STANFORD HEALTH CARE
A PUBLICATION FOR EMPLOYEES OF STANFORD HEALTH CARE
SPRING 2019
RESILIENCE 101 NEW STANFORD HOSPITAL POWER OF ATTENTION
New Stanford Hospital Getting Closer to Opening Day After a decade of visionary planning and design, we have moved closer and closer to opening our new 824,000-square-foot, 368-bed state-of-the-art hospital. What began in 2007 will culminate this year when the doors open to the community and the first patient is treated.
2007
May 2013
July 2019
Approval process begins
Official ground-breaking
June 2011
April 2019
Certificate of Occupancy/ building activation begins
Approved by Palo Alto City Council
Temporary Certificate of Occupancy
July/August 2019 Dress rehearsals
from the CEO Dear Colleagues, No doubt, you have all experienced stress in your work. Job-related pressures are among the top stressors that our American workforce faces. That is especially true in health care. We work in a demanding field—stress comes with the territory. And we spend a third of our lives working. So, it’s not surprising that this time can affect how we feel physically and mentally. How we deal with the demands of our jobs is critically important and can have
enormous influence over our well-being and ability to perform to our full potential. In life, we can’t always control what happens to us, but we can control what we do next. As an institution and as individuals, we can promote well-being in the workplace and tap into strategies to increase our resilience. That’s the theme of this edition of SHC People. In it, you’ll find ideas for reducing stress and increasing your capacity to bounce back from challenges. You’ll also learn about efforts underway at SHC to help our employees achieve personal wellness goals. My hope is that, after reading these stories, you will feel inspired and motivated to consider ways to integrate new, positive habits into your own life—at work and at home.
ON THE COVER: Resilience 101 begins with taking care of oneself at work, as the Advance Practice Providers do on their Wellness Walks (center). Top row (L to R): The Contracts Administration team takes a break from their desk job to ride bikes; the New Stanford Hospital from the garden level; and the Food Services team shares nutrition information and guides health behavior at team meetings.
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September 2019 Opening events
October 2019 Ribbon cutting and first patient
There are other stories to explore, too— about our 500P Activation Champions, our StandOut program’s check-in process. DAVID ENTWISTLE PRESIDENT & CEO
STANFORD HEALTH CARE PEOPLE is produced by the Corporate Communications Department. Send comments to communications@stanfordhealthcare.org.
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EALTH CARE ATTRACTS PEOPLE WHO ARE GIVERS. THEY ARE DRAWN TO THE COMPLEXITY, PROBLEM SOLVING, AND MEANING IN MEDICINE AND OFTEN WORK TIRELESSLY TO SERVE OTHERS AT A DETRIMENT TO THEMSELVES. THOSE SAME QUALITIES OF COMPASSION AND CARING ARE AT THE HEART OF WHY THEY EXPERIENCE HIGH RATES OF BURNOUT. “There’s an excellent reason why flight attendants instruct passengers to put on their own oxygen masks first in the event of an emergency,” said David Entwistle, President & CEO of Stanford Health Care. “If you don’t take care of yourself, you won’t be in a position to help anyone else.” CONTINUED ON PAGE 4
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Today, 65 percent of US employees cite work as a significant source of stress. More than a third experience chronic stress. Physicians are at an even higher risk, with roughly half experiencing some sign of burnout. “So we believe that burnout is the price of success, when in fact a growing body of research shows just the opposite is true,” said Entwistle. “When we prioritize our well-being, our decision making, creativity and production improve dramatically.”
Resilience Is the Ultimate Burnout Buster “Resilience is defined as the ability to confront adversity or challenges and bounce back from them,” said Bryan Bohman, MD, Chief Medical Officer for University HealthCare Alliance. “Resilient people tackle problems from the perspective of: What part of this do I own? What can I contribute to the solution? Rather than: Why is this happening to me? They don’t see themselves as victims; they function at a high level regardless of their circumstances.” “Resilience is the reservoir of resources people draw from to face and address change and disruption,” said David Jones,
Chief Human Resources Officer. “As you’re experiencing change and being tasked emotionally, mentally and physically, the more you can draw from a deep reservoir of resources, the more effectively you can move through those changes and stay productive, stay positive, stay focused and stay effective.”
The Professional Fulfillment Model Although personal resilience is essential to combating burnout, there is a growing understanding that organizations have a role to play. “Wellness is not only about personal resilience or just taking care of ourselves with sleep, exercise and nutrition,” said Tait Shanafelt, MD, Chief Wellness Officer for Stanford Medicine. “We now recognize how the system, the work environment in which we function, is a critical driver and the next frontier to make progress.” To combat the high rate of burnout among physicians, Stanford Medicine developed the Professional Fulfillment Model, which acknowledges three factors necessary for professional fulfillment: personal resilience, an organizational culture of wellness, and an efficient practice or work environment. “We believe that this approach of looking at professional
Studies show that employees who spend at least 20 percent of their day DOING SOMETHING experience less burnout. What is the most meaningful part of your workday?
“Having conversations with patients, families or with staff help us to remember why we chose this profession and how much little things we do matter. Having face-to-face conversations instead of using technology allows us to have a connection in which we can feel appreciated and valued, just by a smile, a gesture or a small thank-you.” KAREN NELSON Social Work and Case Management
“The most meaningful part of my day is scheduling and speaking with our new patients for appointments. I enjoy helping others, and that is what I get to do daily.” MONA SUMMERS
“Individual check-ins take up a big chunk of the day, but I think that face-to-face connection is so important to make sure no details are missed.” CARMITA BROUSSARD Perioperative and Interventional Services
Orthopaedic Surgery Clinic
“The most meaningful part of my day is when I know I’ve left a patient feeling well cared for or when I know I have provided important, efficient and effective care.” KATHERINE CHAN Clinical Advice Services
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improvement efforts, which employees at every level contribute to, are helping to create a consistent, reliable workplace, a key factor in reducing stress among employees. Human Resources is working to shape a culture of wellness at SHC. “We are helping to impact the employee experience, everything from the work environment that we create, to trying to have a workplace of high trust and high integrity, to helping leaders be sensitive, highly skilled and effective,” said Jones. StandOut is an important part of that effort. “The more time a person can spend in the areas of their strengths, the higher their resilience, and the higher their productivity, engagement and effectiveness,” he said. SHC’s comprehensive employee wellness program, HealthySteps to Wellness, helps employees build their own personal resilience. Its programs include wellness classes and customized team trainings in skills such as mindfulness, meditation, stress management and positivity, and wellness grants to fund a team’s self-directed wellness activities. “The goal of all of our efforts is to help employees find meaning, joy and purpose at work,” said Terry Palmer, MS, Associate Program Manager for HealthySteps to Wellness.
“We are helping to impact the employee experience, everything from the work environment that we create, to trying to have a workplace of high trust and high integrity, to helping leaders be sensitive, highly skilled and effective.” fulfillment (as opposed to burnout alone) is applicable to everybody in any job across Stanford Health Care,” said Bohman. “Many of the same stressors that affect physicians are occurring in every level of the health care organization. How are you being treated by your boss? Are you feeling appreciated and supported? Are you given the tools you need? Is the organization working on processes that allow you to complete your work efficiently without having to put in a superhuman, superstressful amount of effort?” Stanford Health Care is committed to creating a workplace that nurtures professional fulfillment. Ongoing quality
SUPPORT FROM CO-WORKERS is critical in our work-life health and reminds us we are not alone in our journey. Provide an example of how you and your teammates support one another.
“I am lucky to work in an area where we all offer support or ask for support on the days that are challenging. Break time also allows us to make a quick trip across the street to grab a drink from Starbucks. Sometimes that little outing can make a world of difference when we are feeling stressed or overwhelmed.” LETICIA RODRIGUEZ Cancer Center South Bay Medical Oncology
“My co-workers help me by answering my questions and showing me how to do things I don’t know how to do yet. I support them by helping them in any way I can.” CARL ROGERS Informatics Education
“We have an unwritten code that we all just jump in and do whatever tasks need doing. We share the workload, try our best to make it fair and balanced, have a good sense of humor about life and take an interest in each other’s lives.” GREG HOOVLER Cath Angio Pre-Procedure
“We always cover for each other; if someone has something they need to do that has come up, we never hesitate to let that person go, and someone on the team will pick up. If it has been a stressful time in someone’s life, again everyone will jump to take items off of the other’s plate—i.e., do the schedule, be the on-call manager.” DONNA HEALY Cancer Center Network – Infusion
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Resilience Takes Practice Just as building muscle strength requires exercise, resilience requires practice to develop the skills, behaviors and attitudes that contribute to physical, emotional and professional well-being. Asking self-reflecting questions, meditating, mindful breathing, physical exercise, building community, finding meaning and connections at work— all these micro practices can impact general resilience. “These practices are easy to do, and easy not to do,” said Jeff Edgar, Practice Manager for Organizational Development. “At the end of the day, you must build the habits to expand your resiliency battery pack,” he said. “When your battery pack is full, and you’re energized and engaged, performance is better. When we get depleted, we are not our best selves.” How one builds resilience varies from individual to individual. For some, the simple act of walking the dog or taking a run clears the mind and builds resilience. Others refuel their tanks by getting home in time to have dinner with their families or connecting with colleagues after work. There are employees across Stanford who have built
“At the end of the day, you must build the habits to expand your resiliency battery pack. ... When your battery pack is full, and you’re energized and engaged, performance is better.” resilience practices into their daily work. A team of OR nurses ends every huddle with the question, “What’s your resilience level today?” A group of contract administrators bikes to lunch together, getting physical exercise while also building the social connections that are critical to emotional health. Nurses on B2 practice mindful breathing as they gel in and out of a patient’s room, re-centering themselves for the next patient encounter. A group of Advanced Practice Providers meets for lunchtime walks to combat the isolation of their jobs. “We can’t eliminate all stress from our work; that’s not even realistic,” said Entwistle, who finds solace in bicycling. “But we can incorporate practices that make us all more resilient.”
GRATITUDE AND FORGIVENESS have been found to improve emotional and physical health. How do you practice gratitude in your life?
“I write a diary every day, and each day I write down three things I am grateful for. That’s basically the last thing I do each day before I fall asleep.” PATRICK BARTOSCH Communications
“I practice gratitude in teaching my kids what to be thankful for each and every day.” ASMAA ALI Ambulatory Care Services
“I am always thankful for help at work and keep a grateful spirit. Sharing my great life with others gives me the most pleasure. In addition, I love to help people everywhere I go. ALLEN ORSI Quality, Patient Safety and Effectiveness
“I am thankful to be alive every day—cancer free for five years! I make sure that I show random acts of kindness to all and treat all people with respect.” JENNIFER BELL Professional Billing Organization
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UHA Bringing Wellness to UHA There’s always more we can do to improve our general well-being, such as exercise, stress reduction and weight loss. “To me, wellness means living a healthy and balanced life,” says Sherrice Adelson, Director of Operations for University HealthCare Alliance–South Bay and a Wellness Ambassador. “I have always been passionate about sharing different wellness strategies in the hopes that at least one person may incorporate one
strategy that could make an impact on their overall well-being.” Ambassadors are in some ways coaches. They actively listen to colleagues to identify their needs and help them devise action plans to achieve them. It can be as simple as encouraging someone to incorporate more fruits and vegetables into their diet, helping them find a few healthy recipes to work into their meal plans or launching a step-challenge to motivate the office to be more active. Other wellness themes may include: mindfulness, gratefulness, taking time out for yourself, breathing, exercising and getting enough sleep. Adelson is helping organize the Wellness Ambassador program in the South Bay. Recently, she met with 15 of her colleagues to discuss the program and plot their path forward. “These meetings
are meant to help them take on a leadership role that will ultimately set them up to be successful,” says Adelson. The first step was WELLNESS AMBASSADOR SHERRICE ADELSON understanding what wellness means to them. “It went back to caring for themselves as individuals,” says Adelson. “They wanted to know about wellness in terms of day-to-day practical strategies they could incorporate into their own lives, and then share these ideas with peers.” “It’s all about engaging your teams,” she says, “to incorporate wellness into their day-to-day lives in a positive and inspiring way.”
Health care is a demanding field and, at times, can be stressful. WHAT DO YOU DO OUTSIDE OF WORK that fulfills you, motivates you and brings balance to your life?
“We deal with reality every day, and taking a break from that is refreshing, so sometimes I watch mindless movies. Also, I enjoy spending time in my garden or with my pets.”
“Reading provides a way to get away from the here and now. I participate in two book clubs that adds a social layer as well as some additional stimulation, as we share our different takes on the book, subject, author, etc.” EVE PERSONETTE Patient Financial Services
MARTHA BERRIER Clinical Operations
“I attend exercise classes. I also sing in my church choir. I also make time for myself every day to meditate and calm my mind.” MALINDA KAPLAN Hospitality Services
“I exercise right after work: a strenuous hike in the beautiful open space preserves in the nearby hills, or a cardio/weightlifting workout at the gym, or lap swimming in the outdoor Menlo Aquatics pool; followed by a healthy dinner, and either social calls to family and friends and/or a fun movie.” LUCIA MILLER Pelvic Health Center
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RESILIENCE
AT WORK Like building muscle mass, strengthening resilience is something that must be practiced regularly. HealthySteps to Wellness has partnered with teams across Stanford Health Care to bring education and physical and mental health practices such as mindful breathing, meditation, positivity, and stress management to their huddles, lunches and staff meetings. Here are a few examples of how teams are building resilience. ADDIE MCCLENDON, RN, RELAXING IN F-GROUND’S NEW RELAXATION ROOM.
from their sedentary jobs, said Lin. “You can get really caught up doing the same The Contract Administration team thing every day and get into bad habits,” manages, reviews and negotiates the he said. “Biking is a great way to re-center legal terms of thousands of contracts. haven’t ridden a bike since “Basically sitting at your PLAN (ISP) yourself. DEVELOPINGthat ANinvolves INTEGRATED STRATEGIC REQUIREDI REAL college, and desk, eight hours a day, clicking andSTAFF FROM EACH OF THE now I do it every day.” INTEGRATION BETWEEN FACULTY AND typing,” said Greg Lin, Contract Specialist. THREE STANFORD ORGANIZATIONS. TO CREATE THIS COLLABORATION, “We wereGROUPS really concerned withEACH FOCUSED ON Food Services 13 WORK WERE FORMED, A SPECIFIC increasing AREA, physical activity and providing years ago, Food Services transformed STRATEGIC WITH REPRESENTATIVES FROM ALLSix THREE opportunities for people to take breaks theTOGETHER food philosophy at Stanford Health ENTITIES PARTICIPATING. EVERY MONTH, TEAMS CAME TO and figure out how to be a little CareSTRATEGIC by providing fresh, local, ingredientSHARE EXPERIENCES, IDENTIFY KEYhealthier ISSUES AND SHARE in what we do.” RECOMMENDATIONS TO INFORM THE DIRECTION OF driven, THE ISP.plant-forward options in a well The team contacted HealthySteps rounded menu for patients, families, to Wellness and scheduled a series of visitors and staff who make choices to lunchtime information sessions that eat on campus every day. To support and covered topics like reducing stress, ground the philosophy, Food Services healthy eating, mindfulness, miniDirector Jodi Krefetz and her managerial meditation practices, positive psychology team share nutrition information and and staying active. According to Lin, guide healthy behaviors with their staff the talks were optional, but many team of 200-plus employees. Wednesday members attended. To further promote huddles are famous for food tastings, wellness, Lin applied for a Wellness Grant new recipes, exercises and the “whys” to purchase six bikes. As a result, Menlo of a balanced routine. Krefetz partners Park team members bike to lunch or to with HealthySteps to Wellness monthly after-work gatherings. Having the bikes to enrich and expand the content of the parked outside their offices gives Lin and huddles, sharing a consistent message of his colleagues a reason to take a break making health and wellness a priority.
Contract Administration
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“Our job as leaders is to inform, be transparent and help link meaning about daily standard work to the overall goal of providing excellent care to patients and their families,” said Krefetz. “In doing so, we can build confidence and resiliency with our staff through the daily hurdles of life. Our huddles are all about joy and well-being—what we are doing well, what could be even better and what we are doing to take care of ourselves. Having that open communication about health and wellness has made our team successful.”
Advanced Practice Providers The Center for Advanced Practice developed a wellness program for its advanced practice providers (APPs) to relieve stress, build resilience and prevent burnout. A survey of practitioners identified six contributing factors to burnout: sleep, nutrition, physical activity, decompression, social connections and transportation. From those, the Center created a Wellness Committee, co-led by APPs from SHC and Stanford Children’s Health. The Task Force publishes a monthly newsletter that includes nutrition tips, meditation practices and upcoming wellness activities. They also created a transportation tip sheet for carpooling and alternative transportation information, and began offering 30-minute Wellness Walks on the main campus to provide an opportunity to get some exercise and connect with colleagues. Many APPs practice individually in different departments and different locations. “We’re all very isolated from JODI KREFETZ (L) AND OLGA GONZALEZ (R) SHARE A FOOD TASTING AT A RECENT TEAM HUDDLE.
HEALTHY STEPS TO WELLNESS HELPING EMPLOYEES BUILD RESLIENCE
APPs PRACTICE RESILIENCE BY GETTING IN SOME EXERCISE AND CONNECTING WITH COLLEAGUES DURING THEIR WELLNESS WALKS. PICTURED HERE ARE (L TO R): KELLY BUGOS, JENNIFER HUNTER, AIDEE SENCION, CARRIE SCRIBNER AND JORDAN SLOAN.
“How do we slow ourselves down and be mindful and reconnect with who we are and what brought us into the profession in the first place? Your ability to connect and show compassion for another individual really starts with your ability to connect and show compassion for yourself.” one another,” said Cate Arima, NP-C, who works at SHC-Emeryville. There, she is part of a community of APPs who “buddy up” with a different colleague each month for support and fitness. “The most rewarding part of our wellness activities has been the bringing together of the community,” said Arima. “Otherwise, we wouldn’t meet these people at all.” Next on the Wellness Committee’s agenda is launching a series of HealthySteps to Wellness “Wellness on Wheels” classes, the cost of which will be offset by a $1,000 HealthySteps to Wellness grant.
Nursing Like physicians, nurses are at a greater risk of burnout. Nurses are facing rising demands at the point of care, increasing use of technology and an increasing focus on efficiency. To help nurses stay engaged and connected to their work, the Stanford Nursing Department has purposefully and systematically integrated a multifaceted program based on the Theory of Human Caring principles of Jean Watson, PhD, RN, AHN-BC, FAAN.
“How do we slow ourselves down and be mindful and reconnect with who we are and what brought us into the profession in the first place?” That question is at the core of the self-reflection and resiliency training happening at all levels of nursing across the organization, said Katie Stephens, MSN, DNP(c), RN, PCCN, Director of Nursing Excellence and Magnet Programs. “Your ability to connect and show compassion for another individual really starts with your ability to connect and show compassion for yourself.” These teachings have inspired new behaviors. Nurses on B2 created a midafternoon huddle to checkin on each other and offer support. Interventional platform nurses do centering exercises during huddles and practice compassionate communication. Many nurses have begun using the Gel In/Gel Out process as a centering moment to be present for the next patient encounter. “Sometimes very small things can make a big difference,” said Stephens. “When you start to get a critical mass of people behaving like that, it will change everything.” 8 / STANFORD HEALTH CARE PEOPLE
Created in 2011, the HealthySteps to Wellness comprehensive employee health and wellness program is available to all Stanford Health Care employees. HealthySteps to Wellness supports individual wellness goals and works with teams to transform their health, wellness and culture. “Our program focuses on working with departmental teams, hosting educational speaker events and promoting peer support to boost personal resiliency,” said Terry Palmer, MS, Associate Wellness Program Manager. “It’s really about bringing all three components of the model—culture of wellness, efficiency of practice and personal resilience—together into our programs to help employees find joy, happiness and meaning at work.” The program offers customized Team Trainings to all SHC departments to help employees build resiliency practices. Topics include Meditation and Relaxation, Self-Care and Stress Management, Positive Psychology Interventions, Positive and Compassionate Communication, Mindsets, and Action Planning for Physical Health Foundations. HealthySteps to Wellness can also conduct 15-minute stretch breaks and resistance-band training to teach employees simple exercises that increase flexibility and fitness. “A lot of our training is helping to raise awareness about self-care and identifying the things we need as individuals to refresh ourselves so we can be our best at work,” said Alexandria Blacker, MPH, Wellness Manager. Twice a year, HealthySteps to Wellness awards Wellness Grants ranging from $200 to $1,000 to departments that demonstrate a commitment to wellness through self-directed activities. “We’ve had night shift nursing units get CSA baskets so they have access to healthy food in the middle of the night,” said Blacker. “Other teams have done physical fitness classes together.” For more information, go to the HealthySteps to Wellness website at wellness.healthysteps4u.org. STANFORD HEALTH CARE PEOPLE / 9
Ditch the Drama. The average person spends two and a half hours a day in drama—time spent feeling miserable, tattling, score keeping, judging, gossiping. That’s the finding of drama researcher Cy Wakeman, founder of Reality-Based Leadership. “That’s 816 hours of your precious year lost to drama,” she said. “That’s time you spend feeling like a victim, at the mercy of your circumstances. Productive time you can’t recapture.” Wakeman researches how much time and energy is lost to unproductive thinking and interruptive thought processes—the things, she said, that take energy away from results and quality of life. “Drama is emotional waste in the workplace,” said Wakeman. “With good mental processes, you can eliminate that emotional waste.” Her philosophy offers a new lens through which employees can shift their attention inward, focus on personal accountability and uncover their natural state of innovation. “When you focus on everything that sucks, you feel bad and everyone around you feels bad. Yet we choose to go there every single day,” said Wakeman. “The good news is that it doesn’t have to be that way.” She describes places called “low self” and “high self.” When your low self is at work, you’re seeing the world through the eyes of your ego, said Wakeman. Your circumstances seem to be the source of your pain. “You are the victim. You feel better by venting.” But when you are in high self, you see the world from a different viewpoint. “You are compassionate, you’re helping not judging. You are full of ideas,” said Wakeman. “You can see options on how you can impact the world.” 10 / STANFORD HEALTH CARE PEOPLE
The key to flipping the toggle switch between low and high self is self-reflection. “Self-reflection is the ultimate drama diffuser,” said Wakeman. “When you pause and self-reflect, you bypass your ego and tap into a better part of your brain.”
QUESTIONS FOR SELF-REFLECTION When you find yourself frustrated at work, venting to co-workers or procrastinating about an unwanted assignment, ask yourself the following self-reflective questions to move beyond complaining to helping and having an impact.
1
What do I know for sure? “Oftentimes it is our egos, our
internal stories that are stressing us out, not our reality,” said Wakeman. “If I think that my boss didn’t tell me information because he doesn’t care about me, that’s really just a story. What I know for sure is that I need information that I didn’t receive. Stay with what you know for sure. Give people benefit of the doubt. No one’s out to get you. Maybe your boss just forgot or didn’t think of it.”
2
What could I do to help? In times of stress, it’s easy
to blame others or the system. That is unproductive time spent venting, said Wakemen. Instead, focus on what you can do to help rather than fixate on what is wrong. “Your circumstances are not the reason you can’t succeed,” she said. “They are the reality in which you must succeed.”
3
If I were great right now, what would I be doing? “This last question is
the way to move beyond right and wrong and just feel good about the work you complete,” said Wakemen. “It shows you where you can have impact in the world, and we all want and crave impact. We want to know we can make a difference. “Happiness is really dependent on the accountability we take for our circumstances. Not our circumstances,” said Wakeman. “By ditching the drama, you realize that you’re not at the mercy of your circumstances. It’s the ultimate empowerment.”
CY
SAYS • ACCOUNTABILITY IS A MIND SET, NOT A SKILL SET. • HAPPINESS IS A CHOICE. • STEP INTO THE POWER YOU ALREADY HAVE. • STOP JUDGING. START HELPING. • LIVE WITH GREAT EXPECTANCY, NOT GREAT EXPECTATIONS. • LIFE’S MESSY. LIVE HAPPY. • THERE WILL ALWAYS BE EXTENUATING CIRCUMSTANCES. SUCCEED ANYWAY. • WORK WITH THE WILLING. • SUFFERING IS COMPLETELY OPTIONAL. • DITCH THE DRAMA.
DRAMA BY THE NUMBERS
Hours Lost a Day/Person
2.5
HOURS A DAY/PERSON
17
HOURS A WEEK
68
HOURS A MONTH
816
HOURS A YEAR
Grit. Gratitude. Forgiveness. HOW TO CHOOSE TO BE HAPPY Spend 30 minutes talking with Fred Luskin, PhD, Director of the Stanford University Forgiveness Project, and you will inherently feel better. A forgiveness researcher and Senior Consultant in Health Promotion at Stanford, Luskin teaches people ways to manage their stress and live lives of greater satisfaction. He spoke to SHC Leaders in January, sharing with them his keys to building resilience and happiness through gratitude, forgiveness and grit. Here are some of his thoughts. I don’t believe that one can be happy without these three practices: gratitude, forgiveness and grit. Much of happiness is an inside job. You have to make an overarching decision that you want to have a good day, that happiness is a priority. And then you have to develop interior skills that make you a little less responsive to external stress. If you don’t have some kind of orientation toward your own life that you want to be happy or have a decent day, then you’re not going to be the kind of person who responds to stress skillfully. Gratitude helps protect you a little bit from the stress you encounter every day because if you wake up in the morning, and at least remember that “I may not love my job, but I can walk,” that’s a really good buffer. And it works for everybody. Happiness is a process state, which cannot happen without regular
doses of gratitude. It doesn’t have to be a big deal. If you’re working in the medical field, you just remind yourself that you’re not a patient. I have a heart that works. My leg is not banged up. I’m not dying. The most important gratitude you can practice is toward people, to constantly be noticing and reminding yourself that you’re loved, that people are kind to you and that people cooperate with you. You have to retrain your mind to see the good in both yourself and others. It is estimated that about 70 percent of our happiness comes from relationships, and you can’t have a relationship without being willing to forgive. We are finding that forgiveness is a really underappreciated skill that is at the heart of any long-term successful relationship. Forgiveness lessens physical and emotional stress and decreases hurt, anger, depression and blood pressure. It also increases physical vitality, hope, optimism and conflict-resolution skills.
Gratitude helps protect you a little bit from the stress you encounter every day because if you wake up in the morning, and at least remember that “I may not love my job, but I can walk,” that’s a really good buffer. Lastly, one cannot be a happy human being without resilience and grit. Life is not designed to be easy and simple, so you have to cultivate resilience to deal with it. Those are just truths no matter where you work. Life outside of you is always going to be unpredictable and chaotic. And you have to make a decision inside that even within that chaos, I’m going to practice some stuff that will serve me well. Sometimes life is hard, and you have to practice being resilient a lot to just endure. Resilience is simply a part of this life.
PRACTICE GRATITUDE There are many stress-reducing practices that can improve your health and happiness, says Fred Luskin, but first you must choose to have a good day. Then, he says, you can build in mental practices to help you withstand the daily stresses that life will throw at you. Here are four of Fred’s favorites: 1. Sit for 45 seconds and think about who has been kind to you in the past 36 hours. The minute you stop your chatter and reflect upon that, your blood pressure plummets, your mind clears because you’re not stressed and you start opening pathways in the brain that have totally different end points. The minute you remember who’s been kind to you, you then want to be kind. 2. Breathe into and out of your belly two to three times, and then picture someone you absolutely adore. Feel that affection in the area around your heart. 3. Have a conversation with someone else about somebody who’s close to you, and don’t spend one second complaining. 4. The world is never going to give you exactly what you want all the time. Practice the serenity prayer: “Grant me the serenity to accept the things I cannot change; the courage to change the things I can; and the wisdom to know the difference.”
PRACTICE HAPPINESS
Four of Fred’s happiness practices that will help you build resilience: 1. Prioritize people over things. 2. Turn to a person rather than your phone. 3. Look at a picture of someone you love. 4. Send somebody a nice text. STANFORD HEALTH CARE PEOPLE / 11
THE
NEW Stanford Hospital DIGITALLY DRIVEN (FROM L TO R) RAJIV RAMDEO, LEAD COMMUNICATIONS ENGINEER; ALPA VYAS, VICE PRESIDENT OF PATIENT EXPERIENCE; AND ANN-MARIE YAP, EXECUTIVE DIRECTOR OF TECHNOLOGY.
The Connected Patient: A Peek Inside Stanford’s New Digitally Driven Hospital It’s easy to see how the new Stanford Hospital will look now that the exterior is complete; the interiors are built out; and the furniture, equipment and art are being installed. Less visible but equally important is how the new hospital will feel to patients when it opens this fall. Multiple teams throughout Stanford Health Care have helped create a digitally driven patient experience that matches the majestic façade of the new structure, said Alpa Vyas, Vice President of Patient Experience. “The service and the culture we create inside must complement and enhance the physical environment.” From the moment patients and family members come through the doors of the new Stanford Hospital, a compassionate team of caregivers and staff will shepherd them through their health care journey. Digital tools developed specifically for the new space will also assist them.
Digital Companion Teams at Stanford are designing a patient experience that will take advantage of smartphone technology to guide patients through their inpatient visit. Stanford’s MyHealth app will act as the digital companion for patients at the new Stanford Hospital, said Aditya Bhasin, Vice President of Software. Patients can check in using MyHealth and speed up the admitting process before their scheduled surgery or inpatient 12 / STANFORD HEALTH CARE PEOPLE
stay. The app will also remind them about appointments and provide step-by-step directions to locations within the building. “Navigating a large medical campus can be confusing,” said Vyas. “The way-finding capability will help quell that stress and improve the experience.” More than 500,000 people are already using MyHealth for their outpatient care at Stanford Health Care; the software team is now enhancing the app for patients staying at Stanford Hospital. Health information will populate inpatients’ MyHealth accounts before, during and after a hospital stay. “We are building location awareness and health information content into our digital platform,” said Bhasin. “As a result, we will know where patients are in their journey, and provide them with relevant information throughout their continuum of care.”
The Patient Room Every room in the new Stanford Hospital will be private and equipped with a 55-inch television screen, an iPad and a bedside remote. Using
a keypad, patients can select movies, on-demand TV, music, relaxation videos, white noise, spiritual content and patient education information; they can also stream their own content into the entertainment system. Patients will be able to control the temperature of their room, lighting and window blinds, all without getting out of bed. Additional family space has been designed into every patient room, with plug-ins for electronic devices and storage for personal belongings.
Enhanced Communication Improving the ability of caregivers to communicate and collaborate easily—in a way that protects patient privacy—was a priority, said Vyas. Stanford has implemented a secure messaging platform that allows care teams to communicate about a patient’s personal health information in a protected environment, said Troy Foster, Senior Manager for Network Infrastructure. “It provides seamless communication between all members of a treatment team via phone call or text,” he said. The system runs on iPhones and is being used by more than 3,500 physicians and 2,000 nursing and ancillary staff. “From a patient experience perspective, we are looking at how technology can help automate processes so team members have more time to focus on patient care,” said Vyas. “Care teams and staff are testing and refining many of these new technologies now. The goal is to be comfortable using all the new technology before moving into the new space so teams can be ready to care for our patients.”
500P CHAMPIONS (L TO R) AUSTIN WILSON, CYNTHIA PARKE, NERISSA AMGERS, DARREN BATARA
Meet the 500P Champions Think about the work that goes into opening a hospital— new staff and equipment, redesigned protocols and site visits from regulatory agencies. Everything must be in place before the first patient walks through the door. To ensure that everything is ready for the move to 500 Pasteur, Stanford Health Care has created the 500P Champions, who are working together to make sure that the new hospital is ready next fall. The to-do list is long. “How are we going to validate that everything is where it’s supposed to be?” notes Maggie Suarez, Project Manager for Transition Strategy, 500P Activation. “How do we coordinate moving patients from 300 to 500P? How do we get thousands of new people over to 500P, and how do we get them trained and prepared to operationalize the new area?” The program provides tools and support for 500P Champions to partner with multiple departments and lead efforts to validate equipment, coordinate patient moves and make sure the hospital is ready. Champions come at three levels: lead, core and frontline staff. Right now, lead and core Champions are immersed in detailed planning. They meet monthly and update their teams. As the move gets closer, more frontline staff will get
involved. Champions apply for the position and are chosen for a variety of reasons. “In selecting the Champions, department leaders considered staff who have already been working on 500P and are familiar with department workflows,” says Suarez. Hospitality Department 500P Program Manager Cassandra Loh is responsible for Environmental Services, Food Services, Patient Transport, Patient Equipment Management and the Facilities Service Response Center. “I need to coordinate with all directors to make sure we are on the timeline,” says Loh. “Buying equipment, hiring, onboarding, bringing in supplies, rehearsing, making sure we have the proper staffing.” Move planning has been in the works for around 10 years but it’s front and center now. To get everything done, Champions deliver a lot of mutual support. “The most important thing is I have good leadership and a good team,” says Loh. “It’s the talent we have and how we all work together. I’ve never worked in a place where I can pick up the phone or send an email and people respond so rapidly. Everyone is one text away.” On the operations side, Cynthia Parke, Senior Program Manager for Patient Care Services (PCS), has been working on 500P for more than three years. With colleagues Nerissa Ambers, Darren Batara and Austin Wilson, Parke and the PCS team oversee patient care areas—from equipment and supply planning to licensure, move-day logistics and staff training. “We’ve done a lot of model work outside the facility to optimize clinical workflows across
the organization,” says Parke. “But when you bring those plans into the building, teams will need to make adjustments and concessions to optimize the clinical spaces. It’s about creating an environment that supports quality patient care while maintaining a healing environment for both patients and staff.” The PCS team is also supporting operational activities for new managers and staff to get the building up and running. They have eight months, and will need all hands on deck, to make the 500P move successful. “Every day, the PCS team is keeping track of multiple timelines to best align operational requirements for first patient day,” says Parke. “There’s no one person who can do that. You have to rely on relationships, trust, networking and the entire 500P team. It’s the only way this will be successful.”
MAGGIE SUAREZ (L) AND CASANDRA LOH LEADING THE TEAM OF 500P CHAMPIONS DURING A RECENT TRAINING SESSION.
Right now, there are 200 Champions, and another wave will join for the three-day dress rehearsal in July. When the hospital opens in November, happy faces will be everywhere. “It’s a lot of hard work, and things are constantly changing, but it is also an exciting time,” says Suarez. “There will be tears of joy when that door opens because people have dedicated so much time and heart to this project.” STANFORD HEALTH CARE PEOPLE / 13
SATISFACTION
PERFORMANCE
ENGAGEMENT
ATTENTION Checking In on StandOut Check-ins
BURNOUT
THE POWER OF
THE BASIC TENETS OF THE STANDOUT PROGRAM INCLUDE: KNOW YOUR STRENGTHS, TAKE THE ENGAGEMENT PULSE, AND CONNECT THROUGH CHECK INS.
It’s a good idea to take stock of what’s happening in our work lives—what’s going right, what’s going wrong. That’s the idea behind StandOut check-ins, which give team members and their managers a little space to reflect on the past week. These interactions are a good way to maximize the good and identify problems before they become serious. Think of it as mindfulness for the workplace.
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“It’s a way to connect with my team leader to express what I loved about my job and which activities made me feel strong,” says Center of Excellence Architect David Simpson. “It’s also an opportunity to reflect on the significance of my work. Doing it weekly provides real-time feedback, not waiting until the end of the year and saying, ‘I’m frustrated.’” The approach is simple. Employees check in weekly, reflecting on their strengths, dislikes, and near-term priorities and logging them into StandOut. Managers review the feedback and circle back with individual team members. Stanford Health Care had been looking for a better way to assess employee engagement. Following a rigorous vetting process, StandOut was implemented in July 2018. In addition to the weekly check-ins, there are quarterly, eight-question pulse checks to see the bigger picture. “If we do check-ins once a week and pulse checks once a quarter, we’re going to have a pretty good feel on how our team members at Stanford Health Care are feeling and doing,” says Simpson. The program is designed to spark conversations between staff and leadership, to address the issues that might otherwise come up only during a performance review. The goal is to reduce burnout, increase engagement and improve retention. But there’s also a ripple effect. Increased engagement can translate into better performance and, in turn, improved patient satisfaction. The results from the pulse checks have been impressive. Team members who check in weekly or biweekly are 25 percent more engaged than those who skip the process. And when team leaders start check-in conversations, engagement more than doubles from 26 to 54 percent. Turns out, a little communication can go a long way. “We really are taking a stance on how we want to relate to each other, focusing on strengths and near-term results,” says Simpson. “I think it will pay off.”
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The Power and Impact of Check-ins. Here’s How They’re Working for Five Employees: Janelle Maxwell Administrative Business Operations Manager in Cancer Center I manage a team of 12, but we work in multiple locations, and my Patient Flow Coordinators are often in clinic rooms, where I can’t just stop by. Check-ins have been a great way to feel more connected with my team. It has quickly become central to how I keep up-to-date with each team member’s real-time priorities. It has also helped me to understand more about our strengths and how we work together as a team.
Elvira (Elvie) Rambac Nurse Educator and Clinical Nurse, AAU F3 At least every two weeks, I check in with my manager face-to-face. She starts off the meeting by going over what I’ve shared in the tool. We have always had a great relationship, but checking in means that she now has much more detail on what is going on with me each week. For example, the week my daughter left home to start college in Southern California was hard— I mentioned it during our meeting and my manager was quick to check in with me to make sure that I was OK. I really appreciated that she was so ready to look out for me.
I found that my loathe was the same every week—timecards! I felt like managing timecards was something I had to do every day, and it really took me away from the patient care work that I love. Together, we talked through ways to make timecard management less onerous, such as blocking two slots per week to focus on it, instead of letting it take over a chunk of every day. It really helped to have someone talk through how I can make the most of my time. Overall, StandOut check-ins have become part of how we work in F3, and it has brought us together as a team.
Amanda Chawla Executive Director of Supply Chain I am directly involved in how a team of seven direct report leaders use StandOut check-ins. Each person has made use of the tool to their individual requirement to be “value add.” One director associates this tool similar to a concept from social media as a “work” Instagram for realtime communications and updates. You can count on him to respond on what he needs, loves and loathes in real time. Another uses it as her running to-do list, which means that, when it comes to my 1-1 with her, I have real detail on her priorities. Regardless of the small differences in how we use the tool, it has made us feel much more connected. Even in weeks when activities do not allow for face-to-face time, StandOut check-ins are our formal touchpoint and are incorporated as part of the tiered huddles and standard work. Essentially a digital touchpoint that has enabled us to be more connected and grow as a team.
Patty Falconer
Assistant Patient Care Manager, F3
Executive Director Cancer Care Programs and Cancer Network
When a team member checks in, I use the scoring system to get a quick sense of how they’re doing. If they’ve filled in the comments boxes, it tells me much more. Whether the feedback is positive or negative, I like to follow up in person, either to explore what’s bugging them or to celebrate something that has gone well. Check-ins have helped me too. My manager and
We see engagement as paramount to our work— it’s part of quality, C-I-CARE, safety and patient experience. After all, an engaged employee is willing to go the extra mile. In the Cancer Center, we’re actively looking for ways to show how check-ins fit in the context of clinical practice. For example, when it comes to “loves,” we ask team members to share
Van Bellew
what they loved about a patient interaction. We’re also using it as a feedback mechanism—check-ins are one way to help us understand what Cancer Center employees need. In my immediate team, we agreed to be open when it comes to StandOut from the outset. We share our strengths, loves, loathes and pulse check results. Given that we are geographically dispersed, the digital tool is a great way to keep up the connection between us. It helps us feel linked together, and in my weekly face-to-face 1-1s, I use what was shared in the digital tool as a foundation for our in-person check-ins.
MY REWARDS When did you last check your benefits? Benefits are so much more than medical and dental. Did you know that the below are available to SHC employees? Back-Up Care: Back-Up Care is there for you when your regular dependent care for children or elderly is unavailable. You have access to 80 hours of family care per calendar year at SHC-subsidized rates. Identity Theft Protection: SHC partners with PrivacyArmor® to proactively monitor your identity and credit. Fidelity 1 on 1: Not sure how to plan for retirement? Schedule a 1:1 with a dedicated Fidelity adviser to make the most of your money. Schedule an appointment by phone at 800.642.7131 or online at getguidance.fidelity.com/shclpch. Information on these benefits and many more can be found at healthysteps4u.org.
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VALLEYCARE OUR PATIENTS NOW
VALLEY CARE ValleyCare’s Stroke Solution With Assist From SHC ValleyCare isn’t a primary stroke center —yet—but they’re making tremendous strides. Until recently, they did not have a 24/7 neurologist. But now, with help from Stanford Health Care and some high-tech teleconferencing technology, a neurology consult is just a secure broadband connection away. “Anytime there is an acute stroke through the ER, or with a patient who has already been admitted, we call a VALLEYCARE’S PRASHANTH KRISHNAMOBAN, MD (L) AND DENISE FERRER, RN (R).
PATIENTS AT VALLEYCARE CAN NOW IMMEDIATELY CONNECT WITH A TELESTROKE NEUROLOGY FELLOW AT STANFORD FOR A CONSULT.
Stroke Alert, contact Stanford Transfer Center and connect with the Telestroke Neurology Fellow,” says ValleyCare Stroke Program Manager Denise Ferrer, RN. In Palo Alto, the neurology fellow goes into Epic and views the patient’s medical history and recent CT scans. In Pleasanton, clinicians set up a telemedicine device (about the size of an iPad) in the patient’s room. With onsite assistance from an ER physician or bedside nurse, the fellow assesses the patient and suggests next steps. “They give a neurology consult and determine whether it’s a stroke,” says Ferrer. “They can prescribe tPA or make other neurological recommendation.” If clot-busting tPA is called for, ValleyCare clinicians can administer the drug. If the patient needs a procedure, such as an embolectomy to free up blood flow to the brain, they can be airlifted to Palo Alto. Most important, the
consult happens fast. Time is brain, and teleneurology accelerates stroke care. To make the process even more seamless, the ValleyCare staff have received additional training and new technology, such as CT Profusion, radiology software that can differentiate between healthy and damaged tissue. The new program was funded by local philanthropists and has been in place since mid-December. Since then, ValleyCare staff have called 25 stroke alerts, administered tPA four times and flown one patient to Stanford Hosptial for an embolectomy. Those numbers are relatively small, for now, because the hospital is not yet a primary stroke center. Most of those patients are walk-ins—people who didn’t realize they were having a stroke—but that’s about to change. ValleyCare is applying to the Joint Commission for stroke center certification. They hope to have that finalized this summer.