Feasibility study of a chaplain-delivered compassion intervention to improve psychological safety among interprofessional healthcare teams

Project Summary/Abstract: Healthcare provider burnout is pervasive in oncology, and it imparts harm to providers and patients, increases healthcare and workforce disparities, and exacerbates projected physician and nursing shortages. Although burnout is primarily caused by organizational stressors, supportive and cooperative interdisciplinary teams

foster psychological safety and are protective against burnout. For this reason, interventions to improve burnout require organization-directed approaches that address team dynamics and working environment (as opposed to only focusing on individual resilience). Although there has been a multitude of small studies

investigating several interventions to prevent burnout, the evidence base remains extremely low due to the poor quality of data and measurement approaches. As a first step to address the critical and unmet need for evidence-based, acceptable, and scalable team-based interventions to improve burnout, we developed

Compassion Centered Spiritual Health Team Intervention (CCSH-TI), which includes mindfulness and compassion-based approaches to bolster compassion for self and others and to improve psychological safety and team civility. CCSH-TI is delivered by hospital chaplains who comprise a well-established and highly

acceptable non-sectarian clinical service present in nearly two-thirds of all US hospitals and trained to provide emotional, psychosocial, and spiritual care to a broad range of patients and staff. The current proposal will use a phase 1 clustered randomized, wait-list controlled, and mixed-method study to (1) examine the feasibility and

acceptability of CCSH-TI and (2) develop and validate a novel, low-burden ambulatory assessment “toolkit” to improve the measurement of psychological safety and burnout. Employees (n = 80; nurses, advanced practice providers (APPs), physicians, staff) working at an NCI-designated Comprehensive Cancer Center will be

randomized by team to CCSH-TI or wait-list. We will evaluate CCSH-TI feasibility (accrual, retention, CCSH-TI attendance) and acceptability (satisfaction, credibility, perceived benefit). Focus groups will identify contextual determinants of feasibility, acceptability, and implementation success. At pre/post-intervention and 12-week

follow-up, we will conduct 3-day ambulatory assessments: (1) Ecological Momentary Assessments (EMA) of social connection, incivility, and burnout; and (2) Electronically Activated Recorder (EAR), a method of periodically and unobtrusively sampling acoustic observations that has been validated and established outside

the healthcare environment. We will develop and validate EAR behavioral codebooks tailored to the healthcare environment to quantify behavioral indices of psychological safety, incivility, and interprofessional teamwork. This proposal is an innovative and ‘real world’ approach to increase access, equity, and inclusion of burnout

prevention and mitigation among all healthcare providers and that improves scientific rigor of research on burnout by developing a novel, objective, low-burden assessment toolkit.