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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to address burnout among healthcare providers by testing strategies to boost mental health and job satisfaction. Participants will receive training to enhance emotional well-being, optimize Electronic Health Records (EHR) use, or improve work performance. The goal is to reduce stress and increase control over work lives. Healthcare providers at Keck Medical System experiencing job stress may find this study beneficial. As an unphased trial, it offers providers the chance to explore innovative strategies for improving work-life balance and mental health.

Will I have to stop taking my current medications?

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

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research has shown that several methods have been tried to help healthcare workers deal with burnout. For the Performance Improvement treatment, studies found that workplace changes can improve well-being and reduce burnout by boosting engagement and resilience. These methods are generally safe and helpful for workers.

The Emotional Wellbeing approach uses therapies like cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT). These well-known therapies have proven effective in managing stress and improving mental health in various settings, demonstrating they are safe and well-tolerated.

The EHR Skills Optimization treatment focuses on improving the use of electronic health records (EHRs) to reduce stress. Research indicates that better EHR training can help healthcare workers manage their workload more effectively, decreasing burnout. This approach is considered safe because it focuses on building skills and solving problems.

Overall, these treatments have shown promise in previous studies for improving mental health and job satisfaction, suggesting they are safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these stress reduction strategies for burnout because they offer innovative approaches compared to traditional stress management techniques like medication or one-on-one therapy. The Emotional Wellbeing arm uses group sessions led by licensed therapists, combining cognitive behavioral therapy and acceptance and commitment therapy, which help participants build on their emotional skills over consecutive sessions. The Performance Improvement arm focuses on enhancing workplace perceptions through virtual group sessions, providing participants with practical skills to improve their work environment. Additionally, the EHR Skills Optimization arm targets electronic health record (EHR) efficiency, offering personalized educational sessions that address clinicians' specific challenges and preferences, which can directly reduce stress related to administrative tasks. These varied approaches provide targeted, practical solutions that could be more effective and sustainable for managing burnout.

What evidence suggests that this trial's treatments could be effective for reducing burnout?

This trial will explore various strategies to address burnout in healthcare professionals. One arm will focus on improving work environments through performance improvement sessions, as research has shown that system-level changes can enhance mental health and job satisfaction. Another arm will evaluate emotional wellbeing interventions, using therapies like cognitive behavioral therapy and acceptance and commitment therapy, which have effectively lowered stress and improved mental health. Additionally, the trial will assess the impact of EHR Skills Optimization, as simplifying the Electronic Health Record (EHR) system can reduce stress for clinicians. Together, these strategies offer promising ways to address burnout in healthcare professionals. ^{1 3 4 6 7}

Who Is on the Research Team?

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

Principal Investigator

University of Southern California

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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 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 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]

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 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]

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]

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]

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]

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]

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]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10734365/

Electronic Health Record Stress and Burnout Among ...

This systematic review showed that EHR use was a perceived contributor to clinicians' stress and burnout in hospitals, primarily driven by poor usability and ...

2.

jamanetwork.com

jamanetwork.com/journals/jamanetworkopen/fullarticle/2822959

Electronic Health Record Usability, Satisfaction, and ...

This survey study of 2067 family physicians found that there was significant variation in usability across EHR functions, with alerts receiving the lowest ...

3.

nam.edu

nam.edu/perspectives/electronic-health-record-optimization-and-clinician-well-being-a-potential-roadmap-toward-action/

Electronic Health Record Optimization and Clinician Well ...

This paper provides strategies to help health care organizations embark on their EHR optimization journey toward improved patient care and clinician well-being.

4.

sciencedirect.com

sciencedirect.com/science/article/pii/S235291482400145X

The influence of electronic health record use on healthcare ...

The findings indicate that the use of EHRs contributes to healthcare provider burnout, which may diminish the quality of care provided to patients.

5.

edhub.ama-assn.org

edhub.ama-assn.org/steps-forward/module/2820544

Best Practices for Implementing a New EHR System

This toolkit offers pragmatic STEPS for a health care organization transitioning to a new electronic health record (EHR) system.

6.

edhub.ama-assn.org

edhub.ama-assn.org/course/272

Electronic Health Record (EHR) CME - AMA Ed Hub

This self-paced electronic health records training focuses on helping physicians and care providers enhance their record data management understanding and ...

7.

medinform.jmir.org

medinform.jmir.org/2021/9/e29374/

Using a New Model of Electronic Health Record Training to ...

In this paper, we propose an innovative model of EHR training using high-fidelity EHR simulations designed to facilitate efficient optimization of EHR use by ...