The primary intervention asks staff to meet with others in the same role and to consider
the following questions:
The Ask: When staff are busy or overwhelmed by work, what tasks can others do
(people in each of these groups) to help make your job better or easier?
The Offer: When people in other groups are busy or overwhelmed, what tasks can your
group do to help make staff jobs better or easier?
After this information is collected, at an in-person meeting of all staff and faculty,
the study team will divide everyone into groups by clinic and then by the four roles. The
study team will hand out the idea list and ask participants to review the list, discuss
whether there are new or additional ideas which should be added, and then prioritize
staffs top five "asks" and top five "offers" for staff role.
Negotiation of asks/offers: The study team will hold 1-4 subsequent brief meetings at
each clinic where staff are again sub-divided into four groups by role. Each group will
review the asks from people in other roles and decide whether these are actions that
staff can help with or whether there are barriers. The clinic champions will work with
the groups to address barriers (which could include lack of information, lack of
training, disagreements about need, etc). The ultimate goal will be for groups to come to
consensus agreement on at least three ways staff can assist people in other roles. In
some clinics this may be straightforward and require just one meeting. In other clinics,
it may take several meetings.
Implementation: Once the asks and offers are finalized, it will be up to the physician
champions to help promote these agreements at the clinic, follow up with staff and with
the nursing, medical assistants, and clerical champions to ensure that people are
following thru with commitments to help, and trouble shoot problems that come up.
Coordination with Leadership: a department leader will serve as the liaison between the
clinic champions and members of leadership that oversee clinical functions. This leader
meets regularly with these leadership groups and will help troubleshoot challenges to
implementing the asks and offers which need higher-level approval or input.
Ongoing process improvement: Over time, the study team will send up to four brief,
anonymous surveys to all staff asking whether the staff are indeed doing the things that
staff committed to do and whether other role groups are following thru on the
commitments. This provides an opportunity for people to identify and report problems.
This data will be anonymously fed back to the physician champion that is tasked to
troubleshoot and address the problems identified, working with the liaison as
appropriate. This will likely require continuous process improvement and revisiting to
ensure success.
Evaluation: The study team proposes to measure burnout and team centeredness using
anonymous on-line surveys.
Brief surveys: At several points during the year, the investigators will send out brief
surveys. These ask for the clinic and job role and then ask participant to rate how much
effort they have made to help others, how much effort others have made to help them, and
if there are open-ended comment about what is or is not working. This information will be
used to improve the intervention at each clinic.
Qualitative interviews regarding clinic culture will also be conducted with the project
champions at each clinic who are helping to implement the project.
This study is Institutional review board (IRB) exempt and will have a waiver of
documentation of informed consent with survey completion representing consent.
