A boatload of simultaneous priorities, a multitasking frenzy, role overload, time constraints, financial pressures, racing minds, exhaustion and stress — these are realities in health care (and life) today. And they are killers. In health care, these realities are killers of quality, engagement, morale, Hospital Consumer Assessment of Healthcare Providers and Systems scores, and the health and well-being of patients and families, health care leaders, physicians, and staff.
It would help to set priorities, to identify the select few objectives with the greatest impact and chase after them relentlessly. It would help to get better organized, add more staff, improve efficiency, learn to lead more effectively, hire more dynamos, engage process improvement teams, and lengthen each day by a few more hours. We've been trying to do all that without sufficient relief.
I propose a single, powerful approach that will help care providers and staff, patients and families all experience less stress and better results. The approach involves helping everyone — leaders, physicians, staff and patients alike, to master and use the skill of mindfulness. Mindfulness is transformative — for individuals and for organizations.
Mindfulness and Its Benefits
Mindfulness is the practice of focusing our attention purposely on the present moment and accepting it without judging. It is all about openly experiencing what is there. Mindfulness used to be considered a New Age skill, but no more. It's made its way into the mainstream, with everyone from kids to new mothers to physicians and CEOs recognizing its value and taking steps to make it habit.
In the personal realm, no matter what your role in life, mindfulness helps you engage fully in what you're doing and what's happening around you and within you. It helps you savor the pleasures and deal more effectively with adverse events. It stops you from worrying about the future or dwelling on regrets or negative past experiences. Also, it reduces rumination and stress. It boosts working memory. It helps you to focus your attention. It makes you less reactive and more reflective. It increases cognitive flexibility and creativity. And it improves relationships.
In health care specifically, mindfulness produces powerful benefits for leaders, staff, clinicians and patients alike:
Mindfulness offers significant benefits to executives. Imagine if you were to consistently practice mindfulness in your everyday work. You would focus fully on one major priority at a time. You would stop to reflect on what is actually happening in the present moment, how people are acting and reacting, what they're experiencing, seeing, hearing and learning. You would be plugged into the realities. You would tune into yourself and your inner wisdom, and you would experience others in a positive, open-minded and curious way. You would strengthen your focus and your relationships and make better decisions.
Mindfulness helps staff to create a positive and healing patient and family experience. When physicians and staff are mindful with patients and families, they notice cues and gain invaluable information that helps them to address concerns and provide safe and effective care. They feel more compassion and communicate with greater empathy. They ease patient and family anxieties, because patients and families feel their caring. They encourage patients and families to open up, to trust and to partner in their care.
As mindfulness expert Jon Kabat-Zinn says, only when we are mindful with patients will we release our innate compassion. He calls mindfulness “presence of the heart.” When caregivers really listen — in compassionate silence, taking in what's happening, instead of trying to fix it, push it away, hurry out of the room, or contemplate the next pressing thing they have to do — this is deeply healing for the patient.
Mindfulness benefits physicians professionally. Ronald Epstein, M.D., and Michael Krasner, M.D., at the University of Rochester School of Medicine and Dentistry, have confirmed that mindfulness training for physicians has a powerful, positive impact on care decisions, patient perceptions of their doctor and physician job satisfaction. Physicians benefit from a stronger feeling of connection with their patients, greater patient satisfaction and retention, reduced stress, and professional pride in their positive impact.
Nurses benefit, too. Nurses deal night and day with high-stress, high-emotion situations. It's not easy to stay focused and tuned in. Mindfulness is a de-stressor. It is an antidote to the rampant pressures that nurses experience, helping them to maintain inner resilience so they can be non-distracted, open, compassionate and receptive with patients, while taking care of themselves.
Also, according to a recent study of 3,000 hospitals by Press Ganey, the nurse communication factor on HCAHPS is the rising-tide metric. When scores improve, so do scores on other HCAHPS dimensions, including responsiveness of hospital staff, pain management and overall rating of the hospital. Organizations that implement training in the language of caring, which ought to include staff skill-building on mindfulness, can achieve substantial gains in top-box HCAHPS scores. And improved scores strengthen the hospital's reputation and reduce financial risk under value-based purchasing.
The organization wins. If caregivers were to embrace mindfulness, we would see a revival in the doctor-patient relationship. We would see health care shift from fixing body parts to healing the whole person. Patients would engage, physicians would be more gratified, nurses would be less stressed and happier, and executives would be more focused and effective. The results: fewer errors, more accurate diagnoses, better patient outcomes, greater patient satisfaction, higher HCAHPS and Consumer Assessment of Healthcare Providers and Systems Clinician & Group scores, healthier and more fulfilled physicians and staff, reduced absenteeism, more physician and nurse retention, and even reduced cost.
With mindfulness, all partners on the health care team can enhance their effectiveness, their impact, and their own health and job satisfaction.
What about Mindfulness for Patients?
As we take steps to transition from a health care system that supports illness to one that advances wellness, we also should be educating and engaging patients and families to learn and practice mindfulness. There is a compelling evidence base that demonstrates the power of mindfulness to help people with chronic pain, anxiety, panic, gastrointestinal distress, sleep problems, depression, psoriasis, fatigue, high blood pressure, headaches and improved immune function. Mindfulness is critical to effective self-care and should be the No. 1 item on a patient's post-discharge plan and lifelong wellness plan.
Here are four suggestions to advance mindful practice:
- Help people learn it. Initiate programs that help patients and staff learn this mental discipline. It is learnable and there are many resources and people available to help you shape the optimal approach.
- Make mindfulness a job expectation for staff. After all, it's central to quality, safety, patient outcomes, stress management, wellness and the exceptional patient experience. Articulate in your service standards, job descriptions and competency-building processes the primacy of mindfulness in all interactions.
- Promote the six-second approach. Suggest that people (including you) start small and experience the energizing and calming impact of mindfulness. Invite people to focus on their breathing, pairing one deep, centering breath with a frequent, routine activity, such as every time you wash your hands or knock on a patient's door. Stop. Center yourself with one deep breath, taking one second to inhale through the nose and five seconds to exhale through the mouth. Then, you can approach the patient with compassionate attention and respect.
- Start with you. You'll benefit personally and be much more credible and effective making the case with those who provide care and service in your organization.
The One Skill That Can Transform Health Care
The Institute for Healthcare Improvement calls for transformation of the health care system in accord with the Triple Aim:
- improving the patient experience of care (including quality and satisfaction);
- improving the health of populations;
- reducing the per capita cost of health care.
We discuss changing delivery systems, models of care, incentives and many other external variables as possible solutions. It's time to go internal. By adopting and promoting mindfulness, we can transform ourselves so we are more focused, reflective, resourceful, open, creative, efficient and resilient as we make tough decisions and tackle the backbreaking work of transforming the health care system.
Wendy Leebov, Ed.D., is a partner with Language of Caring in Boynton Beach, Fla.