Fostering Resilience: The Role of Team Dynamics in Mitigating Burnout and Enhancing Well-Being in the Neurocritical Care Unit

OBJECTIVES: Staff in neurocritical care units (NCCUs) are particularly vulnerable to burnout, negatively affecting team dynamics and education. We evaluated the impact of several stakeholder-led, resilience-building interventions on staff burnout and team dynamics in the NCCU. DESIGN: Participatory, stakeholder-led, quality improvement intervention-based project with serial cross-sectional surveys. SETTING: NCCUs at the Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, within the Johns Hopkins Medicine NCCU Division. SUBJECTS: Multidisciplinary NCCU members, including fellows, attending physicians, advanced practice providers (APPs), pharmacists, nurses, and ancillary staff, were eligible. Participation was voluntary and anonymous. INTERVENTIONS: Between October 2023 and September 2024, a multidisciplinary working group identified key drivers of burnout and impaired team dynamics and implemented interventions targeting individual and organizational resilience. Strategies included a shared vision statement, a zero-tolerance pledge for unprofessional behavior, enhanced leadership communication, recognition mechanisms, team-building professional development sessions, social events, workflow revisions, and restructuring of educational programs. MEASUREMENTS AND MAIN RESULTS: Surveys were conducted at baseline, 6 months, 1 year, and 2 years, using the Maslach Burnout Inventory and Team Dynamics Surveys. The average response rate was 68% (53% nurses, 20% faculty, 9% fellows, and 18% APPs/pharmacists/ancillary staff). Over 2 years, the median (interquartile range) total emotional exhaustion score improved from 25 (19-30) to 9 (9-18), depersonalization score from 9 (7-13) to 5 (5-10), and the personal accomplishment score from 29 (26-32) to 40 (32-40; all p < 0.001). Sustained improvement was also noted in all domains of the Team Dynamics Survey (all p < 0.001). During this timeframe, the mean fellow in-service examination score also increased between April 2024 (pre-intervention) and April 2025 (+14%; p < 0.001), 1-year post-intervention. CONCLUSIONS: A participatory, stakeholder-driven quality improvement initiative with multipronged interventions targeting resilience and team dynamics reduced burnout, improved team well-being, and was temporally associated with improved trainee educational performance in high-acuity NCCUs. This framework is feasible, sustainable, and adaptable to other ICU environments.