# A quality improvement initiative to improve operating room well-being: the Microaffirmations in Perioperative Personnel Project (The MAPP Project)

## TL;DR

A project using small acts of recognition in operating rooms improved staff well-being and reduced burnout over six months.

## Contribution

The MAPP Project introduces microaffirmations as a scalable strategy to enhance workplace culture in healthcare.

## Key findings

- Burnout scores decreased significantly from 1.06 to 0.87 over six months.
- Perceived microaggressions and their impact declined during the intervention.
- Professional fulfillment scores increased slightly, though not statistically significant.

## Abstract

Burnout and lack of professional fulfilment are prevalent among perioperative personnel, often exacerbated by a culture that lacks positive reinforcement. Microaffirmations—small, intentional acts of recognition—may offer a scalable strategy to improve workplace culture and well-being. The primary objective was to evaluate the impact of a microaffirmation-based intervention, the Microaffirmations in Perioperative Personnel Project (MAPP Project), on professional fulfilment and burnout. The secondary objective was to evaluate changes in perceived and experienced microaggressions among perioperative staff.

A toolkit of microaffirmation examples was disseminated to perioperative members, and volunteer peer MAPP coaches modelled affirming behaviours. Surveys were administered at baseline before start of the intervention and at 3 and 6 months after the end of the intervention. The primary outcomes of professional fulfilment and burnout were measured using the validated Professional Fulfillment Index. Secondary outcomes including perceived and experienced microaggressions were assessed via a custom Microaggressions Impact Questionnaire.

A total of 388 responses were collected across the three time points. Mean fulfilment scores increased from 2.53 at baseline to 2.67 at 6 months (P=0.222), whereas burnout scores decreased from 1.06 to 0.87 (P=0.029). Perceived microaggressions and their reported impact also declined. Among 67 participants who completed all three surveys, trends were consistent but not statistically significant. Survey response rates were 63%, 40%, and 41% at each time point, respectively.

The MAPP Project was associated with improved fulfilment, reduced burnout, and decreased perceived microaggressions among perioperative staff. These findings suggest that microaffirmation-based interventions may be a feasible and effective strategy to enhance workplace culture in health care settings.