Participants and Context

The intervention was carried out at a major teaching hospital in a European capital, with the active participation of its Occupational Health Department. This is a large central hospital. Considering the dimension of the hospital and after discussing with the Occupational Health Department director, an inpatient clinical department was chosen as the target population for the action research. This particular service was chosen for three main sets of reasons. First, it has one of the highest occupancy rate of the hospital and its inpatients are mostly elderly with multiple pathologies, and a high mortality rate, which creates a demanding environment for health professionals, therefore, putting them at a higher risk for stress-related issues. Some of the patients, because of their age and/or severity of their condition, have to stay at the hospital for repeated periods of time, which leads to the development of stronger ties between the patients and their families and the health professionals, which subsequently leads to a greater emotional weight of negative outcomes. Second, the specific sector chosen was also mentioned by the Chief Nurse of the Hospital as a service with a history of interpersonal friction among its professionals, hence reflecting yet another risk factor for burnout. Third, because of the multiple pathologies of its inpatients, this is a service which needs to be in permanent contact with other specialties within the Hospital. This creates interdependencies and competition for limited resources (professionals, equipment, and diagnostic resources), which many times results in increased conflict levels between this service and others.

The inpatient clinical department has several sectors, all coordinated by a Senior Specialist that is also Full Professor at the University. Within the department, there are overall more than 100 of workers including doctors, nurses, ancilliary personnel, administrative assistants, a psychologist, social assistants, and a nutritional technician. Overall, at the time of the intervention, the department had 81 beds, an average of 84 patients per day, and an average occupancy rate of 97.3%. In average, the internment of the patients’ lasted for 6.6 days and the department reported a high mortality rate of 8.5%. Our intervention was developed in one of those several sectors (sector A).

Sector A has 21 beds and is divided in four teams, each coordinated by a senior specialist, responsible for some younger residents. With an occupancy rate averaging over 100%, it is usual to have patients stay in stretchers in the corridor, due to a lack of available beds, up to a maximum of 10 stretchers. Overall, the sector comprises 13 doctors (including the head of the sector, doctors, and residents), 17 nurses, and 10 health assistants. Being a teaching hospital with a strong link to the university, the focus of physicians is simultaneously on providing care for the patients but also on training younger professionals and developing research. Each of the four teams was also composed of nurses, supervised by the Chief Nurse. The nurses from this sector were mostly young and the group presented a high turnover rate.