Positive emotion skills combat burnout among health care workers

• Intervention improved well-being in workers who were highly stressed by the job
• Health care worker burnout was on the rise before COVID-19 and continues today
• Addressing significant structural barriers in U.S. health care ‘needs to be a top priority’
• Easily accessible individualized solutions also are needed to boost well-being in stressed health-care workers

CHICAGO — The COVID-19 pandemic exacerbated already rising rates of burnout among American health care workers. A new Northwestern University study found learning and practicing skills that increase positive emotion like gratitude, mindful awareness and self-compassion helped improve health care workers’ well-being and reduce stress and anxiety.

The study was published June 24 in PLOS ONE.

“Even before COVID-19, health care workers were significantly challenged by the stresses of the job, and any tools we can give them to lessen that stress even a little bit is a win,” said corresponding author Judith Moskowitz, chief of intervention science in the department of medical social sciences at Northwestern University Feinberg School of Medicine.

But just like with any intervention — diet, exercise, addiction recovery, etc. — these skills only work if you practice them, Moskowitz said.

The study enrolled 554 health care workers to participate in a five-week, online, self-guided intervention that targets positive emotion. The intervention designed by Moskowitz and colleagues included eight skills that evidence shows improve well-being. They include noticing and savoring positive events, gratitude, mindful awareness, positive reappraisal, personal strengths, attainable goals and self-compassion.

More than half (52.8%) of participants who signed up to learn the positive emotion skills never logged in to complete any of the lessons. Those who completed all five weekly skill lessons of the intervention (9% of the sample) improved significantly more on positive emotion compared to those who did not use the intervention.

“Constraints in the U.S. health care system can make it really hard for individuals to take any time for self-care, and that’s a big problem,” Moskowitz said. “While systemic and organization-level changes in health care are critically important to address the causes of burnout, health care workers also need individual-level tools that are easily accessible to help them cope with the stress of the job.”

In contrast to previous studies of stress-reduction interventions among health care workers that restricted samples to only nurses or physicians, this new study enrolled health care workers from a wider variety of roles — including administrative and others — and demonstrated the impact of the intervention did not differ based on role.

Future studies will focus on increasing engagement and accessibility

When asked why they didn’t complete the intervention, participants pointed to logistical issues (i.e. not receiving the initial email to login to the platform or not recalling enrolling in the study). One participant said, “I totally forgot that I opted in and ignored the emails because of my busy schedule. I wish I made more time to participate as I intended. I would have loved to see if it worked.” Others found the daily reminders to practice the skills too demanding, saying once they missed a few lessons, “it seemed impossible to catch up and I lost interest, but would love to have an opportunity to participate again now that I understand the time requirement.”

Moskowitz said future studies teaching this intervention may restructure the skill delivery to include an introductory session that summarizes all eight skills at the beginning, so participants know what to expect throughout the five-week program.

“We’d say, ‘Here’s a number of things you can try that have been shown to improve well-being for people experiencing all kinds of life stress. We’d like you to try them all because you don’t always know which ones work for you until you try them. Once you figure out which ones are your go-tos, make practice of those skills a habit,’” Moskowitz said.

Feedback also reflected a mismatch between individually directed interventions that are used to address health care systems-level factors in the U.S. that drive burnout, such as low staffing, limited childcare options, workday breaks, etc. One participant said, “An online module was just an extra thing for me to do on top of the billions of other tasks I had to do.”

Moskowitz said the intervention is more likely to be successful at reducing burnout if implemented in parallel with changes to health care system-level policies. For that, she said, leaders within the U.S. health care system should follow the Surgeon General Dr. Vivek Murthy’s Framework for Mental Health and Well-Being in the Workplace. It outlines five essentials for strengthening workplace mental health and well-being, helping organizations develop, institutionalize and update policies, processes and practices that best support the mental health and well-being of all workers.

Importance of combatting burnout in health care

Moskowitz has studied the health and well-being effects of this positive emotion regulation intervention in a number of samples experiencing a range of life stresses, including people newly diagnosed with HIV, dementia caregivers, patients diagnosed with metastatic breast cancer and people living through the COVID-19 pandemic.

In this study, burnout was measured using the 16-item Oldenburg Burnout Inventory, which assesses two dimensions of burnout: exhaustion and disengagement from work. Burnout is strongly correlated with depression and anxiety, as well as a host of negative physical health outcomes, including poor sleep, risky health behaviors (e.g. reduced physical activity, increased substance use), and physical health concerns such as headaches and gastrointestinal disturbances.

Health care worker burnout, specifically, is associated with reduced effectiveness in health care delivery and increased risk to patient well-being and medical errors. Other well-being measures of positive affect, meaning and purpose, anxiety, depression and social isolation were measured using Patient-Reported Outcomes Measurement Information System (PROMIS) [48–50] computer adaptive tests.

Funding for the study was provided by the Northwestern University Clinical and Translational Sciences Institute (grant UL1TR001422), the Northwestern Memorial Foundation and a grant from the Peter G. Peterson Foundation Grant.