Kansas City Veterans Affairs Medical Center, Kansas City, MO Veterans' Health Administration, VA Heartland Network, Kansas City, MO Veterans' Health Administration National Center for Organization Development, Cincinnati, OH Pulmonary and Critical Care Medicine Service Line, Kansas City Veterans Affairs Hospital, Kansas City, MO.
Am J Med Qual. 2021;36(6):422-428. doi: 10.1097/01.JMQ.0000735516.35323.97.
Provider burnout is a significant health care concern. It is unclear whether high reliability organization (HRO) practices can prevent it. The Truman Veterans Affairs Medical Center (VAMC) undertook an initiative implementing HRO principles and assessed for impact on burnout metrics. This became known as the Transformative HRO Initiative Via Employee Engagement (THRIVE2) model. THRIVE2 consisted of Just Culture training, Clinical Team Training, and continuous process improvement through Lean. Truman VAMC was compared with other Veterans Health Affairs (VHA) facilities regarding burnout and employee satisfaction metrics. Truman VAMC saw significant changes in multiple HRO metrics (P < 0.001) as well as improvements in work group psychological safety and employee exhaustion (P < 0.001). High burnout rates decreased by 52% (6.2%-2.95%; P < 0.001). Truman VAMC went from 75th to the No. 1 ranked VHA facility regarding Best Places to Work. These findings have significant national policy implications given the effects of burnout.
提供者倦怠是一个严重的医疗保健问题。目前尚不清楚高可靠性组织（HRO）的实践是否可以预防它。杜鲁门退伍军人事务医疗中心（VAMC）开展了一项实施 HRO 原则的计划，并评估其对倦怠指标的影响。这就是众所周知的通过员工参与实现变革性 HRO 倡议（THRIVE2）模式。THRIVE2 包括公正文化培训、临床团队培训以及通过精益进行持续的流程改进。杜鲁门 VAMC 与其他退伍军人健康管理局（VHA）机构就倦怠和员工满意度指标进行了比较。杜鲁门 VAMC 在多个 HRO 指标（P < 0.001）以及工作小组心理安全和员工疲惫感（P < 0.001）方面都发生了显著变化。高倦怠率下降了 52%（6.2%-2.95%；P < 0.001）。杜鲁门 VAMC 在最佳工作场所方面从第 75 位跃升至 VHA 设施排名第一。鉴于倦怠的影响，这些发现对国家政策具有重要意义。
