Web-based Implementation for the Science of Enhancing Resilience Study

Optimizing provider well-being is critical to the delivery of safe and high quality care to
the most vulnerable of patients: very preterm babies.

Major innovative objectives of this proposal include testing the Web-based Implementation for
the Science of Enhancing Resilience (WISER) program's effectiveness in enhancing resilience
among Neonatal Intensive Care Unit (NICU) health workers, evaluating its effect on unit
safety culture, and examining its effect on clinical outcomes in preterm infants. The WISER
program is an established but low-intensity yet engaging intervention, which integrates
education and behavior modification to boost provider well-being and resilience in order to
create an organizational environment which prevents patient harm.

Care for the more than 50,000 very low birth weight (VLBW; < 1500 gm) infants born annually
in the United States is challenging and expensive. Quality of care and outcomes vary widely.
Increasing technical demands and patient acuity have pushed burnout among health workers to
the breaking point. The few tested interventions that improve caregiver resilience lack
feasibility for widespread adoption. This study is designed to achieve the following aims:

1. Test the effectiveness of WISER in improving NICU health professional resilience;

2. Test the effectiveness of WISER in improving patient safety and organizational outcomes;

3. Test the sustainability of WISER; and

4. Describe the barriers and facilitators of the WISER program.

The investigators will test the efficacy of the WISER Program in the NICU setting using a
stepped-wedge mixed-methods randomized controlled trial (swRCT) at six tertiary care NICUs.
The results of this trial will also provide insights into the causal relations between health
worker resilience, the organizational environment, and clinical outcomes among infants born
VLBW.

Two blocks with 3 NICUs each will be randomly assigned to one of two intervention cohorts.
The WISER NICUs program consists of six 10-minute videos delivered over the course of a
six-month period. Following the end of the initial intervention, each NICU will receive
individualized feedback/refresher webinar at 12 months, and a final follow-up at 24 months.
The investigators will use measures of perception (surveys of health professional's
perceptions) and quantifiable measures (clinical measures) to assess the efficacy of the
intervention in different domains (resilience, organizational environment, and health).
Qualitative methods will provide further insights into facilitators and barriers of the
efficacy of WISER.

Inclusion Criteria:

1. Location: newborn center, i.e. the NICU or a step down unit

2. Provider:

1. Primary work place is the Newborn Center

2. Full time equivalent of >=40%

3. Date of hire more than 4 weeks prior to start of the intervention

3. Provider groups:

1. Attendings that identify your newborn center as their primary site of work (not
physicians from satellite NICUs)

2. NICU fellows

3. Nurse practitioners

4. Physician Assistants

5. Nurses, including nurse leadership (managers, educators)

6. Nurse Assistant

7. Respiratory care providers

8. Transport specialists if primarily neonatal transport team

9. Newborn Center Social workers

10. Newborn Center Clerks

11. Newborn Center Pharmacists

12. Newborn Center Physical, Occupational, Speech, and Developmental Therapists

13. Newborn Center Nutritionists

14. Newborn Center Lactation Consultants

Exclusion Criteria:

1. Location: Labor and delivery or the newborn nursery

2. Provider: Work is delivered mostly outside the newborn center (this may affect
providers who delivery services across the hospital such as residents, surgeons,
anesthesia, consultants, nutritionists, PT/OT (these are included if they are mostly
dedicated to the newborn center)

3. Float personnel

4. Does not speak english

5. Cannot operate computer or smart phone