P-10: Clinician Heal (Know) Thyself - A Quality Improvement Initiative for Mindfulness in Emergency Medicine
Mrs. Gillian Dyck
Gillian Dyck BScN RN,
Dr. Arthur Eugenio,
Dr. Andrea Alvarez,
Linda Rodrigues BA
Cambridge Memorial Hospital
The last 20 years has seen a growing body of literature on the application of mindfulness within medicine, with benefits yielded for both patients and clinicians alike. Also seen in the last 20 years is a rise in stress and burnout among clinicians working in time-constrained and resource-limited practice environments. It has been proposed that Mindfulness may help serve as an antidote to clinician burnout, and support the 4th component of the “Quadruple Aim” – Improving the work-life of health care providers. In the Emergency Department, based on the assumption that staff burnout is present – being an area of fast-paced, stressful, and time-constrained work, our goals are to improve staff self-awareness, situational awareness, increase resilience, and decrease burnout, through the application of mindfulness strategies.
In this “vanguard” quality improvement project we developed a focused curriculum in Mindfulness geared toward Physicians, Nurse Practitioners, and Charge Nurses in the Department of Emergency Medicine. The program ran from January to April 2018. All participation in the program was encouraged, but voluntary. Pre-workshop surveys (Maslach Burnout Inventory – Health Services Survey) were implemented for baseline measures, in three main areas of focus, emotional exhaustion, depersonalization, and personal accomplishment. Suggested resources were also provided as a means of introduction to Mindfulness. The program consisted of 3 parts: 1) Session 1 – 2.5 hr workshop introducing mindfulness theory and strategies, and the “7 tools”- a set of inter/intrapersonal tools which can be used in skillful response to challenging human interactions. 2) Self-Reflection Period – which involved the completion of the MHS EQi-2.0 (Emotional Intelligence) assessment tool, and a 1:1 coaching session. 3) Session 2 – Practicing the tools with Standardized Patients, who provided the team with challenging scenarios that commonly occur in the ED environment.
A total of 32 participants took part, out 38 invitations. Reasons for non-participation included scheduling and time commitment challenges, personal/family reasons, and lack of interest in the subject matter. Session evaluations showed that there was an increase in knowledge and understanding of mindfulness, an improved appreciation for the effectiveness of mindfulness, as well as a commitment to utilize the tools. Participants shared that the SP sessions had high impact and calls were made to incorporate this style of practice again in the future. We have been impressed with both the feedback, and the uptake of the strategies, and believe that this is supportive toward the ultimate achievement of our goals. We look forward to observing and monitoring the gradual changes in the department over time.
We are currently distributing the post-program measure – repeating the MBI-HSS, and planning for some focus groups for feedback and reflections on the program for qualitative understanding of the program’s true impact. We have begun collecting some anecdotal narrative from participants on utilization of the tools in their ongoing practice. We look toward future iterations of the program, continuing to build and modify to strengthen the utilization of time, resources and maximize impact.