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Empowering Staff Wellbeing: A Team-Based QI Initiative
Get PDFProject 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
ART THERAPY: AN ALTERNATIVE SOLUTION FOR VETERANS SUFFERING FROM TRAUMA AND PTSD
Get PDFThis project aims to explore artistic solutions to the psychological problems veterans face with re-entering society after serving time with the U.S. military. Art is one-way veterans can explore creative outlets for their trauma and through working with CreatiVets, they will be able to have a safe space to express themselves. CreatiVets is a non-profit specializing in art-based programs to help veterans deal with trauma. They already have programs that feature painting, sculpting and songwriting. A sewing program will be introduced into the organization so veterans will be able to express themselves through fiber arts. The sewing class will be done once a month to begin and gradually increase as the popularity does
Resolving Gimbal Lock Using Quaternions
No full textGimbal lock is a common phenomenon for objects in 3D space in which one degree of freedom is lost due to an alignment of two axes of rotation. In this presentation, we demonstrate how quaternions can be used to remedy gimbal lock. Quaternions are a 4D extension of complex numbers with the useful property that the group of quaternions of norm 1 (SU(2)) is the double-cover of the group of 3D rotations (SO(3)). We showcase how this can be applied to the gimbal lock problem using a simulation in Unity
Operating Room Acquired Pressure Injury Prevention
Get PDFOur change project focuses on preventing pressure injuries in OR patients using an alternating pressure overlay and gel pad system during surgery and recovery. Pressure injuries cost the healthcare system upwards of 37,000, significantly lower than the long-term cost of pressure injuries. Keystakeholders include nurse managers, surgical nurses, and hospital administration, while facilitators include evidence-based research and staff interest in improving patient care. Barriers to implementation include initial equipment costs and potential resistance from staff. The plan includes staff training, system implementation, and ongoing monitoring of pressure injury rates, compliance, and cost savings. Long-term implications of this intervention include cost savings, expandability to other units, improved patient outcomes, enhanced nurse satisfaction, and the potential for systemic changes that reduce pressure injuries across healthcare settings. Thissystem will reduce hospital-acquired pressure injuries, promote evidence-based practices, and foster trust and confidence in nursing care, improving patient and nurse satisfaction
Support, Self-efficacy, and Burnout in Teachers of Children with Special Needs
No full textStudents with disabilities tend to perform academically below their peers and so require the best quality of teacher that they can get (Brunsting et al., 2024). In general, students perform better when their teachers have higher self-efficacy (Mahmoodi et al., 2022), but teacher self-efficacy decreases when teaching children with disabilities (Guo et al., 2021). Additionally, teachers can experience burnout, which is associated with low self-efficacy (Brunsting et al., 2014) and poorer learning outcomes (Alqahtani et al., 2023). Both burnout and low self-efficacy have been linked to a lack of resources and struggles adapting to novel or unique teaching methods, which may indicate a relationship between teacher support, self-efficacy, and burnout (Brunsting et al., 2014; Cerbin-Koczorowska et al., 2023). This study analyzed how teacher support correlated with both teacher self-efficacy and burnout. This was an online study in which 113 teachers completed questions about school support, self-efficacy in teaching students with disabilities, and burnout (specifically emotional exhaustion). We hypothesized that teacher support would be positively correlated with teacher self-efficacy and negatively correlated with teacher burnout/emotional exhaustion. Teacher support was positively correlated with teacher self-efficacy, r(111) = .34, p \u3c .001, r2 = .12. Teacher support was negatively correlated with burnout, r(112) = -.53, p \u3c .001, r2 = .28. Results suggest that teachers of students with disabilities may have higher self-efficacy levels and lower burnout levels when they receive greater support from their schools. These findings could have implications for how to maximize academic achievement for students with disabilities
Mandatory Bedside Rounding in the Cardiac ICU
Get PDFThe Mandatory Bedside Rounding in the Cardiac ICU project aims to enhance patient outcomes by implementing a standardized, nurse-led rounding protocol. Inconsistent ICU rounding practices currently contribute to miscommunication, preventable medical errors, and patient dissatisfaction. Research supports that structured bedside rounding improves interdisciplinary collaboration, care coordination, and patient safety. This proposed change involves using structured checklists, integrating documentation into the electronic health record (EHR), and training ICU staff to ensure compliance. Implementation follows a phased timeline: protocol development, staff education, pilot testing in STEMI/heart failure units, and full ICU rollout. The estimated $150,000 budget includes training, EHR updates, patient and nurse surveys, and IT support. Initial outcomes target a 10% increase in patient satisfaction and improved communication. To measure success, both patient discharge surveys and periodic nurse feedback tools will be used to gather real-time data and monitor impact. Although a reduction in length of stay (LOS) may not be immediately evident, particularly during early rollout, improved coordination and earlier discharge planning may yield measurable effects over time. Ultimately, bedside rounding empowers nurses, boosts team communication, and promotes consistent, patient-centered care, laying the foundation for long-term improvements in ICU workflow and health outcomes
Quality Improvement Initiative to Decrease Excessive Testing for Streptococcal Pharyngitis in Adults in an Outpatient Clinic Setting
Get PDFProject Title: Quality Improvement Initiative to Decrease Excessive Testing for Streptococcal Pharyngitis in Adults in an Outpatient Clinic Setting
Background and Rationale: Current guidelines recommend utilization of a clinical decision-making tool, like the Centor score, in conjunction with confirmatory diagnostic methods, such as a throat culture or rapid test, rather than either method alone. The existing practice at the clinic site was to test most adults with upper respiratory infection symptoms (e.g., sore throat, cough, fever, sinus congestion) with little discretion. With the reported prevalence of streptococcal pharyngitis or “strep throat” in adults being 5-15%, universally testing adult patients could result in a positive test due to being a carrier, despite the causative organism of pharyngitis likely being viral. This contributes to antibiotic misuse and potentially antimicrobial resistance.
SMART Aim: The aim of this project was to decrease unnecessary rapid testing for Group A pharyngitis by 40% in patients over the age of 18 who present with upper respiratory symptoms to a primary care clinic in Murfreesboro, Tennessee, by December 13, 2024.
Methods: The protocol for the QI initiative called for the provider to calculate a Centor score prior to performing a rapid test for strep throat and to document the score in the encounter note. Ideally, a rapid strep test should only be performed for a Centor score ≥ 2. Data collection and compliance rates were completed by a chart review during implementation.
Outcomes: This QI initiative resulted in a 56% reduction in unnecessary testing for streptococcal pharyngitis. Also, antibiotic prescriptions were reduced by 20%. There was no significant change in the length of visit in minutes or significant increase in point-of-care testing for other URIs, such as Covid-19 or Influenza A & B. There were no missed cases of strep throat during the implementation