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Brief ReportBrief Report

Improving Resilience and Combating Burnout in US Army Health Care Teams

Alyssa M. Coleman, Meredith M. Hartzell, Robert C. Oh, Tamara S. Funari, L. Omar Rivera and Jill A. Brown
The Journal of the American Board of Family Medicine May 2020, 33 (3) 440-445; DOI: https://doi.org/10.3122/jabfm.2020.03.190350
Alyssa M. Coleman
From Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Aberdeen Proving Ground, MD (AMC, JAB); General Dynamics Information Technology, Reston, VA (AMC); Former Oak Ridge Institute for Science and Education participant in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Belcamp, MD (MMH); Wozniak University, Box Elder, South Dakota (MMH); Madigan Army Medical Center, Joint Base Lewis-McChord, WA (RCO); United States Central Command, Tampa, FL (TSF); Former General Dynamics Information Technology contractor in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division (LOR).
MPH, CPH
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Meredith M. Hartzell
From Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Aberdeen Proving Ground, MD (AMC, JAB); General Dynamics Information Technology, Reston, VA (AMC); Former Oak Ridge Institute for Science and Education participant in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Belcamp, MD (MMH); Wozniak University, Box Elder, South Dakota (MMH); Madigan Army Medical Center, Joint Base Lewis-McChord, WA (RCO); United States Central Command, Tampa, FL (TSF); Former General Dynamics Information Technology contractor in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division (LOR).
PhD
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Robert C. Oh
From Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Aberdeen Proving Ground, MD (AMC, JAB); General Dynamics Information Technology, Reston, VA (AMC); Former Oak Ridge Institute for Science and Education participant in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Belcamp, MD (MMH); Wozniak University, Box Elder, South Dakota (MMH); Madigan Army Medical Center, Joint Base Lewis-McChord, WA (RCO); United States Central Command, Tampa, FL (TSF); Former General Dynamics Information Technology contractor in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division (LOR).
MD, MPH, CASQM
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Tamara S. Funari
From Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Aberdeen Proving Ground, MD (AMC, JAB); General Dynamics Information Technology, Reston, VA (AMC); Former Oak Ridge Institute for Science and Education participant in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Belcamp, MD (MMH); Wozniak University, Box Elder, South Dakota (MMH); Madigan Army Medical Center, Joint Base Lewis-McChord, WA (RCO); United States Central Command, Tampa, FL (TSF); Former General Dynamics Information Technology contractor in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division (LOR).
RN, MSN, MMAS, ACNS-BC
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L. Omar Rivera
From Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Aberdeen Proving Ground, MD (AMC, JAB); General Dynamics Information Technology, Reston, VA (AMC); Former Oak Ridge Institute for Science and Education participant in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Belcamp, MD (MMH); Wozniak University, Box Elder, South Dakota (MMH); Madigan Army Medical Center, Joint Base Lewis-McChord, WA (RCO); United States Central Command, Tampa, FL (TSF); Former General Dynamics Information Technology contractor in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division (LOR).
PhD
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Jill A. Brown
From Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Aberdeen Proving Ground, MD (AMC, JAB); General Dynamics Information Technology, Reston, VA (AMC); Former Oak Ridge Institute for Science and Education participant in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division, Belcamp, MD (MMH); Wozniak University, Box Elder, South Dakota (MMH); Madigan Army Medical Center, Joint Base Lewis-McChord, WA (RCO); United States Central Command, Tampa, FL (TSF); Former General Dynamics Information Technology contractor in support of Army Public Health Center, Health Promotion and Wellness Directorate, Public Health Assessment Division (LOR).
PhD
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    Figure 1.

    The elements of self-care.

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    Figure 2.

    Application of holistic health concepts in personal life word cloud.

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    Table 1.

    Demographic Variables*

    Variable (Valid N)n (%) of Health Care Team Members
    Sex (N = 334)
        Male105 (31)
        Female229 (69)
    Age in years (N = 335)
        22–3495 (28)
        35–44109 (33)
        45–5485 (25)
        >5543 (13)
    Ethnicity (N = 334)
        Asian/Pacific Islander31 (9)
        African American37 (11)
        Hispanic/Latino45 (13)
        White (non-Hispanic or Latino)200 (60)
        Other14 (4)
        Prefer not to answer7 (2)
    Years worked in current location (N = 333)
        Less than 1 year95 (29)
        1–3 years136 (41)
        4–7 years69 (21)
        8–11 years19 (6)
        12 years or more14 (4)
    Occupation categorized (N = 318)
        Provider119 (37)
        Nurse157 (49)
        Other occupation42 (13)
    • ↵* n = 374 at pre-course. Some health care team members declined to answer demographic questions; therefore, valid N varies for each variable.

    • View popup
    Table 2.

    Outcome Changes over Time (n = 186)

    ParameterPre-CourseTwo-Month Follow-upP value
    Burnout
        Emotional exhaustion
            n (% high)71 (38%)80 (43%)
        Depersonalization
            n (% high)57 (31%)56 (30%)
        At least 1 burnout symptom96 (52%)90 (48%)>0.05
    Job satisfaction>0.05
        Never0 (0%)1 (1%)
        Rarely2 (1%)3 (2%)
        Occasionally5 (3%)8 (4%)
        Sometimes28 (15%)25 (13%)
        Frequently36 (19%)37 (20%)
        Usually86 (46%)83 (45%)
        Always28 (15%)27 (15%)
    Satisfaction with PCMH<0.01
        Never6 (3%)4 (2%)
        Rarely10 (5%)11 (6%)
        Occasionally11 (6%)12 (7%)
        Sometimes66 (36%)38 (20%)
        Frequently24 (13%)32 (17%)
        Usually43 (23%)51 (27%)
        Always24 (13%)37 (20%)
    Self-efficacy
        Mean (SD)2.8 (0.7)3.2 (0.6)<0.01
    • PCMH, patient-centered medical home; SD, standard deviation.

    • View popup
    Table 3.

    Local Implementation of Move to Health Action Plan*

    Variablen (%) of Health Care Team MembersTotal Valid N
    Stage of action plan implementation187
        Not started (0% complete)16 (9%)
        Beginning implementation (1%–10% complete)65 (35%)
        Some implementation (11%–30% complete)66 (35%)
        About half implemented (31%–50% complete)16 (9%)
        Mostly implemented (51%–70% complete)15 (8%)
        Almost fully implemented (71%–99% complete)7 (4%)
        Fully implemented (100% complete)2 (1%)
    Changed patient interactions, n (% yes)141 (87%)163
    Received support from:
        The facility92 (47%)189
        Course facilitators97 (51%)187
    • ↵* n = 187 at follow-up. Some health care team members declined to answer questions; therefore, valid N varies for each variable.

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The Journal of the American Board of Family     Medicine: 33 (3)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 3
May/June 2020
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Improving Resilience and Combating Burnout in US Army Health Care Teams
Alyssa M. Coleman, Meredith M. Hartzell, Robert C. Oh, Tamara S. Funari, L. Omar Rivera, Jill A. Brown
The Journal of the American Board of Family Medicine May 2020, 33 (3) 440-445; DOI: 10.3122/jabfm.2020.03.190350

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Improving Resilience and Combating Burnout in US Army Health Care Teams
Alyssa M. Coleman, Meredith M. Hartzell, Robert C. Oh, Tamara S. Funari, L. Omar Rivera, Jill A. Brown
The Journal of the American Board of Family Medicine May 2020, 33 (3) 440-445; DOI: 10.3122/jabfm.2020.03.190350
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