Case Study: Resilience Training

SIEMENS Healthineers Case study Resilience Training siemens-healthineers.com/insights/improving-patient-experience Foreword by Siemens Healthineers Siemens Healthineers strives to understand the broader changes taking place in the healthcare sector, which approaches may improve working practices, and to share these insights with our community. Healthcare professional’s resilience, mental health and wellbeing is a priority. The situation created by the COVID-19 pandemic has made it even more relevant and necessary. Learning about resilience and applying these learnings to everyday challenges can be instrumental in many aspects of the healthcare workplace and range of functions: dealing with stress and challenges, self-awareness, and conscientiousness for one’s mental well- being on the job and beyond. After all, the human brain and mind can be trained, can be strengthened and shaped to support a demanding task. Training these skills can sometimes appear inaccessible, even odd to some and the step from good intention to concrete action can be challenging to realize – but it is instrumental and helpful nonetheless. This case study explores how Siemens Healthineers committed to listen to the need of healthcare organizations, act and implement a comprehensive online resilience training. The aim was to make these techniques available for healthcare workers and professionals and evaluate the impact. Partnering with The Center for Mind and Body Medicine (CMBM) was crucial in making this program a reality. We trust this case study will provide information and insights for implementing similar programs in healthcare organizations worldwide. For more information on Siemens Healthineers Insights, please visit: siemens-healthineers.com/insights-series Dr. Christina Triantafyllou VP, Head of Improving Patient Experience, Siemens Healthineers Executive summary Between January and May 2021, Siemens Healthineers on by COVID-19 and the digitalization of interactions. offered an innovative online program: resilience training The techniques covered included meditation, mindful for healthcare professionals and Siemens Healthineers breathing, biofeedback and relaxation response tech- employees. The program emphasized stress and niques, guided imagery, expressive writing and drawing. body awareness, self-care, and social support. It was Mindful eating and the use of simple ceremonies and intended to help and support healthcare workers and rituals to build a network of support was also incorpo- Siemens Healthineers employees build resilience and rated into the sessions. During the trainings, participants try out tools to deal with the stress and trauma brought were encouraged to share and express their feelings on by the COVID-19 pandemic. The program was offered as well as reflect on what they had learned in previous in collaboration with The Center for Mind and Body sessions. Furthermore, they were encouraged to practice Medicine (CMBM), a recognized expert on building on their own time each week what they have learned resilience and addressing population-wide psychological during the weekly session. trauma. CMBM has offered Mind-Body Skill Groups, as they name their resilience training, for almost 30 years, At the end of the program, participants were invited but the resilience training mentioned in this case study to provide evaluation feedback. The results were over- was the first to be offered exclusively online and for a whelmingly positive. “Excellent” and “good” were by far mix of employees and healthcare professionals together. the most common ratings applied to different aspects of the program, and overall 85 percent of respondents Participants included Siemens Healthineers employees said they would recommend a similar program to others. from 28 departments and healthcare professionals from The evaluation feedback also included a majority stating 13 healthcare providers across the globe. The selection that the program specifically strengthened listening, was arbitrary, based on individuals’ willingness and avail- empathy, and human connection within the group. ability to participate with the commitment to share what they had learned with their colleagues and within their Leading healthcare organizations around the world are organizations. beginning to look for ways of helping healthcare pro - viders, professionals and the population deal with the They participated in a total of 16 hours of online sessions, effects of the pandemic on stress, morale and mental all intended to introduce and explore the various aspects well-being – effects that many feel could last years. The of mind-body techniques, specifically as they might be success Siemens Healthineers had with these resilience- used to counter stress and trauma of the type brought building groups may serve as a model and an inspiration. Case study · Resilience Training 3 Introduction One of the discussions about the COVID-19 pandemic, Participants from across the globe that is not being held often enough, concerns a time Participants included healthcare professionals from after the pandemic has ended – when people are no 13 providers across the globe, plus Siemens Healthineers longer at risk, but healthcare professionals are still employees from 28 departments. paying the price for the extraordinary physical, mental and emotional ordeal endured since early 2020. There is global concern that some of them might still be paying that price for years to come. Siemens Healthineers published an Insights Series paper in Summer 2020 entitled “Managing the impact of care- giver stress and trauma in the COVID-19 era: a strategy toward resilience-building”. Though published at a time before the issue of caregiver trauma was on the radar of very many people, the paper’s authors nevertheless had this prescient warning: “The ability of healthcare leaders to address their staff’s trauma and stress will be essential to their organization’s long-term viability and the future of patient care.”1 It was with this priority in mind that Siemens Healthineers joined forces with the Washington DC-based The Center for Mind-Body Medicine (CMBM), which for nearly 30 years has been a leader in developing strategies and techniques to successfully address population-wide psychological trauma. Among CMBM’s innovative approaches are Mind-Body Skills Groups (MBSG), which employ experiential and integrative techniques such as breath work, movement, self-expression, meditation, guided imagery, autogenic training. All intended to help participants develop better self-care skills, lower levels of stress, improve mood, help prevent chronic health conditions, and overall build badly needed resilience. 1 Gordon JS, Miller AJ, Nieto Alvarez I, Triantafyllou C. Managing the impact of caregiver stress and trauma in the COVID-19 era: a strategy toward resilience- building. Siemens Healthineers Insights Series [Internet]. 2020;(9). Available from: siemens-healthineers.com/insights/news/managing-theimpact-of- caregiver-stress-andtrauma.html 4 Case study · Resilience Training CMBM and Siemens Healthineers devised an innovative Mind and body reaction to an experience online approach which was the first of its kind. Previously, Mind-Body Skills Groups had been onsite sessions, for Anxious individual volunteers, for one specific organization or L a population group in a specific geographic region. The new format had the ability to bring people together Reduces • remotely, emphasizing small groups where the remote Mental processing capacity • nature of the meeting allowed for international and Digestion and nutrient absorption inclusive exchange. In this way the format was also pioneering how to give more people access to such kind of training. K Increases • Emotionally sensitive The program was designed specifically for healthcare and reactive workers and others in the healthcare field, intended • Biomarkers in blood to help them with stress and, in some cases, trauma and saliva: Catecholamines ‒ brought on by the various effects and consequences Cortisol level ‒ of the pandemic. Participants included healthcare pro - Alpha-amylase ‒ fessionals from 13 providers across the globe: USA, • Heart rate Germany, UK, Portugal, Italy, Mexico, Colombia, India. • Respiration rate Also, Siemens Healthineers employees from 28 depart- • Blood pressure ments enrolled: application specialists, marketing and product development managers, diagnostic imaging product developers, innovation managers, education developers, and enterprise services consultants. The Relaxed selection was arbitrary, based on individuals’ willingness and availability to participate, and with the commitment K to share what they had learned with their colleagues Increases and within their organizations. • Mental focus • Biomarkers in blood or saliva: ACh This case study briefly describes the stages of the journey • taken by participants in the skills groups and then exam- Immune response ines the results of a pre- and post-program evaluation. We believe these responses provide a clear case for the K success of the program, and a strong argument for other Reduces organizations to help their employees become more resil- • Emotional reaction ient in the face of stress and trauma. • Heart rate • Respiration rate • Blood pressure Case study · Resilience Training 5 Resilience Training The program The skills groups approach emphasizes techniques Session 4 examined the science and applicability such as mindful breathing with the abdomen soft and of guided imagery and the power of creating mental relaxed, biofeedback, and guided imagery. The program images that evoke desired positive emotions and is designed to make the most of these and tailored in responses instead of ones driven by trauma and stress. such a way as to focus their benefits on reducing stress and building resilience. The participants were shown Session 5 explored the relevance of emotions and how to employ these methods in their everyday life emotional expression, and the potential of writing and gave each the means to continue practicing on as an outlet for emotions. their own. Session 6 explored the relation between stress and Participants were divided into small groups of six to seven digestion, the importance of appropriate nutrition, people. The sizing of these groups was crucial, intended hydration and how mindful eating can enhance the to support as much human interaction as the online pleasure of eating and the satisfaction of making nature of the meetings would allow, but keeping ex - choices. changes small and low-key enough so participants could feel safe. Between January and May 2021, they met for Session 7 built on the importance of mindful eating eight two-hour online sessions – an eight-stage journey to explore the overall relevance of mindfulness in through the science and potential of mind-body health. physical and mental health and well-being. Session 1 introduced the foundations of how the mind Session 8 concluded with further exploration of the and body work, including the nervous system and stress power of drawing, active listening in the group, and response. It established an overview of breathing, self- the healing potential of certain social ceremonies or awareness, and self-expression in the form of simple rituals. drawings. Each session included an exchange and check-in, Session 2 explored the science of biofeedback, which during which participants were encouraged to share people can use to control bodily processes that are their thoughts and feelings, followed by an educational typically involuntary, such as muscle tension, blood component and then a focus on experiential learning pressure, or heart rate. and an exchange of perspectives. The exercises were also provided to the participants in written or audio Session 3 explored various forms of meditation as a format to further encourage practice and evaluate means of quieting the stress response, making it easier benefits in their everyday life. to be aware of emotions, give them space to be, and put them into perspective. 6 Case study · Resilience Training “It was a great course; the meditation program was excellent.” Trauma Radiographer, Healthcare Provider based in Manchester, England The Results Evaluations were conducted before and after the Data were collected on a voluntary basis from partici- program. Upon comparison there was a significant pants of the ten groups and included 54 entries. Data improvement in anxiety, depression, and stress, was anonymized and evaluated by an independent including secondary traumatic stress, which is the analyst. The Depression Anxiety and Stress Scale emotional duress that results when an individual hears (DASS-21) and the Professional Quality of Life Scale about the first-hand trauma experiences of another. (ProQol) were instruments used for evaluation. On Participants were quoted as saying things like, “It really average, participants were experiencing normal levels moved me emotionally, and I feel I have better ways to of depression, anxiety, and stress before and after, work with my issues now” and “The experience in this although the scores were significantly improved group really influenced my life in a positive way, both following the skills groups. physically and emotionally.” Depression, Anxiety and Stress Scale (DASS-21)2 Professional Quality of Life (ProQol)2 8 50 p < 0.001 p = 0.749 7 45 (not significant) 6 40 5 p < 0.001 35 4 30 p = 0.003 p = 0.147 p = 0.009 Score Score 3 25 (not significant) (not significant) 2 20 1 15 0 10 Depression Anxiety Stress Compassion Burnout Secondary Satisfaction Traumatic Stress Pre – n = 52 Post – n = 38 Pre – n = 52 Post – n = 38 2 Data were collected from 43 women and nine men. Ages and gender were anxiety, compassion satisfaction, and burnout outcomes where there was not obtained for the 2 participants who did not fill out questionnaires before not enough variance at the MBSG level to give a stable estimate for the vari- the groups. Ages ranged from 24 years to 64 years with an average age ance parameters. For these outcomes, a marginal model was run to account of 38.8 ± 9.3 years. Of those responding at the post-measurement, 97% for the repeated measures of individuals over time. Fixed factors in all models attended more than half (5) of the MBSG sessions, and 82% attended at included time. Additional models were run with the fixed factors of gender, least seven sessions. attendance, and the interactions of gender and attendance with time to deter- The statistical models allowed all data to be included in the analysis. Data mine if results were different between men and women or whether they were analysis was performed using SPSS version 27. The MIXED procedure was dependent on the number of MBSG’s attended. The Means and Standard Errors used to run linear mixed models to account for the clustering of individuals in the graphs above are the Estimated Marginal Means and Standard Errors in the MBSGs. The MBSGs were a random factor in all models except the from these models. Case study · Resilience Training 7 In addition, a vast majority of respondents rated the program as excellent or good, including with respect to its practical application to personal life and practical application to professional life. Overall, 85% said they would recommend online Mind-Body Skills Groups to others. “This was a very well-run and instructive online group. Despite the difficulties inherent in the telemedicine format, this group was very effective in fostering a sharing, containing space while also imparting very helpful tools for mindfulness and stress management.” Clinical psychologist, Healthcare Provider based in Manhasset, NY 8 Case study · Resilience Training “An excellent open experience to learn new mindful techniques and to meet people from around the world.” Consultant Radiographer, Healthcare Provider based in Stoke-on-Trent, England Conclusion “Sometimes, we all must remember to take a break, Suggested follow-up on listen to our body and our soul. Taking this course means to breathe in, breathe out and remind yourself siemens-healthineers.com/insights/ what is important in life. Accepting that we all struggle, transforming-care-delivery in one way or another. Problems won’t be solved, but • it is important to learn different techniques that can be Insights Series, Issue 17: Protecting those who protect others. applied throughout the day that will help to deal better Available at: siemens-healthineers.com/ with aspects that concern you. Pick and choose the one insights/news/protect-healthcare-workers- that works best for you. Thank you for this beautiful covid-19 mind-opening experience.” • Insights Series, Issue 9: Managing the impact Global Services Marketing Manager, of caregiver stress and trauma in the COVID-19 Siemens Healthineers, New York, USA era: a strategy toward resilience-building. Available at: siemens-healthineers.com/news/ managing-the-impact-of-caregiver-stress-and- As we look back on the program and absorb the feedback trauma.html from the participants, two things are clear. The health- • Insights Series, Issue 10: Remote work for care providers who participated learned valuable skills healthcare professionals. and techniques for dealing with stress, and for managing Available at: siemens-healthineers.com/ stressful and traumatic situations in both the short and insights/news/five-steps-towards-more- remote-care-delivery.html long term. They also learned how to better support members of their care teams, as well as their patients. In About the authors addition, our Siemens Healthineers colleagues benefited from gaining an understanding of what their partners in healthcare have gone through. This program has been an Christina Triantafyllou, PhD inspiration to all involved as all have learned valuable Vice President Head of Improving Patient Experience at Siemens Healthineers techniques for dealing with the stress and trauma during christina.triantafyllou@siemens-healthineers.com challenging times such as the COVID-19 pandemic. Isabel Nieto Alvarez, MSc All in all, this online program has proven to be a success- Senior Key Expert on Improving Patient Experience at Siemens Healthineers ful approach to 1) develop individuals’ resilience to cope isabel.nieto@siemens-healthineers.com with challenging times, 2) globally foster active listening between professionals working in health-centered organizations and 3) ultimately support healthcare professionals to continuously deliver high-value care to patients. Healthcare organizations’ sustainability depends on the resilience of individuals and teams. Case study · Resilience Training 9 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · HOOD05162003247552 · online · 11396 0122 · ©Siemens Healthcare GmbH, 2022