This proposal serves the mission of the NICHD to ensure that all children have the chance to achieve their full potential for healthy and productive lives. Optimizing provider well-being is critical to the delivery of safe and high quality care to he most vulnerable of patients: very preterm babies. Major innovative objectives of this proposal include testing the Web-based Implementation for the Science of Enhancing Resilience (WISER) program's effectiveness in enhancing resilience among Neonatal Intensive Care Unit (NICU) health workers, evaluating its effect on unit safety culture, and examining its effect on clinical outcomes in preterm infants. The WISER program is an established but low-intensity yet engaging intervention, which integrates education and behavior modification to boost provider well-being and resilience in order to create an organizational environment which prevents patient harm. Care for the more than 50,000 very low birth weight (VLBW; < 1500 gm) infants born annually in the United States is challenging and expensive. Quality of care and outcomes vary widely. Increasing technical demands and patient acuity have pushed burnout among health workers to the breaking point. The few tested interventions that improve caregiver resilience lack feasibility for widespread adoption. We must improve health workers' ability to cope with the stress at the workplace in order to create an environment that supports safer, better care. This study is designed to achieve the following aims: 1. Test the effectiveness of WISER in improving NICU health professional resilience; 2. Test the effectiveness of WISER in improving patient safety and organizational outcomes; 3. Test the sustainability of WISER; and 4. Describe the barriers and facilitators of the WISER program. We propose to test the effectiveness of the WISER Program in the NICU setting using a stepped-wedge mixed-methods randomized controlled trial (swRCT) at six tertiary care NICUs. The results of this trial will also provide insights into the causal relations between health worker resilience, the organizational environment, and clinical outcomes among infants born VLBW. This proposal builds on and expands the existing collaborative relationships among the expert interdisciplinary research team. If successful, this proposal will represent a breakthrough for the neonatal patient safety movement and provide a model for scaling up nationally.

Public Health Relevance

Resilience means a healthcare provider's ability to cope, recover, and learn from stressful events, as well as their access to resources that promote health and well-being. Neonatal intensive care unit (NICU) health professionals' need to have particularly good resilience, because their work is extremely stressful and their patients, fragile preterm infants, require their undivided attention. We propose a feasible and engaging intervention to enhance resilience among NICU health professionals promoting their ability to provide safe care.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Koso-Thomas, Marion
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Stanford University
Schools of Medicine
United States
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Sexton, J Bryan; Adair, Kathryn C; Leonard, Michael W et al. (2018) Providing feedback following Leadership WalkRounds is associated with better patient safety culture, higher employee engagement and lower burnout. BMJ Qual Saf 27:261-270
Tawfik, Daniel S; Profit, Jochen; Morgenthaler, Timothy I et al. (2018) Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors. Mayo Clin Proc 93:1571-1580
Profit, Jochen; Sharek, Paul J; Cui, Xin et al. (2018) The Correlation Between Neonatal Intensive Care Unit Safety Culture and Quality of Care. J Patient Saf :
Tawfik, Daniel S; Phibbs, Ciaran S; Sexton, J Bryan et al. (2017) Factors Associated With Provider Burnout in the NICU. Pediatrics 139:
Profit, Jochen; Sharek, Paul J; Kan, Peiyi et al. (2017) Teamwork in the NICU Setting and Its Association with Health Care-Associated Infections in Very Low-Birth-Weight Infants. Am J Perinatol 34:1032-1040
Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C et al. (2017) Context in Quality of Care: Improving Teamwork and Resilience. Clin Perinatol 44:541-552
Doram, Keith; Chadwick, Whitney; Bokovoy, Joni et al. (2017) Got spirit? The spiritual climate scale, psychometric properties, benchmarking data and future directions. BMC Health Serv Res 17:132
Sexton, J Bryan; Schwartz, Stephanie P; Chadwick, Whitney A et al. (2017) The associations between work-life balance behaviours, teamwork climate and safety climate: cross-sectional survey introducing the work-life climate scale, psychometric properties, benchmarking data and future directions. BMJ Qual Saf 26:632-640
Tawfik, D S; Sexton, J B; Kan, P et al. (2017) Burnout in the neonatal intensive care unit and its relation to healthcare-associated infections. J Perinatol 37:315-320