caring for your care team paper-2016

REDBRICK HEALTH

Caring for your Care TeamHow to reduce stress and increase resiliency in your workforce

2 © 2016 RedBrick Health Corporation

Over a dozen leading health systems representing more than 140 hospitals

have selected the RedBrick platform to drive health improvement among

their employees and employees’ dependents. RedBrick’s health

engagement platform and services increase meaningful engagement to

enhance employee health and to provide a foundation for broad-based

population health strategies. RedBrick’s flexible technology and services

are tailored to meet the needs of busy caregivers in these settings.

3© 2016 RedBrick Health Corporation

69%of healthcare

workers reportedbeing stressed

17%of healthcare

workers reportedfeeling highly

stressed

CARING FOR YOUR CARE TEAM

There are only a few jobs more stressful than a front-line healthcare worker.

One survey showed 69% of healthcare workers reported being stressed

with 17% feeling highly stressed.1

It is easy to see why: Healthcare workers face life and death decisions;

responding to unexpected and rapid changes in patient conditions;

comforting emotional patients and family members; managing regulatory,

quality, financial and administrative pressures, as well as challenging

interpersonal relationships.2, 3 As a result, exposure to stress is considered

an occupational hazard for hospitals by the Centers for Disease Control

and Prevention.4


AN INDUSTRY UNDER STRESS

A RedBrick analysis of 122,000 unique health assessment

results from employees of our health systems clients

revealed that levels of stress varied significantly among

health systems. Interestingly, our health systems clients’

average level of stress didn’t vary significantly from our

overall book of business.

And, as we looked at the self-reported average coping

levels among these same health systems, we see a wide

variation as well. This may indicate that some health

systems have better ways to help their employees

manage coping with stress than other health systems.

Further research is underway to understand the unique

factors that correlate to stress and coping levels.

5.6

5.5

5.4

5.3

5.2

5.1

5.0

4.9

4.8

4.7

4.6

4.5

4.4

A B C D E F G H I

Average level of self-reported stress by health system client

Results from nine di�erent health systems clients

10 = HIGH STRESS

0 = LOW STRESS

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Average self-reported ability to cope with stress by health system client

Results from nine di�erent health systems clients

7.6

7.5

7.4

7.3

7.2

7.1

7.0

6.9

6.8

6.7

6.6

A B C D E F G H I

10 = COPING WELL

0 = NOT COPING WELL

Ave

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ab

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The impact of continued exposure to stress can be

severe. Terms like “compassion fatigue,” “burnout,”

“emotional exhaustion” and “moral distress” are now

commonplace in conversations among healthcare

managers and caregivers.

For physicians, one study revealed that high levels

of stress can impact many areas, ranging from

lower job satisfaction to a desire to switch careers

to issues related to patient safety.5 High stress levels

similarly impact nurses, as the chronic exposure to

stress and work complexity negatively affects nurse

managers’ health and their decision-making processes,

potentially threatening individual, patient and

organizational outcomes.6

Frequency of selected category

What causes stress in your life?

12%

11%

40%

21%

18%

56%

10%

15%

26%

3%

58%

0 5 10 15 20 25 30 35 40 45 50 55 60 65

Work

Money

Family responsiblities

Relationships

Health problems a�ecting my family

Housing costs

Personal health concerns

Economy

Job stability

Other

Personal safety

RedBrick health system book of business, 122,000 unique health assessments.

The analysis also reveals that work is the top stress

trigger in health systems, followed by money, family

responsibilities and relationships.


RedBrick Health outcomes analysis: Stress requires specific focus

Likelihood of achieving clinically meaningful risk reduction compared to those who engaged only in their usual healthy activities but not in RedBrick programs. Study includes 182K Health Assessment and 84K Screening participants.

BMI: >=5% weight loss; baseline BMI >= 30

Non-HDL Cholesterol: >=10% reduction in non-HDL cholesterol; baseline non-HDL-C >=160 mg/dL

Nutrition: Increase fruit and vegetable consumption >= 1 serving/day; baseline <5 servings per day

Physical Activity: Increase minutes of moderate or vigorous activity >=60 min/week

Stress: Improve stress coping at least 1 category

Tobacco: Report no tobacco use at follow-up; baseline reported tobacco use

CREATING A CULTURE OF MINDFULNESS AND RESILIENCY

Addressing stress requires a focused multi-modal

approach. Our RedBrick Insights research has

demonstrated that stress is unique in that the ability

to cope with stress improves most when individuals are

engaged in specific, stress-related coaching, education

and/or activities.

In contrast, when individuals engage in non-stress-specific

health and well-being activities, the improvement is

reflected in many other domains. For example,

coaching for weight loss leads to improvement in

areas such as physical activity, nutrition and cholesterol,

while only people who engage in stress-reduction-related

activities show improvement in stress levels. Similarly,

the pattern of generalized improvement for non-specific

activities is mirrored with non-HDL cholesterol and

telephonic coaching. Our research also shows that the

highest levels of overall positive behavior change occur

when people are given a choice of digital tools, person-to

person support and group activities to learn mindfulness,

resiliency and other stress-reduction strategies.

Health system employees are highly diverse and reflect

a broad spectrum of backgrounds, education levels,

ethnicities and cultures. While most of the research

about mindfulness and resiliency in health systems is

focused on physicians and nurses, no employee group

is immune to the impact of stress. When creating stress-

reduction programs, it is imperative to segment the

different populations and implement strategies that

maximally engage, empower and support the broadest

portion of the employees.

PARTICIPATION IN AN ACTIVITY COMPLETION OF AN ACTIVITY

USING DIGITAL TOOLS Any focus area Specific focus area Any focus area Specific focus area

BMI 23% 27% 37% 42%

Stress 0% 24% 2% 26%

TALKING WITH A HEALTH COACH Any focus area Specific focus area Any focus area Specific focus area

Non-HDL Cholesterol 9% 32% 12% 38%

Stress 9% 60% 10% 61%

Health improvement outcomes when focusing in any health area vs. specific focus area


A high level of stress in healthcare settings is an undeniable problem.

But fortunately, there are effective solutions for health systems to address

stress and increase resiliency in their care teams. In this paper, we will focus

on five of these solutions: digital tools, person-to-person support, on-site

and group activities and environmental support.

DIGITAL TOOLS

Digital coaching tools can be a primary support model

for improving stress levels, mindfulness and resiliency.

The primary goals of any behavior change program are:

to spark engagement, identify motivation for change,

present options, generate commitment and nurture

ongoing success.

Once new habits are formed and the individual identifies

personalized mindfulness and resiliency strategies, there

are a myriad of supporting tools and technologies

available, such as guided meditation recordings and

mindfulness apps. Without habit formation, however,

many single-focus digital tools are often used a few

times, and then simply forgotten.

“For many healthcare workers with hardly a second to

spare in their life, sometimes a one-minute interaction

with a comprehensive digital behavior change program

every couple of days is enough to start making a big

difference,” says Dr. Jeff Dobro, chief medical officer

at RedBrick Health.

“The key is to present individuals a series of personalized

options for stress-management strategies and then

create personal, social and structural triggers to embed

the habit in a person’s daily routine. For example,

one of my personal favorite stress-less habits is to put

a notebook and a pen in front of my clock on my

nightstand, and before my mind starts spinning with

ideas and thoughts as I try to sleep, I write them down

to deal with tomorrow,” Dr. Dobro adds.


PERSON-TO-PERSON SUPPORT

A person with high stress levels can often feel so

overwhelmed that even figuring out where to start

seems impossible. A well-trained coach with a solid

underpinning of a behavior change framework can

peel away the barriers to change, identify the unique

motivations and goals for the individual, and attain

a commitment to take the first steps of change and

success. By fostering an ongoing relationship, the

coach serves as a mentor, cheerleader, teacher,

facilitator and ultimately the catalyst that supports

an individual throughout his or her journey to mindful-

ness and resiliency in a way that is impossible with

digital tools alone.

Carrie, a health system employee, describes her

life-changing experience with a coach as she worked

to improve her stress level: “I was stuck in a vicious

cycle and I realized I needed help.”

Carrie describes her interactions with the coach as

follows: “Our meetings are relaxed and goal-oriented.

We identify any hurdles that may be standing in my

way, and then we identify the small bites I can take

out of those hurdles to make them less of an issue.”

Through a series of changes focused on stress

management strategies related to her sleep habits,

nutrition choices, exercise, finding time for herself

and involving her family in the process, Carrie has

seen a remarkable improvement. “All of the changes

have made a huge difference,” she says.

ON-SITE AND GROUP ACTIVITIES

Most successful organizations complement individual

activities with a comprehensive program that includes

regular communications, leadership education,

mindfulness activities and ongoing education sessions.

Jan, an on-site RedBrick health coach at a large

hospital, comments: “Stress management, mindfulness

and work-life balance are the most requested

presentations of the Wellness Department. I’ve done

stop-by tables on stress and mindfulness, and I use

mindfulness practices in my one-on-one coaching

sessions and weight management groups. Recently,

as part of the mindfulness committee, I’m helping to

coordinate and disseminate stress management and

mindfulness activities throughout the hospital, and we

are in the process of rolling out an ‘Intro to Mindfulness’

course hospital-wide. The activities have made a

palpable difference, as one participant told me, ‘… the

meditation has been really wonderful for me; I enjoy

it and continue to do it on a daily basis. I feel much

lighter and happier.’”


ENVIRONMENTAL SUPPORT

For many people, a quiet, peaceful place to escape for

a short period can provide a well-needed respite and an

opportunity to recharge for the remainder of the day.

Many organizations start by creating meditation rooms

from larger closets or underutilized spaces.

Main Line Health in Pennsylvania created Oasis Rooms,

which are quiet rooms with natural light that have a

comfortable couch, yoga mats, floor cushions, peaceful

paintings, inspirational quotes and relaxing music.

The rooms have proven very popular, with one room

receiving over two hundred visits per month.

Create the conditions for supporting mindfulness in the workplace:

1 Develop a multi-dimensional approach that provides choice to employees, including digital tools, coaching and environmental support.

2 Recognize that only programs and activities focused on reducing stress and increasing resiliency are likely to have a meaningful impact on overall stress levels.

3 Offer group activities for social support and individual programs to help people on their own time.

4 Enlist leadership support to model mindfulness and purposeful work.

5 Empower and encourage a culture where individuals can bring their best selves to work.


STRESS: THE TIME TO ACT IS NOW

Leading health systems across the country are

implementing comprehensive programs to address

stress and increase resiliency. Lauren Chestnut, a

program manager in Wellness and Work/Life at The

Children’s Hospital of Philadelphia, helps lead these

efforts. She reports, “Our Wellness vision at The

Children’s Hospital of Philadelphia is to evolve

and improve the physical and emotional health and

well-being of our employees. We strongly feel that

employees need to be at their best to reach their

maximum potential, which in turn contributes to

their quality of life and the health system’s success.

Our leadership has identified stress and resiliency to

be a core area of focus, and to support this we have

implemented a variety of tools—digital, telephonic

and on-site health coaching, leadership support, and

also internal collaborations for offering mindfulness,

yoga, support groups and EAP workshops.”

The need to address stress goes far beyond burnout,

potential patient safety impacts and employee

satisfaction. Mounting evidence shows that stress

can have a long-term impact on individuals’ health

and increased levels of cardiovascular mortality.7

As part of healthcare provider organizations, the

employee programs have to provide the same

compassionate care for the caregivers as the providers

do for their patients, and fortunately, there are

“treatments” that do work. The scientific evidence

is clear: Strategies for stress management such as

cognitive-behavioral training as well as mental and

physical relaxation all reduce stress.8

Unlike a simple pill or surgery, the treatment for stress

requires a comprehensive, focused, and multi-modal

approach that takes into account engagement barriers,

personal choices and learning styles to create durable,

healthy habit formation and a supportive workplace

environment for employees and caregivers.

Do you want to learn more about how to reduce stress

and increase resiliency in your workforce? We can help.

Contact the RedBrick sales team to learn more about

our solutions for health systems. Call us at 855-776-5515

or email us at [email protected].


REFERENCES

1 http://thehiringsite.careerbuilder.com/2014/02/10/americas-stressful-jobs/

2 Moustaka, A., & Constantinidis, T. C. (2010). Sources and effects of work-related stress in nursing. Health Science Journal, 4(4), 210–216.

3 Balch, C. M., & Shanafelt, T. (2011). Combating stress and burnout in surgical practice: a review. Thoracic surgery clinics, 21(3), 417–430.

4 http://www.cdc.gov/niosh/docs/2008–136/

5 Rosenstein, A. H. (2012). Physician stress and burnout: what can we do? Physician executive, 38(6), 22.

6 Shirey, M. R., Ebright, P. R., & McDANIEL, A. N. N. A. (2013). Nurse manager cognitive decision-making amidst stress and work complexity. Journal of nursing management, 21(1), 17–30.

7 Steptoe, A., & Kivimäki, M. (2013). Stress and cardiovascular disease: an update on current knowledge. Annual review of public health, 34, 337–354.

8 http://www.cochrane.org/CD002892/OCCHEALTH_preventing-occupational-stress-in-healthcare-workers

HSM-109 05/16

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caring for your care team paper-2016

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