Achieving the Quadruple Aim by Reducing Burnout: A Randomized Trial of a Compassion Based Curriculum for Outpatient Teams
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Providence Health & Services
- Enrollment
- 341
- Primary Endpoint
- Change in Burnout Score on Maslach Burnout Inventory
Study Overview
Brief Summary
To demonstrate that a multimodal intervention can reduce burnout in a multidisciplinary primary care practice while improving other components of the Quadruple Aim including staff engagement, patient experience, productivity and quality.
Detailed Description
Recruitment
This was a randomized trial of eleven internal medicine and family medicine clinics of Providence Medical Group (PMG) in Portland Oregon. All of the clinics were non-residency clinics. The study was conducted between January 2015 and January 2016. Introductory meetings were held with leadership dyads (medical director and manager) of all 23 clinics in the Portland area to overview the curriculum and outline conditions of study participation. Expectations included: holding the curriculum sessions during usual work hours, endorsement of participation by clinic staff, and that specific individuals would be identified to facilitate sessions for the clinic. Leadership of each clinic, subsequently, discussed the curriculum with the staffs of the clinics and eleven committed to participate and were then randomized. The staffs of the intervention clinics then received the twelve session Strengthening Compassion curriculum. Four of the intervention clinics held the sessions at the beginning of the day and opened clinic 80 minutes late. One clinic held the sessions during an extended lunch hour.
Randomization and Follow-up
Eleven clinics volunteered to participate. (47.8% of eligible clinics) Five clinics were randomly selected to participate in the Strengthening Compassion curriculum and six were selected as controls.
341 individuals participated in the study, including providers, clinical, and administrative staff. The baseline survey was completed by 153 participants in the intervention clinics and 188 participants in the control clinics. 244 of the initial participants completed a survey at the end of the intervention period and 191 at 6 month follow up Participants in the intervention clinics engaged in a 12 session curriculum offered every other week for six months. Each session lasted 80 minutes and all staff at the intervention clinics were expected to participate. A total of 16 hours of experiences were provided.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •All employees working in selected clinics
Exclusion Criteria
- Not provided
Arms & Interventions
Intervention Clinics
Participants in the intervention clinics experienced a 12 session compassion curriculum intevention offered every other week for six months. Each session lasted 80 minutes and all staff at the intervention clinics were expected to participate. A total of 16 hours of experiences were provided.
Intervention: Compassion Curriculum (Behavioral)
Control Clinics
Completed baseline, end of curriculum, and 6 month follow up survey. Otherwise no intervention
Outcomes
Primary Outcomes
Change in Burnout Score on Maslach Burnout Inventory
Time Frame: Baseline, 6 Months and 12 Months
Score on Maslach Burnout Inventory: Maslach Burnout Inventory - Human Services Survey (MBI-HSS) is a 22-item survey that covers 3 areas: Emotional exhaustion (EE), Depersonalization (DP), and Low sense of personal accomplishment (PA). There are multiple questions for each of these subscales and responses are in the form of a frequency rating scale (never, a few times a year or less, once a month or less, a few times a month, once a week, a few times a week, every day).
Change in Compassion: Score on Santa Clara Brief Compassion Scale
Time Frame: Baseline, 6 Months and 12 Months
Score on Santa Clara Brief Compassion Scale: The Santa Clare Brief Compassion Scale is a brief index that assesses compassion and its link to prosocial behaviors. An example from a 'compassion for humanity' item include ""When I hear about someone (a stranger) going through a difficult time, I feel a great deal of compassion for him or her." Responses are given on a 7-point scale from "Not at all true for me" to "Very true for me."
Change in Mindfulness: Mindful Attention Awareness Score
Time Frame: Baseline, 6 Months and 12 Months
Mindful Attention Awareness Score: The trait MAAS is a 15-item scale designed to assess a core characteristic of mindfulness, namely, a receptive state of mind in which attention, informed by a sensitive awareness of what is occurring in the present, simply observes what is taking place. Scored on a scale 1=almost never--\> 6=almost always
Change in Intent to stay on Caregiver survey
Time Frame: Baseline and 12 months
Intent to stay on Caregiver survey
Secondary Outcomes
- Change in Cancer Screening Rate(Baseline, 6 Months and 12 Months)
- Change in Visit per month(Baseline, 6 Months and 12 Months)
- Change in BP control(Baseline, 6 Months and 12 Months)
- Change inCaregiver Engagement measured on annual Willis Tower Watson Survey(Baseline and 12 months)
- Change in Panel Size(Baseline, 6 Months and 12 Months)
- Change in Diabetes Control(Baseline, 6 Months and 12 Months)
- Change in Patient Experience on routine Press Ganey Survey(Baseline, 6 Months and 12 Months)
Investigators
Mark Rosenberg, MD
Director, Compassionate Care
Providence Health & Services