at Keck Medicine

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants undergo various interventions including Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, EHR skills optimization, and performance improvement training.

12 weeks

6 sessions every 2 weeks

Follow-up

Participants are monitored for changes in burnout, emotional well-being, and work efficiency.

6 months

Treatment Details

Interventions

• Control
• EHR Skills Optimization
• Emotional Wellbeing
• Performance Improvement

Trial Overview The study tests interventions designed to reduce clinician burnout: psychological training to address stress-related mental health issues, individualized EHR optimization training, and systemic redesign for clinician-directed changes.

Participant Groups

Group I: Performance Improvement Experimental Treatment 1 Intervention

This arm consists of 6 virtual group sessions taking place over every 2 weeks for a total of 12 weeks. The sessions target improving perceptions of the work environment through foundational performance improvement knowledge and skills, and they will be led by a member of the systems-reengineering team. Between sessions, participants will be asked to follow through on tasks outlined in the learning sessions and share in the next session. If a session is missed, they will be provided with a prerecording of the didactic material presented in the learning sessions.

Group II: Emotional Wellbeing Experimental Treatment 1 Intervention

This arm consists of 6 30-minute group sessions taking place every 2 weeks for a total of 12 weeks. The sessions will be led by licensed therapists based on cognitive behavioral therapy and acceptance and commitment therapy. Session topics are sequential in nature such that each session builds on the previous session. Between sessions, participants will complete worksheets based on the material covered in the previous session. If a participant misses a session, they will be provided with a pre-recording with the content they missed.

Group III: EHR Skills Optimization Experimental Treatment 1 Intervention

This arm consists of 6 individual educational sessions taking place every 2 weeks for a total of 12 weeks which will be scheduled to accommodate clinicians schedule and preferences. These sessions will be led by a member of the clinical informatics team and target optimization of the EHR. The sessions will be conducted on site, virtually, or a combination of both onsite and virtual. Between sessions participants are to note any challenges, questions, or recommendations related to the EHR. If participant misses 2 sessions, they will be asked to reschedule, but if they miss 3 sessions they may be asked to withdraw from the intervention.

Group IV: Control Active Control 1 Intervention

Participants randomly assigned to the control condition will continue as usual care and will not complete any intervention during the duration of the study.

Who Is Running the Clinical Trial?

University of Southern California

Lead Sponsor

Trials

956

Recruited

1,609,000+

Findings from Research

The transition of UCHealth's EHR training program to a fully virtual format during the COVID-19 pandemic resulted in a significant increase in EHR satisfaction, with provider Net Promoter Scores rising by 39 points and staff scores by 29 points, indicating a high likelihood of recommending the program.

Post-training surveys showed a reduction in burnout, with 10% more providers and 9% more staff reporting 'no burnout' after the virtual training, demonstrating the program's effectiveness in improving both EHR experience and staff well-being.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Sprint Outpatient Electronic Health Record Training and Optimization Effect on Provider Burnout. English, EF., Holmstrom, H., Kwan, BW., et al.[2023]

Electronic health records (EHRs) can enhance patient-provider communication and improve healthcare quality, but they also contribute to clinician burnout and depersonalization in patient interactions.

To mitigate burnout and enhance the effectiveness of EHRs, it is important to involve clinicians in the design process, streamline workflows, and utilize custom templates that simplify documentation requirements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Optimized Use of the Electronic Health Record and Other Clinical Resources to Enhance the Management of Hypogonadal Men. Goldman, A., Kathrins, M.[2022]

A longitudinal case study of EHR optimization in two large Danish hospitals revealed that the program has had mixed success, indicating challenges in effectively organizing and managing the optimization process.

Involving clinicians in the EHR optimization process creates tensions for hospital managers between the need for standardization and the desire for local adaptation, highlighting the complexity of balancing centralized control with local autonomy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Challenges in user-driven optimization of EHR: A case study of a large Epic implementation in Denmark. Bansler, JP.[2021]

Optimizing electronic health records (EHR) can help reduce burnout and improve user satisfaction among healthcare providers, but measuring the success of these optimizations is complex.

A comprehensive evaluation of EHR optimization outcomes should combine objective measures with feedback from providers to ensure long-term improvements in satisfaction and effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring success: perspectives from three optimization programs on assessing impact in the age of burnout. Lourie, EM., Stevens, LA., Webber, EC.[2021]

A study involving 122 clinicians found that high levels of time spent using electronic health records (EHR) after hours and high message volume are significantly associated with increased emotional exhaustion, with odds ratios of 12.52 and 6.17 respectively.

Despite the link between EHR use and exhaustion, no EHR measures were found to correlate with high levels of cynicism among clinicians, suggesting that different aspects of EHR use may impact burnout in varied ways.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. Adler-Milstein, J., Zhao, W., Willard-Grace, R., et al.[2021]

The effective use of electronic health records (EHRs) is crucial for improving health care quality and patient safety, but there are documented risks of EHRs contributing to system flaws and patient harm.

To mitigate these risks, the authors recommend a coordinated approach that includes integrating EHR implementation with health care process improvement, ensuring safety in EHR design, conducting safety testing, and facilitating rapid communication of any safety issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EHR safety: the way forward to safe and effective systems. Walker, JM., Carayon, P., Leveson, N., et al.[2021]

The study highlights that the impact of electronic medical records and other health care innovations on patient safety is not direct; instead, it depends on how these systems influence healthcare providers' cognitive performance.

Interviews from two hospitals revealed that while electronic systems can enhance cognitive performance, they can also create challenges, leading to both positive and negative effects on patient safety and quality of care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety. Holden, RJ.[2021]

The study found that as the time since a healthcare provider's last encounter with a specific clinical problem increased, the quality of care metrics for that problem generally declined, indicating a measurable decay in clinical knowledge.

Using Electronic Health Records (EHR) data, the research demonstrated that tracking the frequency of exposure to targeted clinical problems can help identify areas where healthcare providers may need additional training or interventions to maintain high-quality care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Electronic health record as a research tool: Frequency of exposure to targeted clinical problems and health care providers' clinical proficiency. Wysocki, T., Diaz, MCG., Crutchfield, JH., et al.[2018]

Continuous recording of real-world electronic health record (EHR) use can help identify usability and safety issues that may not be captured in traditional lab-based testing.

Improving the usability of EHRs through real-world data can enhance the overall safety and quality of healthcare delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Continuous Video Recording of Electronic Health Record User Sessions to Support Usability and Safety. Wright, A., Aaron, S., Zuccotti, G.[2019]

The fitcor intervention is a novel internet and app-based program designed to help healthcare workers manage stress, addressing a critical gap in traditional stress reduction methods that often fail to reach this population due to their demanding schedules.

This randomized controlled trial will involve over 800 healthcare workers across various settings in Germany, assessing the effectiveness of the intervention through multiple measurement points, including psychological and physiological indicators of stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

mHealth interventions to reduce stress in healthcare workers (fitcor): study protocol for a randomized controlled trial. Baumann, H., Heuel, L., Bischoff, LL., et al.[2023]

Three web-based interventions—Three Good Things, Gratitude Letter, and Looking Forward Tool—were tested in three studies involving a total of 521 healthcare workers, showing significant improvements in emotional exhaustion, depression, happiness, work-life balance, and emotional recovery after the interventions.

Despite some exceptions in long-term effects, these brief and engaging tools demonstrate promise in alleviating burnout among healthcare workers, highlighting the potential for simple self-care strategies to enhance well-being in this high-stress profession.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Three Good Tools: Positively reflecting backwards and forwards is associated with robust improvements in well-being across three distinct interventions. Adair, KC., Kennedy, LA., Sexton, JB.[2021]

Individual-level stress-reduction interventions for healthcare workers can significantly reduce stress symptoms in the short term (up to 6.8 points on the Maslach Burnout Inventory) and medium term, based on a systematic review of 117 studies involving over 11,000 participants.

Combining different types of stress interventions may provide even greater short-term benefits, but the long-term effects remain uncertain, highlighting the need for better-designed studies to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Individual-level interventions for reducing occupational stress in healthcare workers. Tamminga, SJ., Emal, LM., Boschman, JS., et al.[2023]

The BREATHE workshop, aimed at reducing burnout among behavioral health providers, showed small but significant improvements in cynicism, emotional exhaustion, and positive expectations for clients over a six-month period, despite no significant differences compared to a control group.

While BREATHE did not outperform the control condition overall, it suggests potential benefits for participants and indicates a need for further refinement to better support distressed providers and their organizations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of a Burnout Reduction Intervention for Behavioral Health Providers. Rollins, AL., Kukla, M., Morse, G., et al.[2019]

References

1. Germany pubmed.ncbi.nlm.nih.gov

Virtual Sprint Outpatient Electronic Health Record Training and Optimization Effect on Provider Burnout. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Optimized Use of the Electronic Health Record and Other Clinical Resources to Enhance the Management of Hypogonadal Men. [2022]

3. Ireland pubmed.ncbi.nlm.nih.gov

Challenges in user-driven optimization of EHR: A case study of a large Epic implementation in Denmark. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Measuring success: perspectives from three optimization programs on assessing impact in the age of burnout. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. [2021]

6. England pubmed.ncbi.nlm.nih.gov

EHR safety: the way forward to safe and effective systems. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Electronic health record as a research tool: Frequency of exposure to targeted clinical problems and health care providers' clinical proficiency. [2018]

9. Netherlands pubmed.ncbi.nlm.nih.gov

Continuous Video Recording of Electronic Health Record User Sessions to Support Usability and Safety. [2019]

10. England pubmed.ncbi.nlm.nih.gov

mHealth interventions to reduce stress in healthcare workers (fitcor): study protocol for a randomized controlled trial. [2023]

11. England pubmed.ncbi.nlm.nih.gov

Three Good Tools: Positively reflecting backwards and forwards is associated with robust improvements in well-being across three distinct interventions. [2021]

12. England pubmed.ncbi.nlm.nih.gov

Individual-level interventions for reducing occupational stress in healthcare workers. [2023]

13. United States pubmed.ncbi.nlm.nih.gov

Comparative Effectiveness of a Burnout Reduction Intervention for Behavioral Health Providers. [2019]