Clinicians around the country face a variety of stressors that can lead to burnout and decreased well-being. At Ohio State, efforts to promote and support clinician well-being include facilitated traumatic event debriefings, monthly Schwartz Rounds®, and a preventive health initiative that offers staff retreats, free mindfulness courses, and culinary medicine classes.
This case study was informed by interviews with Steven Gabbe, MD, former CEO and President of the Wexner Medical Center; Maryanna Klatt, PhD, Professor of Clinical Family Medicine; Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FAANAP, FNAP, FAAN, University Chief Wellness Officer, and Dean of the College of Nursing; Susan Moffatt-Bruce, MD, PhD, MBA, FACS, Executive Director, University Hospital; Beth Steinberg, MS, RN, NEA-BC, Associate Chief Nursing Officer, Critical Care and Emergency Services; Andrew Thomas, MD, MBA, FACP, Chief Medical Officer, Wexner Medical Center; and Kenneth Yeager, PhD, LISW-S, LICDC, Clinical Director of the Stress, Trauma, and Resilience Program.
Ohio State Wexner Medical Center. Photo provided by The Ohio State University.
Introduction and Overview
Clinician well-being efforts within the Ohio State health system are primarily focused on trauma recovery support and open communication between clinicians on the social and emotional issues they face in providing care.
The Stress, Trauma, and Resilience Program houses two key programs that support clinician well-being: Brief Emotional Support Teams and Schwartz Rounds®. Brief Emotional Support Teams offer mental and psychological support to clinicians after stressful and traumatic events, facilitating team debriefs and identifying individuals who may need additional support. Schwartz Rounds® provide a venue for clinicians to openly and honestly discuss difficult cases and experiences and to support one another in those experiences. This opens doors to human connection and lessens the burden each clinician faces in dealing with issues alone.
Dr. Steven Gabbe, former chief executive officer of the Ohio State Wexner Medical Center, has played a significant role in shaping and funding these programs and has served as a transparent and vocal role model for clinicians and trainees. Dr. Gabbe’s leadership has helped cultivate a culture that is rooted in well-being. Recently, in his honor, Ohio State launched the Gabbe Health and Wellness Initiative, a preventive health initiative that offers staff retreats, free mindfulness courses, and culinary classes. The initiative launched in fall 2018, and additional programming will be added over the next several years.
Ohio State measures clinician well-being through a biannual engagement survey, which allows it to identify units that may need additional support.
Stress, Trauma, and Resilience Program
Brief Emotional Support Teams
Through the use of Brief Emotional Support Teams (BESTs), Ohio State’s Stress, Trauma, and Resilience (STAR) Program offers mental and psychological support to clinicians after stressful and traumatic events, such as the loss of a patient. BESTs are trained clinicians who provide immediate, direct, and temporary emotional support to clinicians and staff after stressful or traumatic events. Since its inception in 2009, the program has trained more than 450 clinicians to recognize and deploy trauma recovery services for individuals and teams.
BESTs use a framework that helps teams nurture a culture of built-in support among peers in the workplace. BESTs identify individuals and teams that need additional support after a traumatic event and lead them through activities that build upon and reinforce the existing relationships between team members. Initial funding for clinician activities within the STAR program came from the medical center—$300,000 per year for three years. The program now hosts a yearly fundraising event, Faces of Resilience, to continue the program. In 2018, it raised $580,000.
Prior to the launch of BESTs, STAR program leadership conducted “STAR rounding”—walk-throughs of individual units to educate clinicians on forthcoming programs and services. Program leadership also used previously scheduled electronic health record trainings to speak to clinicians about programming and how to access support services. When asked about their biggest lessons in creating a program in which clinicians feel safe to share their experiences of traumatic events, STAR program leadership notes, “You can’t build trust without getting out and meeting people. People are more likely to seek help with those they are familiar with.”
An in-house operating line (STAR line) is a resource for clinicians to identify a trained trauma debriefing facilitator after a traumatic event. A call to the STAR line will notify the STAR program team, who will deploy trained employees to respond to the event. The STAR team will typically respond within 24 hours.
Training to become a facilitator includes a half-day session taught by STAR program leadership. To protect the fidelity of the model and ensure all BESTs are taught in the same manner, only a few individuals are trained to teach the half-day course. A star worn on their clothing easily identifies trained clinicians.
The immediate trauma debriefing is typically 15-20 minutes. While it can be challenging to pull a trained clinician away from their workflow to facilitate a trauma debriefing on another unit, the short time frame of a debriefing has made it easier to use.
A typical debriefing includes psychological first aid, a seven-stage crisis intervention, motivational interviewing, and cognitive reframing to help reframe harmful narratives after traumatic events. This approach helps to prevent clinicians from developing “manufactured memories” in which they often assign blame to themselves. Following the initial trauma debriefing, STAR program staff follow up individually with clinicians to connect them with additional support services if needed.
The STAR program maintains a database of trauma debriefings and the outcomes of each intervention. To date, more than 2,000 interventions have taken place. Current data suggest that a large majority of individuals (80-83%) who participate in a STAR-facilitated trauma debriefing return to the floor and finish their shifts. Another 7-10% need additional services following the debriefing, usually in the form of three to five confidential counseling sessions offered through the Employee Assistance Program, and 7-10% are connected with Ohio State’s trauma-informed outpatient therapy clinic for more intensive and longer-term treatment.
Badges identify clinicians who are trained to facilitate trauma debriefings. Photo provided by The Ohio State University.
Schwartz Rounds® offer clinicians regularly scheduled time to openly and honestly discuss the social and emotional issues they face in caring for patients and their families. These sessions are interdisciplinary, often including physicians, nurses, social workers, advanced practitioners, chaplains, and allied health professionals.
Ohio State holds Schwartz Rounds® the first Friday of every month. These meetings are open to all clinicians and medical center staff and typically include an average of 180 people. A free lunch is included. A multidisciplinary team of nine clinicians develops topics for these monthly meetings. Typically, a meeting includes a case-based multidisciplinary panel presentation, followed by a facilitated discussion.
Schwartz Rounds® often illustrate that many clinicians may be struggling with similar issues. In connecting clinicians with one another, these meetings provide an opportunity for clinicians to discuss similar challenges they may be facing and to underscore that they are not alone in those challenges. These meetings also provide a space for colleagues to converse with each other in a nonjudgmental way.
Informal feedback surveys are used at the conclusion of each session to help inform future meetings. Program leadership notes that Schwartz Rounds® contribute to a supportive culture within the medical center community by intentionally opening lines of communication and providing space for clinicians to openly discuss issues they are facing and the feelings that accompany them.
.@OSUWexMed offers clinicians regularly scheduled, interdisciplinary sessions to candidly discuss and support one another following difficult cases. This lessens the burden each faces in dealing with issues alone #ClinicianWellBeing
Gabbe Health and Wellness Initiative
Launched in fall 2018, the Gabbe Health and Wellness Initiative coordinates programs to improve the well-being of faculty and staff through education and preventive health programming. The initiative currently offers a free mindfulness course, culinary medicine classes, and well-being retreats. It is run by one full-time staff person and overseen by a 10-member steering committee that meets quarterly to discuss upcoming priorities and new programming. Funding for the initiative is provided through an internal risk management grant to support patient and staff safety initiatives.
Clinicians participate during Mindfulness in Motion session. Photo provided by The Ohio State University.
Developed by Dr. Maryanna Klatt, Mindfulness in Motion is an eight-week program to help clinicians reduce stress and build mindfulness skills. Piloted in 2004 as part of an exploratory grant from the National Institutes of Health, the program now includes weekly one-hour on-site sessions.
Sessions occur during mealtime and food is provided. Each session aims to teach participants relaxation techniques, effective sleep habits, mindful eating techniques, and more. Overall, the program teaches participants to use their bodies to focus on the present moment, to explore what causes them to experience stress, and to learn techniques for reducing stress. Upon completing the eight-week program, clinicians receive a monthly in-person “booster” session to sustain their outcomes.
Since its inception, more than 300 clinicians of all disciplines have participated in the program. Early research suggests that participation in the program can reduce burnout and increase work engagement. Results also indicate a decrease in perceived stress, burnout, and inflammation in overweight individuals. Participants claim it has changed their relationship to stress and has empowered them to access choices they didn’t realize they had. Program facilitators note that the program helps to create community, increase collaboration, and improve teamwork within units. To date, 18 Ohio State staff have been trained to deliver the program, widely increasing its availability.
The Gabbe Health and Wellness Initiative currently offers a free five-session course on culinary medicine in which clinicians and staff learn basic cooking skills, share a meal, and discuss a case study.
Each session offers tips and educational materials on how to eat healthier. This is followed by a group cooking lesson in which the 16-person class cooks and eats a meal together. While eating, the group discusses a case study related to culinary medicine. Case study topics have included an introduction to culinary medicine, anti-inflammatory diets, cancer nutrition, eating healthy fats, and weight management and portion control.
The course is currently in its second cohort. Informal written surveys are used at the end of each cohort to measure participant satisfaction and to identify future areas of improvement.
The Gabbe Health and Wellness Initiative is currently piloting staff well-being retreats. Units can request funding to support unit-specific off-site retreats to enhance team-building skills and to promote team communication. Retreat agendas vary and are developed in coordination with the unit lead. Program leadership hopes that the retreats offer a morale boost for teams who may be dealing with stress and provide an opportunity for teams to enhance relationships in a fun environment.
Staff well-being retreat. Photo provided by The Ohio State University.
Assessment and Continuous Improvement
A biannual survey is administered to all clinicians, trainees, and staff within the Ohio State health system to assess overall engagement and well-being. A “pulse survey” is administered in the off year for units and teams that noted low engagement numbers on the biannual survey. Leadership is currently considering adopting the Mini Z Burnout Survey in their next biannual survey (fall 2019).
Cappelucci, K., M. Zindel, H.C. Knight, N. Busis, and C.M. Alexander, eds. 2019. Improving clinician well-being at The Ohio State University: A case study. NAM Action Collaborative on Clinician Well-Being and Resilience, National Academy of Medicine, Washington, DC. https://nam.edu/clinicianwellbeing/case-study/ohio-state-university.
Conceptual Model Factors
- Professional Relationships
- Culture, Leadership, and Staff Engagement
- Level of Support for All Health Care Team Members
- Team Structures and Functionality
More Case Studies in This Series
College of MedicineThe Ohio State University College of Medicine, home to more than 800 students, offers a variety of curriculum- and non-curriculum-based programs to enhance and support student well-being. Its culture, rooted...
College of NursingThe Ohio State University College of Nursing—home to approximately 2,200 students enrolled in baccalaureate, master’s, doctorate of nursing practice, and doctorate programs—offers a variety of curriculum and...
About: Nurse, Student/Trainee
Emergency Medicine Residency ProgramResidency can be an inherently stressful time, and the transition from medical student to resident can be an especially stressful event. Needs assessments and dedicated long-term resources have been essentia...