Culture change: How one hospital scaled up their wellness program during COVID-19

July 27, 2020

For more and more Canadian hospitals, employee well-being is now a key part of their mission. Introducing new strategies to help prevent burnout in physicians and other health care workers through mindfulness and resiliency programs is often the first step. Getting employee buy-in is key: it can often be the difference between success and failure.

This is where Dr. Mary Elliott, a psychiatrist at the Princess Margaret Cancer Centre in Toronto, has had some unique success.

In just five months, she and her colleagues, Marnie Escaf and Alyssa Macendo, developed a workplace program called BRITE — Building Resilience within Institutions Together with Employees — and rolled it out to 1,400 staff. It was so well received that one year later, BRITE was introduced to the entire University Heath Network (UHN), reaching more than 10,000 employees.

So, what’s the secret behind BRITE? And how has Dr. Elliott achieved widespread uptake of the program?

 

Micro-practices: wellness as you work

Previously, Dr. Elliott had developed a program at Princess Margaret called Compassion, Presence and Resilience Training (CPR-T) for Health Care Providers. In it, she blended longer mindfulness and self-compassion practices to be done at home, with micro-practices — short acts of self-care — to use throughout the workday.

She knew, from staff feedback, that the micro-practices stuck.

“I think that a couple of minutes just to take a breath, that clenched feeling, you just kind of let it go … I guess I can say that over time it’s a healthier way to work.” – Participant

“I had people come up to me and say, ‘You know, I’m still using that S.T.O.P. practice or putting a hand on my heart just before I have to break bad news to a patient,’ Dr. Elliott explains. “To be able to connect with their experience as they’re working in these small ways has helped foster their sense of well-being.” 

BRITE™ Practice: S.T.O.P

In this practice you are invited to put an intentional pause in your day, in order to become aware of your experience in the present moment.

Tip:  Link the use of  S.T.O.P. to routine activities, such as washing your hands, turning on your computer, or waiting for the elevator.

Those micro-practices eventually became the basis for BRITE, a program designed to improve staff well-being, employee engagement and ultimately the quality of care at work, through the cultivation of individual resilience “on the go.”

“It’s anything you do in that moment to care for yourself, when you realize there’s some anxiety, stress, pressure or reactivity,” says Dr. Elliott.

 

Make it easy, so people can do it

Designing BRITE to be easy became Dr. Elliott’s mantra.  She developed six domains of resiliency and two micro-practices per domain and outlined situations when each would be helpful.

The hospital designated a “domain of the month” to focus on, and for five months the program was tested at leadership safety huddles, with managers and directors of interdisciplinary health teams dedicating a portion of their daily 10-minute meeting to a BRITE practice.

“The director of inpatient care, for example, tells me that she uses the self-compassion break with teams whenever they have a critical incident debrief and they find it helpful,” recalls Dr. Elliott.

Dr. Elliott and her colleagues refined the practices, ensuring none took longer than one minute to complete. She developed “practice cards” to be handed out at the huddles, which contained simple instructions on how to do the practice and tips on how staff could integrate it into their workday.

In April 2018, the BRITE model was formally launched at a hospital retreat, where leaders from the pilot project worked in groups of three to teach the practices to other staff members — each taking a turn guiding a practice.

“My whole idea behind this was that we shouldn’t need to depend on experts like me. We should develop a program that anybody can teach,” explains Dr. Elliott.  

To help ensure the program “stuck,” managers were asked to nominate people from their team to become “BRITE lights” or ambassadors. Their role was to learn more about the program, change the practice cards from month to month and encourage other staff members to get involved.

 

A common language of wellness

After several months, the BRITE program began to catch on and become an integral part of the workday.

The phrase “take a BRITE moment” even became a regular way for colleagues to express the need for a wellness break.

Dr. Elliott gives the example of a pharmacist at Princess Margaret, who had been closely following a cancer patient. Upon learning the patient had died, the pharmacist went into a back room to do the R.A.I.N. practice, where you nourish yourself with kindness and compassion. A colleague recognized the situation and suggested she “take a BRITE moment” and go outside for some air.

BRITE™ Practice: R.A.I.N.

Begin by recalling a recent event or circumstance that triggered strong or difficult emotions.

Tip: Use in times of feeling anger, humiliation, grief, or anxiety. R.A.I.N. is a tool that can help you feel calm, balanced, and less reactive.

“It’s given staff this common language and permission to acknowledge that our work is stressful. It normalizes the experience,” says Dr. Elliott.

Before BRITE even reached its six-month evaluation, other hospitals in the UHN wanted in.

In the spring of 2019, it was rolled out to Toronto General Hospital, Toronto Western Hospital and Toronto Rehabilitation Institute, reaching more than 10,000 employees.

 

A foundation to deal with COVID-19

Considering Dr. Elliott’s success with BRITE, it’s no surprise that when COVID-19 hit Princess Margaret Hospital this year, she was well placed to respond with a new wellness support.  The CREATE program focused on compassion, resilience and team-building, pairing Dr. Elliott and a dozen other supportive care professionals with individual clinical teams. They began to meet regularly, using the BRITE practices as a foundation to deal with the stresses of the pandemic.

“It was a base to springboard from with respect to wellness interventions we could use to help teams,” says Dr. Elliott.

For example, when the clinical team she was aligned with had a particularly tough morning with a COVID patient, the staff huddle focused on a gratitude practice — learned through BRITE — where colleagues took the time to pause and reflect on the appreciation they had for someone or some aspect of their team, naming what they were grateful for and noticing how it felt to go through this team exercise.

“We had a common language to be speaking from as we supported teams through COVID,” she adds.

 

Spreading BRITE even further

Currently, Dr. Elliott is evaluating how BRITE was implemented across UHN.

In the future, she’d like to see the program and its short, bite-sized pieces developed into an app, as a way to scale it to other health care institutions.

“The goal of BRITE was to impact the culture and create space where individuals feel safe to talk about stresses and strains and positivity.”

Interested in peer support?

The Wellness Connection is an online, safe space for physicians and medical learners to gather and discuss shared experiences, get support, seek advice and help each other. Virtual group support sessions, led by trained facilitators and offered in different formats and approaches, are available each week and address a range of topics.

Learn more

_

This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule.  Feel passionate about this topic? Please connect with us at jouleinquiries@cma.ca.

Previous
Five research discoveries affecting clinical care for COVID-19
Five research discoveries affecting clinical care for COVID-19

Read an update from the DynaMed Infectious Disease team about five research discoveries that have affected ...

Next
Taking stock during times of high stress: risk factors and red flags
Taking stock during times of high stress: risk factors and red flags

Health care professionals have been facing intense uncertainty and demand due to the pandemic, making it to...

The CMA has up-to-date, reliable resources on COVID-19 for physicians and patients.

Stay current