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Workplace WellnessDuring COVID-19:
As a Supervisor, What Can I Do?
KAYLAN A. BABAN, MD MPH | CHIEF WELLNESS OFFICER
SCHOOL OF MEDICINE & HEALTH SCIENCES
GEORGE WASHINGTON UNIVERSITY
Workplace Wellness During COVID-19:What Can I Do as a Supervisor?
u Evidence-based tips
u Strategies and Resourcesu Maintaining resilience and managing stress among your team
u Continuing to support your own wellness
Your Role in the GW Experience
u We have been fortunate at the GW Healthcare Enterprise to have an explicit mission, and clear communications at the level of organizational leadership during this time.
u However, we know one of the biggest predictors of workplace wellness for any individual is the management style of their immediate supervisor.
u We know that leadership at the GW Healthcare Enterprise is dedicated to their teams’ wellness and performance – at all levels –and are offering this resource to support your efforts, as you support GW’s.
Even under usual circumstances, those working in healthcare environments face high rates of burnout
Among our best-studied group (physicians), one third are burned out.
The lifestyle and experiences associated with our chosen professional environment can put us at risk:
§ Stress & 2nd victim syndrome
§ Perceived limited control
§ Limited exercise
§ Irregular and poor eating habits
§ Sleep deprivation
§ Health maintenance visits
§ Work-Life balanceDyrbye, Liselotte N., et al. "Burnout among US medical students, residents, and early career physicians relative to the general US population." Academic Medicine 89.3 (2014): 443-451.Shanafelt, Tait D. "Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care." JAMA 302.12 (2009): 1338-1340.
This will be a marathon, not a sprint.u Disruption of our usual roles and
routines
u Adjustment to new work flows and responsibilities
u Uncertainty day-to-day
u Limited understanding of the virus
u Concern for health of our families, communities, selves
What can we learn from marathoners?
u Marathon training focuses on endurance-related factors, such as lactate threshold.
u They learn to conserve energy by identifying what is necessary to them, and focusing only there.
u Their training also teaches what it feels like to run out of energy, allowing them to make adjustments if they feel it happening.
u This approach can be instructive for us – as team leaders, and for ourselves.
Davidson J. The Difference in a Sprinter’s and a Marathon Runner’s Training. SportsRecwebsite. https://www.sportrec.com/534699-the-difference-in-a-sprinters-a-marathon-runners-training.html September 6, 2011. Accessed March 19, 2020.
Self-Awareness: Important for You and Your Team
u Experiencing some stress now is normal and appropriate, and can even boost performance… to a point
u Pushing through stress that is too high can reduce performance and resilience
u Like a marathoner, being aware of signs of stress – among your team and yourself –can help with effective management
u Take one day at a time
u Use the tools provided (below)
u Seek help when you need it
Martinchek M, Bird A, Pincavage AT. Building Team Resilience and Debriefing After Difficult Clinical Events: A Resilience Curriculum for Team Leaders. MedEdPORTAL. 2017;13:10601. Published 2017 Jul 12. doi:10.15766/mep_2374-8265.10601
Workplace Wellness Predictors
u Organizational mission/purpose is explicit
u Each employee has a clear sense of their role in advancing that mission
u Transparent, two-way communication with leadership
Grant, A. M. (2008). The significance of task significance: Job performance effects, relational mechanisms, and boundary conditions. Journal of Applied Psychology, 93(1), 108–124.Grant, A. M., & Hofmann, D. A. (2011). It’s not all about me: Motivating hand hygiene among health care professionals by focusing on patients. Psychological Science, 22(12), 1494–1499Schultz K, Delva D, Kerr J. Emotional effects of continuity of care on family physicians and the therapeutic relationship. Can Fam Physician. 2012;58(2):178–185.
Workplace Wellness Predictors
u Supportive work relationships, especially with supervisors
u Leadership who role-model wellness
u Flexibility when possible
u Value and respect for the individual
u Perceived self-efficacy
Grant, A. M. (2008). The significance of task significance: Job performance effects, relational mechanisms, and boundary conditions. Journal of Applied Psychology, 93(1), 108–124.Grant, A. M., & Hofmann, D. A. (2011). It’s not all about me: Motivating hand hygiene among health care professionals by focusing on patients. Psychological Science, 22(12), 1494–1499Schultz K, Delva D, Kerr J. Emotional effects of continuity of care on family physicians and the therapeutic relationship. Can Fam Physician. 2012;58(2):178–185.
Practical Steps: Organizational Mission and Your Team’s Role
u There is particular clarity to our organizational purpose at this time.u Depending on your area of GW, it may help to make your
team’s vital role in supporting that mission explicit.
u Make sure members of your team are familiar with the most current protocols and guidelines at GW.u What role they are expected to take in carrying these out.u Who to contact if anything does not go as planned.
u Encourage questions, suggestions, and concerns.u Your team members are experts in their own experience of GW,
and may have noticed something that can be helpful to others.
Oldenburger D, Baumann A, Banfield L. Characteristics of Medical Teams in Disaster. Prehospital and Disaster Medicine. 2017;32(2):195-200. doi:10.1017/S1049023X16001461
Practical Steps:Transparent Two-Way Communication
u Reliable communication: Timely, organized, consistent
u Daily updates may be appropriate given rapidly-shifting news and protocols.
u Amplify relevant messages from elsewhere in the organization.
u It is OK to share limits on current knowledge/plans. Be clear about anything currently unknown; other approaches can cause more confusion and anxiety.
u Two-way communication
u Schedule regular team meetings – remotely if appropriate – with an agenda that explicitly includes opportunity for discussion, questions, suggestions/concerns.
u Proactively check-in with your team – how are they doing?
u Make it known that you are interested and available to discuss individual situations and needs.
Quinn P. Crisis Communication in Public Health Emergencies: The Limits of 'Legal Control' and the Risks for Harmful Outcomes in a Digital Age. Life Sci SocPolicy. 2018;14(1):4. Published 2018 Feb 6. doi:10.1186/s40504-018-0067-0Runciman WB, Merry AF. Crises in clinical care: an approach to management. Qual Saf Health Care. 2005;14(3):156–163. doi:10.1136/qshc.2004.012856
Practical Steps:Supportive Relationships with Leaders
u Find opportunities for warm, genuine connection.u Make eye contact, smile (this is audible, even when not visible), enquire
how they are.
u Intentionally make time for informal debriefing.
u Encourage your team members to do the same.u Brief empathetic encounters in the workplace are as predictive of
wellness as deeper relationships.
u These connections support the wellness of both giver and receiver.
Martinchek M, Bird A, Pincavage AT. Building Team Resilience and Debriefing After Difficult Clinical Events: A Resilience Curriculum for Team Leaders. MedEdPORTAL. 2017;13:10601. Published 2017 Jul 12. doi:10.15766/mep_2374-8265.10601
Mastoianni K, Storberg-Walker J. Do work relationships matter? Characteristics of workplace interactions that enhance or detract from employee perceptions of well-being and health behaviors. Health Psychology and Behavioral Medicine. 2014 Aug; 798-819.
Holt-Lunstad J. Fostering Social Connection in the Workplace (editorial). American Journal of Health Promotion. 2018 Jul.
Bennett JB, Weaver J, Senft M, Neeper M. Creating Workplace Well-Being: Time for Practical Wisdom. The Handbook of Stress and Health: A Guide to Research and Practice, First Edition. Edited by Cary L. Cooper and James Campbell Quick. 2017 by John Wiley & Sons, Ltd.
Shanafelt T, Sloan J, Habermann T. The well-being of physicians. Am J Med. 2003;114(6):513-517
Opportunities for Connectionu Patient-employee interactionsu Colleague interactionsu Team meetingsu Following challenging encounters
u “Difficult” experiencesu Poor outcomes
u Interpersonal relationships at work are important sources of support… particularly from managers/team leaders
Brooks, S.K., Dunn, R., Amlôt, R. et al. Protecting the psychological wellbeing of staff exposed to disaster or emergency at work: a qualitative study. BMC Psychol 7, 78 (2019). https://doi.org/10.1186/s40359-019-0360-6
Practical Steps:Value and Respect for the Individual
Stress and anxiety are high, and work volume may be picking up. This is a time when the steps below are particularly important.u Voice appreciation, and acknowledge difficulties.u Be flexible when possible.u Maintain boundaries:
u Separation between professional and personal lives is key to avoid burnout at a time of high demand.
u Avoid unscheduled intrusive (ex: phone or text) or after-hours communications if non-urgent.
Felstead A, Henseke G. Assessing the growth of remote working and its consequences for effort, well-being and work-life balance. New Technology, Work & Employment, October 2017,
Practical Steps: Role Model Wellness, Encourage Self-Care
Like marathon runners, it is important for leaders and their team members to be attuned to when stress is too high, or energy is running low.
u Flexibility regarding schedules and roles, when possible.
u Role modeling and encouraging attention to basic needs.
u Sleep, hydration, physical activity, healthy snacks, regular meals.
u Engaging the Relaxation Response (aka: Parasympathetic Nervous System)
“A state of deep rest that changes the short- and long-term physical and emotional responses to stress.”
u Studies show benefit for emotional and physical health, cognitive performance, and productivity.
u Evidence-based methods include meditation, mindfulness, tai chi, and yoga, but also exposure to nature (even a potted plant), physical activity, prayer, socializing, music, art, group visits, reading.
Individual members of your team will have different needs and preferences.
u Share available resources (below) and encourage them to spend at least 10 minutes daily in any practice that works for them, to support and maintain resilience.
Pacing Ourselves…u The finish line is ahead of us, even if
not as close as we would like.u In the meantime, we will continue to
receive guidance from leadership, support one another, and set small goals for our own self-care.
u Immediate supervisors are the first-line in supporting workplace wellness… and you can do so most effectively when also taking care to support yourself, and seeking assistance when needed.
u A little bit of patience and humor –for ourselves and others – always helps.
Contact me at: [email protected]
Resources to Share with Your TeamMORE COMING IN GW HEALTHCARE ENTERPRISE DAILY DIGEST EMAILS
In the midst of a challenging time, we have meaningful support and resources available.
u As a community, we are as prepared as possible thanks to strategic planning and clear communications from GW Healthcare Enterprise leadership.
u As individuals, effective self-care tools do not need to be time-intensive:u Mindful movementsu Micro breaksu Brief connectionsu Hydrationu Healthful snacksu High-intensity interval training (if needed)u Sleep (quality, quantity)
u Resources for mental health and other support for ourselves and our families are available through EAP programs and others (see below).
Resources For Our GW CommunityAll requests are free and confidential:u MFA Employee Assistance Program
now includes SupportLinc
u Call: 888-881-LINC (5462)u Visit: www.supportlinc.com
(username: mymfa)
u GW Hospital Employee Assistance Programu Call: 800-932-0034u Text: 858-224-2094
u Visit: http://uhs.acieap.comu Email:
u DC Physician Health Programu Call: 256-673-2747
u Physician Coaching through Medical Society of DCu Schedule:
https://denageorgemd.as.me/?appointmentType=13592360
Toolkit: On-the-Fly Practicesu We are not cognitively or emotionally at our best when stress is too high
u “Microbreaks” are quick, informal, effective for short-term care
u Shown to improve surgeon physical function and mental focus during
long/difficult procedures
u Examples you can encourage – and role model – to manage stress include:
u Focusing on a physical experience
u If you are walking, notice: Weight shifting, or arms swinging
u If you are sitting, notice: Feet on the floor, points of contact with the chair
u If you are in conversation: Deep intentional breath, then re-focus on the conversation
u Stretching – brings attention away from thoughts, releases physical tension
Park AE, Zahiri HR, Hallbeck MS, et al. Intraoperative "micro breaks" with targeted stretching enhance surgeon physical function and mental focus: a multicenter cohort study. Ann Surg. 2017;265:340-346.Kinder P, Braun S, Deeb G, et al. “Awareness is the first step”: An interprofessional course on mindfulness & mindful-movement for healthcare professionals and students, Comp Ther Clin Prac, vol 25, 2016, 18-25.
Toolkit: One-to-Two Minute Practices
Brief formal practices include (resource links below):
u Box breathing
u Body scan – guided or alone
u Brief seated or walking meditation
Just one or two mindful deep breaths can yield short-term benefits at work in busy settings.
Gotter A. Box Breathing. Healthline website. https://www.healthline.com/health/box-breathing. February 22, 2019. Accessed March 18, 2020.1 Minute Guided Body Scan Meditation for Beginners. YouTube website. https://www.youtube.com/watch?v=E07n7Dtk4iA. April 4, 2018. Accessed March 18, 2020.Brach T. Brief Meditation: Arriving in Mindful Presence. Tara Brach website. https://www.tarabrach.com/brief-meditation-1-minute. July 13, 2016. Accessed March 18, 2020.Brach T. Walking Meditation Instructions. Tara Brach website. https://www.tarabrach.com/wp-content/uploads/pdf/Walking-Meditation-Instructions.pdf. Accessed March 18, 2020.
Toolkit: Deeper Practices
More resources at the GWell Center for Healthcare ProfessionalsQuick Links > Wellness > Resources > Community-Wide > Self-Care
Long-term benefits of mindfulness practices – cognitively, emotionally, physically – are seen when engaged in daily for at least 10 minutes.
Many resources are now available for free.
u To the best of your ability: Eat well, exercise, and get enough sleep. u Activity: Nike Training Club, J&J 7 Minute Workout, YouTube, Class Pass Go ($)
u Sleep: Combine an intentional wind-down period with meditation, CBTi app, reading, music…
u Meals: InstaCart, Meal prep kits, GrubHub… we are lucky to have &pizza, but diversity!
Lopresti AL, Hood SD, Drummond PD. A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep, and exercise. J Affect Disord. 2013 May 15;148(1):12-27.Beezhold BL, Johnston CS, Dalgle DR. Vegetarian diets are associated with healthy mood states: a cross sectional study in seventh day Adventist adults. Nutr J. 2010 Jun 1;9:26.
Toolkit: Support Your Physical Wellness
Toolkit: Stay Connected with Your Communities
Social Distancing Social Isolation
u Reach out to your networks! u Silver lining: Family and friends are
very likely home without plans, too
u Find ways to stay engaged with your communities
u Faith: Are services available online?
u Volunteering: Other ways you can raise awareness and support the mission?
Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont). 2007;4(5):35–40.
Houseparty
Toolkit: How to Help If You Cannot be OnsiteWe all chose healthcare to help and heal others, and this is a difficult time not to be on the front lines.
Direct patient care is not the only way to make a meaningful impact (our medical students with their Clinical Public Health training particularly know this truth).
u Combat misinformation and unsafe attitudes.
u Remotely check on older neighbors, vulnerable family and friends.
u Provide social support to friends who need it.
u Find opportunities for advocacy, particularly supporting those most vulnerable.
u Amplify request donations of PPE – we are well-set at this time, but always better to be over-prepared:
u Call 202-715-4559, or email [email protected]
u Stay tuned for structured opportunities to support our front line providers.
Toolkit: How to Combat Cabin Feveru Explore the world virtually
u Streaming concerts – ex. Berlin Philharmonic’s Digital Concert Hallu Museum tours – ex. Smithsonian Natural History, Guggenheimu Virtual exhibits – ex. Google Arts and Cultureu Historical sites – ex. Stonehenge
u Keep your brain stimulatedu Novel research or other publicationsu Puzzles, free language classes, webinars
u Catch up on sleepu Almost all of us are experiencing sleep debt, this can be a good time to
boost immunity by catching upu Hit your to do list
u We all have one. And we always feel better when it’s done.
Pacing Ourselves…u The finish line is ahead of us,
even if not as close as we would like.
u In the meantime, we will continue to receive guidance from leadership, support one another, and set small goals for our own self-care.
u A little bit of patience and humor – for ourselves and others – always helps.
Contact me at: [email protected]
Engaging the Relaxation Response:Good for the Individual, and the Organization
“High Reliability Organizations (HROs) must have extremely low failure rates, because the costs of failures are extremely high” – think nuclear power plants, as an example.
u Healthcare is typically not an HRO, but we strive to be.
Studies show that implementation of mindfulness techniques in healthcare “provide an effective framework to create HROs.”
Agency for Healthcare Research and Quality defines High Reliability as “a condition of persistent mindfulness.”
u Awareness of what is happening around and inside of us, and responding intentionally.Hales, DN, et al., Creating High Reliability Organiations Using Mindfulness, Journal of Business Research (2016),
