Investigating the impact of a Positive Participatory Organisational Intervention on Burnout in New Zealand Emergency Department Staff – Multisite Study

Multicomponent intervention targeting individual, group and system levels. Our individual-level intervention will consist of a positive psychological intervention. Individual HCWs will choose from 3 positive psychological interventions and participate in those most appropriate for them. Members of the Local Champions Group (LCG) will decide, from 2 possibilities, which group-level intervention their department will use. All ED staff will be able to use the system-level Quality Improvement Learning System (QILS). Individual intervention will be one of the following positive psychological interventions: Mindfulness-based, Three Good Things, Cognitive Behavioural Therapy (CBT)-based. Mindfulness-based intervention will include standard grounding, centering, observing and breathing practices. Three Good Things intervention will consist of reminders and encouragement to consider and document reflections relating to "good things" that have happened/are happening at work, home, family, etc. Cognitive-Based Therapy intervention will consist of a standard step-wise observation of thinking, consideration of cognitive distortions, then re-framing of thoughts. Individuals will choose which of these they participate in. They are able to participate in none, one, two, or all three over time. These interventions will be delivered online via a web-portal designed specifically for this study. These will be available throughout the duration of the intervention period. While the content and duration of each will vary, none of these individual-level interventions will take longer than 100 minutes in total. Each intervention will be completed in brief periods, less than 10 minutes, over a duration of 1 month. Web-portal analytics will be used to determine adherence to individual interventions. Group level interventions will be one of Learning from Excellence, or Clinical Event Debriefing. The Learning from Excellence intervention is a department-wide approach to feedback to colleagues in which a strengths-based view is used. This is consistent with a "Safety-2" mindset. To ensure relevance and acceptability, each department will apply their own particular approach to these interventions. The Learning for Excellence intervention will require a process that makes it simple for staff to lodge and receive brief, relevant, timely feedback. For example, the LCG of a given department may adopt a brief electronic questionnaire, accessed by a QR code that is widely available throughout the department, into which staff can lodge feedback about a member of staff or a group of staff. A dedicated team will be required to review and forward that feedback. For example, a representative from each staff group will meet weekly to asses the feedback and forward that via the electronic means most appropriate to a given staff member. In addition, a summary of feedback will be publicised each week to the entire group at an appropriate site or sites, e.g. the homepage on the department intranet, and a poster on the Wellbeing noticeboard in the tea room. The Clinical Event Debriefing intervention is intended to ensure that staff involved in important clinical events are routinely able to participate in a "hot debrief" which are brief, structured, timely, relevant reflections upon those clinical events. These are designed to take up to 10 minutes, and take place within the clinical workspace or adjacent (e.g. a training room) as soon as possible after an important clinical event. They will always be done during of immediately after a given shift. If further actions are required after the CED, for example, a larger team debrief, these can be organised for a later date. In partnership with the Primary Investigator and based upon a consideration of the needs of their ED, the LCG will decide which of these interventions will be implemented in their ED. All ED staff will be exposed to the group level intervention while maintaining an ability to opt out of engaging with these. For example, should a LCG decide to implement the Clinical Event Debriefing intervention, participation in a given debrief will always remain optional for all ED staff. Similarly, while all ED staff will have exposure to Learning From Excellence, no staff are obliged to actively contribute, rather all contributions must be voluntary. The implementation of the group level intervention will vary at each ED and will work slightly differently, the intention is that these become "business as usual", so that these become part of the daily practice and culture of each ED. Monitoring of adherence will be determined by the LCG, and may include via use of a hot debrief form, or contributions to a Learning from Excellence forum, for example. System level intervention will be QILS: Quality Improvement Learning System. This will be a robust system for identifying areas for improvement at the department level and implementing these using robust QI methods. Important features include simple, timely access to all staff, timely and careful consideration by a QILS team, transparent prioritisation of improvement projects, potential for involvement of all staff in solution generation and work, and robust feedback.