Randomized controlled trial of the "WISER" intervention to reduce healthcare worker burnout

Abstract

Objective: Test web-based implementation for the science of enhancing resilience (WISER) intervention efficacy in reducing healthcare worker (HCW) burnout.

Design: RCT using two cohorts of HCWs of four NICUs each, to improve HCW well-being (primary outcome: burnout). Cohort 1 received WISER while Cohort 2 acted as a waitlist control.

Results: Cohorts were similar, mostly female (83%) and nurses (62%). In Cohorts 1 and 2 respectively, 182 and 299 initiated WISER, 100 and 176 completed 1-month follow-up, and 78 and 146 completed 6-month follow-up. Relative to control, WISER decreased burnout (-5.27 (95% CI: -10.44, -0.10), p = 0.046). Combined adjusted cohort results at 1-month showed that the percentage of HCWs reporting concerning outcomes was significantly decreased for burnout (-6.3% (95%CI: -11.6%, -1.0%); p = 0.008), and secondary outcomes depression (-5.2% (95%CI: -10.8, -0.4); p = 0.022) and work-life integration (-11.8% (95%CI: -17.9, -6.1); p < 0.001). Improvements endured at 6 months.

Conclusion: WISER appears to durably improve HCW well-being.

Clinical trials number: NCT02603133; https://clinicaltrials.gov/ct2/show/NCT02603133.

Fig. 1

A Schematic of WISER study design. Active WISER period shaded gray. Seven assessment points presented in circles: two baseline assessment (A₁ and A₂), two 1-month follow-ups (B and E), two 6-month follow-ups (C and F), and one re-pre (D) that was a second baseline assessment for Cohort 2 for comparison with a 1-month post of Cohort 1. B CONSORT Diagram. Efficacy of WISER intervention: cohort 1 change at 1-month (B–A₁) vs. cohort 2 control (D–A₂). Within-cohort change from baseline to 1-month: B–A for cohort 1; E–D for cohort 2; Within-cohort change from baseline to 6-months: C–A for cohort 1; F–D for cohort 2; Effectiveness comparison of cohort 2 change versus cohort 1 at 1-months: (B–A) vs. (E–D); Effectiveness comparison of cohort 2 change versus cohort 1 at 6-month: (C–A) vs. (F–D).

Fig. 2. Effect of WISER on the percent concerning scale.

Statistical comparisons between combined cohort baseline to 1-month post and 6-month post provided in brackets.

Fig. 3. Effect of WISER compared with prior samples.

Percent concerning emotional exhaustion in WISER and across 818 work units in 31 hospitals in Michigan. Each bar represents a work unit or WISER study findings. EE - emotional exhaustion. PRE - emotional exhaustion at baseline.