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Meeting caregivers on the front lines

A snack cart is a gateway to wellness services

December 2020

WHO WOULD THINK that something as simple as a mobile snack cart could appreciably boost the wellness of hospital staff?

To be fair, the cart, which is known around the halls of the Delaware-based ChristianaCare as the wellbeing wagon,” offers more than just snacks. For many of the health system’s employees, the cart serves as a gateway to a wide range of services offered by the health system’s Center for WorkLife Wellbeing.

The cart rolls through the hallways of ChristianaCare during “wellbeing rounds.” Two members of the 12-person wellness team typically staff the cart, handing out snacks (dark chocolate and trail mix are always popular), drinks and comfort items like lip balm that may happen to be in short supply.

The real purpose of the cart, however, is to spread the word about the far-reaching wellness program and to give people a chance to talk. Members of the wellness team take the opportunity to check in on the system’s caregivers (a term that applies to all staff) and see how people on the front lines are really doing.

“We’ve created a culture where we’re normalizing help-seeking behavior.”

Heather Farley, MD

~ Heather Farley, MD

“We’re giving people comfort items, but we’re also providing in-the-moment support,” says Heather Farley, MD, an ED physician who is ChristianaCare’s chief wellness officer. “We’re able to proactively check on people and ask them how they’re doing, then serve as a conduit to peer support or more intensive mental health resources when needed.”

A long track record
ChristianaCare started its wellness program about five years ago, with a Care for the Caregiver peer support program. Many of the center’s other resources— such as help for clinicians facing malpractice suits— initially focused on physicians and advanced practice clinicians. The center officially expanded its efforts to all caregivers just before the pandemic struck.

By the time the pandemic arrived, says Dr. Farley, the health system had a lot of experience offering wellness support. “We’ve fundamentally changed our culture from shame and blame when bad things happen to one where we embrace psychological safety and mutual support.”

The wellbeing wagon helps reinforce those principles by sending wellness team members into the front lines. Some interactions border on the mundane: “Someone may say, ‘I’m so hungry, but I don’t have time to get lunch,” so we find a protein bar.”

But on other stops, particularly since the pandemic began, caregivers may hang around the cart a little longer, and the resulting conversations can last a half-hour. “We might move into a more private area to talk about what that person needs and what resources we can provide or refer someone to,” Dr. Farley says.

While the cart predates covid, she notes that it has undergone some significant changes because of the pandemic. “We added items to the cart to meet the needs of our caregivers like ear protectors, hand lotion and hand sanitizer,” she says.

More importantly, the wellness staff try to make sure the cart visits those areas that need the most help. “There’s a heavy emphasis on the covid units, the emergency department and other areas that are supporting covid,” Dr. Farley says. “If we hear that one unit is having a harder time this week, we’re able to get there and add on additional time to spend with them.”

It’s also not unusual to see ChristianaCare’s senior leaders rounding in the hall. “Communication is happening between caregivers and not only members of the wellness team, but senior leaders as well.”

What caregivers need
According to Dr. Farley, interactions with caregivers over the cart have led to a number of system-level changes.

During the acute phase of the pandemic, for instance, the health system prepaid for day care and provided information on elder care. It also created changing areas and stocked disposable scrubs so caregivers wouldn’t have to wash possibly infected clothing at home.

For those who didn’t feel safe going home because of covid, the health system provided accommodations at local hotels. ChristianaCare has also created a caregiver relief fund funded by community donations to help meet unexpected financial or other types of hardships that caregivers are having due to the pandemic. And there are daily wellbeing texts that contain positive messages or self-care tips that have been extremely well-received.

The wellness program has launched another new program: psychological first-aid training for leaders. “We’re training our leaders on how to recognize distress,” Dr. Farley says. “It will multiply our ability to recognize issues and support our caregivers.” The goal is to train leaders to be the program’s eyes and ears. “That’s so important because we can’t be everywhere,” she explains.

While the wellness program was well-used before the pandemic, participation has exploded since the spring surge. “We saw a ten-fold increase in the number of requests for team-group support,” Dr. Farley says, “and a three-fold increase in individual, one-on-one peer-support encounters. We’ve created a culture where we’re normalizing help-seeking behavior.”

More essential than ever
Looking ahead, Dr. Farley says that one goal for the cart—and the wellness program—is to encourage caregivers to continue to talk to each other about the challenges they’re facing. She says that’s important because in health care, it’s critical for caregivers to talk to each other. That kind of connection has become difficult during the pandemic.

“We know that collegiality and camaraderie are major predictors of well-being in general,” she says, “and especially well-being at work. That’s difficult now, because so many opportunities that used to exist are gone.” Dr. Farley worries that as the weather gets colder and the days grow shorter, those interactions will become even more scarce.

“If we can build in opportunities for those discussions,” she adds, “they will continue after we’re gone, and the mutual support we offer each other will continue.”

Such conversations are even more important now that, as the pandemic drags on, caregivers are experiencing pandemic fatigue. “People are no longer just putting their heads down and getting through it on adrenaline,” Dr. Farley points out. “They’re tired, and they’re starting to process the experiences they’ve had. The support we give them now remains essential. It’s not the time to let our feet off the gas.”

Heather Farley, MD (white coat) and her team on wellbeing rounds.

Edward Doyle is Editor and Publisher of Today’s Hospitalist.

Published in the December 2020 issue of Today’s Hospitalist
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