Burnout prevention in the ICU
Report: Michael Krassnitzer
In intensive medicine, burnout has a major impact on the quality of care. For example, in intensive care units, where the staff suffers burnout, statistics indicate that patients remain longer in an artificial coma than in ICUs that are more or less free of burnout. ‘Obviously, that does not happen consciously,’ says Prof. Wolfgang Lalouschek, Medical Director of The Tree Health Care Centre in Vienna and Director of Medical Coaching, a consulting institute. ‘It’s rather the accumulation of small decisions that lead to measurably poorer outcomes.’
The clinical staff is particularly at risk of burnout. Several studies conducted in Western countries agree that 20% of physicians and caregivers manifest burnout symptoms and about 50% are considered vulnerable. Personal disposition and the occupational environment influence individual burnout risk. Emotional and physical exhaustion, negative attitudes towards patients and colleagues, as well as reduced physical and mental working capacity, are the major burnout symptoms. In particular, ICU teams come under extreme stress.
Several ICUs within the Vienna Hospital Association (Wiener Krankenanstaltenverbund), one of Europe’s largest healthcare facilities, joined in the pilot project Burnout Prevention in ICUs. Several approaches were developed to reduce burnout risk and increase job satisfaction. Since 40 of the 180 volunteers were physicians, the physician-nurse ratio of the study participants roughly corresponded to the actual ratio in the ICUs.
Initially, burnout-relevant factors among physicians and nurses were surveyed. Then, aiming to develop improvements or solutions, the participants underwent 12-18 months of systemic coaching, either in a team or individually. Systemic coaching is a person-centred and solution-oriented approach that focuses on the professional role. The coach does not offer direct or preconceived solutions, but helps the person being coached to formulate goals and develop solutions.
In the Viennese pilot study, the coaching phase has largely been completed and results are now being evaluated. According to Prof. Lalouschek (who led the project) the coaching showed ‘significant improvements compared to the previous situation, be it in terms of individual self-perception, or organisational and structural issues’.
Quality of work, work and information flows as well as leadership markedly improved during the coaching phase. The rounds focus more on interdisciplinary cooperation and are better planned, information flows are clearly defined and coordination with other wards and departments is improved, Prof. Lalouschek reports, adding: ‘Contradicting orders and information deficits were significantly reduced while the social climate and the subjective quality of work have improved.’
• The expected high level of burnout among ICU staff was confirmed
• However, the clinical staff are highly motivated and dedicated
• The staff are highly prepared to engage in additional training and to initiate improvements
• Ethical considerations continue to play a major role among ICU staff.
‘We saw that the staff is highly motivated to change those things they have the power to change,’ Prof. Lalouschek says. All improvements were realised without additional hiring and or major restructuring, he adds. ‘When people feel they are being listened to, and taken seriously, they are incredibly constructive and committed.’
One drawback: Not all the ICU managers participated in the study and, as the professor emphasises: ‘The room for manoeuvre is much greater when all hierarchy levels are involved’.
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