Positive communication for decreasing burnout in intensive-care-unit staff: a cluster-randomized trial

Abstract

Purpose: Occupational burnout is common among intensive-care-unit (ICU) staff and adversely affects staff well-being and patient care. We hypothesized that a multicomponent intervention based on organizational support and workplace climate improvement would reduce burnout. Methods: The 1:1 cluster-randomized Hello trial involved 370 ICUs from sixty countries allocated to either the intervention or usual care. The four-week intervention designed to promote a positive workplace culture and within-team support used posters, email nudges, greetings during morning meetings, role modeling, and positive messages in boxes and on noticeboards. The primary endpoint was burnout prevalence, measured using the Maslach Burnout Inventory. Secondary outcomes included MBI subscale scores, well-being, job satisfaction, ethical climate, intention to leave, work safety, and professional conflicts. Results: Before the intervention, burnout prevalence was 59.4% (95% CI, 58.6–60.5), with no difference between arms. After the intervention, 4966 intervention-arm and 4602 control-arm healthcare professionals completed the MBI. Burnout prevalence was significantly lower in the intervention arm relative to controls (52.2% vs. 63.3%; adjusted odds ratio, 0.56; 95%CI 0.46–0.68; P < 0.001). Among MBI sub-scales scores, emotional exhaustion and depersonalization were lower, and personal accomplishment was higher in the intervention arm. Staff in the intervention arm reported better job satisfaction, workplace safety, ethical climate, and patient- and family-centered care; they were less often considering a job change. Conclusions: The Hello intervention reduced burnout and improved workplace culture among ICU staff. Given the pragmatic design, the intervention tested may have broad applicability. Trial registration: The trial was registered on ClinicalTrials.gov on June 18, 2024 (NCT06453616).