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Forty-five good things: a prospective pilot study of the Three Good Things well-being intervention in the USA for healthcare worker emotional exhaustion, depression, work–life balance and happiness
  1. J Bryan Sexton1,2,
  2. Kathryn C Adair1
  1. 1 Duke Center for Healthcare Safety and Quality, Duke University Health System, Durham, North Carolina, USA
  2. 2 Psychiatry, Duke University School of Medicine, Durham, North Carolina, USA
  1. Correspondence to Dr J Bryan Sexton; bryan.sexton{at}


Objectives High rates of healthcare worker (HCW) burn-out have led many to label it an ‘epidemic’ urgently requiring interventions. This prospective pilot study examined the efficacy, feasibility and evaluation of the ‘Three Good Things’ (3GT) intervention for HCWs, and added burn-out and work–life balance to the set of well-being metrics.

Methods 228 HCWs participated in a prospective, repeated measures study of a web-based 15-day long 3GT intervention. Assessments were collected at baseline and 1, 6 and 12-month post-intervention. The primary measure of efficacy was a derivative of the emotional exhaustion subscale of the Maslach Burnout Inventory. The secondary measures were validated instruments assessing depression symptoms, subjective happiness, and work–life balance. Paired samples t-tests and Cohen’s d effect sizes for correlated samples were used to examine the efficacy of the intervention.

Results 3GT participants exhibited significant improvements from baseline in emotional exhaustion, depression symptoms and happiness at 1 month, 6 months and 12 months, and in work–life balance at 1 month and 6 months (effect sizes 0.16–0.52). Exploratory subgroup analyses of participants meeting ‘concerning’ criteria at baseline revealed even larger effects at all assessment points (0.55–1.57). Attrition rates were similar to prior 3GT interventions.

Conclusion 3GT appears a promising low-cost and brief intervention for improving HCW well-being.

Ethics and dissemination This study is approved by the Institutional Review Board of Duke University Health System (Pro00063703). All participants are required to give their informed consent prior to any study procedure.

  • burnout
  • depression
  • work-life balance
  • happiness
  • three good things
  • burnout intervention

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  • Contributors JBS developed the procedure, collected the data, contributed to analyses and cowrote the paper. KCA contributed to analyses and cowrote the paper.

  • Funding This work was supported by NIH grant number R01 HD084679-01.

  • Competing interests None declared.

  • Ethics approval This study was approved by our institutional review board (Study Protocol ID: Pro00063703).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The authors will share survey data from the study on reasonable request to the first author.

  • Patient consent for publication Not required.