Making a Change Through Well-Being

Apr 08, 2024

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A lightbulb moment for me going through the training to be a peer ambassador is that there are certain things that are inherent in being a healthcare worker that make us really good at what we do, but also very vulnerable at the same time.

Beth Miller

By working together on various well-being initiatives at CommonSpirit Health, Lesly Kelly, PhD, RN, FAAN, a nurse scientist, and Beth Miller, MAOM-L, BSN, RN, CPXP, system director of patient safety, developed a passion for promoting personal and team well-being in their health system.

Now, by participating in the National Academy of Medicine (NAM) Change Maker Campaign for Health Workforce Well-Being, their work is positively impacting nurses and sparking a national movement to support clinician well-being.

Can you talk about the NAM Change Maker campaign, and share with us what it aims to do?

Lesly: The NAM Change Maker campaign is about organizations really showing how to put well-being into action and the interventions that support well-being. So, rather than just talking about and measuring well-being, they really want to show how we can improve it through actions. And that includes highlighting organizations and people that are doing it well, then telling others about them, and making sure that everybody has access to the best evidence and the best way that we can support well-being.

CommonSpirit always valued well-being prior to the pandemic. But then even more so during the pandemic; we formed an advisory group on resilience and well-being. And that turned into a strategic aim and a broad goal for well-being, even long before NAM was asking us to make it a priority. We developed a holistic framework to support our well-being initiatives and goals. We really put out resources and activities and support for our staff, and we were getting to have a little bit of a name for ourselves about our well-being work, collaborating with other organizations like Intermountain and Banner, putting out some papers talking about our well-being framework.

So, because of CommonSpirit’s reputation around well-being, we may have been a little bit sought out by the National Academy of Medicine [NAM]. We were highlighted in one of the first kickoff campaigns where we got to speak at a conference with Dr. Vivek Murthy, the U.S. surgeon general, and talk about some of the work that we've been doing at CommonSpirit and some of the actions that we've been taking to improve well-being.

Tell us about your work in the well-being space and how it connects to patient safety.

Beth: One of the things that's very clear when we have a safety event, obviously it affects the patient, but it affects the nurse as well. When nurses recognize that they made a mistake or an error, it can be a devastating experience. I really believe that peer support is a necessity in those scenarios because of the fragility of [the nurse’s] well-being in those moments. We know that there's a lot of stigma on needing help, but there's also a lot of stigma when making mistakes.

Someone who makes a mistake often has insight to share with the team that can help prevent that thing from happening again. And if they're not provided that type of support in those moments and they walk away from the organization, all that learning walks away as well. And so that’s another layer to this that is very important in terms of safety. I also think that motivates us in terms of making the program available to everyone in all of our care sites: acute care, long-term care and the clinic space. We want to make sure that our care is as safe as possible, and we can never really get there if we don't have feedback from those that are affected by it.

What prompted you personally to get involved with well-being at CommonSpirit and then with the NAM Change Maker program as an accelerator? And how has your own experience played a role in this work?

Lesly: I remember when the NAM Action Collaborative kicked off, and I thought it was right where we needed to be. We had been measuring well-being for decades, and it was time to actually do something about it. Then, of course, the pandemic started. And so we moved into putting fires out, and the whole world changed.

So, personally, some of our research got put on hold, but a lot of our implementation science went into effect. So when the national plan came out in 2022, [we realized that] the pandemic actually moved us forward in the well-being space. While we never would've wished the pandemic to happen, we now know that the world is aware of what's going on in the clinician well-being space, and that we have a lot of work to do.

We know that it's not just about the individual. We know that we need to focus on our care environments. We know that nurses have been looking at this issue for a very long time. And now this is being recognized on a national level. The accelerator campaign is the opportunity to look at these interventions and accelerate them forward.

Beth: I was a local nurse leader at a facility at the time the work kicked off. My focus was the pandemic and carrying out those duties, which changed on a daily basis.

We were all struggling in different ways and for different reasons. And so we had a lot of grassroots conversations on a personal level as we were all trying to figure out what to do. The more we had those conversations, the more we realized, OK, there's a big opportunity here.

That was really an “aha” moment for me. As nurses, we're very action-oriented, we're very care plan-oriented. You assess and you want to move to action. Therefore, part of that action for me at that time was to reach out to my partners in CommonSpirit’s national office, [including] Lesly and others. As a facility nurse leader at the time, I knew that we had a lot of internal resources and connections.

If you were to think about the NAM Change Maker campaign and the content you've gained from it, how are you specifically applying it to your unit, your hospitals and the hospitals in the CommonSpirit health system, since you're both at the system level?

Lesly: In the Change Maker campaign, you have to pick from the priorities [in the NAM National Plan]. And so we picked, I think, three or four. All these things kind of came together, and we stepped back and looked and we said, "This is really our peer support program that we're building." We call it Peer Ambassadors.

What we found is that peer support was, obviously, happening disparately across our large 140-hospital health system. We had some parts of our system that were not doing any peer support, some using different types of curriculum and some with homegrown programs. What we really saw was a need for a standardized peer support program so that everybody had access.

We often think of peer support as that first tier, well-being care that everybody deserves, that can mitigate secondary traumatic stress, compassion fatigue, burnout or a crisis situation. This is kind of a foundation and a basis for well-being in your work environment. What we wanted to do was make sure that this was built out across our entire system and accessible and available for all. It's no small feat to do this across a health system that has 140 hospitals. So we're making sure that it's built out with the right resources, the right training. Our well-being team, our human resources team, our legal team, our social workers, our chaplains, so many of us came together to talk about how to do this. We reviewed a lot of curriculum. We ultimately decided on the Stress First Aid curriculum through the Department of Veterans Affairs, because it's a very evidence-based curriculum that uses the right model of care for how we should address these situations.

We built a model where we can educate individuals to train the peer supporters. We set in place a complementary program called Code Kindness so that, in those crisis situations, there's the right support. And then we're making sure that we roll it out in a systematic fashion, so that everybody is getting it done in a rigorous manner.

Talk about how this work is important on an individual level?

Beth: I believe everyone who works in healthcare has times when they could use peer support and times when they could provide peer support – I’ve had both experiences, so I know how beneficial peer support can be.

On an individual level, I know how much peer support helped me in those moments. I think one of the things in my own journey of learning to be a peer supporter was the concept that's outlined in the Stress First Aid curriculum about the double-edged sword of values and ideals for caregivers. As caregivers, we're very proud of ourselves for being selfless and for being servants. We often place others' welfare above our own as a result of that. So even though the guiding ideal for the nursing profession is to be that caregiver and to be selfless and to be very giving, there is a cost to that.

A lot of times nurses and other clinicians think, OK, we're very tough and we have this ability to endure. You saw that a lot during the pandemic. But with that stoicism comes a lack of awareness about our own needs, and sometimes about our own weaknesses and things that we need to take care of.

I think what bonds all healthcare workers together is that we have this shared set of ideals, but it can create problems for us if it's not taken care of appropriately. So when you're asking about why this is important on the individual level, I think it's why it's important on the hospital system level as well. Because the thing that makes us all really cohesive and really good at what we do can be a weakness as well.

What has been your biggest learning from this experience?

Beth: I think the biggest learning for me is that you can start wherever you're at. A lot of the well-being resources and toolkits are very thorough and thought out. But the implementation part of it is actually very simple. Consistency is really important when you're thinking about actually moving into that implementation phase.

We chose a couple of things to work on as a group, because obviously we were stretched very thin and had a lot of competing priorities. Because those things were developed in a consistent manner, we could really see the difference they were making. What I really learned is the importance of having courage and just trying something.

Lesly: There’s that saying “Don't let perfection be the enemy of progress.” That would probably be my biggest learning. I think I'm the other side of the coin from Beth – it’s the academic – or former academic – in me. We always wanted to do things by the book and be the new innovation and the thing that's never been done before. But when you look at a large health system, there's always a space where something's not being done. And as Beth said, implementation needs to happen. The learning has definitely been: Don't take the long path to get this perfect outcome solution when your clinicians need something today.

Are there other key steps or advice you would offer to someone who’s thinking about this kind of work?

Beth: I would say educate yourself. Educate yourself about what's available, what those elements are in the NAM toolkit r in the NAM program. There are a lot of resources, and I think that in itself can be overwhelming. What NAM has done helps to point you in the right direction. And definitely have courage. Don't be afraid to try. Don't be afraid to fail, because there's value in that as well. Any work that's being done in this space is good work. Even if the work stops at OK, I'm just inquiring about this and I've learned a couple of things myself, there's value in all of those things.

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