Implementation and effectiveness of a physician-focused peer support program

Abstract

Background: The practice of medicine faces a mounting burnout crisis. Physician burnout leads to worse mental health outcomes, provider turnover, and decreased quality of care. Peer support, a viable strategy to combat burnout, has been shown to be well received by physicians.

Methods: This study evaluates the Peer Outreach Support Team (POST) program, a physician-focused peer support initiative established in a 2-hospital system, using descriptive statistical methodologies. We evaluate the POST program using the Practical Robust Implementation and Sustainability Model (PRISM) framework to describe important contextual factors including characteristics of the intervention, recipients, implementation and sustainability infrastructure, and external environment, and to assess RE-AIM outcomes including reach, effectiveness, adoption, implementation, and maintenance.

Results: This program successfully trained 59 peer supporters across 11 departments in a 2-hospital system over a 3-year period. Trained supporters unanimously felt the training was useful and aided in general departmental culture shift (100% of respondents). After 3 years, 48.5% of physician survey respondents across 5 active departments had had a peer support interaction, with 306 successful interactions recorded. The rate of interactions increased over the 3-year study period, and the program was adopted by 11 departments, representing approximately 60% of all physicians in the 2-hospital system. Important implementation barriers and facilitators were identified. Physician recipients of peer support reported improved well-being, decreased negative emotions and stigma, and perceived positive cultural changes within their departments.

Conclusions: We found that POST, a physician-focused peer support program, had widespread reach and a positive effect on perceived physician well-being and departmental culture. This analysis outlines a viable approach to support physicians and suggests future studies considering direct effectiveness measures and programmatic adaptations. Our findings can inform and guide other healthcare systems striving to establish peer support initiatives to improve physician well-being.

Fig 1. The Practical Robust Implementation and Sustainability Model (PRISM) as applied to POST.

In green at the top are PRISM factors, including the domains of intervention, recipients, implementation and sustainability infrastructure, and external environment, with important components included. Below in orange are the RE-AIM outcomes including reach, perceived effectiveness, adoption, implementation and maintenance. Included below these outcomes are major considerations for each. AFM, adult and family medicine; HNS, head and neck surgery; EM, emergency medicine; ICU, intensive care unit; OBGYN, obstetrics and gynecology; PICU, pediatric ICU; MFS, maxillofacial surgery.

Fig 2. The anatomy of a peer support interaction.

Overview of the components emphasized in the 4-hour training starting from the initial outreach and proceeding to the closing of the interaction. Tools and scripting are provided for each of these components within the training. EAP, Employee Assistance Program; PWBC, Physician Well Being Committee.

Fig 3. Peer supporter training feedback.

Responses to the feedback survey from physicians who underwent the virtual training displayed in stacked percentages. Understanding role refers to role as a peer supporter in the POST program. Resources refers to the Employee Assistance Program, Physician Well Being Committee, and other mental health resources available to physicians after a difficult or adverse event. Number of survey respondents = 37.

Fig 4. Programmatic feedback.

5-point Likert scale responses from the departmental survey displayed in 100% stacked bars among survey respondents who were aware of the POST program and responded to the question. n = 66 for “Impact on Department,” n = 65 for “Recommend Program” and n = 64 for “Overall Satisfaction.” “Interaction impact” refers to perceived helpfulness of a POST interaction by peer support recipient (n = 32).