Brief mindfulness-based intervention to improve clinician mindful behaviours and well-being at two US hospitals: a randomised controlled, mixed methods trial

Embedding mindfulness practice into routine hand hygiene moments improved clinicians' mindful awareness but did not significantly improve well-being. In a randomized controlled trial at two Veterans Affairs academic medical centers, 343 physicians and nurses who engaged with the intervention showed significant increases in mindfulness scores at one month and seven months compared to controls. Well-being scores showed only modest, non-significant trends toward reduced distress. Qualitative findings indicated high acceptability and perceived benefits such as enhanced focus and calm, though time pressures and cultural barriers hindered sustained practice. Microinterventions that integrate mindfulness into clinical workflows may offer scalable approaches to support clinician presence and mental resilience.

Study at a glance

Abstract

BACKGROUND: Clinician burnout is prevalent and associated with poorer patient safety outcomes. Although mindfulness-based interventions can improve clinician resilience, most are time-intensive and not easily embedded into clinical workflows. We thus evaluated a brief mindfulness-based intervention designed to enhance mindful awareness and clinician well-being among physicians and nurses. SETTING: Two Veterans Affairs academic medical centres in (Ann Arbor, MI, USA) and (Houston, TX, USA). DESIGN: A randomised controlled, mixed methods study was conducted. Physicians and nurses were randomised to intervention or control at the team/unit level. Quantitative data were collected at baseline, 1 month and 7 months; qualitative interviews and group discussions explored acceptability and perceived impact. PARTICIPANTS: A total of 456 clinicians were randomised and 343 consented to participate (170 intervention and 173 control). Participants included attending and resident physicians and registered nurses working on inpatient general medicine wards. INTERVENTION: The intervention integrated mindfulness practice into routine hand hygiene moments. Components included self-directed online training and a brief facilitated group discussion led by site mindfulness champions. Control participants received no intervention. MAIN OUTCOME MEASURES: Primary outcomes were self-reported mindfulness (Five Facet Mindfulness Questionnaire (FFMQ)-possible range 1-5, higher scores better) and well-being (Well-Being Index (WBI)-possible range -2 to 9, lower scores better). RESULTS: Clinicians highly engaged (completed modules and discussion) with the intervention showed significant increases in mindfulness (FFMQ) at 1 month (β=0.23; p< 0.001) and 7 months (β=0.23; p<0.001) versus controls. Well-being (WBI) improved modestly over time, with non-significant trends towards reduced distress in the intervention group. One hundred forty-eight clinicians participated in a group discussion and 16 in a semistructured interview. Qualitative findings indicated high acceptability and perceived benefits, including enhanced focus and calm, but identified time pressures and cultural barriers to sustained practice. CONCLUSIONS: Embedding mindfulness into routine behaviours such as hand hygiene is feasible and improved clinicians' mindful awareness, although it did not significantly improve well-being. Microinterventions that integrate mindfulness into clinical workflows may offer scalable approaches to support clinician presence, focus and mental resilience. TRIAL REGISTRATION NUMBER: NCT05261282.