Identifying Factors that Contribute to Joy and Gratitude for Emergency Medicine Health Care Providers Amidst the COVID-19 Pandemic

Study Objectives: During COVID-19, emergency medicine (EM) providers have labored to protect the health of their patients, often at the expense of their own well-being. Increased demands imposed on providers without intentional efforts to evaluate and improve wellness can lead to burnout, attrition, and compromise patient care. Practices that promote mindfulness, reflection and gratitude have been shown to reduce burnout. The Institute for Healthcare Improvement (IHI) Framework for Improving Joy In Work provides an approach to restore joy and engagement by first identifying elements that "matter most” to health care workers. The objective of this study was to identify common themes and associations that contribute to EM provider and staff (1) joy in work, (2) gratitude, and (3) personal wellness. Methods: A descriptive study used an electronic survey tool with open-ended questions adapted from the IHI framework to assess what matters most. Q1: What brings you joy in your work? Q2: Thinking back to what matters most, what are you grateful for? Q3: What do you do to maintain your personal wellness? In Nov. 2020, email listservs were used to recruit a voluntary sample of emergency physicians, advanced practice providers APPs, residents, fellows, nurses and staff from 10 academic and community hospitals. Data were managed in Qualtrics and Excel. Qualitative analysis used inductive thematic coding by two authors independently, with verification by a third. Information redundancy signaled saturation for common themes. Pivot tables examined themes across demographics. Associations were analyzed using chi-square, Fisher’s exact test, and odds rations (95% CI). Results: Of 254 respondents, 63% were female and 89% identified as White. Roles were 32% physicians, 8% APPs, 16% residents/fellows, and 44% nurses/staff. Response rates were 39-54% for providers. Common themes for joy in work were patient care (47%) and teamwork/camaraderie (43%), followed by feeling valued/appreciated (13%), making a difference (13%), and teaching/mentoring (9%). EM providers at academic sites were more likely to find joy in teaching/mentoring than those in the community (p=0.01;OR 10.5, 95% CI 1.3-82.6). For gratitude, themes were teamwork/camaraderie (13%), family (12%), health (7%), and supportive work environment (7%). Themes for maintaining personal wellness were physical exercise (46%), time with family and friends (32%), hobbies (15%), and self-care (13%). Conclusions: Results of this study reveal common themes for EM providers and staff surrounding joy, gratitude, and wellness. By identifying elements that matter most, systems can take next steps in rejuvenating their health care team. Implications from our findings suggest that practices and future research to remove barriers and encourage meaningful provider-patient interactions, team camaraderie, teaching/mentoring, physical activity, and time with family/friends could increase joy and fulfillment for frontline health care workers.