Fostering Resilience: The Role of Team Dynamics in Mitigating Burnout and Enhancing Well-Being in the Neurocritical Care Unit.

Abstract

Staff in neurocritical care units (NCCUs) are particularly vulnerable to burnout, negatively affecting team dynamics and education. We evaluated the impact of several stakeholder-led, resilience-building interventions on staff burnout and team dynamics in the NCCU. Participatory, stakeholder-led, quality improvement intervention-based project with serial cross-sectional surveys. NCCUs at the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, within the Johns Hopkins Medicine NCCU Division. Multidisciplinary NCCU members, including fellows, attending physicians, advanced practice providers (APPs), pharmacists, nurses, and ancillary staff, were eligible. Participation was voluntary and anonymous. Between October 2023 and September 2024, a multidisciplinary working group identified key drivers of burnout and impaired team dynamics and implemented interventions targeting individual and organizational resilience. Strategies included a shared vision statement, a zero-tolerance pledge for unprofessional behavior, enhanced leadership communication, recognition mechanisms, team-building professional development sessions, social events, workflow revisions, and restructuring of educational programs. Surveys were conducted at baseline, 6 months, 1 year, and 2 years, using the Maslach Burnout Inventory and Team Dynamics Surveys. The average response rate was 68% (53% nurses, 20% faculty, 9% fellows, and 18% APPs/pharmacists/ancillary staff). Over 2 years, the median (interquartile range) total emotional exhaustion score improved from 25 (19-30) to 9 (9-18), depersonalization score from 9 (7-13) to 5 (5-10), and the personal accomplishment score from 29 (26-32) to 40 (32-40; all p < 0.001). Sustained improvement was also noted in all domains of the Team Dynamics Survey (all p < 0.001). During this timeframe, the mean fellow in-service examination score also increased between April 2024 (pre-intervention) and April 2025 (+14%; p < 0.001), 1-year post-intervention. A participatory, stakeholder-driven quality improvement initiative with multipronged interventions targeting resilience and team dynamics reduced burnout, improved team well-being, and was temporally associated with improved trainee educational performance in high-acuity NCCUs. This framework is feasible, sustainable, and adaptable to other ICU environments.