Pain Point Elimination Bringing Better Longitudinal Engagement and Satisfaction project: qualitative mixed-methods study investigating a pragmatic intervention on physician well-being

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.