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A pilot study of an emotional intelligence training intervention for a paediatric team
  1. Ellen Bamberger1,
  2. Jacob Genizi1,
  3. Nogah Kerem1,
  4. Ayalla Reuven-Lalung2,
  5. Niva Dolev2,
  6. Isaac Srugo1,
  7. Amnon Rofe3
  1. 1Pediatric Department, Bnai- Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
  2. 2EQ il, Haifa, Israel
  3. 3Bnai- Zion Medical Center, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Isreal
  1. Correspondence to Dr Jacob Genizi, Pediatrics Department, Bnai Zion Medical Center, Haifa 21048, Israel; genizij{at}gmail.com

Abstract

Objective Emotional intelligence (EI) is the individual's ability to perceive, understand and manage emotion and to understand and relate effectively to others. We examined the degree to which EI training may be associated with a change in EI among different medical personnel and patient satisfaction.

Design, setting and participants The EI of 17 physicians and 10 nurses in paediatric ward was prospectively evaluated with Bar-On's EI at baseline and after 18 months. 11 physicians who did not undergo the intervention served as controls.

Interventions The intervention consisted of a training programme comprising group discussions, simulations and case studies.

Main outcomes and measures Pre-emotional quotient inventory (EQ-i) and post-EQ-i scores and patient satisfaction surveys of nurse and physicians pre-intervention and post-intervention were analysed.

Results The mean overall EI score of the study sample rose from 99.0±9.6 (both plus and minus mathematical operations standing for SD) at baseline to 105.4±10 (p<0.000) after 18 months, with the most robust increase (nearly 6%; p<0.003) manifested among physicians. In contrast, the control group's EI scores did not change over this period. Within the intervention group, physicians displayed a statistically significant increase in three of the five EI dimensions, compared with only one of the five EI dimensions for nurses. Patient satisfaction scores relating to physician care rose from 4.4 pre-intervention to 4.7 post-intervention (p=0.03).

Conclusion An EI intervention led to an overall increase in EI scores, with a significant improvement in patient satisfaction. These findings suggest important potential benefits for both staff and their patients.

  • EQ
  • Training
  • Pediatric
  • patient satisfaction

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What is already known on this topic?

  • Emotional intelligence (EI) is the individual's ability to perceive, understand and manage emotion and to understand and relate effectively to others.

  • Emotional intelligence is associated with reduced occupational stress, enhanced interpersonal relations, higher quality leadership and better performance at both the individual and the team levels.

  • To date the vast majority of EI studies in the medical field have shown that Emotional intelligence is associated with reduced occupational stress, enhanced interpersonal relations, higher quality leadership and better performance at both the individual and the team levels.

What this study adds?

  • Emotional intelligence training offers important benefits to both medical professionals and patients.

  • Emotional intelligence may be enhanced with respect to residents to the extent that these professionals are given the opportunity and motivation to apply what they learn.

Introduction

Emotional intelligence (EI) is the individual’s ability to perceive, understand and manage emotion and to understand and relate effectively to others. EI has also been defined as “a cross-section of interrelated emotional and social competencies, skills and facilitators that determine how effectively we understand and express ourselves, understand others and relate with them and cope with daily demands”.1 ,2 EI has been validated as a distinct form of intelligence whose component abilities and skills ‘hang together’3 to capture an individual's ability to perceive, understand and manage emotion. As a construct, EI has been found to explain unique variance in individual well-being4 ,5 and the quality of social interactions.6 In the workplace, EI is associated with reduced occupational stress,7 ,8 enhanced interpersonal relations,9–11 higher quality leadership12 ,13 and better performance at both the individual14–16 and the team17–19 levels. These findings suggest that higher levels of EI among medical staff may have beneficial implications for both medical staff and their patients.

However, research on EI in medical settings is limited, with the vast majority of studies in this context examining the predictive validity of EI in selecting medical students and residents20 ,21 and the protective role of EI in buffering medical staff from occupational stress and burnout.8 ,16 ,22 Wagner et al23 found a limited correlation between physician EI and patient satisfaction and Weng et al24 found a relationship between physician EI and patient trust. Yet with the exception of those studies, little is known regarding performance-related implications of EI among medical staff. Moreover, while the findings of Wagner et al and Weng et al noted above23 ,24 imply a positive association between EI among medical staff and work-based outcomes, this relationship cannot be taken for granted. For instance, some EI scholars suggest that occupations involving intensive human interaction, such as medicine, may require higher levels of EI than others in order to manifest a performance improvement.25 ,26 In addition, EI's influence on performance-related outcomes may be contingent on cognitive load, with smaller effects manifesting when individuals are cognitively fatigued or forced to divide their attention.27

Furthermore, even assuming that EI is indeed associated with enhanced performance among medical professionals, questions remain as to the degree to which EI is malleable and can be developed and sustained on the basis of a training intervention. In this area, too, the existing literature leaves many open questions. On the one hand, research in developmental, organisational and neuropsychology suggests that changes in the competencies which comprise EI can occur in adulthood.4 ,28–30 On the other hand, to the extent that EI is based more on automatic (as opposed to deliberate or conscious) mental processes,31 EI may be less amenable to enhancement through training.27 Training may also have limited performance-related effects if those receiving the training lack the motivation to implement newly learned skills. In terms of empirical research, while several studies outside the medical context document an improvement in EI among employees following EI training,32 ,33 only one of these34 used a control group and demonstrated evidence of a sustained improvement. Moreover, to date, no study has examined the efficacy of EI training in medical settings. Accordingly, little is known as to whether EI training can effect a shift in EI among medical personnel, no less in outcomes that might be associated with such a shift, such as patient satisfaction.

Against this background, the current study sought to examine the degree to which EI training may be associated with a change in EI among medical personnel. Additionally, we test the degree to which EI training is associated with enhanced patient satisfaction and the degree to which differences in pre-training and post-training levels of EI, staff situational affect and patient satisfaction may differ across different medical personnel sectors (nurses and physicians).

Method

Sample and study design

Data were collected at two points in time, with time 2 data collected 18 months after time 1 baseline data (ie, immediately following the 18-month intervention). A total of 22 physicians (nine residents and 13 senior doctors) and 15 nurses employed in the department of paediatrics of a large metropolitan teaching hospital in Northern Israel were assigned to the intervention condition at time 1. All of the resident and senior physicians present in the department during time 1 participated in the study; 15 of the 27 nurses were invited by the charge nurse on the basis on their willingness to commit to the process. Due to natural attrition, only 27 of these original 36 participants (seven residents, 10 senior doctors and 10 nurses) advanced/participated at time 2. The control group comprised 16 physicians with a similar ratio of residents to senior doctors (10 senior doctors and six residents) who were recruited from the variety of medical and surgical subspecialists. Similar, to the intervention group, at time 2, there was a slight decrease in participation (seven senior doctors and four residents).

The study used a prospective (pre-training/post-training) experimental design. The study was approved by the local Institutional Review Board committee and written informed consent was obtained from all participants.

Procedure

All participants completed a baseline EI questionnaire at the end of April 2012, along with a state affect instrument. At the same time, parents of patients in the paediatrics department were asked to complete a patient satisfaction survey. One week later, all study participants met individually with an EI specialist to review their score on the EI questionnaire, after which those assigned to the intervention group began an 18-month EI training programme (described below). On conclusion of the training, parents of paediatric patients were again surveyed regarding patient satisfaction and post-hoc measures of EI were taken in both the control and the intervention groups.

The training programme comprised 10 sessions that met every month for 90–120 min and was divided into two steps. The initial sessions consisted of the core topics of EI. During the first four sessions, an EI specialist outlined the meaning of EI, its centrality to patient-focused medicine and its impact on the quality of medical care. In the following sessions, which were tailored to the departmental needs, the intervention group members participated in role plays and simulations, small group discussions and case study analyses and were responsible for preparing and then making presentations on selected EI topics, including care-provider stress, burnout and well-being; intergenerational relationships; managing patient relations; effective communication and relaying ‘difficult’ information (eg, death, malignancy or poor prognosis); effective listening skills and acknowledging medical errors. For each topic, small group discussions were held following the staff member presentation, the aim of which was to allow each participant to relate the topic to his or her own experience as a medical professional.

Measures

Bar-On's1 emotional quotient inventory (EQ-i) was used to measure study participants' EI. The EQ-i is a self-report measure consisting of 133 items covering what Bar-On describes as the five main dimension of EI, namely intrapersonal EI, interpersonal EI, adaptability, stress management and general mood (the five composite scales and their constituent factors are shown in table 1), and yields an overall EQ score.

Table 1

Pre- and post-training EQ-i scores by job type

The EQ-i is a textual response format ranging from ‘very seldom or not true of me’ (1) to ‘very often true of me or true of me’ (5) and takes approximately 30 min to complete and is appropriate for individuals aged ≥17 years. In brief, the EQ-i contains 133 items in the form of short sentences and employs a 5-point response scale with a list of the inventory’s items. The EQ-i is suitable for individuals aged ≥17 years.

Pérez et al35 report an average α of 0.85 for the measure as a whole and, in the current study, Cronbach's α for the summary scale encompassing all five EI dimensions was 0.91 prior to the intervention and 0.89 when assessed post-training. Patient satisfaction was measured using a 15-item scale drawn from the three hospital-based patient satisfaction instruments examined by Cohen et al.36 Patients completed two versions of this questionnaire, one focusing on doctors and the other on nurses (sample item: “To what extent are you satisfied with the team of doctors/nurses that took care of you?”). Across all four patient satisfaction instruments (ie, pre-training and post-training measures of satisfaction with (a) doctors and (b) nurses), Cronbach's α was >0.90.

Data analysis

Differences between staff-type pre-intervention and post-intervention were examined with the Kruskal-Wallis test. Statistically significant staff-type differences were then explored using the Mann-Whitney U test with Bonferroni-type correction for multiple tests. EI shifts among individual participants were estimated on the basis of the relative change in EI between the control and the intervention groups. Differences between pre-training and post-training scores for both the staff overall and for specific groups of staff (ie, nurses, residents and senior physicians) were examined with the non-parametric paired Wilcoxon Z test. The Kruskal-Wallis test was used to assess whether pre-training and post-training shifts in EI were significantly different between the staff types. To assess changes in patient satisfaction, item-specific pre-intervention and post-intervention scores were compared using the Mann-Whitney U test with Bonferroni-type adjustment for multiple tests. For all analyses, non-parametric tests were chosen to account for the relatively small sample size and the non-normal distribution of the scores. Overall significance was set at 0.05. To account for multiple testing, significance was set to 0.01 for testing differences in the five EI areas. Statistical analysis was performed using SPSS software (V.21; SPSS, Chicago, Illinois, USA).

Results

Intervention group findings

Pre-training and post-training mean group EQ-i scores (including the five composite scales) for those in the intervention and control groups are presented in table 1. For the intervention group, the mean overall pre-training score was slightly below the measure's standard mean value of 100 (99.0±9.6; ±stands for SD), as were the mean pre-training scores for two of the five composite scales: intrapersonal (98.1±11.5) and adaptability (97.1±9.1). The pre-training scores for the other three composite scales were slightly above the mean value: stress management (100.4±12.0), general mood (100.6±9.2) and interpersonal (102.6±9.2). A group-level analysis shows that, in pre-training, there was a statically significant difference in overall EI between the doctors, who scored 103, and the nurses, who scored only 92.1 (p<0.02).

Subsequent to the training, the mean overall EI score for those in the intervention group rose above the measure's standard mean value of 100 (105.4±10) and all except the interpersonal scores were statistically significant. A group-level analysis reveals a statically significant difference between the doctors and nurses in overall EI post-training as well, with scores of 108.7 (±7.5) and 99.9 (±11.7), respectively (p<0.025).

Magnitude of the shift in EI: intervention group

Pre-intervention to post-intervention shifts in both overall and dimension-specific EI scores are presented in table 1 and figure 1. The results in the table indicate a statistically significant shift in both overall and dimension-specific EI scores from pre-intervention to post-intervention (p<0.001). By staff type, the overall EI score rose significantly for the doctors (p<0.003), but only marginally for the nurses (p=0.114). A dimension-specific analysis indicates that the doctors showed a statistically significant increase in all scores except the interpersonal scale and general mood, while the nurses experienced a statistically significant increase only in stress management (see table 1).

Figure 1

Graph showing the comparison of investigation group emotional intelligence composite scale scores before and after the intervention. * indicates the statistically significant results. EQ, emotional quotient.

Comparative shift in EI: intervention versus control

Initial EI scores were similar in the control and intervention groups. After the training, the intervention group scored significantly higher in the intrapersonal, stress management and adaptability scales than did those in the control group. In the control group, there was no significant difference in any of the scores between the first and second administration of the EI instrument.

Shift in patient satisfaction

We measured patient satisfaction separately for the nurses and doctors (table 2). While overall patient satisfaction with both groups of staff improved (for nurses, from 4.5 to 4.6; for doctors, from 4.4 to 4.7), the improvement was statistically significant only for the doctors (p=0.03) (figure 2). Moreover, an item-specific analysis reveals no single patient satisfaction parameter with a statistically significant improvement for nurses, whereas patient satisfaction with doctors improved significantly (p<0.05) across nearly two-thirds of the 15 satisfaction variables assessed.

Table 2

Comparisons of pre/post patient satisfaction

Figure 2

Graph showing the dimension-specific patient satisfaction with physician performance before (blue) and after (red) emotional intelligence training.

Discussion

Our findings show that an 18-month EI training intervention was associated with general improvement in the overall and dimension-specific EI of the participating medical staff compared with controls who did not undergo the training. Among those participating in the training intervention, the improvement in EI was more robust among physicians than nurses. Additionally, the intervention was associated with a significant increase in patient satisfaction with physicians (although not with nurses).

Several factors may account for the more substantial increase in EI among physicians as compared with nurses. One factor likely has to do with differences in job demands and expectations. While the training provided insights into skills, competencies and approaches that individuals may use to enhance their EI, it did little to affect the structural factors which determine the opportunities staff members may have to actually apply these newly learned skills and approaches or their motivation to do so. Whereas physicians may have had some opportunity to experiment with applying the approaches learnt in the training, it may be that nursing staff lacked the time and/or motivation to experiment with alternative approaches to meeting their job demands. Another factor that may help explain the more modest improvement in EI among nurses may be differences between the two groups in their overall level of burnout. Prior research has shown that nurses tend to experience higher levels of burnout than physicians, perhaps due to greater effort-reward imbalance.37–39 Higher levels of emotional exhaustion, depersonalisation and cynicism—core dimensions of burnout—among nurses may have attenuated the impact of EI training in this group.

Our findings show a nearly 10% statistically significant improvement in patient satisfaction with physician care from baseline to the post-intervention measure—an improvement that can likely be attributed to the effects of the EI training among the senior physicians. In contrast, given only the slight improvement in the nursing EI scores as discussed above, it is not entirely unexpected that their patient satisfaction scores did not differ between the pre-intervention and post-intervention period.

The finding that the EI intervention was associated with a significant improvement in nearly two-thirds of the items assessing patient satisfaction with physicians is noteworthy. The magnitude of this improvement was significant, in contrast to the null effects of a patient discharge intervention reported by Manit et al.40 The different outcomes may be attributed to the duration of the intervention (a single passive intervention versus a long-standing engagement of the paediatric staff). Finally, while it is difficult to place a value on patient satisfaction, the magnitude of improvement in patient satisfaction noted above suggests that EI interventions may offer substantial economic utility, particularly to the extent that enhanced satisfaction is associated with reduced risk of malpractice suits,41 better post-discharge compliance by patients42 and enhanced hospital competitiveness.43

Study limitations

While we observed significant improvements in EI in the intervention group compared with the control condition, the study was conducted in a hospital with a single paediatric unit, making it impossible to collect data from a precisely paired control sample. Instead, the control group comprised senior doctors and residents from a variety of other medical departments whose pre-test EI scores were similar to those of the intervention group without included nurses. Moreover, as any activity or gathering in the workplace might improve intrapersonal and interpersonal relations, the control group should have also undergone periodic meetings. Further, our relatively small sample size in the intervention group heightens the likelihood of attenuation of variance. This lack of statistical power may underlie some of the marginal or non-significant effects, thus raising the risk of type II errors. To address these limitations, we hope in the near future to undertake a multicentre study involving more healthcare worker participants.

Implications

Our results suggest that EI training can offer important benefits to both medical professionals and the patients they care for. With respect to physicians, it is likely that the benefits of such training may be enhanced to the extent that these professionals are given the opportunity and motivation to apply what they learn. This may require structural shifts in the way the physician workload is allocated, as well as shifts in hospital and departmental policies and practices.

With respect to nurses, our findings suggest that more immediate implications of EI training are likely to be limited to nurses' own emotional well-being (as indicated by the significant improvement in the stress management dimension of EI for this group). However, given the toll that stress and burnout take on nurse retention44–46 and the fact that staff retention is positively associated with patient care,47 ,48 it is likely that EI training—by enhancing nurses' well-being—will ultimately have long-term benefits for patient care as well.

References

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Footnotes

  • EB and JG have equally contributed.

  • Contributors EB: interpretation of data for the work and drafting the work. JG, AR-L and IS: substantial contributions to the conception or design of the work and drafting the work. NK: acquisition, analysis and revising the work. ND: substantial contributions to the conception or design of the work and revising the work. AR: interpretation of data for the work and revising the work. All authors have approved the final version of the work to be published and have agreed to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Bnai Zion Institutional Review Board.

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