Publication Date
Spring 4-2025
Presentation Length
Poster/Gallery presentation
College
Gordon E. Inman College of Nursing
Department
Nursing, School of
Student Level
Graduate
SPARK Category
Scholarship
Faculty Advisor
Elizabeth Morse, MPH, DNP, FNP-BC
SPARK Session
10:15-11:45 DNP poster Projects
Presentation Type
Poster
Summary
Project Title: Empowering Staff Wellbeing: A Team-Based QI Initiative
Keywords: Burnout, wellbeing, DNP, primary care, QI methodology
Background and Rationale: The consequences of burnout in healthcare are alarming: worse patient outcomes, lack of continuity of care, higher turnover, and increased cost to employers. Many studies of burnout and wellbeing of clinicians focus on larger institutions such as hospitals and Federally Qualified Health Centers. Over the past several years, burnout has been discussed among our small, eight-person clinician team working in a small, non-profit primary care clinic. Yet, there has been no formal assessment of the level of burnout among the team with validated tool, and as such, addressing the issue has been difficult without any measures.
SMART Aim: The aim of this quality improvement project was to improve the well-being in the clinician team in this clinic by January 25th, 2025 as evidenced by an average improvement of 1 point on the Well-Being Index score.
The Well-Being Index tool was invented by the Mayo clinic to assess risk of burnout and wellbeing in healthcare setting. It has been validated by multiple studies for use with physicians, nurse practitioners, physician assistants, medical residents, and several other medical populations. It is important to note that a higher score on the Well-Being Index is associated with a higher risk of adverse outcomes like burnout, turnover, severe fatigue, and poor quality of life whereas a lower score is associated with lower risk of adverse outcomes. The scoring system ranges from negative 2 to 9. The threshold score for MDs is ≥ 3 and threshold score for APPs is ≥ 2, with these scores indicating higher risk for adverse outcomes.
Methods: A baseline Well-Being survey was conducted anonymously in mid-January 2024 of the clinician team (3 MDs, 3 NPs, and 2 PAs). At the end of January, overall results were discussed with the team, and evidence was shared regarding contributing factors to burnout in primary care. Two brainstorming sessions followed to reach a consensus of change ideas specific to clinical context in how to improve overall team wellbeing and decrease burnout. Collaboration occurred with other departments that would be involved with change ideas on best ways to implement. Rapid change cycles were implemented in from May-June 2024 (delegation, work efficiency), July-August 2024 (workload, improved EHR efficiency), and September-October 2024 (assessing patient volume from previous years; standardizing coverage for PTO). There was an attempt for a cycle in December 2024 that was unsuccessful due to manager of the department being out of the office for extended period of time.
Outcomes: Results from baseline Well-Being index in January 2024 demonstrated that 4 of the 5 APPs were at higher risk for adverse outcomes including burnout, severe fatigue, poor quality of life, and increased risk of turnover within 24 months. None of the MDs met the threshold score for higher risk of adverse outcomes. Results from the Well-Being index in January 2025, post-intervention, showed 3 of 4 APPs remained at higher risk for adverse outcomes and 1 of the 3 MDs at a higher risk for adverse outcomes. The team average Well-Being scores from 2025 to 2024 did show a 0.81 decrease overall. However, if looking at the subgroups (i.e. MDs, APPs), the average score of the APP team increased 0.20 points, and then average MD score decreased 1.67 points. Again, the lower the score, the less risk of adverse outcomes. It is important to note that before the 2nd Well-Being Index assessment, one of the APPs resigned (on 1/4/25), so the sample size decreased to 7 clinicians (3 MDs, 4 APPs).
Conclusion: Despite individual and team-based interventions addressing some of the key causes of burnout in primary care, the clinician team’s Well-Being Index score average did not decrease by 1 point. In addition, the APP team had indications of higher risk of adverse outcomes in 2024 and by 2025, one of the APPs did resign.
Implications for Practice: Implementing scheduled, validated assessments of staff wellbeing, along with organizational changes supporting a culture of wellness, can reduce burnout in staff. Reducing burnout decreases the risk of essential patient-facing clinicians leaving the workforce which results in increased cost for the organization, interrupted patient care, and negatively impacts staff morale.
Recommended Citation
Smith, Rebecca Lauren; Morse, Elizabeth; and Phillippi, David, "Empowering Staff Wellbeing: A Team-Based QI Initiative" (2025). SPARK Symposium Presentations. 261.
https://repository.belmont.edu/spark_presentations/261
DNP Spark Project LS.pptx (767 kB)
Distibution signed.pdf (533 kB)
