Do you want to build a snowman? or perhaps, a wellness program? – part 2

for part 1 – click here!

Strengths to leverage

by Una Harrington

Over the last two years at WRaP EM, we have spent many hours trying to distil down what are the key strengths we could leverage to help start wellness programmes in our EDs or perhaps gain momentum around a wellness agenda.  There is a lot of information out there – and it can be daunting when you Google search ‘wellness ED’. There is a lot of mumbo jumbo but luckily for us, a lot of hard evidence too!

Here are our top four tips:

1. Use the science

There is a large body of scientific work that you can use to help you gain momentum and credibility. The evidence is so robust in fact, that you might even be able to get early buy in from the nay sayers and sceptics in your midst!

Look to the extensive body of work by Tait Shanafelt to understand what is the monetary cost of burnout, and how finding meaning in your work helps not only to protect you from burnout but also allows you to give excellent patient care. [1]   At WRaP EM, we have found that any proposal that will saves the ED money and improves patient care is a great way to get early buy in for a project.

For the hard evidence on the benefits of mindfulness-based practice, look no further than the work of Prof Craig Hassed and Dr Sarah Lazar – proving that mindfulness can change your neuroanatomy, cognition and even your DNA. [2] [3]  At QEII ED, this was used as evidence to get approval to run four minutes of guided meditation at the 4.30 pm handover.

Even more interesting, there is now some evidence to suggest that teams that practice mindfulness together, perform better together. [4] Perhaps consider presenting this in the same way you would justify simulation-based training for improving your team’s performance.

Look to Dr Jane Lemaire’s work to help you gain momentum around the area of staff nutrition. [5] Perhaps you could use Lemaire’s body of work to help get a healthy food vending machine accessible to your ED or, as happened at QEII, to get funding from the AMAQ to run our Winter Staff Resuscitation Snack Trolley.

These papers can help start a discussion that forgetting to eat or drink water on shift are not ‘Badges of Honour’ to be worn during or after a busy shift but a real problem that could have an effect on both our patient care and the speed and quality of our complex decision making.

Use studies by Riskin and Redelmeier to show respectively that compassionate communication may decrease your re-presentations rates from recurrent ED presenters and also that rudeness can affect the care we provide to our patients. [6, 7]

The above is not an exhaustive list, but perhaps a place to start to help you gain momentum and credibility in the establishment of your wellness activities – it has certainly helped us thus far.

2. Use the FOAM ED influence

Most of our trainees in Australia, cannot remember a time before FOAM ED. In the grand scheme of medical education, FOAM ED is merely in its infancy. However, the growth of the FOAM ED community and its influence on the clinical and non-clinical practice in our Critical Care environment has been and continues to be massive. So, use the FOAM ED influence to help boost your wellness agenda.

Look to Scott Weingart’s Kettle Bells for the Brain Podcast, Vic Brazil’s Timing Tribes and STEMIs Podcast, The ALiEM Wellness Think Tank or a growing body of work on SMACC in Medical Error and Second Victim syndrome. [8-11]

3. Use your local college guidelines

One of the most powerful motivators for any new programme development in ED appears to be “How does it fit into a Quality Improvement and Accreditation strategy?” Use this to your advantage.

Just last year the Australasian College for Emergency Medicine (ACEM) launched their new accreditation guidelines. In this, the very first Domain states that your ED has to demonstrate ‘Promoting the Health, Welfare and Interests of the Trainees’. Within the examples of evidence for this the handbook states the following – ‘Description of how trainees are encouraged to maintain their wellbeing and the resources available for them to achieve this’. [12]

Although sometimes getting awarded and retaining accreditation is a big pain in one’s proverbial, you can leverage this process to get your wellness agenda to the forefront of your department strategic plan.

In summary, there are many strengths that you can leverage

1. The scientific evidence is there
   1. Start with the resources below
   2. Let us know if you find anything else useful so we can share it with others
2. Use the FOAM ED expert community to help you gain traction
3. Highlight early how wellness fits neatly into your Departmental Quality Improvements process

Consider who is coming for tea, what kind of scones you will make, and who can help you prepare them!

So, whether your building a wellness snowman or baking some wellness scones, use the evidence and good luck!

References

1. Shanafelt, T.D. and J.H. Noseworthy, Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc, 2017. 92(1): p. 129-146.
2. Lazar, S. How meditation can reshape our brains. 2011 [cited 2018; Available from: https://www.youtube.com/watch?v=m8rRzTtP7Tc.
3. Hassed, C., The health benefits of meditation and being mindful. Mindfulness@Monash.
4. Fletcher, T. Team Based Mindfulness. 2018; Available from: https://scienmag.com/mindfulness-at-work-ubc-study-first-to-uncover-positive-benefits-for-teams/.
5. Lemaire, J.B., et al., Food for thought: an exploratory study of how physicians experience poor workplace nutrition. Nutr J, 2011. 10(1): p. 18.
6. Riskin, A., et al., Rudeness and Medical Team Performance. Pediatrics, 2017. 139(2).
7. Redelmeier, D.A., J.P. Molin, and R.J. Tibshirani, A randomised trial of compassionate care for the homeless in an emergency department. Lancet, 1995. 345(8958): p. 1131-4.
8. Weingart, S. Kettlebells for the Brain. 2016 [cited 2018; Available from: https://emcrit.org/emcrit/kettlebells-brain/.
9. Brazil, V. Timing, Tribes and STEMIs. 2014 [cited 2018; Available from: http://vimeo.com/95243749.
10. ALiEM. Wellness Think Tank. [cited 2018; Available from: https://www.aliem.com/wellness-think-tank/.
11. Carley, S. Medical Error. [Pod Cast] 2015 [cited 2018; Available from: http://www.smacc.net.au/2016/02/simon-carley-medical-error.
12. ACEM. FACEM Training Programme Site Accreditation. 2017 [cited 2018; Available from: https://acem.org.au/getmedia/003f59d2-b5c9-433f-9ff5-bb0843b2f950/AC549_1-6.aspx.