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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
4 © 2016 RedBrick Health Corporation
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
Ave
rag
e se
lf-r
epo
rted
leve
l of
stre
ss
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
rag
e se
lf-r
epo
rted
ab
ility
to
co
pe
5© 2016 RedBrick Health Corporation
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.
6 © 2016 RedBrick Health Corporation
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
7© 2016 RedBrick Health Corporation
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.
8 © 2016 RedBrick Health Corporation
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.’”
9© 2016 RedBrick Health Corporation
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.
10 © 2016 RedBrick Health Corporation
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].
11© 2016 RedBrick Health Corporation
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