The Work-life Check-ins: a Supervisor-driven Intervention to Reduce Burnout in Primary Care

NCT ID: NCT05436548

Last Updated: 2023-06-29

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: NA
• Total Enrollment: 500 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-01-03
• Study Completion Date: 2026-08-31

Brief Summary

The objective of this study is to evaluate the effectiveness and process of frequent supervisor-employee check-ins in reducing burnout among employees of primary care clinics in Portland, OR. Healthcare workers are at risk for burnout and associated adverse health and safety outcomes, including chronic diseases and occupational injuries. Not only does burnout affect healthcare workers, but burnout also affects the quality of patient care. The proposed study will create a check-in process between supervisors and healthcare workers, which addresses supervisor support, awareness of services and resources, and work-life balance. The Work-life Check-ins project expects to see reduced burnout among employees participating in the check-ins intervention compared to those in the control group.

Detailed Description

Burnout is a manifestation of chronic work stress characterized by emotional exhaustion, cynicism, and diminished self-efficacy. The burden of burnout is alarming, especially within healthcare where it affects at least one-third of the workforce, including clinicians and support staff. The causes of healthcare worker burnout are multifactorial, including systemic pressures (e.g., intensification of charting duties, prolonged work hours with circadian and work-life disruptions, exposure to trauma), and unit-level characteristics (e.g., value misalignment and mistrust between team members and leadership, and lack of supportive services or resources). The modification of these systemic factors requires the lengthy action of stakeholders that have competing agendas. In the meantime, the healthcare workforce remains in urgent need of practical, adaptable, and meaningful solutions to start addressing this pervasive problem. In this conundrum, interventions aimed at improving leader-staff relations - a more readily modifiable target than systemic pressures- have reduced the most proximal emotional effects of burnout. However, new approaches are required so that leadership-focused interventions generate and sustain impactful organizational transformations. The need for such interventions is even more significant amid the exploding levels of work stress related to the COVID-19 crisis.

The objective of this five-year proposal is to conduct a cluster randomized controlled trial (CRT) across 10 OHSU primary care clinics to evaluate the effectiveness and process of a supervisor-focused intervention to reduce burnout. The intervention titled "Work-life Check-ins" will create a process designed to reduce burnout by boosting supervisor support, trust, and value alignment, increasing awareness of appropriate services and resources, and addressing workflow or work-life problems. The central hypothesis is that employees at the six clinics randomly assigned to the intervention will have reduced burnout at the 12- month follow-up compared to waitlist-control clinics. The investigators expect that the intervention will reduce burnout based on our preliminary studies and the integration of evidence-based techniques, including supportive supervision training, goal setting, feedback sessions, and quality improvement cycles. This proposal will accomplish the following specific aims.

Aim 1: Determine the Work-life Check-ins' effectiveness on burnout and secondary outcomes.

The investigators will evaluate the effectiveness of the Work-life Check-ins via surveys conducted among eligible employees (N=552 across the 10 clinics). As the primary outcome, it will be surveyed burnout at baseline and after 12 months. As secondary outcomes, we will examine safety and well-being variables (e.g., turnover intentions, values alignment, supervisor support and safety climate,).

Aim 2: Identify organizational changes produced by the Work-life check-ins. The investigators will conduct a multi-method process evaluation, including implementation metrics (e.g., number and frequency of check-ins) and in-depth interviews with supervisors and workers after implementation. The process evaluation will reveal the extent to which the intervention influenced the adoption of environmental, procedural or educational burnout control and prevention measures.

Conditions

Burnout

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Brief and frequent Work-life check-ins between clinic supervisors and each staff member

Primary care clinics assigned to the intervention will conduct frequent (every 8 weeks) supervisor-employee brief (30 min) check-ins to identify work stressors. Supervisors at such clinics will complete training on how to use the check-ins to address work stressors.

Group Type: EXPERIMENTAL

Supervisor-employee frequent check-ins to identify and address work stressors

Intervention Type: OTHER

Supervisors will complete three training modules: 1) how and why the check-ins are expected to address burnout; 2) how to demonstrate supportive supervision during the check-ins process, and 3) principle of quality improvement applied to the check-ins

Usual practice, waitlist controls

Primary care clinics randomly assigned to the control condition will continue as usual practice. If the check-is are effective in reducing burnout, then supervisor-level training will become available to supervisors at the end of the study

Group Type: EXPERIMENTAL

Usual practice waitlist controls

Intervention Type: OTHER

If the check-ins are successful in reducing burnout, supervisors at the control clinics will be offered the training modules

Interventions

Supervisor-employee frequent check-ins to identify and address work stressors

Supervisors will complete three training modules: 1) how and why the check-ins are expected to address burnout; 2) how to demonstrate supportive supervision during the check-ins process, and 3) principle of quality improvement applied to the check-ins

Intervention Type: OTHER

Usual practice waitlist controls

If the check-ins are successful in reducing burnout, supervisors at the control clinics will be offered the training modules

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• At least 18 years of age
• Employed at one of the 12 OHSU primary care clinics that weren't involved in the pilot study
• Supervisors (medical director, practice manager, supervisors, leads)
• Employees (patient-facing; back and front of the clinic)

• Patient Access Specialists
• Medical Assistants
• MDs, RNs, NPs

Exclusion Criteria

• Under the age of 18
• Employed at an OHSU primary care clinic that participated in the pilot study
• Non-clinic employees

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

Oregon Health and Science University

OTHER

Sponsor Role: lead

Responsible Party

David Hurtado, ScD

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

OHSU

Portland, Oregon, United States

Site Status: NOT_YET_RECRUITING

OHSU

Portland, Oregon, United States

Site Status: RECRUITING

Countries

United States

Facility Contacts

David A Hurtado, ScD

Role: primary

hurtadod@ohsu.edu

503-494-3132

David A Hurtado, ScD

Role: primary

hurtadod@ohsu.edu

617-510-4114

References

Hurtado DA, Boyd J, Madjlesi R, Greenspan SA, Ezekiel-Herrera D, Potgieter G, Hammer LB, Everson T, Lenhart A. The Work-life Check-ins randomized controlled trial: A leader-based adaptive, semi-structured burnout intervention in primary care clinics. Contemp Clin Trials. 2024 Aug;143:107609. doi: 10.1016/j.cct.2024.107609. Epub 2024 Jun 13.

Reference Type: DERIVED

PMID: 38878996 (View on PubMed)

Other Identifiers

STUDY00020965

Identifier Type: -

Identifier Source: org_study_id