By Una Harrington and Shahina Braganza
Part 1 – Addressing the barriers, the sceptics and creating some boundaries
This is not intended to be a recipe taken in toto to translate to other places, but perhaps act as a template around which to frame implementation of a departmental wellness program.
- Get your Directors and ‘leaders’ on board early. Use the scientific evidence to build a business case for the wellness program.*
- Use existing departmental activities as opportunities to conduct wellness activities – educational sessions/handover/meetings
- Gradual introduction – start low, go slow. Use bite-sized material to provoke thought and reflection.*
- Start with the science and emphasise the link to professionalism and performance – especially important in the early phase. There is still stigma and judgement around wellness, and an initial focus on performance may help to legitimise the agenda. [See part 2 for further detail – link]
- Be resourceful – leverage the science behind strategy; use material produced by credible ED identities (eg Scott Weingart, Victoria Brazil) to promote the message.
- Be transparent and share widely, both internal and external to ED – include all clinical streams, and even non-clinical staff; invite other departments; invite the Executive Management Team. Consider presenting a snapshot at the next ED-led hospital-wide grand rounds.
- Be open to feedback and modification – be open-minded about what works/is accepted and what doesn’t.
- Look actively for feedback and ask for this from not just the FACEMS, but the RMOs, Trainees, nurses.
- Also, ask this not only from managers (who tend to be removed from the frontline), but from floor staff.
- Acknowledge that one size does not fit all and that size does matter
Perhaps each individual ED wellness strategy a bit like a recipe for scones. You can start with a basic white scone recipe – and then turn it into fruit scones, apple and cinnamon scones or maybe even cheese scones. The basic ingredients are the same but the flavour can differ greatly depending on whom you are having over for tea!
So, certainly, have a look at and benchmark existing programmes like Gold Coast University Hospital’s oneED programme. But be aware that what works in one place won’t necessarily work in another – it took one year of planning at Queen Elizabeth II (QEII) ED and quite a bit of alteration to merge the oneED approach to the mindfulness sessions that are now run there.
Don’t assume that if you are in a small ED that you are limited either. The QEII is a medium sized non-tertiary ED. In an ED of this size, It can be much easier to introduce new projects, especially if they are a little off piste like embedded mindfulness, as there are less stakeholders to consult once one gains the ED Directors’ buy In. However, there are also advantages to working in a big ED – there, if you wish to start a programme or conduct some wellness related research, you are more likely to have more administrative help or a research assistant at your disposal.
- Persevere!!! You haven’t failed until you’ve given this a good go, and a good go is likely to be at least 12 months.
- Know your boundaries – because of your interest, you may find yourself being asked to offer formal support to staff (eg post assault, or return to work after trauma). Recognise that you are not a therapist, and not qualified to assist at this level. However, see if you can still contribute in a responsible and careful manner.
*Contact Shahina or Una via wrapem.org if we can help you with resources. Here are a few to start you off…….
Shanafelt’s work on Organisational Change
Lazar on Mindfulness and the Brain
Craig Hassed on Effects of Mindfulness
The FOAM Ed Influencers
EMCRIT – Kettle Bells for the Brain
ALiEM – The Wellness Think Tank
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