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Pain Point Elimination Bringing Better Longitudinal Engagement and Satisfaction project: qualitative mixed-methods
Rebecca D Margolis1, Rachel Schwartz2,3,4,5, Hanna Van Pelt6
1Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Background:
Clinician well-being is essential for healthcare sustainability. Burnout and intention to leave remain prevalent in anaesthesiology, yet scalable, evidence-based systems-level interventions are limited. This study aimed to evaluate the impact of a pragmatic, clinician-driven departmental intervention designed to improve daily work experience. We hypothesised that this intervention would reduce burnout and improve related measurements of clinician well-being.
Methods:
This mixed-methods study assessed the Pain Point Elimination Bringing Better Longitudinal Engagement and Satisfaction (PEBBLES) project across two US paediatric anaesthesiology departments over a 14 month period. Participants engaged in facilitated small-group sessions identifying actionable workplace issues that were iteratively addressed with structured feedback. Impact was assessed using both process measures (post-intervention qualitative focus groups analysed with a combined deductive and inductive thematic approach) and outcome measures (pre- and post-intervention quantitative measures of clinician well-being) to provide a comprehensive evaluation. Burnout was defined as the mean of work exhaustion and interpersonal disengagement as measured by the professional fulfilment index, where higher scores indicate greater burnout.
Results:
Between April 2023 and June 2024, 75 clinicians participated. Within the matched participants subgroup, interpersonal disengagement decreased significantly at both 3 and 6 months compared with baseline. Overall burnout increased at 3 months but was not different from baseline by 6 months. Work exhaustion decreased significantly at 6 months. Other well-being metrics remained stable. At 12 months, 83.9% reported participation was worthwhile, and 87.1% would recommend the intervention. Qualitative analyses yielded three major themes: increased perceived agency in the local work environment, enhanced perceptions of being valued, and learned hopefulness that seemed to counter cynicism.
Conclusions:
The PEBBLES intervention was associated with improvements in disengagement and work exhaustion alongside meaningful experiential gains in agency, valuation, and hopefulness. These findings support the feasibility of low-cost, clinician-driven system interventions as practical components of organisational well-being and workforce retention strategies.
