Interventions improve well-being in workers who experienced high levels of stress at work. Healthcare worker burnout was on the rise before COVID-19 and continues to this day. Addressing significant structural barriers in US healthcare must be a “top priority.” Easily accessible, individualized solutions are also needed to improve well-being in stressed healthcare workers.
CHICAGO — The COVID-19 pandemic has exacerbated already rising rates of burnout among U.S. health care workers, and a new Northwestern University study finds that learning and practicing skills that boost positive emotions, such as gratitude, mindfulness and self-compassion, can help improve well-being and reduce stress and anxiety among health care workers.
The study is scheduled to be published in PLOS ONE on June 24th.
“Even before COVID-19, health care workers were struggling with a lot of job stress, so anything we can give them the tools to help reduce some of that stress would be a win,” said corresponding author Judith Moskowitz, intervention science lead in the Department of Medical Social Sciences at Northwestern University Feinberg School of Medicine.
But like any intervention — diet, exercise, addiction recovery — these skills only work if you practice them, Moskowitz says.
The study involved 554 healthcare workers who took part in a five-week online self-guided intervention targeting positive emotions. The intervention designed by Moskowitz and colleagues included eight skills proven to improve well-being: noticing and savoring positive events, gratitude, mindful awareness, positive reappraisal, personal strengths, achievable goals, and self-compassion.
More than half of participants who enrolled in learning positive emotion skills (52.8%) never logged in to complete the lessons. Those who completed all five weeks of skills lessons in the intervention (9% of the sample) experienced significant improvements in positive emotion compared to those who did not use the intervention.
“The constraints of the U.S. health care system can make it very difficult for individuals to take time for self-care, and this is a huge problem,” Moskowitz said. “Systemic, organizational-level changes in health care are crucial to addressing the causes of burnout, but health care workers also need easily accessible, individual-level tools to help them cope with the stresses of the job.”
Previous studies of stress reduction interventions in healthcare workers have limited samples to nurses or doctors, but this new study enrolled healthcare workers in a wider range of roles, including managers, and demonstrated that the impact of the intervention did not differ based on role.
Future research will focus on improving engagement and accessibility.
When asked why they did not complete the intervention, participants pointed to logistical issues (e.g., not receiving the initial email to log into the platform or not remembering that they had enrolled in the study). One participant stated, “Due to my busy schedule, I completely forgot that I had opted in and ignored the email. I wish I had made more time to participate as planned. I would have liked to see if it would work.” Some found the daily reminders to practice the skills too strict, stating that after missing a few lessons, “I lost interest because it seemed impossible to catch up, but now that I understand the time requirements, I would be happy to have the opportunity to participate again.”
Moskowitz said future studies teaching this intervention might restructure the delivery of skills to include an introductory session at the beginning that summarizes all eight skills so participants know what to expect throughout the five-week program.
“We say, 'Here are some strategies you can try that have been proven to improve well-being for people who are experiencing different stressors in their lives. We encourage you to try them all, because you won't know which ones work for you unless you try them. Once you find out which ones work for you, make it a habit to practice those skills,'” Moskowitz said.
Feedback also reflected inconsistencies with individually directed interventions being used to address health system-level factors that contribute to burnout in the U.S., such as staffing shortages, limited child care options, and breaks during the workday. One participant stated, “The online modules were just an extra task to do on top of the billion other tasks I have to do.”
Moskowitz said the interventions are more likely to be successful in reducing burnout if they are implemented alongside health system-level policy changes. To do so, she said, U.S. health system leaders should follow Surgeon General Dr. Vivek Murthy's Workplace Mental Health and Well-Being Framework. The framework outlines five fundamentals for strengthening workplace mental health and well-being and can help organizations develop, institutionalize, and update policies, processes, and practices that best support the mental health and well-being of all employees.
The importance of combating burnout in healthcare
Moskowitz studied the impact of this positive emotion regulation intervention on health and well-being in large samples experiencing a variety of life stressors, including individuals with a new HIV diagnosis, dementia caregivers, patients diagnosed with metastatic breast cancer, and those living through the COVID-19 pandemic.
In this study, burnout was measured using the 16-item Oldenburg Burnout Scale, which assesses two dimensions: fatigue and loss of interest in work. Burnout is strongly correlated with many negative physical health outcomes, including depression and anxiety, poor sleep, risky health behaviors (e.g., reduced physical activity, increased substance use), and physical health problems such as headaches and gastrointestinal problems.
In particular, health care worker burnout is associated with reduced effectiveness of care delivery and increased risk of poor patient health and medical errors. Other health indicators, including positive emotions, meaning and purpose, anxiety, depression, and social isolation, were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS). [48–50] Computer-adaptive testing.
Funding for this research came from the Northwestern University Clinical and Translational Science Institute (grant UL1TR001422), the Northwestern Memorial Foundation, and a Peter G. Peterson Foundation grant.
