Learn how ChristianaCare built foundational well-being programs to lay the groundwork for a Chief Wellness Officer (CWO) position.
A popular metaphor in well-being has become that of the canary in the coal mine, and the idea that one cannot simply build a more resilient canary—one must work to change the toxic environment of the coal mine. Awareness of the incalculable impact of medical errors and adverse events on clinicians prompted ChristianaCare to re-evaluate their approach to well-being and leadership of well-being initiatives.
Making the case for well-being
While some organizations begin their institutional well-being journeys with the appointment of a Chief Wellness Officer, ChristianaCare's Center for WorkLife Wellbeing (the Center) began with a grassroots approach that established well-being programming first.
Early efforts toward creating a culture of well-being occurred in isolated pockets of the organization. A sea change later generated momentum that resulted in organizational commitment of dedicated time and resources. This period was driven by a concerted effort by self-appointed champion leaders equipped to launch initiatives and build consensus. Fortuitously, these efforts paralleled important changes in senior leadership and overt institution-wide efforts to redefine system values and associated behaviors.
This change laid the groundwork for a Chief Wellness Officer to lead organization-wide well-being efforts.
Developing the Intervention
The Center built support for an organizational commitment to caregiver well-being by:
| Presenting the case for well-being to stakeholders. | Forming strategic partnerships with volunteer champions. | Ensuring clinician involvement in all aspects. |
| Clearly articulating the business, quality and safety, regulatory, and moral/ethical rationales | Engaging those working on the front lines to deliver a series of targeted pilot programs that could serve as test cases for the institution | Clinicians who volunteered or with partial time allocations ranging from .20 to .75 FTE performed activities related to both stakeholder development and pilot programming |
The grassroots approach sought to balance reactive programming for health care workers in distress with proactive growth and education-oriented programming designed to build camaraderie and social support and begin culture change. This balance was achieved with 3 pilot programs:
Care for the Caregiver Peer Support Program. An emergency medicine physician (Heather Farley, MD) and a psychologist (Vanessa Downing, PhD) partnered with a multidisciplinary steering committee to develop this initiative. Launched in 2015, the aim was to offer rapid peer support to any caregiver impacted by adverse events and unanticipated outcomes. Forty-five peer supporters were trained to respond using empirically supported approaches to mental health first aid. The program emphasized the importance of embedding the principles of psychological safety into the event review process, with the goal of eventually becoming hardwired into review and debrief meetings, policies, and procedures.
The Opportunity to Achieve Staff Inspiration and Strength (OASIS) Program. This 12-month program brought well-being efforts to the caregivers in the intensive care unit. The program was developed in partnership with frontline workers and funded by an internal grant. OASIS introduced empirically supported positive psychology interventions along with a dedicated physical space for all members of the ICU multidisciplinary team to reset, recharge, and recover in a location away from patients and their families.
Ice Cream Rounds. This reflective and educational session was offered quarterly during protected lecture time to 3 residency programs. The psychologist-led pilot sessions offered residents the opportunity to dive deeply into topics related to burnout, well-being, and personal and professional values.
From isolated pilots to program conceptualization
Although the pilots were initially conceptualized as services for physicians and advanced practice clinicians (APCs), it became clear that there was an appetite and need for well-being services across the organization—from clinicians to environmental services staff to dietary staff to administrative staff and beyond. This awareness, combined with the enlightened mentorship of several senior leaders, culminated in a “perfect storm” of support for a formal business plan proposing a well-being department that would initially serve physicians, with a long-term goal of expanding to serve all caregivers. Work with senior leaders as well as the Strategy and Planning Office to develop a formal business plan ran in parallel to ongoing stakeholder development and pilot project initiatives, and so synthesized critical input from numerous vantage points across the organization.
By the fall of 2017, full time positions were created for a Director of Provider Wellbeing, a Director of Content Development and Training, a Care for the Caregiver Program Manager, and an administrative assistant. Full time status for these critical roles, budgetary support for part time project management help, and designation of the newly created Center for Provider Wellbeing as a distinct department enabled expansion of the 3 pilots and development of additional interventions.
With additional administrative support and dedicated staff, the Center for Provider Wellbeing joined Stanford's Provider Wellbeing Academic Consortium to administer the first systemwide caregiver well-being survey in 2017. The Center also introduced 4 new initiatives that year. A formal, detailed business development plan was presented, approved, and the program and staffing expansion continued.
Five years into the initial work begun by Dr Farley and Dr Downing and 2 years into the business plan, the Director of Provider Wellbeing was promoted to Chief Wellness Officer (Figure 1). The Center began the work of expanding its scope, mission, and vision—along with the creation of a new operational framework—aligned with the overarching goal of serving all caregivers.
The scope and role of ChristianaCare's Chief Wellness Officer are described in detail in this success story.
ChristianaCare's grassroots effort to establish a CWO position was successful because they:
Recognized the value of the “heart and head”: The Center's creation depended upon persuasive arguments that spoke both to the head (ie, with an emphasis on return on investment, value of investment, costs of not taking action) and to the heart, with the latter using humanizing stories that brought potentially “cold” data and statistics to life to help stakeholders understand the “why” of the effort.
Were sensitive to perceptions of resilience programming: Early pilot programs across clinician types yielded one predominant theme—very few clinicians appreciate or identify with the suggestion that they are not resilient enough. Indeed, physicians and APCs bristled at the intimation that their experiences of burnout would be ameliorated with greater toughness or grit. Resilience education is best reserved for use in environments and systems that are just, equitable, and already optimized.
Started with a focused scope: Opting for an initially tight focus and creating services geared toward physicians and APCs was the right decision in the Center's early stages. This approach allowed a small dedicated team to develop interventions and programs with a specific population in mind, and to draw upon an established literature regarding the drivers of burnout and professional fulfillment.
Were unafraid to pilot programs: Frontline caregivers can be notoriously difficult to reach. By piloting interventions with small samples, the Center was able to assess receptivity and implementation. This also built goodwill and identified potential champions for expanding the scope of work. Pilots led to word of mouth about early well-being efforts and generated “buzz” that contributed to an organizational appetite for more programming.
Recognized the importance of non-traditional marketing: The Center certainly relied upon all the traditional approaches to marketing its efforts, including extensive and ongoing partnerships with External Affairs and internal management communications channels. But they also developed novel approaches to spread the word, such as a “wellness wagon,” an actual wagon loaded with snacks and well-being event advertisements that visits every physical location across the system. Additionally, they capitalized on preexisting relationships by training champions—typically trusted and beloved members of their own teams—to deliver messages and education instead of Center leadership or subject matter experts. This approach added layers of authenticity and personalization that were critical to conveying genuine care and concern.
Embraced detractors: The Center made a purposeful decision to learn from potential detractors and others resistant to the initiatives without becoming bogged down or disheartened by them. Some examples of criticisms included the belief that creating a culture of well-being would lead to lowered standards over time, belief that well-being is an individual rather than organizational or systemic responsibility, and perceptions that those who didn't have the strength or stamina may not be cut out for the field of medicine. In many cases, including “nay-sayers” ultimately brought nuance, depth, and complexity to arguments for the existence of the Center, as well as clarity about the scope of its work and positioning within the larger institution. In several notable instances, this early and ongoing outreach led to a transformation of cynics into some of the Center's greatest champions. These experiences and anecdotes of transformation on the individual and system level are among the most rewarding pieces of data to suggest that the Center has moved beyond its grassroots beginnings to become an essential and well-established part of ChristianaCare.
By the end of the first year, peer support was provided to approximately 150 individual caregivers, and requests began coming in for group support for teams. As of this writing, the Center's Care for the Caregiver program provided over 1100 individual peer support encounters and 60 group support sessions. The OASIS Project was initially rolled out to 2400 caregivers in 1 ICU. There are now 10 OASIS rooms spread across 3 campuses (Figure 2). Ice Cream Rounds is now offered in 17 residencies and fellowships, was rolled out for program coordinators, and will include nurse residents in the coming year.
Headquartered in Wilmington, Delaware, ChristianaCare is one of the country's most dynamic health care organizations, centered on improving health outcomes, making high-quality care more accessible and lowering health care costs. ChristianaCare includes an extensive network of outpatient services, home health care, medical aid units, 3 hospitals (1299 beds), a Level I trauma center and a Level III neonatal intensive care unit, a comprehensive stroke center, and regional centers of excellence in heart and vascular care, cancer care, and women's health. It also includes the pioneering Gene Editing Institute and was rated by IDG Computerworld as one of the nation's Best Places to Work in IT. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. We are continually ranked by U.S. News & World Report as a Best Hospital. With our unique CareVio data-powered care coordination service and a focus on population health and value-based care, ChristianaCare is shaping the future of health care. Learn how we deliver greater quality and value at https://christianacare.org.