Decreasing Burnout and Improving Work Environment: The Impact of <i>Firgun</i> on a Pediatric Hematopoietic Cell Transplant Team.

Abstract

Oncology teams are challenged by BO, which may be alleviated by meaningful recognition. In this study, <i>firgun</i>-altruistic acknowledgment-was implemented on a pediatric hematopoietic cell transplant unit to evaluate its impact on staff and work environment. In this longitudinal, mixed-methods pilot study, interdisciplinary inpatient hematopoietic cell transplant providers received web-based <i>firgun</i> education. Electronic administration of validated surveys occurred at baseline and 8 weeks, including Perceived Stress Scale, Professional Quality of Life Scale, Maslach Burnout Inventory, Workplace Civility Index, Areas of Work Life Survey, and WHO-5. Weekly e-mails reminded participants to practice and log <i>firgun</i>. Wilcoxon signed test for paired data compared pre/post results. Interviews conducted at project completion were coded using MaxQDA software. Forty-two participants enrolled; 25 completed pre/post surveys; eight were interviewed. At study end, participants reported feeling less nervous and stressed (<i>P</i> = .008), and less difficulty coping (<i>P</i> = .01; Perceived Stress Scale), while noting increased acknowledgment of others' work (<i>P</i> = .04) and seeking constructive feedback (<i>P</i> = .04; Workplace Civility Index). Marked BO was not evident overall on the Maslach Burnout Inventory; however, emotional exhaustion subscale mean (SD) scores improved from pre (19.4 [8.6]) to post (16 [6.3; <i>P</i> = .02]) and individual items illustrated decreased fatigue (<i>P</i> = .008), frustration (<i>P</i> = .04), and feeling "at the end of my rope" (<i>P</i> = .001). Postintervention participants noted increased receipt of recognition (<i>P</i> = .02; Areas of Work Life Survey), decreased feeling "bogged down" (<i>P</i> = .02), decreased affective stress (<i>P</i> = .04), and negative pre-occupations (<i>P</i> = .04; Professional Quality of Life Scale). Qualitative analysis revealed themes of improved confidence at work and enhanced feelings of trust and teamwork. <i>Firgun</i> is a tool that can potentially reduce BO and stress in interdisciplinary providers, facilitate teamwork, and promote positive work environments in clinical oncology and beyond.