As the new chair of Emergency Medicine at Hennepin County Medical Center (HCMC), James R. Miner, MD, was looking for ways to foster a positive, supportive culture among his physician faculty. HCMC had just completed a system-wide survey of physician burnout. Dr. Miner recalls, “While our department burnout rate was low, all our physicians reported high levels of stress and we realized we were at risk for future burnout. We decided to be proactive and do something to reduce stress within our group. We knew physicians were troubled by constant interruptions and had difficulty focusing in the emergency room (ER), so we decided to give mindfulness a try.”
Twenty-two of HCMC's 28 emergency medicine physicians signed up for four weekly two-hour sessions, during which they participated in group exercises and practiced a variety of mindfulness techniques. All 22 of the physicians who signed up for the training completed at least three of the four sessions, and 18 attended all four sessions—a testament to the value they found in the training. “Some of the physicians we thought would be the most skeptical surprised us and were willing to give it a try. All of the physician participants rated the mindfulness training highly in post-session evaluations,” Miner reports.
Some physicians recognized that things they were already doing—exercising, listening to music for 20 minutes after a shift—were ways of being mindful. “Going through the training helped them see these as essential stress relievers, and that they could now be more purposeful in prioritizing these activities,” Miner adds.
Other physicians learned that they benefit from taking 10 minutes to refocus after a stressful patient event. “After a traumatic experience, such as the death of a child in the ER, a colleague is now more likely to say to the physician involved, ‘I think it would be good if you went off and took a few minutes to refocus,'” Miner remarks. Mindfulness training provided an opportunity for bonding within the department, and this type of response to stress is now understood as a sign of friendship and caring for one another.
What were the keys to success?
The physician leader must truly buy into the practice and benefits of mindfulness for others to engage. The leader can make it clear that well-being is a departmental priority, and that it is an important part of a physician's job to be mentally healthy.
Convey that mindfulness training is being offered to help physicians be better at their jobs. Had HCMC mandated the mindfulness training (rather than offering it as an option), they believe that the outcome would have been very different.
Keep the size of the training sessions to 10-20 participants.
Schedule thoughtfully to avoid creating competing responsibilities for the physician participants. HCMC offered the mindfulness training sessions twice a day, once from 7 to 9 a.m. and again from 5 to 7 p.m. This way, the sessions took place just before or just after a shift. Physicians could choose their preferred session based on their work shift.
Of his own experience with mindfulness training, Dr. Miner says, “If I start a shift in a bad mood, everything will go downhill. Before I come into a busy shift, I collect myself and focus. As I walk in from the parking lot, I have a routine of thinking only about things for which I am grateful. When I get to my desk, I take about five minutes of quiet to clear my mind. I consciously push any personal concerns off for eight hours, protecting myself from stress and burnout. I am more focused. I've been teaching my residents mindfulness, as well.”
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